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Open Access
External and internal factors affecting emotion regulation
(2025-03-05) Horner, Scarlett; Marotta, Jonathan (Psychology); Jakobson, Lorna (Psychology); Kornelsen, Jennifer (Radiology); Todd, Rebecca (University of British Columbia); Greening, Steven
Emotion regulation is defined as changing or maintaining one’s emotions. The Selection, Optimization, and Compensation model of Emotion Regulation (SOC-ER) posits that emotion regulation is influenced by external factors, such as properties of a stimulus, and internal factors, such as cognitive processes. The purpose of this series of studies was to distinguish how external and internal factors contribute to emotion regulation. In Study 1, I identified how ambivalence, an external factor, influences emotion regulation choice. I predicted that participants would be more likely to choose to reappraise ambivalent images compared to non-ambivalent images. Studies 2 and 3 examined how internal factors influence emotion regulation ability. In Study 2, I combined brain imaging and behavioural tasks to determine brain activity produced during emotion regulation could be used to predict individual differences in working memory performance. I predicted that differences in brain activity between reappraise and view conditions would predict working memory scores. In Study 3, I used intrinsic network functional connectivity to evaluate whether differences in network connectivity could be used to predict whether one is reappraising or viewing a negative stimulus. I expected network connectivity to predict emotion regulation ability greater than chance, and that networks associated with emotion (salience network), networks associated with cognitive control (attention control network, frontoparietal networks), and the default mode network would make a reliable contribution to significant classification. Our hypotheses for Studies 1 and 2 were supported, and Study 3 was partially supported. This study has contributed new knowledge to the literature on the neurocognitive mechanisms of emotion regulation by testing predictions derived from the SOC-ER model, which can help identify ways to improve one’s emotion regulation.
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Open Access
The employment preferences of young people in Canada: a discrete choice experiment
(BMC, 2025-02-21) Woodgate, Roberta L.; Isaak, Corinne; Witt, Julia; Tennent, Pauline; Bell, Ashley
Abstract Background Young people across the world are facing numerous challenges, with unemployment and precarious employment being substantial issues, impacting young people with all levels of education. For many young people, the pandemic exacerbated their employment precarity. While efforts were made to ameliorate these pandemic related challenges for young people, information about the employment preferences of Canadian young workers (YW) is limited. The aim of this study was to understand the employment needs, challenges and preferences of Canadian YW in the COVID-19 era and beyond. Methods Using discrete choice experiment, YW from across Canada aged 18–29 years old were recruited to participate in an online survey October 2022 to April 2023 which was offered in both English and French. Nine job attributes were identified based on findings from the qualitative component of this mixed methods project: wage, earnings stability, job flexibility, vacation, sick time, health insurance, and workplace policies (respectful workplace, and being valued and understood as an employee). Respondents were presented with nine choice sets, each representing two scenarios that differ on policies or actions (attributes) related to their employment during the COVID-19 pandemic. Results Based on the respondent (N = 231) sample, analysis revealed that of YW aged 18–29 years, most valued having employment benefits along with workplace policies. These values were strongest for women and 18–21-year-olds. Overall, the employment preferences of Canadian YW in the current study align with four of five attributes considered by the International Labour Organization as minimum standards for decent work. These include adequate compensation, adequate access to health care, adequate free time and rest, and organizational values that support one’s [own and] family values. More specifically, study findings show that within the cohort there are strong gendered and aged-based preferences for non-monetary over monetary job attributes. These include employment benefits along with equitable, supportive employment policies. Conclusions The findings suggest that health and wellbeing are highly valued by YW and are among key drivers of employment preferences for Canadian YW during and after the pandemic, and therefore call for policies in the workplace that support the health and well-being of YW.
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Open Access
Creating accessible and inclusive undergraduate studentship opportunities: the ENRRICH experience
(BMC, 2025-02-16) Beattie, Robert; Russell, Kelly; Wittmeier, Kristy; Mitchell-Dueck, Jenna; Cheung, Kristene; Rastegar, Mojgan; Slike, Alana; Williams, Valerie; Chan, Ming-Ka; Wilson, Mary; Protudjer, Jennifer L.
Abstract Recognizing the systemic exclusion of structurally oppressed groups from academic awards, the ENRRICH (Excellence in Neurodevelopment and Rehabilitation Research In Child Health) summer studentship emphasized the inclusion of structurally oppressed groups. Herein, we outline the processes in creating this funding opportunity, and plans for improvement, including enhanced representation among supervisors.
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Open Access
“I’m not alone”: perinatal women’s experiences in an online self-directed program for perinatal anxiety
(BMC, 2025-02-21) Uchechukwu, Light; Hardman, Madison; Hadley, Isabelle; Gornik, Megan E.; Petty, Sarah K.; Pryor, Teaghan; Alcolado, Gillian; Furer, Patricia; Reynolds, Kristin
Abstract Background Anxiety is highly prevalent during pregnancy and postpartum, and access to treatment can be difficult due to a range of barriers (e.g., time, distance, and service availability). Online treatments have the potential to circumvent these barriers and may, therefore, be beneficial for the perinatal population. The present study leveraged qualitative methods to understand participants’ perspectives on their use of a six-module online self-directed Cognitive Behavioral Therapy (CBT) program for perinatal anxiety as part of a randomized controlled trial. Methods A mixed qualitative method design was used for this study. A total of 95 perinatal women were randomized to an intervention or waitlist control condition for an online self-directed program (Overcoming Perinatal Anxiety; OPA). Both waitlist and intervention participants provided open-ended feedback on each module via online surveys. A subset of individuals (n = 20) assigned to the intervention condition completed a virtual qualitative interview about their experiences using the program. Data obtained from open-ended survey questions and qualitative interviews were analyzed using Conventional Content Analysis (open-ended survey) and Reflexive Thematic Analysis (interviews). Results Open-ended survey data were categorized into three themes, with associated sub-themes: User experience (subthemes: accessibility and modality), Perceptions of content (sub-themes: validating, informative, hopeful, anxiety-inducing, emotionally “heavy”, and helpful), and Barriers to program engagement (subthemes: lack of time and energy, technical difficulties, challenging and external factors). Qualitative interview data were categorized into the following main themes, with associated subthemes: Tensions in engaging with the self-directed program (subthemes: connecting and multi-tasking, “finding the time,” module length and pacing, pen to paper, and “thanks for the reminder but don’t rush me”), “I’m not alone,” (subthemes: relating to the content, sharing anxiety with “inner circle,” and voicing a desire to connect with other “moms feeling the same way”), and “I’m managing my anxiety” (subthemes: “understanding my anxiety,” using “strategies to help with my anxiety,” “taking time for myself,” and moving forward). Conclusion Findings highlight that online self-directed treatment can be an acceptable and feasible option for perinatal anxiety. Findings show promise for the scalability of OPA to improve access to psychological treatment for perinatal people experiencing anxiety. Trial registration Clinical Trial Identifier: NCT04844138 (clinicaltrials.gov). Trial registration submitted: [April 5, 2021] accepted: [April 14, 2021].
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Open Access
Cost-effectiveness of nirsevimab and maternal RSVpreF for preventing respiratory syncytial virus disease in infants across Canada
(BMC, 2025-02-21) Bugden, Samara; Mital, Shweta; Nguyen, Hai V.
Abstract Background Nirsevimab, a long-acting monoclonal antibody, and RSVpreF, a maternal vaccine, are newly approved respiratory syncytial virus (RSV) prophylactics for infants in Canada. Both have the potential to expand prevention efforts, but there is limited evidence regarding their cost-effectiveness and how it varies across the country, despite disparate hospitalisation rates and resource use among different populations. Methods We developed a decision tree model to follow twelve monthly birth cohorts through their first year of life, incorporating risk differentiation based on Canadian region, prematurity, and comorbidities. The model tracked medically attended infections, including hospitalisations, intensive care unit admissions, and outpatient visits, comparing costs (in 2024 Canadian dollars) and effectiveness (in quality-adjusted life years (QALYs)) of nine different immunisation strategies compared to no intervention. The analysis was conducted from both healthcare and societal perspectives. We conducted threshold price analyses, varying the price-per-dose of each product to determine the threshold prices at which expanded coverage becomes cost-effective. Results At base case prices, the optimal strategy varies by region, but in all cases, the optimal strategy is both cost-saving and more effective than no intervention. In southern Canada, it is optimal to immunise only palivizumab-eligible infants (those born very prematurely or with high-risk comorbidities) with nirsevimab, resulting in cost savings of $4.14 and QALY gains of 0.000022 QALY per infant compared to no intervention. In the Northwest Territories, it is best to expand protection with nirsevimab to include all preterm infants (cost savings of $28.68 and QALY gains of 0.00007 per infant). In Nunavik and Nunavut, immunising all infants under 6 months and all infants under twelve months with nirsevimab are the best strategies, respectively (cost savings of $399.61 and QALY gains of 0.000821 per infant in Nunavik, and cost savings of $1067.03 and QALY gains of 0.000884 per infant in Nunavut). Universal, country-wide immunisation with nirsevimab would require a price-per-dose of under $112 to become the most cost-effective prevention strategy. Conclusions The optimal strategy for preventing respiratory syncytial virus disease in Canadian infants depends on product price and regional risk level and resource use. Canadian policy should account for these factors.
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Open Access
Mechanisms of antigen-dependent resistance to chimeric antigen receptor (CAR)-T cell therapies
(BMC, 2025-02-24) Nasiri, Fatemeh; Safarzadeh Kozani, Pouya; Salem, Faeze; Mahboubi Kancha, Maral; Dashti Shokoohi, Setareh; Safarzadeh Kozani, Pooria
Abstract Cancer immunotherapy has reshaped the landscape of cancer treatment over the past decades. Genetic manipulation of T cells to express synthetic receptors, known as chimeric antigen receptors (CAR), has led to the creation of tremendous commercial and therapeutic success for the treatment of certain hematologic malignancies. However, since the engagement of CAR-T cells with their respective antigens is solely what triggers their cytotoxic reactions against target cells, the slightest changes to the availability and/or structure of the target antigen often result in the incapacitation of CAR-T cells to enforce tumoricidal responses. This results in the resistance of tumor cells to a particular CAR-T cell therapy that requires meticulous heeding to sustain remissions in cancer patients. In this review, we highlight the antigen-dependent resistance mechanisms by which tumor cells dodge being recognized and targeted by CAR-T cells. Moreover, since substituting the target antigen is the most potent strategy for overcoming antigen-dependent disease relapse, we tend to highlight the current status of some target antigens that might be considered suitable alternatives to the currently available antigens in various cancers. We also propose target antigens whose targeting might reduce the off-tumor adverse events of CAR-T cells in certain malignancies.
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Open Access
An analytical approach towards attaining leave no one behind using patterns and distributions of inequalities in antenatal and facility delivery coverage in Uttar Pradesh, India
(BMC, 2025-02-25) Namasivayam, Vasanthakumar; Prakash, Ravi; Dehury, Bidyadhar; Isac, Shajy; Wehrmeister, Fernando C.; Becker, Marissa; Blanchard, James; Boerma, Ties
Abstract Background Leave No One Behind (LNOB) is a central, transformative promise of the 2030 Agenda for Sustainable Development Goals. To attain LNOB, systematic analysis of patterns and distributions of inequalities in coverage of health outcomes on a continuous basis at different program delivery layers is required to design tailored health interventions. We analysed the patterns of change and geographic distribution of inequalities in coverage of antenatal care and facility-based delivery in Uttar Pradesh (UP), India and developed a framework to guide health programmers to understand inequalities better, to accelerate progress by reaching those left behind. Methods Data from five-rounds of National Family Health Survey (1992–2021) and two-rounds of Community Behaviour Tracking Survey (2014–2018) is used. Education and wealth have been used as stratifiers. Three measures of inequality- mean difference from mean, slope index of inequality, and inequality pattern index are used to depict the state, district and sub-district level inequalities. Results UP observed a substantial reduction in the education-related inequality in ANC and facility-delivery during 1992–2021. The slope index of inequality declined from 65.3 [95%CI:60.0-70.6] to 9.3 [95%CI:7.8–10.8] for ANC and from 44.7 [95%CI:38.5–50.9] to 29.9 [95%CI:27.8–32.0] for facility-delivery during 1992–2021. The inequality pattern index showed that, with improved reach of interventions, many districts moved towards bottom inequality from top inequality for any ANC while fewer districts for facility-delivery. Even in districts with high coverage and low inequality, sub-district level(blocks) inequality persisted. Similarly, in blocks with high coverage and low inequality, Accredited Social Health Activist (ASHA) level inequality persisted. Interestingly, for the same ASHA area, the patterns of inequality differed for any ANC and facility delivery; in some districts, inequality direction changed based on the stratifier chosen. Conclusions The proposed health equity framework suggests that to achieve LNOB status, understanding inequality with the coverage status is important. If coverage is high and inequality persists, identify the program layer at which maximum inequality persists to identify the left behinds. Whereas, if coverage is poor, programs are required to improve coverage first. Findings also call for a systematic way of collecting and organizing granular data to understand inequality and identify the left-behinds.
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Open Access
The integrated stress response in neurodegenerative diseases
(BMC, 2025-02-19) Bravo Jimenez, Maria Astrid; Sharma, Shivangi; Karimi-Abdolrezaee, Soheila
Abstract The integrated stress response (ISR) is a conserved network in eukaryotic cells that mediates adaptive responses to diverse stressors. The ISR pathway ensures cell survival and homeostasis by regulating protein synthesis in response to internal or external stresses. In recent years, the ISR has emerged as an important regulator of the central nervous system (CNS) development, homeostasis and pathology. Dysregulation of ISR signaling has been linked to several neurodegenerative diseases. Intriguingly, while acute ISR provide neuroprotection through the activation of cell survival mechanisms, prolonged ISR can promote neurodegeneration through protein misfolding, oxidative stress, and mitochondrial dysfunction. Understanding the molecular mechanisms and dynamics of the ISR in neurodegenerative diseases aids in the development of effective therapies. Here, we will provide a timely review on the cellular and molecular mechanisms of the ISR in neurodegenerative diseases. We will highlight the current knowledge on the dual role that ISR plays as a protective or disease worsening pathway and will discuss recent advances on the therapeutic approaches that have been developed to target ISR activity in neurodegenerative diseases.
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Open Access
Scaling up access to antiretroviral treatment for HIV: lessons from a key populations program in Nigeria
(BMC, 2025-02-01) Salihu, Abdulsamad; Jahun, Ibrahim; Oyedeji, David O.; Fajemisin, Wole; Idogho, Omokhudu; Shehu, Samira; Yakubu, Aminu; Anyanti, Jennifer
Abstract Over the years, Nigeria has recorded significant progress in controlling the HIV epidemic in the country. HIV prevalence has reduced from 4.1% in 2010 to 1.4 in 2019. The number of people acquiring new HIV infections decreased from 120,000 in 2010 to 74,000 in 2021, and HIV-related deaths decreased from 82,000 in 2010 to 51,000 in 2021. However, the country still faces challenges such as high HIV transmission among key populations (KP) who account for 11% of new HIV infections. Over the years, the government and development partners involved in HIV response efforts in Nigeria have been establishing and scaling up access to services to help address the needs of KPs. Initially, services for KPs as with the general population in Nigeria were largely preventive. Treatment of PLHIV in Nigeria commenced in 2002 and has increased from about 15,000 to more than 1.78 million PLHIVs in 2023. Despite this progress in treatment coverage, however, KPs are not equitably covered. To address this gap, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) launched an ambitious initiative—the Key Population Investment Fund (KPIF)—to target the unaddressed HIV-related needs of key populations (KPs) who are disproportionately affected by HIV. The KPIF initiative was implemented through partner organizations such as the Society for Family Health (SFH), a KP-friendly and indigenous non-governmental organization. Earlier, the program implemented by SFH was largely an HIV prevention program. SFH’s transformation, transition, and growth to a comprehensive HIV prevention, care, and treatment service provider was necessary to bridge the gap in the needed expansion of HIV services to adequately meet the care needs of KPs and scale up programs. Therefore, this paper’s aim is to share experiences in the transformation of SFH into a comprehensive HIV prevention, treatment, and care service provider in the hope that it may serve as a lesson for organizations with similar objectives.
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Open Access
Drug transporter mRNA expression and genital inflammation in South African women on oral pre-exposure prophylaxis (PrEP)
(BMC, 2025-02-15) Zondo, Nomusa M.; Sobia, Parveen; Sivro, Aida; Ngcapu, Sinaye; Mahomed, Sharana; Mansoor, Leila E.; Asare, Kwabena; Lewis, Lara; Ramsuran, Veron; Archary, Derseree
Abstract Globally HIV remains a major public health problem. In sub-Saharan Africa most new HIV infections occur in adolescent girls and young women. Previously tested antiretroviral drugs as different pre-exposure prophylaxis (PrEP) formulations have shown inconsistent levels of protection against HIV in African women. Besides adherence, biological factors such as drug transporter proteins are increasingly recognized as key modulators of PrEP levels. Drug transporter mRNA expression levels has been significantly correlated to altered PrEP levels in-vitro in different tissues, with inflammation identified as a further modifier of drug transporters mRNA expression and thus PrEP levels. We therefore, aimed to determine possible concordance between drug transporter mRNA expression in the female genital tract (FGT) and blood of N = 45 South African women taking oral PrEP-Truvada® [TDF/FTC)] over 6 months for HIV prevention. Additionally, we determined associations between drug transporter mRNA expression, genital inflammation, and blood-tenofovir diphosphate (TFV-DP). mRNA-expression of four efflux P-gp; MATE-1; MRP-2; MRP-4 and two influx OAT-1 and OAT-3 drug transporters were determined by qRT-PCR. Multiplexed technology was used to measure 27 cytokines to define genital inflammation. Significant positive correlations of mRNA expression for P-gp, MATE-1, MRP-2, and MRP-4 were observed between the FGT and blood at 3- and 6-months post-PrEP initiation (p < 0.05). For OAT-1 however, significant positive correlations were observed pre- and post-PrEP exposure (p < 0.05). Linear-mixed models showed moderate associations between FGT cytokines and drug transporter mRNA expression, with a  direct relationship observed between MIP-1β concentration and MATE-1 mRNA expression. Similarly, PLS-DA showed that in women with genital inflammation, consistently higher mRNA expression of MATE-1 was observed compared to women without genital inflammation. No significant associations were observed between drug transporter mRNA expression and blood TFV-DP. Our results suggest that drug transporters may be similarly expressed in the FGT and blood. Furthermore, genital inflammation may modify PrEP levels by altering drug transporter mRNA expression. Collectively, our data may be used to better understand biological factors that may affect PrEP efficacy in African women who remain vulnerable to HIV.