INTRODUCTION:Psychological resilience equips adolescents to manage distress and foster positive development. However, its multidimensional nature and dynamic relationships with stress and mental health make it difficult to identify specific intervention targets. This study used network analysis to examine the relationships between resilience, perceived stress, academic expectation stress, and depressive problems, identify key resilience processes, and explore developmental differences across adolescence. METHODS:An undirected network model was estimated in a sample of 3336 adolescents in Singapore (mean age of 13.6 years, 54.4% females). Cross-sectional surveys were conducted from 2019 to 2021 and the present study uses the: Singapore Youth Resilience Scale (resilience; 10 nodes), Youth Self-Report (depressive problems; two nodes), Perceived Stress Scale (stress; two nodes), and Academic Expectation Stress Inventory (academic expectation stress; two nodes). RESULTS:The network revealed clear clustering of protective and stress-distress nodes, with perceived helplessness emerging as the most central node. Four resilience domains-emotional regulation, relationships/social support, personal control, and positive self-image/optimism-served as key bridge nodes linking resilience and stress-distress clusters. Personal confidence is highly connected within its domain, suggesting a central role in reinforcing other resilience processes. Sensitivity analyses indicated that the overall network structure was largely consistent across adolescence, although differences in the strength of specific edges involving the key resilience domains were observed. CONCLUSION:Network modeling identified key resilience processes linking stress and depressive problems, highlighting potential intervention targets within the broader stress-distress system. Together, the findings provide insights into developmentally informed and ecologically grounded hypotheses to further develop resilience interventions.

Obesity is projected to affect more than half of the global population by 2035, posing significant health and economic challenges. While lifestyle modification is considered a cornerstone of weight management, its effectiveness often relies on substantial support systems. This study aimed to evaluate the effectiveness of a 12-week, standalone Temporal Self-Regulation Theory (TST)-based weight loss mobile application, which integrates self-regulation techniques, food logging, and dietary nudging, in promoting weight loss among young adults with excess body weight. A two-arm, parallel-group, 1:1 randomized controlled trial was conducted, adhering to the CONSORT-Outcomes 2022 Extension guidelines. Participants completed a face-to-face body composition analysis and online questionnaires addressing sociodemographic, self-regulation of eating behaviour, overeating habits, time perspective, eating phenotype, nutrition knowledge, and psychological flexibility. The intervention group used the Eating Trigger Response Inhibition Program 2.0 (eTRIP 2.0), a 12-week app-based program, while the control group received no active intervention. Both groups attended follow-up measurements at weeks 12 and 24. A total of 165 participants were enrolled between November 14, 2023, and March 27, 2024. At weeks 0, 12, and 24, the mean weight difference between the intervention and control groups were 0.29 kg (95% CI -3.69 to 4.28 kg), -1.76 kg (95% CI -5.96 to 2.43 kg), and -1.60 kg (95% CI -5.92 to 2.65 kg) respectively. While a significantly higher improvement in weight (-0.89 kg, 95% CI -1.51 kg to -0.27 kg, p=0.005), BMI (-0.32 kg/m2, 95% CI -0.55 kg/m2 to -0.10 kg/m2, p=0.005), waist circumference (-1.50cm, 95% CI -2.80 cm to -0.19cm, p=0.03), waist-hip ratio (-0.01, 95% CI -0.011 to <0.001, p=0.04) and body roundness index (BRI) (-0.18, 95% CI -0.34 to -0.02, p=0.02) were observed in the intervention compared to control group at week 12, no significant differences were found once the app access was ceased at week 12. Psychological outcomes, including intention for weight management, did not differ significantly between groups. However, self-regulation (B=3.08, t=3.95, p=0.005) and overeating habit (B=6.11, t=2.84, p<0.001) were identified as significant predictors of weight change at week 24, together explaining 10.7% of the variance in body weight. This explainability increased to 31.6% when age and sex were accounted for. Notably, a higher proportion of participants across both groups expressed a preference for physical activity over diet as their primary weight-loss strategy. This study provides evidence supporting the potential benefits of a TST-based app for improving anthropometric outcomes and psychological constructs. The findings suggest that this intervention holds promise for scalability in both population-based and primary health care settings.

In this systematic review, we aimed to investigate the association of maternal body mass index (BMI) before or during pregnancy and the metabolic profiles of offspring in the life course. We searched six databases: PubMed, Ovid Embase, MEDLINE, Web of Science, Wan Fang data and China National Knowledge Infrastructure, which yielded 3584 unduplicated articles, and after the full-text screening, 12 observational and three intervention studies met the inclusion criteria. Ten studies assessed pre-pregnancy BMI (ppBMI), whereas the remaining used booking BMI during antenatal visits. Most studies (10 out of 15) examined newborn metabolomics, four in early-mid childhood, and only one in adolescents and adults. The number of mother-offspring pairs ranged from 57 to 10,251, and the age of the population ranged from 15 to 44. We found that maternal BMI before or during pregnancy was positively associated with adverse offspring metabolomic profiles, characterized by lipids (higher triglyceride, total cholesterol and lower high-density lipoprotein-cholesterol), amino acids (higher branched-chain amino acids and aromatic amino acids), carbohydrate-related metabolites (higher glucose and insulin). Studies on lipids have the most consistent results in both observational and intervention studies. The impact of maternal BMI on offspring metabolomics exerted from birth till adolescence and young adulthood. Our study highlights a potential intergenerational association between maternal BMI and offspring metabolomic profiles. Interventions on maternal BMI before or during pregnancy showed the potential to reverse the adverse changes in offspring’s metabolic profiles, but long-term health benefits warrant to be verified.

OBJECTIVE:To validate the Patient Health Questionnaire for Adolescents (PHQ-A) as a screening tool for depressive disorders in multi-ethnic Asian adolescents. METHODS:323 English-speaking Singaporean adolescents completed the PHQ-A, Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL), and measures of depressive symptoms (Hamilton Depression Rating Scale), suicidality (Columbia Suicide Severity Rating Scale), adverse childhood experiences (ACES), and quality of life (Youth Quality of Life Instrument - Short Form) as part of a larger nationwide cross-sectional school-based epidemiological study. Internal consistency, construct validity, and diagnostic accuracy of the PHQ-A were evaluated. The area under the ROC curve (AUC) values for Major Depressive Disorder (MDD), Persistent Depressive Disorder (PDD), and Adjustment Disorder (AD) were examined separately. RESULTS:The PHQ-A demonstrated high internal consistency (Cronbach's α = 0.89) and was positively associated with adverse childhood experiences (ρ = 0.11, p = 0.042), suicidality (ρ = 0.43, p < 0.001), and depressive symptoms (ρ = 0.63, p < 0.001), and negatively associated with quality of life (ρ = -0.59, p < 0.001). The performance of the PHQ-A was acceptable for MDD (AUC = 0.79, 95 % CI = 0.72 - 0.85) but poorer for PDD (AUC = 0.68, 95 % CI = 0.58 - 0.77) and AD (AUC = 0.53, 95 % CI = 0.41 - 0.65). CONCLUSION:The PHQ-A shows acceptable psychometric properties for screening for diagnosis of MDD, but not for PDD or AD, among English-speaking Asian adolescents. A cut-off score of ≥ 10 for MDD is recommended.

This study aimed to determine the prevalence and associated factors of depressive symptoms among adolescents in Can Tho City, Vietnam. A cross-sectional study was conducted with 1,054 students aged 15-18 years, recruited from eight high schools using one-off anonymous questionnaires. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale Revised - Vietnamese version. The Self-esteem Scale of Vietnamese Adolescents, the Crandell Cognitions Inventory-Short form scale, the School Connectedness Scale and the Educational Stress Scale for Adolescents were used to assess self-esteem, cognitive distortion, school connectedness and educational stress, respectively. Univariate analyses explored the relationships between sociodemographic variables and depressive symptoms. Pearson correlations were calculated for the associations between variables. Multiple regression was used to adjust for the factors that contributed to depressive symptoms in adolescents. The findings revealed that 37.4% of adolescents in Can Tho City, Vietnam, experienced depressive symptoms. Factors influencing depression in adolescents include cognitive distortions, academic pressure, exposure to interpersonal violence, consumption of alcohol and smoking, family history of depression, family incarceration and experiences of digital sexual violence. These results underscore the urgent need for a multilevel and multidimensional intervention strategy involving parents, educators, mental health professionals and policymakers to promote early identification, provide support and enhance mental health literacy among adolescents.

Background It is known that gestational diabetes mellitus (GDM)-complicated pregnancies could affect maternal cardiometabolic health after delivery, resulting in hepatic dysfunction and a heightened risk of developing non-alcoholic fatty liver disease (NAFLD). Hence, this study aims to summarise existing literature on the impact of GDM on NAFLD in mothers and investigate the intergenerational impact on NAFLD in offspring. Methods Using 4 databases (PubMed, Embase, Web of Science and Scopus) between January 1980 and December 2023, randomized controlled trials and observational studies that assessed the effect of maternal GDM on intergenerational liver outcomes were extracted and analysed using random-effects meta-analysis to investigate the effect of GDM on NAFLD in mothers and offspring. Pooled odds ratio (OR) was calculated using hazards ratio (HR), relative risk (RR), or OR reported from each study, with corresponding 95% confidence intervals (CI), and statistical heterogeneity was assessed with the Cochran Q-test and I2 statistic, with two-sided p values. The study protocol was pre-registered on PROSPERO (CRD42023392428). Findings Twenty studies pertaining to mothers and offspring met the inclusion criteria and 12 papers were included further for meta-analysis on intergenerational NAFLD development. Compared with mothers without a history of GDM, mothers with a history of GDM had a 50% increased risk of developing NAFLD (OR 1.50; 95% CI: 1.21–1.87, over a follow-up period of 16 months–25 years. Similarly, compared with offspring born to non-GDM-complicated pregnancies, offspring born to GDM-complicated pregnancies displayed an approximately two-fold elevated risk of NAFLD development (2.14; 1.57–2.92), over a follow-up period of 1–17.8 years. Interpretation This systematic review and meta-analysis suggests that both mothers and offspring from GDM-complicated pregnancies exhibit a greater risk to develop NAFLD. These findings underline the importance of early monitoring of liver function and prompt intervention of NAFLD in both generations from GDM-complicated pregnancies. Funding No funding was available for this research.

BACKGROUND:Meibomian gland dysfunction (MGD) is a leading cause of dry eye disease, affecting over a third of the global population. This disease is associated with ocular discomfort, reduced visual quality, and quality of life. Novel treatments like Intense Pulse Light (IPL) therapy and Low-Level Light Therapy (LLLT) have been reported to be useful in refractory MGD treatment. However, no systematic review has explored the utility of combining these two therapies. METHODS:Medline, Embase, and CENTRAL databases were searched for articles on LLLT + IPL therapy in MGD. A meta-analysis of single means was conducted to assess clinical endpoints. RESULTS:Analysis of 12 studies showed that LLLT + IPL therapy in MGD patients led to a significant decrease in Ocular Surface Disease Index score (MD: -22.8, 95 %CI: -29.1 to -16.5, I2 = 97.5 %, p < 0.001), and a significant increase in both Tear Break-up Time (MD: 2.2 s, 95 %CI: 0.9 s to 3.4 s, I2 = 98.6 %, p < 0.001) and Schirmer test (MD: 1.5 mm, 95 %CI: 0.6 mm to 2.5 mm, I2 = 0.0 %, p = 0.001) at ≤ 3 months post treatment. These improvements were sustained in a sensitivity analysis at endpoints ≥ 6 months post treatment. While the percentage of loss of meibomian gland area (n = 4, MD: -3.8 %, 95 %CI: -7.2 % to -0.4 %, I2 = 40.0 %, p = 0.031) was reported to be significantly reduced, this was not found to be sustained at endpoints ≥ 6 months post treatment (n = 2, MD: 5.9 %, 95 %CI: 1.8 % to 10.0 %, I2 = 0.0 %, p = 0.005) in two studies. CONCLUSIONS:This meta-analysis provides quantitative evidence supporting the clinical efficacy of LLLT + IPL therapy in MGD. Future research should evaluate its long-term safety and efficacy and compare it with alternative treatments.

BACKGROUND:Postpartum depression (PPD) is highly prevalent and plagues a significant proportion of parents. Postpartum depression also exerts various negative consequences on infant development and parent-infant relationships. Social support is identified as an important factor influencing many parental predictors, and may affect the development of PPD. OBJECTIVE:This study aimed to investigate how perceived social support can indirectly influence PPD symptoms in parents at 6 months postpartum by influencing postpartum anxiety, parental satisfaction, and parental self-efficacy (PSE). METHODS:A secondary analysis of data from a randomized controlled trial was used with a cross-sectional exploratory design. A total of 400 Singaporean parents (200 couples) were included, and structural equation modeling was used to analyze the relationships between PPD and potential predictors. RESULTS:Findings revealed a less adequate fit between the hypothesized model and the data collected. Social support was found to be a significant predictor of postpartum anxiety, PSE, and parental satisfaction. Postpartum anxiety was a significant predictor of PPD, but PSE and parental satisfaction were not. CONCLUSION:This study provides an overview of how different parental predictors may be associated with PPD among Asian parents. Postpartum anxiety significantly predicted PPD, but social support had negative effects on postpartum anxiety, parenting satisfaction, and PSE. The findings provide further insight into how parents at risk of PPD can be identified and demonstrated how social support might negatively impact parental outcomes. More qualitative research with Asian parents is needed to further explain these findings and inform the development of future interventions.

BACKGROUND:Social comparison, the process of evaluating one's characteristics in relation to others, influences individuals' self-perception and behavior. However, instruments are scarce for assessing social comparison in the medical setting. OBJECTIVES:Our aim was to develop and validate a new scale for assessing social comparison. MATERIALS AND METHODS:Seven statements were developed, encompassing the perceived normality of having rashes, the tendency to compare their situation with others, and the emotional response when seeing someone better or worse off than themselves. The instrument was piloted in 15 patients for readability and face validity, then prospectively validated using modern psychometric methods in 1,053 adult patients with eczema or psoriasis from three tertiary dermatological centers in Singapore. RESULTS:Of 1,053 adult patients, 802 (76.2%) had eczema, and 251 (23.8%) had psoriasis. Exploratory factor analysis (using a 70% sample split) showed a single factor model comprising three questions (Eigenvalue: 1.4). Confirmatory factor analysis with the remaining 30% of the sample confirmed an excellent model fit. Cronbach's alpha was 0.7, and inter-item correlations ranged from 0.42 to 0.46. In the Rasch analysis, item fit statistics and item characteristic curves showed appropriate discrimination between response options, although reliability was suboptimal with a person separation reliability of 0.63. CONCLUSIONS:Comprising 3 questions, the newly derived social comparison scale showed acceptable psychometrics as a measure of social comparison for clinical and research purposes in dermatology. Its brief nature likely results from its brevity and applicability to conditions beyond eczema and psoriasis, which warrants further investigation.

ObjectiveWe aimed to summarize the association between gestational diabetes mellitus (GDM) and its intergenerational cardiovascular diseases (CVDs) impacts in both mothers and offspring post-delivery in existing literature.MethodsPubMed, Embase, Web of Science, and Scopus were utilized for searching publications between January 1980 and June 2024, with data extraction and meta-analysis continuing until 31 July 2024. Based on a predefined PROSPERO protocol, studies published as full-length, English-language journal articles that reported the presence of GDM during pregnancy and its association with any CVD development post-delivery were selected. All studies were evaluated using the Newcastle-Ottawa Scale. Maximally adjusted risk estimates were pooled using random-effects meta-analysis to assess the risk ratio (RR) of GDM, and overall and subtypes of CVDs in both mothers and offspring post-delivery.ResultsThe meta-analysis was based on 38 studies with a total of 77,678,684 participants. The results showed a 46% increased risk (RR 1.46, 95% CI 1.34-1.59) for mothers and a 23% increased risk (1.23, 1.05-1.45) for offspring of developing overall CVDs after delivery, following a GDM-complicated pregnancy. Our subgroup analysis revealed that mothers with a history of GDM faced various risks (20% to 2-fold) of developing different subtypes of CVDs, including cerebrovascular disease, coronary artery disease, heart failure, and venous thromboembolism.ConclusionsThese findings underscore the heightened risk of developing various CVDs for mothers and offspring affected by GDM, emphasizing the importance of preventive measures even right after birth to mitigate the burden of CVDs in these populations.

BACKGROUND:Previous studies have investigated the various effects of parenting on infant developmental outcomes. In particular, parental stress and social support have been found to significantly affect the growth of the newborn. Although many parents today use mobile apps to obtain more support in parenting and perinatal care, few studies have examined how these apps could affect infant development.OBJECTIVE:This study aimed to examine the effectiveness of the Supportive Parenting App (SPA) in improving infant developmental outcomes during the perinatal period.METHODS:This study adopted a 2-group parallel prospective longitudinal design and recruited 200 infants and their parents (N=400 mothers and fathers). The parents were recruited at 24 weeks of gestation for a randomized controlled trial conducted from February 2020 to July 2022. They were randomly allocated to either the intervention or control group. The infant outcome measures included cognition, language, motor skills, and social-emotional development. Data were collected from the infants when they were aged 2, 4, 6, 9, and 12 months. Linear and modified Poisson regressions were used to analyze the data to examine between- and within-group changes.RESULTS:At 9 and 12 months post partum, the infants in the intervention group were found to have better communication and language skills than those in the control group. An analysis of motor development revealed that a larger proportion of the infants in the control group fell under the at-risk category, where they scored approximately 2 SDs below the normative scores. The control group infants scored higher on the problem solving domain at 6 months post partum. However, at 12 months postpartum, the infants in the intervention group performed better on cognitive tasks than those in the control group. Despite not being statistically significant, the intervention group infants were found to have consistently scored better on the social components of the questionnaires than the control group infants.CONCLUSIONS:Overall, the infants whose parents had received the SPA intervention tended to fare better in most developmental outcome measures than those whose parents had received standard care only. The findings of this study suggest that the SPA intervention exerted positive effects on the communication, cognition, motor, and socioemotional development of the infants. Further research is needed to improve the content and support provided by the intervention to maximize the benefits gained by infants and their parents.TRIAL REGISTRATION:ClinicalTrials.gov NCT04706442; https://clinicaltrials.gov/ct2/show/NCT04706442.

We investigated the relationship of preconception maternal retinal vasculature and utero-fetoplacental circulation in ensuing pregnancy. Embedded in a hospital-based, prospective preconception cohort, 396 women with a singleton live birth were included for analysis. We assessed retinal vascular caliber during preconception phase and retrieved ultrasonogram results documenting utero-fetoplacental circulatory indices using Doppler ultrasonography and documented them at 18-21 weeks, 24-28 weeks, and 32-34 weeks where available. We performed a modified Poisson regression to estimate the relative risk of utero-fetoplacental abnormalities, adjusting for major confounders including pre-pregnancy and blood pressure. Per 10 μm increment in maternal preconception retinal venules was associated with over two-fold risks in developing notching (Relative risk [RR]: 2.84; 95% confidence interval [CI]: 1.79, 4.81) and ≥95th percentile umbilical artery pulsatility index (2.36; 1.72, 3.23) during mid-to-late pregnancy, respectively. Women with preconception retinal venular widening tended to demonstrate steeper resistance increments in both maternal uterine arteries and fetal umbilical arteries during mid-to-late pregnancy.

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Background Adjusting to new or additional parenting responsibilities increases stress and affects parental well-being. Existing research has highlighted both parents’ desire to receive more support. It has also been found that receiving sufficient social support enhances parenting outcomes. With the increasing popularity of mobile health apps, a Supportive Parenting App (SPA) intervention was developed to fulfill the support needs of parents during the perinatal period. Objective This study aimed to examine the effectiveness of the SPA on parental outcomes during the perinatal period. Methods A 2-group pretest and repeated posttest randomized controlled trial was conducted wherein 200 couples (N=400 mothers and fathers) were recruited from 2 public health care institutions in Singapore. Parents were randomly assigned to intervention (100/200, 50%) or control (100/200, 50%) groups. The SPA intervention consisted of a mobile app–based psychoeducation and peer support program to support parents from pregnancy to 6 months post partum. The outcome measures included postnatal depression, anxiety, parental bonding, parental self-efficacy, perceived social support, and parenting satisfaction. Data were collected at baseline (at >24 weeks of gestation—age of viability in Singapore) and at the first, second, fourth, sixth, ninth, and 12th month post partum. Linear mixed models were used to compare parental outcomes between the groups, and a linear mixed model for repeated measures was used to examine within-group changes. Results Parents in the intervention group mostly showed better outcomes compared with those in the control group. Parents in the intervention group had higher perceived social support than those in the control group at the first (effect size=1.59, 95% CI 0.38-2.80; Cohen standardized effect size=1.31; P=.01), second (effect size=1.98, 95% CI 1.09-2.88; Cohen standardized effect size=2.21; P=.003), and fourth (effect size=2.57, 95% CI 1.62-3.51; Cohen standardized effect size=2.72; P=.048) months post partum. However, parents in the intervention group showed significantly poorer parental bonding (effect size=1.67, 95% CI 0.24-3.11; Cohen standardized effect size=1.16; P=.02). The other parental outcomes did not differ significantly between groups. The scores of mothers and fathers also differed significantly for all outcomes except parental self-efficacy. Conclusions Parents in the intervention group generally fared better, especially regarding perceived social support. However, the lack of statistical significance in most outcomes showed the limited effectiveness of the SPA intervention, which may be because of the COVID-19 pandemic. Parental differences in outcome scores suggest that mothers and fathers have different support needs; therefore, interventions should be tailored accordingly. Further improvements and evaluations are needed to examine the effectiveness of the SPA intervention in enhancing parental outcomes. Despite statistically insignificant results, limitations should be considered to further improve mobile health app–based interventions such as SPA, as they could serve as reliable and convenient sources of support for parents. Trial Registration Clinicaltrails.gov NCT4706442; https://clinicaltrials.gov/ct2/show/NCT04706442

OBJECTIVETo investigate the association between preconception maternal retinal arteriolar calibre and fetal growth.DESIGN, SETTING AND POPULATIONA hospital-based, prospective preconception cohort including 369 women with a singleton live birth.METHODSWe collected detailed information on sociodemographic status, pregnancy history and lifestyle, and performed retinal imaging at the preconception visit.MAIN OUTCOME MEASURESWe retrieved medical records documenting fetal growth biometrics (e.g., abdominal circumference [AC], head circumference [HC], femur length [FL]) at 11-13, 18-21, 24-28, and 32-34 weeks throughout pregnancy. We then computed the z scores for all fetal growth biometrics from 14 weeks of gestation where data were available, referencing the INTERGROWTH-21st fetal growth chart. We used a linear mixed model to estimate the association between maternal preconception retinal arteriolar calibre and fetal growth biometrics z scores throughout pregnancy, with random intercept accounting for repeated measures within individuals. We then performed a multivariable linear regression of maternal preconception retinal arteriolar calibre and z score changes for all fetal growth biometrics between 24-28 weeks and 32-34 weeks of gestation, after full adjustment.RESULTSMaternal preconception generalised retinal arteriolar narrowing was consistently associated with a reduction in fetal AC z scores (-0.34; 95% CI -0.66 to -0.03) throughout pregnancy. In addition, women with preconception generalised retinal arteriolar narrowing tended to have significantly reduced z score changes in AC (-0.41; 95% CI -0.90 to -0.001) and fetal FL (-0.55; 95% CI -1.00 to -0.10) between 24-28 weeks and 32-34 weeks of gestation, respectively.CONCLUSIONSOur findings suggest that women with narrower preconception retinal arterioles had smaller fetuses, evidenced by reductions in AC and FL z score throughout pregnancy.