Background/Objectives: Approximately 53.4 million U.S. adults aged 50 or older have low bone mass, yet male bone health remains under-researched. This study evaluated the effects of one year of prune supplementation on bone health in older men susceptible to, or with, osteopenia. Methods: A total of 59 men (aged 55-80 years) were randomly assigned to one of three groups: 100 g prunes, 50 g prunes, or 0 g prunes (control; multivitamin only) daily, with each group also receiving 450 mg elemental calcium and 800 IU vitamin D3 via a multivitamin. Dual-energy X-ray absorptiometry (Lunar model DXA; GE Healthcare, CA, USA) scans and blood samples were collected at baseline, 3 months, 6 months, and 12 months. Results: No significant changes were observed in total bone mineral density (BMD) or lumbar spine BMD over one year. There were no significant changes in C-reactive protein (CRP). Osteoprotegerin (OPG) decreased significantly in all groups; however, the decrease was significantly greater in the control group compared to the levels in both prune groups. Sclerostin (SOST) significantly increased over time within all groups. Tartrate-resistant acid phosphatase-5b (TRAP5b) increased in all groups, albeit in the control group, it increased significantly more over time compared to the increase in the 100 g group. Conclusions: Overall, prune supplementation, regardless of dosing, did not increase total or lumbar BMD or aid in maintaining bone density beyond the levels achieved by Ca++ and vitamin D3 supplementation in older men susceptible to, or with, osteopenia (with a negative T-score down to -2.5 standard deviations (SD) below the mean). Although between-group differences were observed in select secondary biomarkers (OPG, TRAP5b), these did not correspond to detectable changes in BMD and should therefore be considered exploratory rather than directly indicative of clinical bone benefit. Additional research is needed to fully understand the effects of prunes on bone metabolism in men.

Using a pattern-centered approach, this investigation sought to identify latent subgroups of family functioning and evaluate their associations with health outcomes. A latent profile analysis was conducted using data from the National Study of Midlife Development in the United States (MIDUS). The sample comprised 5923 married adults between 25 and 74 years old who responded to items measuring family support, family strain, spousal support, spousal strain, and spousal agreement. These aspects of family functioning were used to identify four latent classes: Low Functioning (5.0%), Moderate Support with Elevated Strain (31.7%), High Support with Elevated Strain (13.7%), and High Functioning (49.6%). Compared to the other classes, individuals in the High Functioning class had greater psychological well-being and were less likely to have a chronic physical condition. The findings of this study highlight the importance of the systemic context of families in understanding the role of close relationships in health.

This systematic review evaluates the effectiveness of decision-making skill-focused interventions targeting adolescents and young adults on three key outcomes: cognitive abilities, risk behaviors, and career choices. We reviewed 11 studies published between 2014 and 2024 using a pre-post-research design. The interventions include in-person structured curricula (k = 3), in-person counseling sessions (k = 3), and online programs (k = 5). The review indicated that decision-making interventions effectively improve adolescents’ cognitive abilities as well as their career decision self-efficacy and adaptability. The findings related to risk behaviors were mixed. Sex differences occurred both at the initial stage and over time, but these differences were generally small in size. Online interventions were generally less time-intensive than in-person interventions. Applying the NIH Stage Model for Behavioral Intervention Development revealed that all but one study operated at stages II or III. Recommendations were made for future research and practice on decision-making interventions for adolescents and young adults.

Although adolescent attachment to their parents significantly impacts adolescents' sexual behaviour, its specific association with their goal-directed thoughts and relationship values remains underexplored. This study examined associations between parental attachment (angry-distress, availability, and goal-corrected partnership), goal-directed thinking, and relational attitudes, as well as the relevance of these cognitions for delaying sexual debut and for future planning. High school students in Florida were recruited to participate in the Sexual Risk Avoidance Education (SRAE) programme. The analytic sample included 497 U.S. high school students (Mage = 15.43, SD = 1.04; 49.5% female) who completed the SRAE entry survey and reported no history of sexual intercourse. Structural equation modelling was employed to examine the associations. Results indicated that adolescent attachment were significantly and positively associated with higher levels of goal-directed thinking. Angry-distress and availability were significantly and positively related to healthier relational attitudes. Additionally, healthier relational attitudes were significantly associated with an increased willingness to delay sexual debut, while goal-directed thinking was positively associated with future planning. Demographic covariates also played significant roles within the model. Findings suggested that adolescents' attachment, relational attitudes, and goal-directed thinking may serve as important protective factors supporting healthier sexual decision-making and future planning.

Background/Objectives: Approximately 53.4 million U.S. adults aged 50 or older have low bone mass, yet male bone loss remains under-researched. This study evaluated the effects of one year of prune supplementation on bone health in osteopenic men. Methods: Fifty-nine men (55–80 years) were randomly assigned to one of three groups: 0 g prune (control), 50 g prune, or 100 g prune daily, along with 450 mg elemental calcium and 800 IU vitamin D₃. Dual-energy X-ray absorptiometry (DXA) scans and blood samples were collected at baseline, 3, 6, and 12 months. Results: No significant changes were observed in total bone mineral density (BMD) over one year. C-reactive protein (CRP) was significantly higher in the control group compared to the 50 g group at all time points. Osteo-protegerin (OPG) decreased significantly in all groups, however, the decrease was significantly greater in the control compared to both prune groups. Sclerostin (SOST) significantly increased over time in all groups, albeit to a greater degree in the control group. Tartrate-resistant acid phosphatase-5b (TRAP5b) increased in the 50 g and control group but remained stable in the 100 g group. Conclusions: Overall, prune supplementation did not improve BMD beyond that of the calcium and vitamin D₃ supplementation however, there was a modest effect on biomarkers of inflammation and bone metabolism.

Background: Managing heart failure (HF) can be challenging for rural dyads, potentially contributing to depressive symptoms. Coping resources may be important components for dyadic interventions targeting depressive symptoms.Purpose: To explore actor and partner effects of coping resources on depressive symptoms in rural HF dyads.Methods: Using a cross-sectional design, data were collected from 42 rural HF dyads using the Interpersonal Support Evaluation List-12, Social Problem-Solving Inventory Revised-Short, Global Family Function, Family APGAR, and the Center for Epidemiological Studies-Depression scales. Data were analyzed using the Actor-Partner Interdependence Model.Results: Patients were 66.42 and caregivers were 60.83 years old. No partner effects noted. Significant actor effects for patients and caregivers between their own social support and depressive symptoms and their own problem-solving and depressive symptoms were found. There was also a significant actor effect between the caregivers' family satisfaction and depressive symptoms.Conclusions: Dyadic interventions that enhance coping resources are needed.

BACKGROUND:Managing heart failure (HF) is stressful for rural dyads who experience unique challenges to optimal HF self-care and a higher emotional burden. Tailored, dyadic problem-solving interventions that support teamwork in managing HF problems may enhance dyadic HF self-care and reduce depressive symptoms. OBJECTIVE:To examine the feasibility and preliminary effects of a telephone-based, tailored, dyadic problem-solving intervention on problem-solving, patient and care partner contributions to HF self-care, and depressive symptoms. METHODS:Using a dyadic single-group repeated-measures design, 41 rural HF dyads participated in 8 telephone sessions to address dyadic HF-related problems. Data on problem-solving, HF self-care, and depressive symptoms were collected at baseline and at 5, 9, and 13 weeks. Descriptive statistics were employed to analyze demographics and outcome variables. Changes in patient and care partner outcomes were analyzed using dyadic growth curve modeling. RESULTS:Patients were on average 66.54 years old, mostly White (69.2%), married (66.7%), and female (59%). Care partners were on average 60.83 years old, mostly White (70.7%), married (75.6%), females (58.5%), and spouses (68.3%). Patient scores significantly improved for problem-solving ( b = 0.45, P < .001), self-care maintenance ( b = 2.29, P < .001), and depressive symptoms ( b = -1.81, P = .002). Self-care confidence significantly increased in both patients ( b = 2.51, P < .001) and care partners ( b = 2.26, P = .01). CONCLUSIONS:Dyadic problem-solving interventions seem to be beneficial in improving problem-solving, HF self-care, and depressive symptoms, especially in rural patients. More research is needed to examine this intervention in a larger clinical trial. CLINICAL TRIALS REGISTRATION:This study is registered at clinicaltrials.gov (#00001621).

Social media has become an integral context for romantic relationship maintenance, yet prior research has yielded mixed findings regarding how specific online behaviors relate to relationship quality, particularly when considering both partners within a couple. The current study extends research on relationship maintenance by examining the contribution of multiple social media behaviors across four social media platforms for relationship quality. Data come from 80 heterosexual couples (N = 160; mean age = 31.96) who completed an online survey. Data were analyzed using multiple actor-partner interdependence models. Results revealed a positive effect for posting photos of partner and relationship and viewing partner's social media content for women's relationship quality and posting comments and private messaging romantic partners for both partners' relationship quality and a negative effect from women's posting updates of the relationship and partners' relationship quality. Yet, the more private messages men sent to partners, the lower the relationship quality was in both partners. The proportions of variance explained ranged from 1.4 to 4.7 percent in men and from 4.9 to 9.8 percent in women. These results suggest that the effect of social media behavior on partners' relationship quality was stronger in women than men. The results underscore that not all partner-directed social media behaviors are uniformly beneficial and that couples and practitioners should attend to how specific online behaviors may differentially influence relationship quality.

Theoretical models involving one or multiple intervening variables often posit whether a cause influences an outcome both directly and indirectly or only indirectly. In testing mediation, this distinction of partial and full mediation has become a subject of debate because of statistical issues. We extend the critique on this notion and provide insights into what a statistically significant direct effect between a cause and an outcome in a mediation model can mean. We also evaluate different effect size measures for direct and indirect effects and offer practical recommendations for assessing mediation mechanisms, which we illustrate using different examples. The broader relevance of these recommendations beyond mediation analysis is discussed.

BackgroundHeart failure (HF) remains a disease of notable disparity for rural veterans, despite recent advancements in clinical treatment. Managing HF in the home is stressful and complex for rural veterans who experience unique barriers to optimal physical and mental health, necessitating adequate support and problem-solving skills. ObjectiveThis study aims to (1) adapt, to the rural sociocultural context, a culturally sensitive, tailored, telephone support and problem-solving intervention (CARE-HF [Supporting Physical and Mental Health in Rural Veterans With Heart Failure]) using findings from preliminary qualitative research and (2) evaluate the effects of CARE-HF on problem-solving and physical and mental health outcomes among rural veterans with HF. MethodsThis study involves a repeated-measures, single-group design. The intervention content was adapted and tailored to the rural sociocultural context using preliminary qualitative data and guided by the Theories of Social Problem-Solving and Stress, Appraisal, and Coping. Veterans are recruited from Veterans Administration home-based cardiac rehabilitation clinics, cardiology clinics that serve veterans, veterans-based community resource centers, and social media campaigns. Veterans with HF (N=100) receive the CARE-HF intervention. This nurse-led intervention comprises 8 telephone sessions that use a five-step, problem-solving process to manage common HF problems in the home: (1) identifying the problem and viewing it in a positive manner, (2) goal setting, (3) generating potential strategies for problem management, (4) choosing and implementing strategies to manage the problem, and (5) evaluating strategy effectiveness. Veterans receive initial problem-solving training during the first session, with follow-up sessions focusing on problem-solving skill reinforcement and assisting veterans in applying these principles to manage self-identified, HF-related problems experienced in the home. Data are collected at baseline and 3, 6, 12, and 18 months from baseline on problem-solving and outcomes of interest (ie, HF self-care; HF symptoms; health care utilization; depressive symptoms; anxiety; HF-specific, health-related quality of life; stress; resilience; and coping). Demographic data will be analyzed using descriptive statistics and multilevel growth curve modeling with restricted maximum likelihood estimation to compare a series of models using Akaike information criteria and Bayesian information criteria fit indices while controlling for covariates. ResultsRecruitment started in April 2023. As of December 2024, we have enrolled 56 veterans. Recruitment is anticipated to end in June 2025, with data collection continuing until all enrolled veterans have completed the 18-month follow-up period. ConclusionsAdapting and testing a culturally sensitive, tailored, telephone intervention to aid support and problem-solving in the home has the potential to provide individualized care to rural veterans where they reside, thereby reducing travel burden while also increasing access to evidence-based care programs. If effective, telephone support and problem-solving interventions could be a low-cost, accessible method to improve physical and mental health in rural veterans with HF. Trial RegistrationClinicalTrials.gov NCT05839067; https://clinicaltrials.gov/study/NCT05839067 International Registered Report Identifier (IRRID)DERR1-10.2196/63498

Insecure attachment has been found to affect an individual's mental health. However, more studies are needed on how individual's insecure attachment contributes to the partner's mental health in couples. The present study examined the dyadic associations between insecure attachment and mental health in couples. Using data from 222 opposite-sex Turkish married couples (Mwives = 38.26 years, Mhusbands = 41.21), we sought to investigate whether individuals' anxious attachment and avoidant attachment were associated with their own as well as with the spouses' depression and anxiety. Actor-partner interdependence model analysis revealed that both husbands' and wives' anxious attachment were linked with their own depression and anxiety. Also, husbands' anxious attachment was associated with wives' anxiety. For avoidant attachment, both husbands' and wives' avoidant attachment were associated with their own depression, and husbands' avoidant attachment was associated with their own anxiety. Anxious attachment explained more variance in anxiety than in depression, whereas avoidant attachment explained more variance in depression. The findings provide valuable insights for couple therapists and mental health professionals, emphasizing the consideration of partners' anxious attachment when working with women who experience symptoms of anxiety. Integrating these findings into attachment-based couple interventions may prove useful in coping with symptoms associated with depression and anxiety. Overall, these findings contribute to a better understanding of the dynamics within insecure attachment and mental health, highlighting the importance of prioritizing the establishment of secure attachment for mental health.

Introduction: Managing heart failure (HF) in the home is stressful and complex for rural dyads who experience unique challenges and barriers to optimal HF self-care (SC). Innovative, tailored, dyadic problem-solving interventions are needed which support teamwork in managing HF SC problems in the home to enhance dyadic HF SC and reduce depressive symptoms. Research Question: Will participation in a 3-month dyadic, telephone-based problem-solving intervention focused on dyadic HF SC problems experienced in the home improve patient and care partner-contributed HF SC and reduce depressive symptoms in rural dyads living with HF? Methods: Using a dyadic single-group repeated-measures design, 41 rural dyads (patient-informal care partner) living with HF participated in 8 telephone sessions with a registered nurse to identify and develop management strategies for dyadic HF SC problems experienced in the home. Data were collected at baseline and 5-, 9-, and 13-weeks post baseline using the Self-care of HF Index (SCHFI), Caregiver Contribution to the SCHFI, and the Center for Epidemiological Studies – Depression Scale. HF patients were mostly female (59%), married (66.7%) Caucasians (69.2%), with 2-3 comorbidities (53.8%) and Class 2 NYHA HF (69.2%). Care partners were primarily female (58.5%), married (75.6%) Caucasians (70.7%), and spouses of the HF patient (68.3%), with 0-1 comorbidities (58.6%), and had been providing care for ≥ 5 years (46.3%). Descriptive statistics were used to examine dyad characteristics and outcome variables at each time point. Changes in patients' and care partners’ outcomes were analyzed using dyadic Growth Curve Modeling within the Multilevel Modeling framework. Results: Across time, patient scores improved for depressive symptoms ( b = -1.81, p = .002) and SC maintenance ( b = 2.29, p < .001). SC confidence increased in both patients ( b = 2.51, p < .001) and care partners ( b = 2.26, p = .01). Increases in patient SC management across time was noted but non-significant ( b = 1.46, p = .133 for patients; b = 0.60, p = .561 for care partners). Conclusions: Problem-solving interventions in rural dyads living with HF may be helpful in addressing HF SC issues and depressive symptoms in the home, especially in HF patients. However, more research is needed to examine this promising intervention in a larger clinical trial.

Objectives: While there are good reasons to assume that mindfulness protects against burnout in students, nothing is known about the role of caring for bliss. This study examined whether caring for bliss moderated the relationship between mindfulness at baseline and aspects of burnout approximately 12 weeks later. Participants: Students (n = 92) from a university in the United States. Methods: Online surveys were administered in 2018. Results: Moderated regression analyses, controlling for depressive symptoms and burnout at baseline, revealed that caring for bliss moderated the relationship between earlier mindfulness and two aspects of later student burnout, namely emotional exhaustion and cynicism. Specifically, exhaustion and cynicism were low when students reported either low or high scores on both mindfulness and caring for bliss. No moderating effect was found for academic efficacy. Conclusions: Mindfulness and caring for bliss appear to work synergistically to reduce aspects of student burnout over time.

IntroductionGratitude has been found to be relevant for relational well-being, and there has been ongoing interest in uncovering the mechanisms by which gratitude functions in interpersonal relationships. Only recently, gratitude has been studied within the context of dyadic coping—the interpersonal process of how partners communicate their stress, support each other during stressful times, and jointly cope with stress—in romantic couples. Drawing up on theoretical models on the functions of gratitude within close relationships and previous research, we aimed to advance this line of research and examined the potential mediating role of gratitude between dyadic coping and relationship satisfaction applying a dyadic perspective. For a more nuanced understanding of gratitude, we differentiated between felt and expressed dyadic coping-related gratitude.MethodsWe used data of 163 romantic mixed-gender couples living in Switzerland. To examine the mediation model dyadically, we applied the Actor Partner Interdependence Mediation Model (APIMeM).ResultsWhile in the presence of gratitude as a mediator, almost no significant direct effects from dyadic coping on relationship satisfaction were found, evidence pointed to a mediating role of gratitude within this process: Provided dyadic coping was related to higher gratitude, which was in turn related to higher own and partner relationship satisfaction. The results were similar for felt and expressed dyadic coping-related gratitude.DiscussionThe finding that gratitude plays an important mediating role within the dyadic coping process offers important future directions for research as well as preventative and clinical work with couples.

Relationship satisfaction is associated consistently with better physical and mental health. Less is known about these associations in daily life, particularly the association between relationship satisfaction and cognitive health. This study examined the daily, within-person association between relationship satisfaction and subjective health markers, including cognitive health. Participants from the United States (N = 303; Mage = 51.71, SD = 7.32) in the Couples Healthy Aging Project (CHAP) completed assessments of relationship satisfaction and health markers every night for eight days. Multilevel modeling was performed by accounting for personal (sex, age, race, education), relational (relationship duration), and contextual (day in the study, weekend day) factors. Within-person, on days when participants were more satisfied with their relationship, they felt healthier, younger, more satisfied with their life, and more purposeful. They also reported a sharper mind, better memory, and clearer thinking; relationship satisfaction was unrelated to whether participants were bothered and disrupted by forgetting. Results indicated that a satisfying romantic relationship is closely associated with better physical, psychological, and cognitive health markers in daily life.

In response to the rising public and scholarly interest in understanding relational experiences in intercultural relationships, we propose a new concept-relational cultural intelligence (RCI)-to describe an individual's ability to learn and apply cultural knowledge in intimate relationships. In this article, we outline the theoretical foundation of RCI, introduce the RCI scale, and present initial results on its reliability and validity. We conceptualize RCI as a type of social intelligence with three dimensions: awareness, skills, and knowledge. This study surveyed 186 individuals in the United States who identified as being currently in an intercultural romantic relationship. The results provide evidence for the reliability and validity of the three-factor scale with 12 items. Results also showed that RCI was related to important aspects of relational experiences, such as relational stress and relationship satisfaction, and that it explained variance in relationship satisfaction above and beyond relational stress, commitment, and relationship duration.

The framework of elementary probabilistic operations (EPO) explains the structure of elementary probabilistic reasoning tasks as well as people's performance on these tasks. The framework comprises three components: (a) Three types of probabilities: joint, marginal, and conditional probabilities; (b) three elementary probabilistic operations: combination, marginalization, and conditioning, and (c) quantitative inference schemas implementing the EPO. The formal part of the EPO framework is a computational level theory that provides a problem space representation and a classification of elementary probabilistic problems based on computational requirements for solving a problem. According to the EPO framework, current methods for improving probabilistic reasoning are of two kinds: First, reduction of Bayesian problems to a type of probabilistic problems requiring less conceptual and procedural competencies. Second, enhancing people's utilization competence by fostering the application of quantitative inference schemas. The approach suggests new applications, including the teaching of probabilistic reasoning, using analogical problem solving in probabilistic reasoning, and new methods for analyzing errors in probabilistic problem solving.