Studies of meat allergic patients have shown that eating meat poses a serious acute health risk that can induce severe cutaneous, gastrointestinal, and respiratory reactions. Allergic reactions in ...affected individuals following meat consumption are mediated predominantly by IgE antibodies specific for galactose-α-1,3-galactose (α-gal), a blood group antigen of non-primate mammals and therefore present in dietary meat. α-gal is also found within certain tick species and tick bites are strongly linked to meat allergy. Thus, it is thought that exposure to tick bites promotes cutaneous sensitization to tick antigens such as α-gal, leading to the development of IgE-mediated meat allergy. The underlying immune mechanisms by which skin exposure to ticks leads to the production of α-gal-specific IgE are poorly understood and are key to identifying novel treatments for this disease. In this review, we summarize the evidence of cutaneous exposure to tick bites and the development of mammalian meat allergy. We then provide recent insights into the role of B cells in IgE production in human patients with mammalian meat allergy and in a novel mouse model of meat allergy. Finally, we discuss existing data more generally focused on tick-mediated immunomodulation, and highlight possible mechanisms for how cutaneous exposure to tick bites might affect B cell responses in the skin and gut that contribute to loss of oral tolerance.
Tick-borne allergies are a growing public health concern and have been associated with the induction of IgE-mediated food allergy to red meat. However, despite the increasing prevalence of tick ...bite-induced allergies, the mechanisms by which cutaneous exposure to ticks leads to sensitization and the production of IgE Abs are poorly understood. To address this question, an in vivo approach was used to characterize the IgE response to lone star tick proteins administered through the skin of mice. The results demonstrated that tick sensitization and challenge induced a robust production of IgE Abs and supported a role for IgE-mediated hypersensitivity reactions in sensitized animals following oral administration of meat. The induction of IgE responses was dependent on cognate CD4
T cell help during both the sensitization phase and challenge phase with cutaneous tick exposure. In addition, IgE production was dependent on B cell-intrinsic MyD88 expression, suggesting an important role for TLR signaling in B cells to induce IgE responses to tick proteins. This model of tick-induced IgE responses could be used to study the factors within tick bites that cause allergies and to investigate how sensitization to food Ags occurs through the skin that leads to IgE production.
Background
Youth mental health has declined since the COVID-19 pandemic began. Health coaching and mindfulness-based intervention may support therapeutic processes that promote resilience in the face ...of risk factors for adverse mental health outcomes. Building Resilience for Healthy Kids (HK) is a school-based intervention designed to support mental health through targeting these processes.
Objective
In this study, we tested HK in a pilot randomized controlled trial. Specifically, we examined intervention effects on the theoretically-informed therapeutic processes of emotion regulation, mindfulness, self-efficacy, and resilience and the clinical outcomes of depression and anxiety symptoms. The trial took place between April and June 2021, offering an opportunity to assess the impact of HK in the context of COVID-19.
Methods
Participants were early adolescents (
N
= 230), randomized to HK or assessment-only. Participants in the intervention condition received weekly one-on-one sessions with health coaches. All youth completed validated self-report measures at baseline and post-intervention.
Results
Linear mixed effects models indicated that participants who received HK had a greater reduction in emotion regulation difficulties, relative to assessment-only controls (
d
= 0.84, large effect). Follow-up analyses revealed that youth who endorsed negative affectivity at baseline experienced more benefits than those who did not, and youth who attended more HK sessions increased in self-efficacy, in addition to improved emotion regulation. Intervention effects did not reach significance for other outcomes.
Conclusions
Findings suggest that HK may support youth in reducing difficulties in emotion regulation, which are precursors to the development of mental health concerns in adolescence.
TRN
NCT04202913, 12/16/2019.
Although suicide is a leading cause of mortality among racial and ethnic minority youth, limited data exists regarding the impact of school-based mental health interventions on these populations, ...specifically. A single-arm pragmatic trial design was utilized to evaluate the equity of outcomes of the universal, school-based mental health coaching intervention, Building Resilience for Healthy Kids. All sixth-grade students at an urban middle school were invited to participate. Students attended six weekly sessions with a health coach discussing goal setting and other resilience strategies. 285 students (86%) participated with 252 (88%) completing both pre- and post-intervention surveys. Students were a mean age of 11.4 years with 55% identifying as girls, 69% as White, 13% as a racial minority, and 18% as Hispanic. Racial minority students exhibited greater improvements in personal and total resilience compared to White students, controlling for baseline scores.
Adolescents from historically racial and ethnic minoritized and low-income communities have higher rates of early-life and chronic difficulties with anxiety and depression compared to non-Hispanic ...White youth. With mental health distress exacerbated during and in the wake of the COVID-19 pandemic, there is a need for accessible, equitable evidence-based programs that promote psychological well-being, strengthen one's ability to adapt to adversity, and build self-efficacy prior to adolescence.
An evidenced-based resiliency-focused health coaching intervention was adapted using a health equity implementation framework to meet the needs of a Title I elementary school in rural Alabama (AL) that serves over 80% Black and Hispanic students. To ensure that the program met local community needs while maintaining core program educational activities, all adaptations were documented utilizing a standard coding system.
Leveraging an existing academic-community partnership with Auburn University and a local AL school district, a new program, Advocates 4-All Youth (ALLY), was created. Three major adaptations were required: (1) the use of local community volunteers (ALLYs) to deliver the program versus health coaches, (2) the modification of program materials to meet the challenge of varying levels of general and health-related literacy, and (3) the integration of the Empower Action Model to target protective factors in a culturally-tailored delivery to ensure key program outcomes are found equitable for all students.
With continued increases in youth mental health distress, there is a need for the development of universal primary prevention interventions to promote mental well-being and to strengthen protective factors among youth from historically disadvantaged backgrounds. ALLY was created to meet these needs and may be an effective strategy if deemed efficacious in improving program outcomes.
Purpose
To examine the role of sleep in a school-based resiliency intervention.
Design
Single group feasibility study.
Setting
Urban middle school
Subjects
Sixth grade students.
Intervention
A total ...of 285, 11–12-year-old students (70% White, 18% Hispanic, 55% female) participated in the six-week 1:1 Healthy Kids intervention. Youth (n = 248) completed electronic surveys at pre–post the 6-week study assessing mental health parameters and self-reported bed and wake time.
Measures
Students were categorized as having insufficient sleep opportunity if they reported time in bed of <9 hours per night.
Analysis
General linear models examined differences between groups for each mental health parameters pre–post-study.
Results
A third of participants (28%) were classified as having insufficient sleep opportunity. Youth with insufficient sleep were more often Hispanic (27% vs 16%; P < .001) and were more often classified with both mild to severe depression and anxiety symptoms (55% vs 35%; P = .004). The health coaching intervention was found to have a significant improvement on overall resilience and self-efficacy only among students who reported sufficient sleep, while no significant intervention effect was found for those students who reported insufficient sleep.
Conclusions
Our findings suggest that youth with poor sleep health may not benefit from school-based resiliency interventions.
Recent reports have shown that the majority of school-aged children and adolescents experience insufficient sleep duration making sleep health a significant public health concern. School-based sleep ...interventions that have the ability to reach large numbers of children simultaneously may be a viable strategy to combat this epidemic. The goal of this topical review is to examine published school-based interventions to identify lessons learned and provide suggestions for future research. Our findings show that school-based sleep interventions to date have been designed as both universal interventions for all students as well as targeted interventions delivered only to those identified as having sleep problems. Unfortunately, most interventions resulted in minimal change in sleep, with only 3 interventions improving sleep by more than 30 min per night. Education-based strategies alone are typically insufficient to produce substantial behavior change. The strategy of screening the most at-risk students and then providing individual and specifically targeted intervention may be an efficient use of resources that schools could utilize. Further work is needed to examine the feasibility and efficacy of school-based interventions in achieving clinically significant improvements in sleep duration at a larger scale to curb the epidemic of insufficient sleep in school-aged children and adolescents.
Tick-borne allergies are a growing public health concern and have been associated with the induction of IgE-mediated food allergy to red meat. However, despite the increasing prevalence of tick ...bite-induced allergies, the mechanisms by which cutaneous exposure to ticks leads to sensitization and the production of IgE antibodies are poorly understood. To address this question, an
in vivo
approach was used to characterize the IgE response to lone star tick proteins administered through the skin of mice. The results demonstrated that tick sensitization and challenge induced robust production of IgE antibodies and supported a role for IgE-mediated hypersensitivity reactions in sensitized animals following oral administration of meat. Induction of IgE responses was dependent on cognate CD4
+
T cell help during both the sensitization phase and challenge phase with cutaneous tick exposure. In addition, IgE production was dependent on B cell intrinsic MyD88 expression, suggesting an important role for TLR signaling in B cells to induce IgE responses to tick proteins. This model of tick-induced IgE responses could be used to study the factors within tick bites that cause allergies and to investigate how sensitization to food antigens occurs through the skin that leads to IgE production.
Delirium assessments in critically ill infants and young children pose unique challenges due to evolution of cognitive and language skills. The objectives of this study were to determine the validity ...and reliability of a fundamentally objective and developmentally appropriate delirium assessment tool for critically ill infants and preschool-aged children and to determine delirium prevalence.
Prospective, observational cohort validation study of the PreSchool Confusion Assessment Method for the ICU in a tertiary medical center PICU.
Participants aged 6 months to 5 years and admitted to the PICU regardless of admission diagnosis were enrolled.
An interdisciplinary team created the PreSchool Confusion Assessment Method for the ICU for pediatric delirium monitoring. To assess validity, patients were independently assessed for delirium daily by the research team using the PreSchool Confusion Assessment Method for the ICU and by a child psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders criteria. Reliability was assessed using blinded, concurrent PreSchool Confusion Assessment Method for the ICU evaluations by research staff. A total of 530-paired delirium assessments were completed among 300 patients, with a median age of 20 months (interquartile range, 11-37) and 43% requiring mechanical ventilation. The PreSchool Confusion Assessment Method for the ICU demonstrated a specificity of 91% (95% CI, 90-93), sensitivity of 75% (95% CI, 72-78), negative predictive value of 86% (95% CI, 84-88), positive predictive value of 84% (95% CI, 81-87), and a reliability κ-statistic of 0.79 (0.76-0.83). Delirium prevalence was 44% using the PreSchool Confusion Assessment Method for the ICU and 47% by the reference rater. The rates of delirium were 53% versus 56% in patients younger than 2 years old and 33% versus 35% in patients 2-5 years old using the PreSchool Confusion Assessment Method for the ICU and reference rater, respectively. The short-form PreSchool Confusion Assessment Method for the ICU maintained a high specificity (87%) and sensitivity (78%) in post hoc analysis.
The PreSchool Confusion Assessment Method for the ICU is a highly valid and reliable delirium instrument for critically ill infants and preschool-aged children, in whom delirium is extremely prevalent.
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