Hair cortisol and substance use among women currently experiencing intimate partner violence: The role of PTSD symptom severity

INTRODUCTION

Substance use is highly prevalent among women experiencing intimate partner violence (IPV) and has been associated with dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis and resulting cortisol response. Posttraumatic stress disorder (PTSD) symptoms may play an important role in exacerbating the association between cortisol levels and substance use behaviors.

PURPOSE

This study examined the role of PTSD symptoms in the relation between cortisol and past month substance use behaviors. The current study used hair cortisol as an index of past 30-day HPA-axis functioning and ecological momentary assessment (EMA) to characterize substance use behaviors more accurately over a 30-day period.

METHOD

Participants were 90 community women who had experienced physical or sexual IPV in the past 30 days by their current male partner and used any amount of alcohol or drugs (M age = 40.71; 54.4 % white). Participants completed (a) a baseline interview, (b) EMA for 30-days, and (c) a follow up interview where they were asked to provide a hair sample for cortisol analyses. Data collection took place from 2018 to 2020.

RESULTS

PTSD severity moderated the relations between cortisol and days of drinking and binge drinking. In the context of high PTSD symptomology, women with high cortisol levels spent, on average, an additional 7.4 days drinking and 8.1 days binge drinking in the past 30 days compared to women with low cortisol levels, in a model adjusted for age.

CONCLUSIONS

Results highlight the prominent role of PTSD symptoms in the association between cortisol and alcohol use among women experiencing IPV.

The Intensity of Formal Child-Care Attendance Decreases the Shared Environment Contribution to School Readiness: A Twin Study

The purpose of this study was to explore if child-care intensity (hours/weeks) and age of onset could moderate genetic and environmental contributions to school readiness. A sample of 648 (85% Whites; 50% Females) pairs of twins was used to compute a GxE, CxE and ExE interaction analyses. The moderation model showed that shared environment explains 48% of individual differences in school readiness for children not attending formal child-care, and decreased gradually to a mere 3% for children attending formal child-care full time, e.g., 40 h per week. Age of onset exerted no moderation effect. The results support the hypothesis that child-care acts as a normalizing environment, possibly buffering negative effects from low-quality home environments on school readiness.

Transcultural adaptation to Spain of the CDPQOL questionnaire specific for coeliac children

This study aimed to translate, cross-culturally adapt, and validate the CDPQOL questionnaire, a coeliac disease (CD)-specific paediatric health-related quality of life (HRQoL) instrument (CDPQOL), in Spanish children with CD. The CDPQOL questionnaire has two versions for children aged 8-12 and 13-18. Translation and linguistic validation were performed following an international consensus process. Internal consistency was calculated using Cronbach's alpha and McDonald's omega coefficients, and convergent validity was assessed with average variance extracted (AVE). Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA), when necessary, were carried out to assess the construct validity. A total of 235 children were included. In the 8-12 age group, a change in the distribution of items to a new structure of three dimensions (negative emotions, food feelings and social interaction) was required. In this new model, CFA supported the fit of the model (χ2/gl = 1.79, RMSEA = 0.077 (IC 95% 0.05-0.100), CFI = 0.969, TLI 0.960, SRMR = 0.081) and Cronbach's alpha and McDonald's omega coefficients were > 0.7 in all three dimensions. In the 13-18 age group, CFA showed that all fit indexes were acceptable (χ2/gl = 1.702, RMSEA = 0.102 (IC 95% 0.077-0.127), p < 0.001, CFI = 0.956, TLI = 0.947, SRMR = 0.103) and Cronbach's alpha and McDonald's omega coefficients were > 0.7 in all three dimensions, except for uncertainty dimension.    Conclusions: The Spanish version of the CDPQOL questionnaire is a useful instrument to assess quality of life in coeliac children whose native language was Spanish spoken in Spain, with changes in item distribution in the younger age group questionnaire. What is Known: • The first specific questionnaire for coeliac children, Dutch Coeliac Disease Questionnaire (CDDUX), which focuses on diet, was translated into Spanish and validated allowing to evaluate the HRQoL of Spanish coeliac children. • Spanish Children and parents feel the disease had no substantial negative impacts on patient HRQoL using this questionnaire, similar to that observed with other countries. What is New: • The age specific for CD children (CDPQOL) was elaborated in the USA and focuses on other aspects not evaluated by CDDUX such as emotional and social issues related to living with CD. • The CDPQOL was translated into Spanish and validated allowing it to be used to assess Spanish coeliac children's QoL.

Measuring Pain-related Behavioral Inhibition and Behavioral Activation System Responses: Further Validity Evidence for the Pain Responses Scale

OBJECTIVES

The Pain Responses Scale and its Short Form (PRS-SF) were recently developed to assess the affective, behavioral, and cognitive responses to pain based on the behavioral inhibition system (BIS) and behavioral activation system (BAS) model of chronic pain. The purpose of this study was to provide additional tests of the psychometric properties of the PRS-SF in a new sample of individuals with chronic pain.

METHODS

A sample of Spanish adults (N = 190) with chronic non-cancer pain completed a translated version of the PRS-SF and a battery of questionnaires measuring validity criteria hypothesized the be associated with BIS and BAS activation, including measures of sensitivity to punishment, sensitivity to reward, pain intensity, pain interference, catastrophizing, and pain acceptance.

RESULTS

Confirmatory factor analysis supported a 4-factor structure for the PRS-SF assessing despondent, escape, approach, and relaxation responses (S-B χ 2 [5] = 1.49, Comparative Fit Index = 0.99, Non-Normed Fit Index = 0.99, root-mean-square error of approximation = 0.051, Akaike Information Criterion = 4113.66), with marginal internal consistency for 1 scale (relaxation) and adequate to good internal consistency for the others. The pattern of associations found between the PRS-SF Scale scores and the validity criterion supports the validity of the instrument.

CONCLUSION

The results provide additional support for the validity of the 4 PRS-SF Scale scores, and the reliability of 3 of the scales. If these findings are replicated in future research, investigators may wish to administer more items from the original Relaxation Scale when assessing this domain to ensure adequate reliability for this scale. The other items from the PRS-SF assessing despondent, escape, and approach responses appear to provide at least adequate reliability. When used in this way, the PRS-SF may be used to measure BIS and BAS responses to pain to: (1) provide further tests of the BIS-BAS model of chronic pain and/or (2) understand the potential mediating effects of BIS and BAS responses on the effects of psychological pain treatments to help determine which specific responses are most responsible for the benefits of treatment, and, therefore, which responses should be specifically targeted to enhance treatment response.

A longitudinal test of problematic alcohol use and binge eating among college women: The moderating role of shame

Problematic alcohol use and binge eating frequently co-occur. High levels of negative affect, negative urgency, and/or shame may increase the likelihood that problematic alcohol use and binge eating co-occur over time.

OBJECTIVE

Examine 1) the temporal relationship between problematic alcohol use and binge eating among college women, who are at high risk for both, and 2) the additive and moderating effects of shared, emotion-based risk factors in models involving both problematic alcohol use and binge eating.

METHOD

In n = 302 college women assessed at two time points across 8 months, we used hierarchical linear regression to invstigate our objectives.

RESULTS

Baseline problematic alcohol use and baseline shame independently predicted increases in follow-up binge eating, controlling for baseline binge eating. In addition, the interaction between problematic alcohol use and shame accounted for further variance in subsequent binge eating (the influence of baseline problematic alcohol use on follow-up binge eating was stronger at higher levels of baseline shame). The reciprocal relationship was not significant: baseline binge eating did not predict follow-up problematic alcohol use independently or in conjunction with risk factors. Neither negative affect nor negative urgency showed predictive effects beyond prior behavior and shame. Results support 1) problematic alcohol use as a prospective risk factor for binge eating, 2) shame as an additive predictor of binge eating, and 3) shame as a positive moderator of binge eating prediction from problem drinking.

CONCLUSION

Addressing shame and problematic alcohol use may be warranted in binge eating interventions for college women.

"Lombard Effect" and Voice Changes in Adductor Laryngeal Dystonia: A Pilot Study

OBJECTIVES

The aim was to describe the acoustic, auditory-perceptive, and subjective voice changes under the Lombard effect (LE) in adductor laryngeal dystonia (AdLD) patients.

METHODS

Subjective perception of vocal effort (OMNI Vocal Effort Scale OMNI-VES), Maximum Phonation Time (MPT), and the perceptual severity of dysphonia (GRBAS scale) were assessed in condition of stillness and under LE in 10 AdLD patients and in 10 patients with typical voice. Speakers were asked to produce the sustained vowel /a/ and to read a phonetically balanced text aloud. Using the PRAAT software, the following acoustic parameters were analyzed: Mean Pitch (Hz), Minimum and Maximum Intensity (dB), the Fraction of Locally Unvoiced Frames, the Number of Voice Breaks, the Degree of Voice Breaks (%), the Cepstral Peak Prominence-Smoothed (CPPS) (dB).

RESULTS

Under LE, the AdLD group showed a decrease of both G and S parameters of GRBAS and subjective effort, mean MPT increased significantly; in the controls there were no significant changes. In both groups under LE, pitch and intensity of the sustained vowel /a/ significantly increased consistently with LE. In the AdLD group the mean gain of OMNI-VES score and the mean gain of each parameter of the speech analysis were significantly greater than the controls' ones.

CONCLUSION

Auditory feedback deprivation obtained under LE improves subjective, perceptual-auditory, and acoustics parameters of AdLD patients. These findings encourage further research to provide new knowledge into the role of the auditory system in the pathogenesis of AdLD and to develop new therapeutic strategies.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:3754-3760, 2024.

The interplay of oxytocin and sex hormones

The neuropeptide oxytocin has historically been associated with reproduction and maternal behavior. However, more recent research has uncovered that oxytocin has a much wider range of roles in physiology and behavior. Despite the excitement surrounding potential therapeutical applications of intranasally administered oxytocin, the results of these intervention studies have been inconsistent. Various reasons for these mixed results have been proposed, which tend to focus on methodological issues, such as study design. While methodological issues are certainly important, emerging evidence suggests that the interaction between oxytocin and sex hormones may also account for these varied findings. To better understand the purpose and function of the interaction of oxytocin with sex hormones, with a focus on estrogens, progesterone, and testosterone, we conducted a comprehensive thematic review via four perspectives: evolutionary, developmental, mechanistic, and survival. Altogether, this synergistic approach highlights the critical function of sex hormone activity for accomplishing the diverse roles of oxytocin via the modulation of oxytocin release and oxytocin receptor activity, which is also likely to contribute to the heterogeneity of outcomes after oxytocin administration.

Social support moderates the relationship between emotion regulation and health-related quality of life in cancer patients

The relationship between emotion regulation (cognitive reappraisal and expressive suppression) and HRQoL in cancer patients is currently gaining momentum, yet, no research to date has investigated the nature of this relationship. The purpose of this study was to investigate the moderating role of social support in the relationship between ER and HRQoL in Nigerian cancer patients. Participants included 361 cancer patients (female = 56.79%, mean age = 41.61, SD 15.47) conveniently drawn from the oncology unit of the University Teaching Hospital, Nigeria. They completed the measures of Functional Assessment of Cancer Therapy-General (FACT-G), emotion regulation and Perceived Social Support. The moderated regression analysis via PROCESS procedures for SPSS Version 3 was used for data analysis. The results showed that cognitive reappraisal significantly predicted HRQoL (β = 2.12, t = 4.39, p = .000). Social support also significantly predicted HRQoL (β = .73, t = 4.57, p = .000). Most importantly, social support moderated the relationship between cognitive reappraisal and HRQoL (β = -.034, t= -4.23, p = .000), but not between expressive suppression and HRQoL (β = -.015, t= -1.61, p = .10). The moderation slope revealed that cognitive reappraisal significantly predicted HRQoL particularly at lower and moderate levels of social support. These findings reveal that the effect of emotion regulation on HRQoL depends much on an individual's level of perceived social support. It also means that social support boosted the positive impact of emotion regulation on HRQoL. The findings highlighted the importance of social-support and emotion regulation particularly, cognitive-reappraisal in improving health-related quality of life in cancer patients.

A systematic review with meta-analyses of the association between stigma and chronic pain outcomes

ABSTRACT

Stigma is common in people experiencing chronic pain and there are indications that it may adversely affect pain outcomes. However, to date, there is no systematic review exploring the impact of stigma on chronic pain-related outcomes. This systematic review and meta-analysis aimed to examine the association between stigma and key chronic pain outcomes and differences in stigma between pain conditions. Seven databases were searched for studies reporting a measure of association between stigma and at least one pain outcome in adults with chronic pain. Studies were screened by 2 independent researchers. Nineteen studies met eligibility criteria and data were extracted, quality-assessed, and narratively synthesised and meta-analysed where possible. Meta-analyses of bivariate cross-sectional correlations demonstrated significant positive correlations between stigma and pain intensity, disability, and depression, with small to moderate effects. Data from 2 prospective studies and those only reporting multivariate analyses that were not included in meta-analyses further supported these findings. There was some evidence that individuals who experience pain conditions with less clear pathophysiology may report greater stigma, although more research is needed. The review highlights that there is a growing number of studies on stigma in the pain field showing an adverse association between stigma and chronic pain outcomes.

Estimating the direct effects of the genetic liabilities to bipolar disorder, schizophrenia, and behavioral traits on suicide attempt using a multivariable Mendelian randomization approach

Bipolar disorder (BD) and schizophrenia (SZ) are associated with higher odds of suicide attempt (SA). In this study, we aimed to explore the effect of BD and SZ genetic liabilities on SA, also considering the contribution of behavioral traits, socioeconomic factors, and substance use disorders. Leveraging large-scale genome-wide association data from the Psychiatric Genomics Consortium (PGC) and the UK Biobank (UKB), we conducted a two-sample Mendelian randomization (MR) analysis to evaluate the putative causal effect of BD (41,917 cases, 371,549 controls) and SZ (53,386 cases, 77,258 controls) on SA (26,590 cases, 492,022 controls). Then, we assessed the putative causal effect of BD and SZ on behavioral traits, socioeconomic factors, and substance use disorders. Considering the associations identified, we evaluated the direct causal effect of behavioral traits, socioeconomic factors, and substance use disorders on SA using a multivariable MR approach. The genetic liabilities to BD and SZ were associated with higher odds of SA (BD odds ratio (OR) = 1.24, p = 3.88 × 10-12; SZ OR = 1.09, p = 2.44 × 10-20). However, while the effect of mental distress (OR = 1.17, p = 1.02 × 10-4) and risk-taking (OR = 1.52, p = 0.028) on SA was independent of SZ genetic liability, the BD-SA relationship appeared to account for the effect of these risk factors. Similarly, the association with loneliness on SA was null after accounting for the effect of SZ genetic liability. These findings highlight the complex interplay between genetic risk of psychiatric disorders and behavioral traits in the context of SA, suggesting the need for a comprehensive mental health assessment for high-risk individuals.

Sea anemones (Actinia equina) show consistent individual differences in boldness and thoroughness but lack a behavioural syndrome

Behavioural syndromes are suites of behaviours that corelate between-individuals but the same behaviours may also show within-individual correlations owing to state dependency or trade-offs. Therefore, overall phenotypic behavioural correlations must be separated into their between- and within-individual components. We investigate how startle response duration (an index of boldness) and time taken to reject an inert item (an index of investigation thoroughness) covary in beadlet sea anemones, Actinia equina. Anemones took longer to reject a more complex item compared to a simpler one, validating this measure of investigation thoroughness. We then quantified between- and within-individual correlations using a Bayesian analysis and an alternative frequentist analysis, which returned the same results. Startle responses decreased with anemone size while thoroughness decreased across repeated observations, indicative of simple learning. For each behaviour, repeatability was significant but relatively low and there was no behavioural syndrome. Rather, the two behaviours showed a negative within-individual correlation in most individuals. Thus, boldness and thoroughness are unlikely to be under correlative selection, and they may instead be expressed independently, in line with the general pattern that cross-contextual behavioural syndromes are comparatively rare. It now appears that this pattern may extend broadly across animal diversity.

Impact of the COVID-19 Pandemic on Youth Substance Use and Substance-Related Risk Factors and Outcomes: Implications for Prevention, Treatment, and Policy

Youth substance use and substance use disorders (SUD) are major public health issues associated with significant societal cost. The coronavirus SARS-CoV-2 (COVID-19) pandemic and pandemic-related lockdowns, school closures, and social distancing dramatically impacted the daily lives of young people worldwide, resulting in major disruptions to normal developmental trajectories and complex (and at times opposing effects) on different SUD risk and protective factors, which contributed to inconsistent outcomes. During the COVID-19 pandemic, substance use prevalence rates decreased in the general population of US youth, but increased for certain vulnerable subgroups. Additionally, overdose deaths related to fentanyl rose significantly among US youth.

Habituation of Brain Activity with Repetition in Color and Picture-Word Stroop Tests

As a widely used mental task for functional near-infrared spectroscopy (fNIRS), the original color-word Stroop task has the advantage of being difficult to habituate, but also the disadvantage of being difficult to understand, especially for children. While the introduction of derived Stroop tasks offers highly promising countermeasures, changes in brain activity during these tests have not been well tested. We investigated the degree of habituation between the original and a derived Stroop task by measuring brain activity to obtain a better fNIRS task design. Fourteen healthy adults participated in the study, and a 10-channel fNIRS device was used. A picture-word Stroop task with lower linguistic conflict than the original was conducted. The original and derived Stroop tests were repeated four times in a 1-week interval. We found that the original Stroop test did not show any significant changes in brain activity with repeated measures; however, brain activity decreased during the derived test. The differences in habituation between the original and derived tests may be due to the differences in the strength of the linguistic conflict. Our findings also highlight the need to consider the effects of habituation when using derived Stroop tasks in repeated measures.

The Effects of Load, Crank Position, and Sex on the Biomechanics and Performance during an Upper Body Wingate Anaerobic Test

INTRODUCTION

The upper body Wingate Anaerobic Test (WAnT) is a 30-s maximal effort sprint against a set load (percentage of body mass). However, there is no consensus on the optimal load and no differential values for males and females, even when there are well-studied anatomical and physiological differences in muscle mass for the upper body. Our goal was to describe the effects of load, sex, and crank position on the kinetics, kinematics, and performance of the upper body WAnT.

METHODS

Eighteen participants (9 females) performed three WAnTs at 3%, 4%, and 5% of body mass. Arm crank forces, 2D kinematics, and performance variables were recorded during each WAnT.

RESULTS

Our results showed an increase of ~49% effective force, ~36% peak power, ~5° neck flexion, and ~30° shoulder flexion from 3% to 5% load ( P < 0.05). Mean power and anaerobic capacity decreased by 15%, with no changes in fatigue index ( P < 0.05). The positions of higher force efficiency were at 12 and 6 o'clock. The least force efficiency occurred at 3 o'clock ( P < 0.05). Sex differences showed that males produced 97% more effective force and 109% greater mean power than females, with 11.7% more force efficiency ( P < 0.001). Males had 16° more head/neck flexion than females, and females had greater elbow joint variability with 17° more wrist extension at higher loads. Males cycled ~32% faster at 3% versus 5% WAnT load with a 65% higher angular velocity than females. Grip strength, maximal voluntary isometric contraction, mass, and height positively correlated with peak and mean power ( P < 0.001).

CONCLUSIONS

In conclusion, load, sex, and crank position have a significant impact on performance of the WAnT. These factors should be considered when developing and implementing an upper body WAnT.

Interpersonal relationships, PNI, and health: Seeds in the 1980s, fruiting trees today

In this contribution to the Special Issue, I highlight how Janice Kiecolt-Glaser's research in the 1980s planted the seeds for two areas of social relationships and health research: loneliness and intimate/marital relationships. I review the foundational "seed" studies from the mid-to late-1980s, the research "saplings" that sprouted and grew during the subsequent twenty years, and the "mature trees" that have gone on to fruit and grow their respective areas of inquiry over the past twenty years. In addition to highlighting the mature trees that have borne rich empirical fruit, my other goal for this contribution is to draw attention to ideas and concepts from Kiecolt-Glaser's work and writing that merit further conceptual and empirical examination in the next generation of research on social relationships, psychoneuroendocrinology, psychoneuroimmunology, and health.

Mediators of working memory and reading in a sample of children with reading difficulty: The roles of phonemic awareness and rapid automatized naming

Working memory (WM) has been consistently linked to reading. However, the mechanism(s) linking WM to reading remain unclear. WM may indirectly exert an effect onto reading through mediators such as phonemic awareness (PA) and/or rapid automatized naming (RAN). In a sample of children with reading difficulty (n = 117), separate mediation analyses tested direct and indirect (through PA and RAN) effects of WM on untimed word decoding and recognition (i.e., basic reading skills) and timed word decoding and recognition (i.e., reading fluency). WM exerted a direct effect on basic reading skills and reading fluency. For basic reading skills, there was a significant indirect effect of WM on reading through the mediation of PA (but not through RAN). By contrast, for reading fluency, there was a significant indirect effect of WM on reading through the mediation of RAN (but not through PA). Findings reinforce the importance of WM, PA, and RAN for broad reading skills, while offering a mechanistic explanation for why poor PA and/or RAN may differentially lead to reading difficulty.

Redundancy effect of initial enactment encoding and subsequent testing on memory enhancement: Insights from an electrophysiological study

Testing is more beneficial for memory retention than restudying the same content. However, the effect of the initial encoding method on the testing effect remains unclear. In this study, a classical testing effect paradigm was employed, along with event-related potentials (ERP), to investigate the electrophysiological processes underlying the effect of enactment encoding on the testing effect. Participants were randomly assigned to the Self-Performed Test (SPT) or Verbalized Test (VT) groups. Both groups underwent three stages: an initial encoding phase, an initial test phase (comprising a source memory task and a restudy task), and a final test phase. During the initial encoding phase, the SPT group encoded action phrases through enactment, while the VT group encoded information through reading. During the initial test phase, the SPT group exhibited superior recognition performance in item memory compared with the VT group. Both groups exhibited significant parietal old/new effects in the source memory task, with only the SPT group displaying parietal positivity during the restudy task. During the final test phase, the behavioral testing effect was exclusively observed in the VT group. Furthermore, the VT group displayed a more pronounced parietal positivity in the test condition compared to the restudy condition, while the parietal positivity between the two conditions was comparable in the SPT group. In summary, the absence of a final behavioral testing effect in the SPT group may be attributed to both enactment and testing primarily enhancing memory performance through recollection-based retrieval, as indicated by the parietal positivity. Consequently, the initial enactment encoding method leaves limited scope for further improvements through subsequent testing. These findings suggest that initial enactment encoding, and subsequent testing may be redundant in improving episodic memory performance.

An information-theoretic analysis of targeted regressions during reading

Regressions, or backward saccades, are common during reading, accounting for between 5% and 20% of all saccades. And yet, relatively little is known about what causes them. We provide an information-theoretic operationalization for two previous qualitative hypotheses about regressions, which we dub reactivation and reanalysis. We argue that these hypotheses make different predictions about the pointwise mutual information or pmi between a regression's source and target. Intuitively, the pmi between two words measures how much more (or less) likely one word is to be present given the other. On one hand, the reactivation hypothesis predicts that regressions occur between words that are associated, implying high positive values of pmi. On the other hand, the reanalysis hypothesis predicts that regressions should occur between words that are not associated with each other, implying negative, low values of pmi. As a second theoretical contribution, we expand on previous theories by considering not only pmi but also expected values of pmi, E[pmi], where the expectation is taken over all possible realizations of the regression's target. The rationale for this is that language processing involves making inferences under uncertainty, and readers may be uncertain about what they have read, especially if a previous word was skipped. To test both theories, we use contemporary language models to estimate pmi-based statistics over word pairs in three corpora of eye tracking data in English, as well as in six languages across three language families (Indo-European, Uralic, and Turkic). Our results are consistent across languages and models tested: Positive values of pmi and E[pmi] consistently help to predict the patterns of regressions during reading, whereas negative values of pmi and E[pmi] do not. Our information-theoretic interpretation increases the predictive scope of both theories and our studies present the first systematic crosslinguistic analysis of regressions in the literature. Our results support the reactivation hypothesis and, more broadly, they expand the number of language processing behaviors that can be linked to information-theoretic principles.

Event representation at the scale of ordinary experience

Weeks are divided into weekdays and weekends; years into semesters and seasons; lives into stages like childhood, adulthood, and adolescence. How does the structure of experience shape memory? Though much work has examined event representation in human cognition, little work has explored event representation at the scale of ordinary experience. Here, we use shared experiences - in the form of popular television shows - to explore how memories are shaped by event structure at a large scale. We find that memories for events in these shows exhibit several hallmarks of event cognition. Namely, we find that memories are organized with respect to their event structure (boundaries), and that beginnings and endings are better remembered at multiple levels of the event hierarchy simultaneously. These patterns seem to be partially, but not fully, explained by the perceived story-relevance of events. Lastly, using a longitudinal design, we also show how event representations evolve over periods of several months. These results offer an understanding of event cognition at the scale of ordinary human lives.

Perceptual subitizing performance in 3- and 4-year-olds: The impact of visual features of sets

Perceptual subitizing is a pivotal skill in children's mathematical development. It is defined as the rapid identification of small numerosities. Previous studies pointed to the contribution of visual features of sets to perceptual subitizing performance in adults. Insights into the contribution of visual features to subitizing performance in the critical 3- to 4-year age range are scant. This study aimed to address this gap by investigating the impact of visual features on perceptual subitizing performance (accuracy and response time) in 3- and 4-year-olds. Participants (119 3- and 4-year-olds) were offered a subitizing task that incorporated pictures of sets of three to five objects. The pictures systematically varied across four visual features: (a) pictorial context (distractors present vs. absent), (b) set homogeneity (homogeneous vs. heterogeneous objects), (c) set arrangement (linearly vs. randomly arranged objects), and (d) set differentiation (distinct vs. overlapping objects). Pictures with distractors, heterogeneous objects, randomly arranged objects, or overlapping objects were associated with lower subitizing accuracy and longer response times compared with pictures without distractors, homogeneous objects, linearly arranged objects, or distinct objects, respectively. Pictures with randomly arranged or overlapping objects along with distractors were associated with even lower subitizing accuracy. Pictures featuring a simple visual design-without distractors and with homogeneous, linearly arranged, and distinct sets-yielded the best subitizing performance in terms of accuracy and response time. Our findings might be explained by the cognitive processes underlying 3- and 4-year-olds' subitizing performance. The findings offer building blocks for future research in the domain and preschool educational practice.

Towards implementation of cognitive bias modification in mental health care: State of the science, best practices, and ways forward

Cognitive bias modification (CBM) has evolved from an experimental method testing cognitive mechanisms of psychopathology to a promising tool for accessible digital mental health care. While we are still discovering the conditions under which clinically relevant effects occur, the dire need for accessible, effective, and low-cost mental health tools underscores the need for implementation where such tools are available. Providing our expert opinion as Association for Cognitive Bias Modification members, we first discuss the readiness of different CBM approaches for clinical implementation, then discuss key considerations with regard to implementation. Evidence is robust for approach bias modification as an adjunctive intervention for alcohol use disorders and interpretation bias modification as a stand-alone intervention for anxiety disorders. Theoretical predictions regarding the mechanisms by which bias and symptom change occur await further testing. We propose that CBM interventions with demonstrated efficacy should be provided to the targeted populations. To facilitate this, we set a research agenda based on implementation frameworks, which includes feasibility and acceptability testing, co-creation with end-users, and collaboration with industry partners.

Social Class, Sex, and the Ability to Recognize Emotions: The Main Effect is in the Interaction

Previous research has demonstrated an inverse relation between subjective social class (SSC) and performance on emotion recognition tasks. Study 1 (N = 418) involved a preregistered replication of this effect using the Reading the Mind in the Eyes Task and the Cambridge Mindreading Face-Voice Battery. The inverse relation replicated; however, exploratory analyses revealed a significant interaction between sex and SSC in predicting emotion recognition, indicating that the effect was driven by males. In Study 2 (N = 745), we preregistered and tested the interaction on a separate archival dataset. The interaction replicated; the association between SSC and emotion recognition again occurred only in males. Exploratory analyses (Study 3; N = 381) examined the generalizability of the interaction to incidental face memory. Our results underscore the need to reevaluate previous research establishing the main effects of social class and sex on emotion recognition abilities, as these effects apparently moderate each other.

Putting Oneself Ahead of the Group: The Liability of Narcissistic Leadership

Integrating insights from interdependence theory with the narcissistic admiration and rivalry concept, we propose that a pivotal obstacle for narcissistic leaders is their inability to sustain benevolent perceptions over time. As people strive to interpret social behavior in terms of self- or other-interest, the narcissistic tendency of prioritizing self-interests over the collective may become apparent and eventually taint their reputation as a leader. We examined how interpersonal motive perceptions-based on attributions of self- and other-interest-would clarify the leadership paradox of narcissism. We tracked 472 participants in 119 teams across four time-points. Narcissistic rivalry (but not admiration) corresponded to increasingly negative leader effectiveness ratings. The extent to which individuals were perceived as self-maximizing and lacking concern for other interests was tightly connected to declines in leader effectiveness across time. Altogether, these results offer insight into how perceived interpersonal motives may explain the downfall of narcissistic leadership.

Do classroom relationships moderate the association between peer defending in school bullying and social-emotional adjustment?

Peer defending has been shown to protect bullied peers from further victimization and social-emotional problems. However, research examining defending behavior has demonstrated positive and negative social-emotional adjustment effects for defending students themselves. To explain these mixed findings, researchers have suggested that associations between defending behavior and social-emotional adjustment may be buffered by protective factors (i.e., defender protection hypothesis) or exacerbated by vulnerability or risk factors (i.e., defender vulnerability hypothesis). Consistent with these hypotheses, the present study aimed to investigate whether relationships with teachers and peers would moderate the association between defending behavior and social-emotional adjustment. This three-wave longitudinal study examined the association between peer nominated defending behavior and later self-reported depressive symptoms and self-esteem in 848 Belgian students in Grades 4-6 (53% girls; Mage = 10.61 years, SD = 0.90 at Wave 1). Peer nominated positive and negative teacher-student relationships (i.e., closeness and conflict) and peer relationships (i.e., acceptance and rejection) were included as moderators. Clustered multiple linear regression analyses demonstrated that defending behavior did not predict later depressive symptoms (β = -0.04, p = .80) or self-esteem (β = -0.19, p = .42). The lack of these associations could be explained by the defender protection and vulnerability hypotheses. However, contrary to our expectations, teacher-student closeness and peer acceptance did not play a protective role in the association between defending behavior and social-emotional adjustment (β = -1.48-1.46, p = .24-0.96). In addition, teacher-student conflict and peer rejection did not put defending students at risk for social-emotional maladjustment (β = -1.96-1.57, p = .54-0.97). Thus, relationships with teachers and peers did not moderate the association between defending behavior and later depressive symptoms and self-esteem.

Inflammatory Knee Synovitis: Evaluation of an Accelerated FLAIR Sequence Compared With Standard Contrast-Enhanced Imaging

OBJECTIVES

The aim of this study was to assess the diagnostic value and accuracy of a deep learning (DL)-accelerated fluid attenuated inversion recovery (FLAIR) sequence with fat saturation (FS) in patients with inflammatory synovitis of the knee.

MATERIALS AND METHODS

Patients with suspected knee synovitis were retrospectively included between January and September 2023. All patients underwent a 3 T knee magnetic resonance imaging including a DL-accelerated noncontrast FLAIR FS sequence (acquisition time: 1 minute 38 seconds) and a contrast-enhanced (CE) T1-weighted FS sequence (acquisition time: 4 minutes 50 seconds), which served as reference standard. All knees were scored by 2 radiologists using the semiquantitative modified knee synovitis score, effusion synovitis score, and Hoffa inflammation score. Diagnostic confidence, image quality, and image artifacts were rated on separate Likert scales. Wilcoxon signed rank test was used to compare the semiquantitative scores. Interreader and intrareader reproducibility were calculated using Cohen κ.

RESULTS

Fifty-five patients (mean age, 52 ± 17 years; 28 females) were included in the study. Twenty-seven patients (49%) had mild to moderate synovitis (synovitis score 6-13), and 17 patients (31%) had severe synovitis (synovitis score >14). No signs of synovitis were detected in 11 patients (20%) (synovitis score <5). Semiquantitative assessment of the whole knee synovitis score showed no significant difference between the DL-accelerated FLAIR sequence and the CE T1-weighted sequence (mean FLAIR score: 10.69 ± 8.83, T1 turbo spin-echo FS: 10.74 ± 10.32; P = 0.521). Both interreader and intrareader reproducibility were excellent (range Cohen κ [0.82-0.96]).

CONCLUSIONS

Assessment of inflammatory knee synovitis using a DL-accelerated noncontrast FLAIR FS sequence was feasible and equivalent to CE T1-weighted FS imaging.

Links Between Best-Friendship Quality and Well-Being From Early Emerging Adulthood to Early Established Adulthood

The aim of this study was to verify whether the links between features of best-friendship quality (intimacy, reliable alliance, conflict) and well-being indicators (self-esteem, loneliness) change from early emerging adulthood to early established adulthood. The moderating effect of gender and investment in romantic life on these links was examined as well. For the purpose, 346 individuals (58% women) completed questionnaires at age 20 and again at age 30. Multilevel analysis were performed for each well-being indicators separately. The results showed reliable alliance to be associated with both well-being indicators, and intimacy to be associated with loneliness. Age moderated the effect of intimacy on self-esteem, whereas investment in romantic life moderated the effect of reliable alliance. Finally, triple interactions emerged between conflict, gender and age in their associations with self-esteem and loneliness, underscoring particularities for men. These results underscore the most influential features of friendship quality for well-being.

Attention Deficit/Hyperactivity Disorder in Individuals with Non-Syndromic Craniosynostosis: A Systematic Review and Meta-Analysis

It is not yet understood whether, and to what extent, craniosynostosis impacts the development of Attention Deficit/Hyperactivity Disorder (ADHD). This PRISMA compliant and PROSPERO pre-registered (ID: CRD42023458640) systematic review and meta-analysis examines the association of single-suture, non-syndromic craniosynostosis with ADHD and inattention/hyperactivity symptoms. Data from 17 independent studies (Nparticipants = 2,389; Mage = 7.3 years) were analyzed, taking into consideration suture location, surgical status, age, and measures administered, where feasible. Few differences were found between cases and controls, but some studies reported high symptom levels. Additional research is required utilizing larger sample sizes and more comprehensive assessment of ADHD.

Power motives, personality correlates, and leadership outcomes: A person-centered approach

OBJECTIVE

We investigated how these motivations combined within individuals to form unique profiles, and how these different profiles relate to personality traits and team behaviors.

BACKGROUND

Dominance, prestige, and leadership motives each play a key role in shaping social success or failure in gaining social rank and influence.

METHOD

We used latent profile analysis across two samples (engineering student project teams, Nstudent = 1088; working adults, Nworker = 466) to identify profile configurations and how such profiles related to important outcomes.

RESULTS

We identified qualitatively distinct profiles: ultra-dominance profile (prominent dominance motive with high prestige and leadership motives); prestigious leadership profile (moderately high prestige and leadership motives, low dominance motive); and weak social power motive profile (low on all three motives). Individuals with the prestigious leadership profile were more likely to emerge as leaders, compared to those with a weak social power motive profile. People with an ultra-dominance profile scored higher on narcissism and tended to perceive themselves as leaders, despite not being deemed more leader-like by teammates.

CONCLUSION

Using a person-centered approach allowed us to identify three power motive profiles across independent samples and generate insights into how these profiles manifest different social behaviors and outcomes.

Stigma, coping strategies, distress and wellbeing in individuals with cervical dystonia: a cross-sectional study

Cervical dystonia (CD) is a movement disorder which causes sustained muscle contractions in the neck leading to abnormal postures and repetitive movements. As it is a highly visible condition, people with CD can experience stigma, which may lead to unhelpful coping strategies and increased psychological distress. This study investigated whether adaptive and maladaptive coping strategies mediate the relationship between stigma and psychological outcomes in people with CD. A total of 114 adults with CD completed measures of stigma, coping, health-related quality of life (HRQOL), psychological distress (depression, anxiety, stress), and psychological wellbeing at one time point. Participants' levels of distress were high, compared to the general population. Correlational analyses showed increased stigma and maladaptive coping (e.g. substance use, behavioural disengagement) were both significantly related to increased distress, lower wellbeing and lower HRQOL, whereas higher adaptive coping (e.g. acceptance, humour) was only related to higher wellbeing. In a parallel mediation model, maladaptive coping strategies mediated the relationship between stigma and distress, HRQOL and wellbeing, but adaptive coping strategies did not. These findings suggest that maladaptive coping may play an important role in explaining the relationship between stigma and some aspects of distress and wellbeing in CD. Interventions which focus on reducing different aspects of maladaptive coping may be helpful to improve wellbeing as well as reducing stigma.

Longitudinal changes in depression and anxiety during the COVID-19 pandemic and the impact of COVID-related factors

OBJECTIVE

This study is an investigation of five specific COVID-related stressors and their longitudinal impact on adult depression and anxiety.

METHOD

A total of 592 adults comprised the initial sample at Time 1 in April/May 2020. Follow-ups were conducted about a month later, again in March 2021 and then in March 2022.

RESULTS

Applied linear mixed effect models showed a significant decrease in mean depression scores and anxiety scores from Time 1 to both Times 3 and 4. Neither change over time in anxiety or depression were found to be related to COVID diagnosis, COVID hospitalization, or COVID death. Self-quarantine was related to changes over time in both depression and anxiety, and household quarantine was related to changes over time in depression.

CONCLUSION

While the fallout of the pandemic continues, it is important to understand how these factors may be affecting mental health to better understand where intervention is necessary.

Everything changes but nothing changes: gender stereotypes in the Italian population

PURPOSE

Gender stereotypes refer to consensual or cultural shared beliefs about the attributes of men and women, influencing society behaviors, interpersonal relationships, education, and workplace. The literature has shown the existence of gender stereotypes on career choices, internalization of roles, and school and social experiences and demonstrates the impact of demographic factors on stereotypes. However, all the studies conducted in Italy available in scientific literature analyzed small sample sizes within specific schools of university settings, with a limited age range.

METHODS

To assess the current state of gender stereotypes in Italy, we conducted an online survey from October 2022 to January 2023 on the general population residing in Italy. The questionnaire comprised sociodemographic factors and questions about gender stereotypes, investigating six fields: games, jobs, personality traits, home and family activities, sports, and moral judgments.

RESULTS

The study involved 1854 participants, mostly women (70.1%) with an undergraduate or postgraduate degree (57.5%). The statistical and descriptive analyses revealed that gender stereotypes influenced respondents' beliefs, with statistically significant effects observed in most questions when stratifying by age, gender, and degree. Principal component analysis was performed to assess latent variables in different fields, revealing significant main stereotypes in each category. No statistically significant differences between men and women were found for the fields home and family activities, games, and moral judgments, confirming that stereotypes affect both men and women in the same way.

CONCLUSIONS

Our results show the persistence of gender stereotypes in any fields investigated, although our cohort is predominantly composed of high educational level women living in the North of Italy. This demonstrates that the long-standing gender stereotypes are prevalent, pernicious, and, unfortunately, internalized at times even by successful women pushbacking and sabotaging them unconsciously.

Validation of Yeo's index in assessing severity of rheumatic mitral stenosis in mixed valve lesions

Introduction

Yeo's Index, product of the mitral leaflet separation index and dimensionless index, is a novel measure of the severity of rheumatic mitral stenosis (MS). We assess Yeo's index in patients with rheumatic MS with or without mixed valve disease.

Methods

In a retrospective cohort study, Yeo's index was measured in 237 cases of rheumatic MS - 124 in a transthoracic echocardiography validation cohort using mitral valve area (MVA) by pressure half-time and planimetry as comparator and 113 in a transesophageal echocardiography (TEE) validation cohort using TEE three-dimensional MVA as comparator. Patients were considered to have mixed valve disease if they had MS and concomitant mitral regurgitation or aortic valve disease.

Results

There were 113 patients with isolated MS and 124 patients with mixed valve disease. Overall, Yeo's index ≤ 0.26 cm showed 93.0 % sensitivity and 87.5 % specificity for identifying severe MS (MVA ≤ 1.5 cm2). In isolated MS, Yeo's index ≤ 0.26 cm showed sensitivity of 94.6 % and specificity of 90.0 % for identifying severe MS, while in mixed valve disease sensitivity was 90.6 % and specificity 86.7 %. Overall, Yeo's index ≤ 0.15 cm showed 83.6 % sensitivity and 94.3 % specificity for very severe MS (MVA ≤ 1.0 cm2). In isolated MS, the threshold of ≤0.15 cm showed sensitivity of 84.4 % and specificity of 92.6 % for very severe MS, while in mixed valve disease sensitivity was 81.3 % and specificity 95.3 %. The presence of atrial fibrillation did not influence the performance of Yeo's index.

Conclusion

Yeo's Index accurately differentiates severity of rheumatic MS with or without mixed valve disease.

The effect of unpredictability on the perception of pain: a systematic review and meta-analysis

ABSTRACT

Despite being widely assumed, the worsening impact of unpredictability on pain perception remains unclear because of conflicting empirical evidence, and a lack of systematic integration of past research findings. To fill this gap, we conducted a systematic review and meta-analysis focusing on the effect of unpredictability on pain perception. We also conducted meta-regression analyses to examine the moderating effect of several moderators associated with pain and unpredictability: stimulus duration, calibrated stimulus pain intensity, pain intensity expectation, controllability, anticipation delay, state and trait negative affectivity, sex/gender and age of the participants, type of unpredictability (intensity, onset, duration, location), and method of pain induction (thermal, electrical, mechanical pressure, mechanical distention). We included 73 experimental studies with adult volunteers manipulating the (un)predictability of painful stimuli and measuring perceived pain intensity and pain unpleasantness in predictable and unpredictable contexts. Because there are insufficient studies with patients, we focused on healthy volunteers. Our results did not reveal any effect of unpredictability on pain perception. However, several significant moderators were found, ie, targeted stimulus pain intensity, expected pain intensity, and state negative affectivity. Trait negative affectivity and uncontrollability showed no significant effect, presumably because of the low number of included studies. Thus, further investigation is necessary to clearly determine their role in unpredictable pain perception.

The Impact of Time Since Menarche for Depressive and Anxiety Symptom Severity in Adolescence and Young Adulthood

PURPOSE

The study mapped depressive and anxiety symptom trajectories throughout adolescence and early adulthood, arrayed by time since menarche, a novel indicator of pubertal change and examined the effect of age of menarche and pubertal timing, more frequently used variables, on depressive and anxiety symptom severity trajectories.

METHODS

Secondary analysis of a cross-sequential prospective longitudinal investigation included a community sample of 262 US, adolescent females. Participants were enrolled in age cohorts of 11, 13, 15, and 17 years. Four annual waves of data were collected. Self-report of age at menarche was categorized into pubertal timing categories. A novel measure "time since menarche" (chronological age at each wave minus age at menarche), was measured along with depressive and anxiety symptom severity. Two-piece growth curve modeling with landmark registration examined depressive and anxiety symptom severity trajectories according to time since menarche.

RESULTS

There was no change (p > .05) in depression and anxiety symptom severity before menarche; however, in the years leading away from menarche, depression and anxiety symptom severity decreased (p < .05). Age at menarche was not associated with change in depressive and anxiety symptom severity (p > .05) and there were no moderating effects of pubertal timing.

DISCUSSION

Depressive and anxiety symptoms decrease in the years leading away from menarche, suggesting puberty-related psychopathology may be transitory in some individuals. Time since menarche may be a clinically relevant indicator of psychological functioning in pubescent adolescent females. Future studies should examine this variable in larger samples, including more adolescents in the earlier stages of puberty.

Insufficient sleep blunts positive, but not negative, affective response to emotionally complex film clips

The effects of sleep deprivation on emotional function are not yet fully understood. Although sleep deprivation has been shown to have larger effects on positive emotional reactivity than on negative, this research has been limited by the use of separate stimuli for positive and negative emotion elicitation. Different sets of stimuli represent a confound that makes it difficult to interpret this difference with confidence. The study reported here was designed to overcome this limitation by using film clips that elicit both positive and negative emotional responses at the same time. Undergraduate participants (33 female, 2 male) completed a laboratory-based emotion elicitation procedure using these film clips. Differences in sleep deprivation, estimated by subjective sleepiness and reaction times, were used to predict responses to these emotion probes. Greater subjective sleepiness was associated with significantly lesser positive responses to the film clips (rs = -0.37, p = 0.03). The relationship between subjective sleepiness and negative responses to the same clips was smaller and not significant (rs = -0.11, p = 0.51). Reaction times were not related to subjective emotional responses in this sample (all p > 0.40). These results support the theory that sleepiness has asymmetrical effects on positive and negative emotional functioning.

Early- to mid-gestational testosterone excess leads to adverse cardiac outcomes in postpartum sheep

Cardiovascular dysfunctions complicate 10-20% of pregnancies, increasing the risk for postpartum mortality. Various gestational insults, including preeclampsia are reported to be associated with adverse maternal cardiovascular outcomes. One such insult, gestational hyperandrogenism increases the risk for preeclampsia and other gestational morbidities but its impact on postpartum maternal health is not well known. We hypothesize that gestational hyperandrogenism such as testosterone (T) excess will adversely impact the maternal heart in the postpartum period. Pregnant ewes were injected with T propionate from day 30 to day 90 of gestation (term 147 days). Three months postpartum, echocardiograms, plasma cytokine profiles, cardiac morphometric, and molecular analysis were conducted [control (C) n = 6, T-treated (T) n = 7 number of animals]. Data were analyzed by two-tailed Student's t test and Cohen's effect size (d) analysis. There was a nonsignificant large magnitude decrease in cardiac output (7.64 ± 1.27 L/min vs. 10.19 ± 1.40, P = 0.22, d = 0.81) and fractional shortening in the T ewes compared with C (35.83 ± 2.33% vs. 41.50 ± 2.84, P = 0.15, d = 0.89). T treatment significantly increased 1) left ventricle (LV) weight-to-body weight ratio (2.82 ± 0.14 g/kg vs. 2.46 ± 0.08) and LV thickness (14.56 ± 0.52 mm vs. 12.50 ± 0.75), 2) proinflammatory marker [tumor necrosis factor-alpha (TNF-α)] in LV (1.66 ± 0.35 vs. 1.06 ± 0.18), 3) LV collagen (Masson's Trichrome stain: 3.38 ± 0.35 vs. 1.49 ± 0.15 and Picrosirius red stain: 5.50 ± 0.32 vs. 3.01 ± 0.23), 4) markers of LV apoptosis, including TUNEL (8.3 ± 1.1 vs. 0.9 ± 0.18), bcl-2-associated X protein (Bax)+-to-b-cell lymphoma 2 (Bcl2)+ ratio (0.68 ± 0.30 vs. 0.13 ± 0.02), and cleaved caspase 3 (15.4 ± 1.7 vs. 4.4 ± 0.38). These findings suggest that gestational testosterone excess adversely programs the maternal LV, leading to adverse structural and functional consequences in the postpartum period.NEW & NOTEWORTHY Using a sheep model of human translational relevance, this study provides evidence that excess gestational testosterone exposure such as that seen in hyperandrogenic disorders adversely impacts postpartum maternal hearts.

Locus of Control as a Mediator of the Relationships Between Motivational Systems and Trait Anxiety

The Reinforcement Sensitivity Theory, first proposed by Gray and later revised, describes three motivational systems: Behavioral Inhibition System (BIS), Behavioral Activation System (BAS), and Fight-Flight-Freeze System (FFFS). Studies have shown that high BIS and FFFS activation are positively related to anxiety symptoms, yet the relationship between BAS and anxiety remains unclear. Research data have also suggested that anxiety symptoms occur with the loss of perceived control. Thus, although studies on the direct effect of locus of control (LOC) on trait anxiety have accumulated for many years, the issue of how LOC may mediate the relationship between BIS/BAS/FFFS sensitivity and anxiety has not been addressed. This study aimed to explore the mediating role of LOC orientation on trait anxiety among young adults in association with these three motivational systems. Cross-sectional data were obtained from 422 volunteers. The BIS/BAS Scale, Trait Anxiety Inventory, and Rotter's Internal-External LOC Scale were applied. A series of mediation analyses were performed to estimate total, indirect, and direct effects. The results showed that BIS and FFFS positively predicted trait anxiety. In addition, LOC positively predicted trait anxiety and BIS. The results of the mediation analyses indicated that LOC functioned as a partial mediator between BIS and trait anxiety. This finding revealed that a high BIS level, one of the motivational systems, was associated with external LOC, which in turn contributed to reporting high trait anxiety in young adults. Hence, BIS and external LOC orientation could be suggested as risk factors for trait anxiety. As the external LOC orientation of individuals with high punishment sensitivity increased, their trait anxiety levels also increased. Therefore, it was suggested that it might be useful to be aware that LOC orientations of individuals with BIS sensitivity may pose a risk for trait anxiety.

Sexual Orientation/Gender Identity Discrimination and Chronic Pain in Children: A National Study

INTRODUCTION

This study provides national estimates of parental perceived child sexual orientation or gender minority (SGM) discrimination and examines associations between SGM discrimination and chronic pain in children.

METHODS

Cross-sectional analysis of the 2020 and 2021 National Survey of Children's Health (N=47,213). Caregivers of children ages 6-17 years old reported whether their child had ever been treated or judged unfairly (i.e., discrimination) because of their SGM identity. Chronic pain in children was defined as frequent or chronic difficulty with repeated or chronic physical pain during the past 12 months, as reported by caregivers. Weighted prevalence estimates for discrimination were calculated for the whole sample and sociodemographic subgroups. Associations between SGM discrimination and chronic pain were estimated using multivariable Poisson regression models adjusting for sociodemographic factors. Analyses were conducted 2022-2023.

RESULTS

Within this nationally representative sample, parents reported 1.4% (95% CI 1.2%-1.6%) of children have experienced SGM-related discrimination. The prevalence was higher among adolescents, females at birth, and those living in suburban areas. Children who experienced discrimination had a higher prevalence of chronic pain (20.2%) compared to those who did not (7.0%, p<0.0001), with an adjusted prevalence rate ratio of 2.0 (95% CI 1.5-2.5, p<0.0001).

CONCLUSIONS

Based on parent report, about 0.6 million children in the U.S. have experienced SGM-based discrimination; these children are twice as likely to have chronic pain. Findings highlight the importance of assessment and intervention for chronic pain in children who may experience marginalization and discrimination due to their sexual orientation and gender identity.

Brain Networks, Neurotransmitters and Psychedelics: Towards a Neurochemistry of Self-Awareness

PURPOSE OF REVIEW

Self-awareness can be defined as the capacity of becoming the object of one's own awareness and, increasingly, it has been the target of scientific inquiry. Self-awareness has important clinical implications, and a better understanding of the neurochemical basis of self-awareness may help clarifying causes and developing interventions for different psychopathological conditions. The current article explores the relationship between neurochemistry and self-awareness, with special attention to the effects of psychedelics.

RECENT FINDINGS

The functioning of self-related networks, such as the default-mode network and the salience network, and how these are influenced by different neurotransmitters is discussed. The impact of psychedelics on self-awareness is reviewed in relation to specific processes, such as interoception, body ownership, agency, metacognition, emotional regulation and autobiographical memory, within a framework based on predictive coding. Improved outcomes in emotional regulation and autobiographical memory have been observed in association with the use of psychedelics, suggesting higher-order self-awareness changes, which can be modulated by relaxation of priors and improved coping mechanisms linked to cognitive flexibility. Alterations in bodily self-awareness are less consistent, being potentially impacted by doses employed, differences in acute/long-term effects and the presence of clinical conditions. Future studies investigating the effects of different molecules in rebalancing connectivity between resting-state networks may lead to novel therapeutic approaches and the refinement of existing treatments.

An evidence-based breathing exercise intervention for chronic pain management in breast cancer survivors: A phase II randomized controlled trial

OBJECTIVE

Explore the preliminary effects of a breathing exercise (BE) intervention on chronic pain among breast cancer survivors.

METHODS

This two-parallel-arm, open-label pilot randomized controlled trial recruited 72 breast cancer survivors who were randomly allocated to either the control or intervention group (n = 36 each). Both groups received usual care and a pain information booklet, while the intervention group received 4 weeks of additional BE. The primary clinical outcome was measured using the Brief Pain Inventory (BPI), with secondary clinical outcomes measured by the Hospital Anxiety and Depression Scale (HADS), Quality of Life Patient/Cancer Survivor Version in Chinese (QOLCSV-C), and Functional Assessment of Cancer Therapy- Breast (FACT-B) immediately post-intervention and at 4-week follow-up. Both adjusted and unadjusted Generalized Estimating Equation models were utilized to assess the BE's potential effects, with safety assessed through participant self-report.

RESULTS

Sixty-eight participants completed the study. Statistical significance was observed in BPI in both adjusted and unadjusted models at post-intervention and follow-up (p < 0.05). BE demonstrated positive effects on anxiety, depression and quality of life improvement across all measures and timepoints in both adjusted and unadjusted models (p < 0.05). The effect sizes were smaller in the adjusted model. Three mild transient discomforts were reported associated with BE practice including dizziness, tiredness and yawning, without requirement of medical treatment. No severe adverse events occurred.

CONCLUSION

This BE intervention appears effective in alleviating chronic pain, anxiety and depression, and improving quality of life for breast cancer survivors. Fully powered large-scale studies are required to confirm its effects.

The role of resilience and coping strategies as predictors of well-being in breast cancer patients

PURPOSE

This study investigated the role of resilience and coping strategies on breast cancer patients' well-being using a structural equation model. To achieve this objective, a model previously developed by Mayordomo's group was partially replicated using a longitudinal study design in an oncological sample.

METHODS

The study was a longitudinal observational survey. Patients with breast cancer were recruited (N = 166). Resilience was measured with the Mexican Resilience Measurement Scale, coping strategies with the Forms of Coping and Dimensions Scale and perception of the psychological well-being with a short-form of Ryff's Scales of Psychological Well-Being at the start and end of adjuvant chemotherapy (T1 and T2 respectively).

RESULTS

The results showed stability in the variables over time and revealed differences with respect to Mayordomo's model. The best predictor of well-being at T2 was well-being at T1. In addition, the model indicated that resilience had a direct impact on well-being through problem-focused coping. Indeed, resilience and problem-focused coping best explained well-being at T2.

CONCLUSIONS

Both at the start and end of adjuvant chemotherapy for breast cancer, problem-focused coping positively predicted resilience, which in turn was a positive predictor of well-being. On the other hand, emotion-focused coping showed no association with resilience or well-being. As part of the multidisciplinary cancer team, oncology nurses have a key role to play in promoting resilience and problem-focused coping as an important goal of psychosocial interventions in breast cancer patients.

Understanding the Preferences and Considerations of the Public Towards Risk-Stratified Screening for Colorectal Cancer: Insights From Think-Aloud Interviews Based on a Discrete Choice Experiment

CONTEXT

Risk stratification has been suggested as a strategy for improving cancer screening. Any changes to existing programmes must be acceptable to the public.

OBJECTIVE

This study aimed to explore the preferences and considerations of individuals relating to the introduction of different risk-based strategies to determine eligibility for colorectal cancer (CRC) screening.

STUDY DESIGN

Participants completed a discrete choice experiment (DCE) within online interviews. Nine conjoint-analysis tasks were created, each with two potential CRC screening programmes. The attributes included personal risk of CRC, screening invitation strategy and impact. Participants chose between programmes while thinking aloud and sharing their thoughts. Transcripts were analysed using codebook thematic analysis.

PARTICIPANTS

Twenty participants based in England aged 40-79 years without previous cancer history or medical expertise.

RESULTS

When choosing between programmes, participants first and primarily looked to prioritise saving lives. The harms associated with screening were viewed as a surprise but also felt by most to be inevitable; the benefits frequently outweighed, therefore, harms were considered less important. Risk stratification using individual characteristics was considered a nuanced approach to healthcare, which tended to be preferred over the age-alone model. Detailed personal risk information could be taken more seriously than non-personalised information to motivate behaviour change. Although it had minimal impact on decision-making, not diverting resources for screening from elsewhere was valued. Individuals who chose not to provide health information were considered irresponsible, while it was important that those with no information to provide should not lose out.

CONCLUSION

Risk-stratified CRC screening is generally aligned with public preferences, with decisions between possible stratification strategies dominated by saving lives. Even if attributes including risk factors, risk stratification strategy and risk communication contributed less to the overall decision to select certain programmes, some levels more clearly fulfilled public values; therefore, all these factors should be taken into consideration when redesigning and communicating CRC screening programmes.

PATIENT OR PUBLIC CONTRIBUTION

The primary data source for this study is interviews with 20 members of the public (current, past or future CRC screening invitees). Two public representatives contributed to planning this study, particularly the DCE.

The role of cue salience in prospective memory commission errors in nonperformed nonfocal tasks

Prospective memory (PM) refers to the ability to remember to execute an intention in the future without having a permanent reminder. These intentions can be performed when they are not relevant or become no-longer needed, the so-called "commission errors". The present study aims to understand the effect of cue salience on PM commission errors with unperformed intentions and on the ongoing task performance-associated costs. Through a between-subjects design, eighty-one participants were assigned to 3 conditions: the no-PM condition, which served as control, and the salient and nonsalient conditions, which were asked to perform a lexical decision task and an incomplete nonfocal prospective memory task (i.e. no PM cues were presented). Subsequently, participants were instructed to no longer execute the prospective intention. In the second phase, a lexical decision task occurred again, including irrelevant PM cues, which should not be answered as such. In the salient condition, cues were salient (i.e. presented in red or blue background). In contrast, in the nonsalient condition, PM cues appeared on a black background, as any other stimuli. In the no-PM control condition, participants only performed an LDT. A commission error occurred when the (irrelevant) intention was performed in this second phase. Results showed that more participants performed a commission error in the presence of salient cues, even when PM intentions became irrelevant. Additionally, when cues were not salient, participants took longer to answer the LDT, as reasoned by the spontaneous retrieval theory. These findings are discussed according to the dual-mechanism account.

Within-person biological mechanisms of mood variability in childhood and adolescence

Mood variability, the day-to-day fluctuation in mood, differs between individuals and develops during adolescence. Because adolescents show higher mood variability and average mood than children and adults, puberty might be a potential biological mechanism underlying this increase. The goal of this preregistered developmental study was to examine the neural and hormonal underpinnings of adolescent-specific within-person changes in mood variability, with a specific focus on testosterone, cortisol, pubertal status, and resting-state functional brain connectivity. Data from two longitudinal cohorts were used: the L-CID twin study (aged 7-13, N at the first timepoint = 258) and the accelerated Leiden Self-Concept study (SC; aged 11-21, N at the first timepoint = 138). In both studies resting-state functional magnetic resonance imaging (rs-fMRI) data was collected, as well as daily mood. Additionally, in the SC study self-reported puberty testosterone and cortisol were collected. Random intercept cross-lagged panel models (RI-CLPM) were used to study the within-person relations between these biological measures and mood variability and average mood. Mood variability and average mood peaked in adolescence and testosterone levels and self-reported puberty also showed an increase. Connectivity between prefrontal cortex (dlPFC and vmPFC) and subcortical regions (caudate, amygdala) decreased across development. Moreover, higher testosterone predicted average negative mood at the next time point, but not vice versa. Further, stronger vmPFC-amygdala functional connectivity predicted decreases in mood variability. Here, we show that brain connectivity during development is an important within-person biological mechanism of the development of mood in adolescents. PRACTITIONER POINTS: Mood variability peaks in adolescence. Within-person changes in testosterone predict within-person changes in mood. Within-person changes in vmPFC-amygdala connectivity predict within-person changes in mood variability.

Development and Validation of a Measure of Self-Efficacy for Advance Care Planning

Medical care received at end-of-life is often not aligned with individuals' values and care preferences. Much can get in the way of an individual communicating and documenting their preferences to care providers and close others, even if it is a goal to do so. The objective of this work was to develop a measure of Advance Care Planning Self-Efficacy (ACP SE) focused on three important behaviors: completing a living will, documenting a healthcare agent, and discussing quality versus quantity of life issues. Measure development was framed by the Transtheoretical Model (TTM) of behavior change. Following the completion of focus groups and formative qualitative work, an independent sample (N = 310, adults aged 50+) was randomly split into two halves for exploratory and confirmatory factor analyses (EFA/CFA). Multivariate analyses examined relationships between ACP SE and other TTM constructs. Results of the CFA demonstrated excellent internal consistency (α = .95) and good model fit (CFI = .89, RMSEA = .13). Self-efficacy was framed by the TTM as situation-specific confidence. Through the measure development process, it was found that confidence to do ACP was impacted by various situational and attitudinal variables. ACP Self-Efficacy was found to differ significantly by Stage of Change. This study produced a reliable and valid measure of situation-specific confidence for ACP grounded within the TTM that could enhance future interventions aimed at increasing participation in ACP.

Health or environment? Understanding which informative message is more effective in replacing red meat with mushroom-based alternatives

Current concerns regarding the health and environmental consequences associated with excessive meat consumption have underscored the importance of guiding consumers towards more sustainable diets. Given this perspective, this study seeks to evaluate the effectiveness of tailored informative messages in shaping consumer behaviour, particularly within the framework of replacing meat with mushroom-based alternatives. Additionally, it explores the factors influencing informative message effectiveness. An experimental online survey was conducted on a sample of 951 Italian consumers. Specifically, the sample was divided into three groups, of which 309 individuals formed the control group, 311 participants received informative messages on the health risks associated with red meat consumption, and 331 participants received informative messages emphasizing the environmental damages linked to red meat consumption. In both treatments, there was support for mushroom-based alternatives. Analyses included subgroup assessments, tests to verify treatments effectiveness, along with OLS regression to pinpoint variables influencing message effectiveness. The results underscore a fair positive impact of the two informative messages (mean scores: 8.75 for health message; 7.01 for environmental message). Noteworthy psychosocial variables, including lifestyle patterns, nutritional perceptions, and ecological attitudes, emerged as determinants in shaping consumers' food choices. While health-related messages exhibit marked influence, the nuanced landscape of diverse drivers and barriers necessitates judicious communication strategies. These insights bear significance for policymakers, health professionals, and marketers, offering guidance for interventions that effectively influence consumer behaviour toward more sustainable and healthier food practices.

Scale for time and space experience in anxiety (STEA): Phenomenology and its clinical relevance

Anxiety is a pervasive emotional state where, phenomenologically, subjects often report changes in their experience of time and space. However, a systematic and quantified examination of time and space experience in terms of a self-report scale is still missing which eventually could also be used for clinical differential diagnosis. Based on historical phenomenological literature and patients' subjective reports, we here introduce, in a first step, the Scale for Time and Space Experience of Anxiety (STEA) in a smaller sample of 19 subjects with anxiety disorders and, in a second step, validate its shorter clinical version (cSTEA) in a larger sample of 48 anxiety subjects. The main findings are (i) high convergent and divergent validity of STEA with both Beck Anxiety Inventory (BAI) (r = 0.7325; p < 0.001) and Beck Depression Inventory (BDI) (r = 0.7749; p < 0.0001), as well as with spontaneous mind wandering (MWS) (r = 0.7343; p < 0.001) and deliberate mind wandering (MWD) (r = 0.1152; p > 0.05), (ii) statistical feature selection shows 8 key items for future clinical usage (cSTEA) focusing on the experience of temporal and spatial constriction, (iii) the effects of time and space experience (i.e., for both STEA and cSTEA scores) on the level of anxiety (BAI) are mediated by the degree of spontaneous mind wandering (MWS), (iv) cSTEA allows for differentiating high levels of anxiety from the severity of comorbid depressive symptoms, and (v) significant reduction in the cSTEA scores after a therapeutic intervention (breathing therapy). Together, our study introduces a novel fully quantified and highly valid self-report instrument, the STEA, for measuring time-space experiences in anxiety. Further we develop a shorter clinical version (cSTEA) which allows assessing time space experience in a valid, quick, and simple way for diagnosis, differential diagnosis, and therapeutic monitoring of anxiety.

Affect variability and cortisol in context: The moderating roles of mean affect and stress

Positive and negative affect have been shown to have implications for hormones like cortisol but how moment to moment changes in affect (i.e., affect variability) influence cortisol secretion is less well understood. Additionally, context characteristics such as mean affect and stress may influence the association between affect variability and cortisol output. In the current study, we examined affect, stress, and cortisol data from 113 participants (age range = 25-63, M = 35.63, SD = 11.34; 29% male; 42% White/Caucasian, 37% Asian or Pacific Islander, 13% Hispanic/Latino, 4% Black/African American, 1% Native American, Eskimo, or Aleut, 4% selected "other" for their race/ethnicity). Participants completed ecological momentary assessments assessing positive and negative affect and stress four times per day for five days and provided saliva samples at each time point. Saliva was assayed for cortisol, and area under the curve with respect to ground was computed. In a three-way interaction, both positive affect mean level and stress moderated the association between positive affect variability and cortisol (b = -1.55, t(100) = -3.29, SE = 0.47, p <.01, β = -4.05). When breaking down this three-way interaction, in the context of low stress and high mean positive affect, variability was positively related to total cortisol output. In contrast, in the context of high stress and high mean positive affect, variability was negatively related to total cortisol output. While greater positive affect variability is generally worse for health-relevant outcomes (as prior research has shown and as we show here at low levels of stress), at high levels of stress, fluctuation in affect may be adaptive. For someone experiencing a high stress week, having fluctuations in positive affect may mean that they are adaptively changing to meet their environmental needs especially when they typically report high mean positive affect levels. There were no associations between negative affect variability and cortisol secretion nor did mean negative affect or stress play a moderating role for negative affect variability. This study provides evidence that positive affect variability's association with cortisol secretion throughout the day may vary based on stress and mean positive affect levels.

The Authentic Self Is the Self-Enhancing Self: A Self-Enhancement Framework of Authenticity

Authenticity refers to behaving in a manner that aligns with one's true self. The true self, though, is positive. From a self-enhancement standpoint, people exaggerate their strengths and overlook their shortcomings, forming positively-distorted views of themselves. We propose a self-enhancement framework of authenticity, advocating a reciprocal relation between the two constructs. Trait self-enhancement was associated with higher trait authenticity (Study 1), and day-to-day fluctuations in self-enhancement predicted corresponding variations in state authenticity (Study 2). Furthermore, manipulating self-enhancement elevated state authenticity (Studies 3-4), which was associated with meaning in life (Study 4), and manipulating authenticity augmented self-enhancement, which was associated with meaning in life and thriving (Study 5). The authentic self is largely the self-enhancing self.

"Being Queer, It Was Really Isolating": Stigma and Mental Health Among Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Young People During COVID-19

Lesbian, Gay, Bisexual, Transgender, Queer, and other sexual and gender minority (LGBTQ+) youth and young adults (YYAs) have poorer mental health outcomes than their cisgender, heterosexual peers in large part due to multilevel stigmatization and minority stress. This was exacerbated by psychological stressors stemming from the COVID-19 pandemic; these experiences intersected with YYA unique developmental stage. Here we explored LGBTQ+ YYA's pandemic-related experiences, focusing on intersections between stigma and belonging, developmental processes, and their relationship to mental health. We conducted qualitative interviews from August to November 2021 with 34 LGBTQ+ YYA ages 14 to 24; interviews were nested within a quantitative study on YYA experiences during COVID-19. Interviews were transcribed and coded using thematic analysis. YYA described how pandemic impacts like quarantine and isolation directly impacted their mental health; these coalesced around four types of thematic shifts: shifts in (1) time, (2) living situations, (3) community supports, and (4) social and political climate. Multilevel stigmatization also created new mechanisms of norm enforcement for LGBTQ+ YYA. Interviews demonstrated how the pandemic also impacted key developmental processes including identity formation and autonomy seeking. The potential consequences of these pandemic-related shifts largely depended on YYA's experiences of stigma and/or belonging throughout the pandemic. Findings suggested that isolation from the COVID-19 pandemic intersected with existing socio-ecological structures in LGBTQ+ young people's lives. Efforts to investigate longitudinal impacts of the pandemic, as well as to intervene to reduce the stigmatization experienced by LGBTQ+ YYA, remain urgent.