There has been growing interest in preventive intervention “crossover” effects on suicidal thoughts and behaviors (STBs), in which targeting early risk factors may mitigate distal risk for STBs without STBs having been the targeted outcomes of the primary study. The present study extends an 11-study integrative data analysis of the Coping Power (CP) intervention (N = 3182) to assess indirect effects of different forms of CP on teacher- and parent-reported STBs as transmitted through different subdimensions of internalizing and externalizing problems. Compared to school-as-usual, all forms of CP (Standard/Group CP, Individual CP, CP with Mindfulness, Internet-Enhanced CP) led to reductions in parent- and/or teacher-reported youth STBs. Subgroup analyses suggested that boys benefitted from Individual CP and CP with Mindfulness mediated by reductions in aggressive behavior, whereas boys in Standard CP saw reductions in STBs mediated by reductions in conduct problems. Girls saw reductions in STBs in CP with Mindfulness mediated by reductions in anxiety. Some inferences made for individual α and β paths and mediation effects differed when using standard parametric approaches for inference versus bias-corrected percentile bootstrapping. These differences highlight cautions regarding statistical inference for prevention researchers who study highly skewed zero-inflated latent variables such as STBs. Findings are discussed in light of (a) earlier etiological research on biological sex-specificity in the pathways to early risk for suicide and (b) how variation in program components of CP and its adaptations may reduce STB risk across different populations, age groups, and modes of program delivery.
Youth and young adults experience high attrition across the HIV care continuum, including elevated risk of antiretroviral therapy (ART) nonadherence and virologic failure. This study examined how financial well-being relates to ART adherence among youth with HIV (YWH), including those using oral or LAI-based regimens. We analyzed baseline data from YWH aged 18–29 years in the United States enrolled between 2023 and 2025 in a randomized controlled trial addressing HIV care barriers, mental health, and substance use. Oral ART adherence was measured using a validated scale, with high adherence defined as a score ≥ 80
Digital health technologies (DHTs) are revolutionizing medical research, offering unprecedented insights into health monitoring and disease detection through continuous, real-world data collection. Here we characterize the data in one of the largest and most demographically rich DHT datasets as part of the All of Us Research Program. Through a historic device distribution effort, the program reached a broad range of participants nationwide, yielding a DHT dataset with an expanded a large demographic scope. This dataset contains Fitbit data from more than 59,000 participants spanning 14 years with more than 39 million step observations and 31 million sleep observations. Nearly half (46%) of participants with Fitbit data also contributed electronic health records, physical measurements, genomics and survey data. This resource enables researchers to study relationships between digital health metrics and clinical outcomes, advancing DHT methodologies through its large size, broad representation and multi-modal data linkage.
Importance:The management of patent ductus arteriosus (PDA) in preterm infants is controversial. Objective:To determine whether expectant management compared with active treatment of a protocol-defined PDA in preterm infants decreases the incidence of death or bronchopulmonary dysplasia (BPD). Design, Setting, and Participants:A randomized clinical trial including infants born at 22 to 28 weeks' gestation and diagnosed with a protocol-defined PDA between the age of 48 hours and 21 days at screening. The trial was conducted from December 2018 to December 2024 at 33 hospitals within the National Institute of Child Health and Human Development Neonatal Research Network. The final date of follow-up was June 2025. Interventions:Infants with PDA were randomized to expectant management (n = 242) or active treatment (n = 240; acetaminophen, ibuprofen, or indomethacin) to close the PDA. Main Outcomes and Measures:The primary outcome was death or BPD at 36 weeks' postmenstrual age. The secondary outcomes included the components of the primary outcome and other morbidities of prematurity. Results:A total of 482 infants were randomized (median gestational age, 25 weeks [IQR, 24 to 27 weeks]; median birth weight, 760 g [IQR, 620 to 935 g]). The trial was stopped for futility and safety after the 50% interim analysis for the primary outcome due to higher survival in the expectant management group. The incidence of death or BPD was 80.9% (195/241) of infants in the expectant management group vs 79.6% (191/240) of infants in the active treatment group (adjusted risk difference, 1.2% [95% CI, -5.7% to 8.1%]; P = .73). The incidence of death before 36 weeks' postmenstrual age was 4.1% (10/241) of infants in the expectant management group vs 9.6% (23/240) of infants in the active treatment group (adjusted risk difference, -5.6% [95% CI, -10.1% to -1.2%]; P = .01). Infections resulting in death occurred in 0.8% (2/241) of infants in the expectant management group vs 3.8% (9/240) of infants in the active treatment group. Conclusions and Relevance:In extremely preterm infants with a protocol-defined PDA, death or BPD did not differ between the expectant management group and the active treatment group. Survival was substantially higher with expectant management. Trial Registration:ClinicalTrials.gov Identifier: NCT03456336.
Although there are many long-term prophylactic treatments available for hereditary angioedema, few studies have assessed patient preferences for these treatments. We aimed to assess patient preferences for long-term prophylactic treatment attributes, including treatment trade-offs and the likelihood of starting or switching to a new treatment. An online discrete-choice experiment survey instrument was developed and administered to adults in the USA with a self-reported diagnosis of hereditary angioedema. Respondents evaluated a series of choices between pairs of hypothetical long-term prophylactic hereditary angioedema treatment alternatives. A total of 250 respondents (81.6
