Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. MethodsWe did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FindingsWe included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58•0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2•8 kg (2•3-3•3). Mortality among all patients was 37 (39•8%) of 93 in low-income countries, 583 (20•4%) of 2860 in middle-income countries, and 50 (5•6%) of 896 in high-income countries (p<0•0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90•0%] of ten in lowincome countries, 97 [31•9%] of 304 in middle-income countries, and two [1•4%] of 139 in high-income countries; p≤0•0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2•78 [95% CI 1•88-4•11], p<0•0001; middle-income vs high-income countries, 2•11 [1•59-2•79], p<0•0001), sepsis at presentation (1•20 [1•04-1•40], p=0•016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1•82 [1•40-2•35], p<0•0001; ASA 3 vs ASA 1-2, 1•58, [1•30-1•92], p<0•0001]), surgical safety checklist not used (1•39 [1•02-1•90], p=0•035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1•96, [1•4...

Objective: Previous literature has shown an inconsistent relationship between physical activity and stressor-evoked blood pressure reactivity. Use of ecological momentary assessment (EMA) may facilitate detecting such a relationship. In this study, the moderating effects of regular physical activity on the magnitude of ambulatory blood pressure (ABP) responses to psychosocial stressors experienced in daily life were examined. Method: Four hundred seventy-seven healthy working adults (ages 30–54) provided ABP readings and recorded their daily experiences, using electronic diaries (ED), over 4 monitoring days. Measures of momentary Task Strain (high demand, low control) and Social Conflict (rating of recent social interaction quality) were used as indices of stressor exposure, and an accelerometry device was used to create 2 indices of physical activity: weekly average and recent (30 min prior to each ED interview). Multilevel models were used to examine the moderating between- and within-person effects of physical activity on ABP fluctuations corresponding with the momentary psychosocial stressors. Results: Weekly physical activity moderated the effects of ABP responses to Task Strain (systolic blood pressure [SBP]: p = .033; diastolic blood pressure [DBP]: p = .028) and Social Conflict (DBP: p = .020), with significant increases in SBP and DBP shown for less physically active individuals but not for more physically active individuals. Similarly, recent physical activity moderated within-person DBP responses to Task Strain (p = .025), with greater DBP increases following less active periods. Conclusion: Our results demonstrate that weekly and recent physical activity may moderate the effects of ABP responses to daily psychosocial stress.

Objective A growing number of studies have associated various measures of social integration, the diversity of social roles in which one participates, with alterations in hypothalamic-pituitary-adrenocortical (HPA) functioning. The pathways through which social integration may be linked to HPA functioning, however, are as yet unknown. The present study examined whether daily social interactions, affective responses, health behaviors, and personality help explain the association between social integration and diurnal cortisol slope. Methods A sample of 456 healthy, employed adults (53.9% female, 82.0% white, 72.2% bachelor’s degree or greater, mean age of 42.86 years) completed a 4-day ecological momentary assessment protocol that measured cortisol, social interactions, affect, sleep, and physical activity at frequent intervals throughout the day. Social integration was measured at baseline. Results Regression results controlling for age, sex, race, and education indicated that more socially integrated individuals showed steeper cortisol slopes (B = −0.00253, p = .006). Exploratory analyses suggested that the consistency (i.e., reduced variability) in nightly sleep midpoint partially explained this association (B = −0.00042, 95% confidence interval = −0.00095 to −0.00001). Personality, mood, social interaction patterns, and nonsleep health behavior differences did not account for the association between social integration and HPA activity. Conclusion This study replicates previous findings linking social integration and HPA functioning, and it examines patterns of nightly sleep as possible pathways through which the association may operate. Results have implications for understanding mechanisms for health risk and for development of future interventions.

An inherent tension between religion and psychotherapy has inhibited the conversation between the two paradigms in determining the most effective approaches to improving mental health outcomes for people of faith. Preliminary research has suggested that the intersection between the two may prove fruitful in providing mental health interventions. As a part of a broader big-data study sponsored by the Bridges Consortium of Brigham Young University and underwritten by the John Templeton Foundation, the present study evaluated the effectiveness of the spiritually integrated strategies of the modality Gestalt Pastoral Care (GPC) focusing on two goals: (a) determining the overall clinical effectiveness of GPC, not previously scientifically validated, and (b) evaluating the effectiveness of GPC in the reduction of symptoms most commonly seen in clients using empirically validated clinical measures. Using a practice-based research design, 324 participants, engaging in individual session format and/or multiperson retreat format, were followed up to 1 year using measures including the Clinically Adaptive Multidimensional Outcome Survey (CAMOS), the Clinical Outcomes in Routine Evaluation (CORE-10), the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorders [DSM]-5(PC-Post-traumatic Stress Disorder [PTSD]-5), and the Spiritual Index of Well-Being (SIWB). A series of paired t-tests compared differences from the first session (pretreatment) to last session (posttreatment) and showed significant improvements in all of the clinical outcomes. These data indicate a slightly stronger relationship between symptom reduction and delivery in the retreat setting. Clinical Impact StatementQuestion: Do individual and retreat formats of Gestalt Pastoral Care (GPC) reduce measures of psychological and spiritual distress? Findings: Both formats of Gestalt Pastoral care resulted in small reductions in psychological and spiritual distress. Meaning: Integrating spirituality into psychotherapeutic settings may yield small benefits for people who seek to integrate their faith into the therapeutic process. Next Steps: Future work must explore the unique benefit of GPC compared to other standard treatments in a racially and religiously diverse sample.

Background High trait conscientiousness is associated with lower cardiometabolic risk, and health behaviors are a putative but relatively untested pathway that may explain this association. Purpose To explore the role of key health behaviors (diet, physical activity, substance use, and sleep) as links between conscientiousness and cardiometabolic risk. Methods In a cross-sectional analysis of 494 healthy, middle-aged working adults (mean age = 42.7 years, 52.6% women, 81.0% White), participants provided self-reports of conscientiousness, physical activity, substance use, diet, and sleep, and wore monitors over a 7-day monitoring period to assess sleep (Actiwatch-16) and physical activity (SenseWear Pro3). Cardiometabolic risk was expressed as a second-order latent variable from a confirmatory factor analysis involving insulin resistance, dyslipidemia, obesity, and blood pressure. Direct, indirect, and specific indirect effect pathways linking conscientiousness to health behaviors and cardiometabolic risk were examined. Unstandardized indirect effects for each health behavior class were computed separately using bootstrapped samples. Results After controlling for demographics (sex, age, race, and education), conscientiousness showed the predicted, inverse association with cardiometabolic risk. Among the examined health behaviors, objectively-assessed sleep midpoint variability (b = −0.003, p = .04), subjective sleep quality (b = −0.003, p = .025), and objectively-assessed physical activity (b = −0.11, p = .04) linked conscientiousness to cardiometabolic risk. Conclusions Physical activity and sleep partially accounted for the relationship between conscientiousness and cardiometabolic risk.