Precocious puberty: diagnosis and management

Precocious puberty is commonly defined as puberty that starts before age 8 years in girls and 9 years in boys. The causes of it may range from a variant of normal development to various pathologic conditions. The etiology of precocious puberty is classified by the underlying pathogenesis into gonadotropin dependent central precocious puberty and peripheral precocious puberty which is independent of gonadotropin but due to different other causes. Variants of precocious puberty include premature thelarche, premature puberche and isolated premature menarche which imply onset of isolated changes without any other signs of sexual development. Precocious puberty might have an impact on final stature owing to premature epiphyseal fusion and also it has got influence on psychosocial wellbeing. Evaluation includes a detailed history, physical examination, biochemical testing and imaging directed towards suspected etiology. Gonadotropin releasing hormone (GnRH) analogues are effective for treatment of central precocious puberty. Treatment of peripheral precocious puberty should be based on the specific cause. Pubertal variants are usually non-progressive and need no treatment but should be monitored carefully. BIRDEM Med J 2022; 12(1): 62-69

Communication strategies and persuasion as core components of shared decision-making for children with life-limiting conditions: A multiple case study

Background: Families and professionals caring for children with life-limiting conditions face difficult healthcare decisions. Shared decision-making is promoted in many countries, however little is known about factors influencing these processes. Aim: To explore the communication strategies used in shared decision-making for children with life-limiting conditions. Design: A longitudinal, qualitative, multiple-case study. Cases were centred around the child and parent/carer(s). Most cases also included professionals or extended family members. Data from interviews, observations and medical notes were re-storied for each case into a narrative case summary. These were subject to comparative thematic analysis using NVivo11. Setting/participants: Eleven cases recruited from three tertiary hospitals in England. 23 participants were interviewed (46 interviews). Cases were followed for up to 12 months between December 2015 and January 2017. 72 observations were conducted and the medical notes of nine children reviewed. Findings: Strategies present during shared decision-making were underpinned by moral work. Professionals presented options they believed were in the child’s best interests, emphasising their preference. Options were often presented in advance of being necessary to prevent harm, therefore professionals permitted delay to treatment. Persuasion was utilised over time when professionals felt the treatment was becoming more urgent and when families felt it would not promote the child’s psychosocial wellbeing. Conclusions: Communication strategies in shared decision-making are underpinned by moral work. Professionals should be aware of the models of shared decision-making which include such communication strategies. Open discussions regarding individuals’ moral reasoning may assist the process of shared decision-making.

Socially Transformative Resilience: A Conceptual Model and Research Agenda for a New Construct

Marginalised individuals face significant and consistent adversities and injustices that their dominant culture counterparts rarely or never face, such as discrimination, low resource access, and violence. These challenges have been linked to poor wellbeing, both empirically and in individuals’ lived experiences. An original approach to improving this situation is introduced here via a novel transtheoretical construct: socially transformative resilience. Socially transformative resilience is conceived as a type of resilience in which individuals not only improve their psychosocial wellbeing in the face of challenge, but also resist, transcend, and/or seek to change the status quo, increasing their liberation as well. The key components and mechanisms of this new construct are described in detail, drawing on theoretical and empirical evidence. Key propositions of the model include the dual importance of moral and emotional initial responses to stressors, the centrality of a multidimensional reflection process, and the utility of acceptability-control appraisals in choosing which actions and resources to activate in service of wellbeing and liberation. An agenda for future research is presented, including examining and refining the model, developing a measure, creating interventions, and investigating relationships with psychopathology.

The neurobiology of smartphone addiction in emerging adults evaluated using brain morphometry and resting-state functional MRI

The characteristics of smartphone addiction (SPA) can be evaluated by neuroimaging studies. Information on the brain structural alterations, and effects on psychosocial wellbeing, however, have not been concurrently evaluated. The aim of this study was to identify abnormalities in gray matter volume using voxel-based morphometry (VBM) and neuronal functional alterations using resting-state functional MRI (rs-fMRI) in emerging adults with SPA. We correlated the neuroimaging parameters with indices for psychosocial wellbeing such as depression, anxiety, stress, and impulsivity. Forty participants (20 SPA and 20 age-matched healthy controls) were assessed using VBM and rs-fMRI. The smartphone addiction scale – Malay version (SAS-M) questionnaire scores were used to categorize the SPA and healthy control groups. DASS-21 and BIS-11 questionnaires were used to assess for psychosocial wellbeing and impulsivity, respectively. VBM identified the SPA group to have reduced gray matter volume in the insula and precentral gyrus; and increased grey matter volume in the precuneus relative to controls. Moderate correlation was observed between the precuneus volume and the SAS-M scores. Individuals with SPA showed significant rs-fMRI activations in the precuneus, and posterior cingulate cortex (FWE uncorrected, p<0.001). The severity of SPA was correlated with depression. Anxiety score was moderately correlated with reduced GMV at the precentral gyrus. Collectively, these results can be used to postulate that the structural and neuronal functional changes in the insula are linked to the neurobiology of SPA that shares similarities with other behavioural addictions.

Identifying Psychosocial Risks and Protective Measures for Workers’ Mental Wellbeing at the Time of COVID-19: A Narrative Review

The spread of the Sars-COV-2 virus has caused crucial changes in the workplace. Almost two years after the start of the COVID-19 era, new and old psychosocial risks in the workplace threaten workers’ mental wellbeing and represent an occupational health challenge. The aim of this review is to identify the most relevant psychosocial factors, negative or protective, contributing to occupational stress during the current pandemic. A literature search was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, Google Scholar and PsycINFO and a total of 51 articles were deemed suitable for inclusion in the review. Analysis of the retrieved articles revealed five main topics related to psychosocial wellbeing in the workplace: (1) Support from colleagues and organizations; (2) Home–work interface and balance; (3) Changes in workload and work demand; (4) Job competence and appropriate training; (5) Job insecurity and financial stress. All five themes were associated with occupational stress and poor mental outcomes, like anxiety, depression, and burnout symptoms. Peer and organizational support seem to have a major impact on workers’ mental wellbeing. Recognizing these factors and projecting interventions that mitigate their effects or boost their efficacy is a fundamental step towards dealing with COVID-19 in the workplace, or any such future emergencies.

What Can We Learn from Rural Youth in British Columbia, Canada? Environment and Climate Change—Issues and Solutions

“What can we learn from rural youth?” was a youth-led arts-based participatory action research project carried out to understand and facilitate positive youth development in two rural communities in the province of British Columbia, Canada. Data was collected using photovoice, visual art, journal reflections, and group discussions. During the study, youth expressed a strong connection with nature for their development or wellbeing. Issues such as environmental degradation and climate change were identified as causes for concern. They discussed human responsibility for environmental stewardship both in their local communities and globally. Climate change hazards such as flood and fire, human action leading to environmental pollution, and human responsibility for environmental stewardship surfaced as issues for their development. Youth expressed a felt responsibility to act on climate change and to reduce the anthropogenic impact on the Earth. Based on youth voices, we conclude that attempts to engage youth in climate action without considering their psychosocial wellbeing, may overburden them.

Reducing Loneliness with an Interactive Live Video Intervention: Experiment (Preprint)

BACKGROUND Loneliness, especially when chronic, can substantially reduce one’s quality of life. Positive social experiences might help to break cycles of loneliness by promoting more prosocial cognitions and behaviors. Internet-mediated live video communication platforms (eg, Zoom and Twitch) may offer an engaging and accessible medium to deliver such positive social experiences to people at scale. Despite their widespread use, there is a lack of research into how these newer platforms’ socially interactive elements affect loneliness-related aspects of users’ psychosocial well-being. OBJECTIVE We aimed to experimentally evaluate whether a socially interactive live video experience improved loneliness-related outcomes to a greater extent than a non-interactive control experience. METHODS We recruited participants from an online survey recruitment platform and assigned half to participate in a socially interactive live video experience with strangers and the other half to a non-interactive control experience that was designed to be identical in all other regards. Participants completed several baseline measures of psychosocial wellbeing, participated in an hour-long live video experience, and then completed some of the baseline measures again. Four weeks later, we followed up with participants to evaluate their change in trait loneliness since baseline. We pre-registered our hypotheses and analysis plan and provide our data, analysis code, and study materials online. RESULTS 249 participants completed the initial study and met inclusion criteria, 199 of whom also completed the 4-week follow-up. Consistent with our predictions, we found that directly after the more socially interactive experience, participants’ feelings of connectedness increased more (p<.001), positive affect increased more (p=.002), feelings of loneliness decreased more (p<.001), social threat decreased more (p=.006), and negative affect decreased more (p=.003) than they did after the less interactive experience. However, the extent of change in trait loneliness between baseline and 4 weeks later did not differ between conditions (p=.853). Future research is needed to examine how these effects might generalize across different contexts and populations, particularly in instances where participants have an expectation of future interaction. CONCLUSIONS Including socially interactive components in live video experiences can improve loneliness-related psychosocial outcomes for a short time. Future work should explore how these benefits can be leveraged towards longer-term prosociality.

Family Advocacy for Residents in Nursing Homes During the COVID-19 Pandemic

To protect one of the most vulnerable populations from COVID-19, nursing homes enacted and enforced visiting restrictions and other measures to limit the spread of this communicable disease. Family members, many of whom are former caregivers, were suddenly cut off from nursing home residents, and struggled to maintain connection with their loved ones residing in nursing homes. The purpose of this study was to describe the experiences of family members of residents in nursing homes in advocating for residents and themselves during a time of uncertainty and many challenges. This study used a qualitative descriptive approach to conduct individual interviews. Ten family members of residents of two nursing homes in a Northeastern state were interviewed by phone or videoconference using a semi-structured guide. Interviews were transcribed verbatim and analyzed using Braun and Clarke’s Reflexive Thematic Analysis. Family members expressed concerns for the lockdown’s impact on residents’ psychosocial wellbeing in addition to the potential physical dangers of COVID-19. They explored creative means of meeting needs for information and interaction, but often felt that these efforts fell short of replicating the connectedness of in-person visits. Family members identified multiple missed opportunities for involvement in care, and voiced willingness to comply with infection prevention guidelines, such as maintaining distance, to be present with residents. Our findings indicate that family members advocated for residents’ interests to ensure quality care. Future research and policy should consider family members as a potential resource for providing care and companionship during times of crisis.

Evaluation of a Web-Based Wellness Program to Reduce Loneliness Among Older Adults

Background Loneliness has been associated with adverse health outcomes, including increased mortality risk. Interventions aimed at addressing maladaptive social cognition have documented efficacy in reducing loneliness among older adults. Purpose The purpose of this study was to determine the feasibility and efficacy of a web-based wellness program in reducing loneliness and improving psychosocial health among older adults with an AARP® Medicare Supplement plan insured by UnitedHealthcare Insurance Company. Methods Eligible individuals were 65 years and older, who self-identified as lonely on a prior survey, and indicated that they had access to the internet through a computer or smartphone. Participants completed up to eight online modules comprised of a short lesson on an aspect of maladaptive social cognition, followed by a comprehension quiz, selection of a short-term goal, and a phone or text chat with a program coach. Four surveys were administered to assess the effects of program participation: (1) prior to the start of the program, (2) after completion of four online modules, (3) after completion of all eight modules, and (4) 30-60 days later. Results Attrition was high. Overall, 220 (42%) program participants completed both T1/T2 surveys, 193 also completed a T3 survey, and 177 also completed a T4 survey. Post-survey data indicated that loneliness and perceived stress decreased while mental wellbeing, resilience, and perception of aging improved. Conclusion Digital interventions aimed at addressing maladaptive social cognition offer potential to reach lonely older adults and support psychosocial wellbeing through reduced loneliness.