Use and misuse of corrections for multiple testing

Comparison of Temporomandibular Disorder Signs and Symptoms in CrossFit® Athletes and Sedentary Individuals

(1) Background: A sedentary lifestyle may aggravate temporomandibular disorder (TMD) symptoms, increasing pain sensitivity and functional limitations. Physical exercise is recommended for pain management and improving quality of life. Comparing CrossFit® athletes to sedentary individuals allows for examining whether regular high-intensity exercise impacts pain sensitivity and functional limitations associated with TMD. This cross-sectional study assessed the signs and symptoms of TMD in CrossFit® athletes compared to sedentary individuals. (2) Methods: Participants (n = 121) were divided into four groups: sedentary with TMD (n = 39), sedentary without TMD (n = 37), CrossFit® athletes with TMD (n = 23), and CrossFit® athletes without TMD (n = 22). TMD signs and symptoms were evaluated using the Research Diagnostic Criteria for TMD (RDC/TMD) axis I, including mandibular movement patterns, range of motion, joint sounds, muscle pain, and jaw dysfunctions. Statistical analyses included chi-square and Dunn's post hoc tests, ANOVA, and Kruskal-Wallis tests. Correlation and regression analyses were performed to examine associations between CrossFit® practice and TMD (p ≤ 0.05). (3) Results: Myofascial pain was the most common diagnosis. All athlete groups exhibited greater mandibular movement amplitudes (unassisted opening without pain, p < 0.001, and protrusion, p = 0.039) and less pain (p < 0.001) than sedentary individuals. Pain reports and palpation-induced pain in muscles and joints were significantly associated with a sedentary lifestyle and TMD (p < 0.001). Joint and muscle pain were more prevalent (frequent) among sedentary participants, regardless of TMD diagnosis. Linear regression analysis showed that sedentary individuals without TMD had significantly reduced unassisted mouth opening amplitudes compared to athletes without TMD (p < 0.05). (4) Conclusions: Pain in the masseter, temporalis, posterior digastric, and medial pterygoid muscles was the most common symptom in sedentary individuals with TMD. They experience higher frequency and intensity of pain, as well as greater limitations in mouth movement. Athletes showed higher frequency of joint noises.

Little evidence for a role of facial mimicry in the transmission of stress from parents to adolescent children

Empathic stress, the spontaneous reproduction of psychosocial stress by mere observation, has been shown to occur between strangers, romantic partners and in mother-child dyads. However, the mechanisms by which stress is transmitted have yet to be understood. We investigated whether facial mimicry modulates the transmission of psychosocial stress. Adolescents (13-16 years old) observed their mothers or fathers (N = 77) undergo a standardized laboratory stressor. Parents' and adolescents' faces were videotaped during the stress task and dyads simultaneously provided multiple samples of subjective stress, heart rate, heart rate variability (HRV), and salivary cortisol. The degree to which adolescents mimicked their parents' facial expressions was calculated in a multi-step procedure based on windowed-cross-lagged-regressions. To integrate the correlational structure of mimicry across different facial action units (AU), an exploratory factor analysis was employed. The solution revealed a two-factor model, constructed of a positive latent factor subsuming mimicked action units associated with the act of smiling and a negative latent factor, subsuming mimicked action units used for various negative emotions. None of the stress markers were significantly associated with the extracted latent factors indexing mimicry between parents and adolescents, providing no statistically significant evidence for an association between facial mimicry and stress-transmission in the parent-adolescent dyad. Bayes Factors generally indicated moderate evidence for a lack of association with the positive and anecdotal evidence for a lack of association with negative latent mimicry factors. In conclusion, our approach to video-based mimicry calculation showed promising results in that mimicry of positive and negative emotions could be detected, albeit no evidence for a link to actual empathic stress transmission in the laboratory was found.

Emotional time lengthening carries over to subsequent neutral events

The perceived time can shrink or expand for emotional stimuli. Converging evidence suggests that emotional time distortions are rooted in the emotional states of the timing agents because emotional stimuli can influence the timing of simultaneous neutral events. As emotional states are transitory, we investigated if time modulating emotional states also influence timing of subsequent neutral events. In each trial, we induced different valence and arousal levels by using affective vibrotactile patterns before participants judged the duration of neutral auditory tones. Compared to neutral patterns, affective patterns modulated participants' time perception of the subsequent tones. We observed an interaction between arousal and valence: Pleasant-Low arousal patterns expanded the timing of subsequent neutral events more than Unpleasant-Low arousal patterns while Pleasant and Unpleasant-High arousal led to a similar temporal expansion. Our results indicate time modulating effects of emotional stimuli are due to changed emotional states and influence time perception likely until the underlying state decays.

The impact of family depression history and childhood adversities on the risk of depression in adulthood among 1,461,034 individuals

OBJECTIVE

To investigate the separate and combined impact of family major depression (MD) history and ten childhood adversities (CA) on the risk of adult MD.

METHODS

All Danish citizens born 1977-2000 with known parental identity were followed from their 18th birthday until diagnosis of MD, migration, death, or December 31, 2022, in nationwide registers. Exposures were family MD history and ten selected CAs. Family MD history was operationalized using the ICD 8th Revision codes 296.09, 296.29, 298.09, and 300.49 or 10th Revision codes F32.0-F33.9. CAs were; relative family poverty, long-term parental unemployment, foster care, parental alcohol abuse, parental drug abuse, parental and sibling somatic illness, parental long-term unemployment, parental separation, and parental and sibling death. Multivariable Poisson regression was applied to estimate the incidence rate ratio (IRR) with 95 % CI of first-time MD.

RESULTS

The study included 1,461,034 individuals (Male: 51.5 %). During a mean follow-up of 14.5 years (SD ± 7.2), 50,231 (3.5 %) of cohort members were diagnosed with first-time MD in adulthood. Family MD history was associated with an IRR of 1.94 (95 % CI [1.88-2.00]) for MD. In all models, both CAs and family MD, separately and combined, were associated with an increased IRR for MD. The IRRs for individuals with a family MD history with or without CA, respectively, were generally relatively comparable.

CONCLUSIONS

Individuals exposed to family MD history and CAs are at increased risk of MD. However, the associations between family MD and onset of MD in adulthood remain largely unchanged regardless of the presence of any of the ten CAs.

Serum glial fibrillary protein reflects early brain injury dynamics and cognitive changes after deep brain stimulation surgery

Deep brain stimulation (DBS) is an efficient treatment for movement disorders, most commonly Parkinson's Disease (PD), dystonia and essential tremor. DBS surgery carries risks, e.g. the risk of delayed peri-lead edema (PLE) and the risk of postoperative cognitive decline. The mechanisms of these complications are not fully understood and there is no established biomarker to screen for these complications after DBS surgery. To explore the diagnostic value of two blood-based markers representative for distinct types of brain injury, we characterized the dynamics of serum glial fibrillary acidic protein (sGFAP, for glial injury) and serum neurofilament light chain (sNfL, for neuronal-axonal injury) following DBS surgery. We analyzed longitudinal dynamics of serum protein levels in 58 patients undergoing deep brain stimulation (DBS) at our center for half a year post-surgery. Serum GFAP responded much more rapidly after brain surgery, returning to baseline after weeks, whereas sNfL only returned to baseline after months. Patients with lower preoperative cognitive performance exhibited higher postoperative sGFAP levels, with sGFAP showing a stronger association with preoperative patient characteristics compared to sNfL. Further studies with long-term clinical follow-up are needed to fully evaluate the utility of sGFAP as a biomarker for both early and delayed complications after DBS surgery, including cognitive decline and potential foreign body reactions to the implanted lead.

Virtual Versus In-Person Intensive Outpatient Treatment for Eating Disorders During the COVID-19 Pandemic in United States-Based Treatment Facilities: Naturalistic Study

BACKGROUND

While virtual therapy has proven effective in treating eating disorders (EDs), little work has examined virtual therapy at higher levels of care, which are treatment options providing more support than weekly outpatient therapy including intensive outpatient (IOP) treatment.

OBJECTIVE

This study aimed to add to the limited research on in-person versus virtual treatment at a higher level of care by comparing treatment outcomes between an in-person IOP and a virtual IOP (VIOP) for patients with EDs. We hypothesized that there would be no differences in improvements between VIOP and in-person IOP groups.

METHODS

This study has a nonrandomized multiple cohort design. Patients with EDs receiving treatment who completed both admission and discharge questionnaires in VIOP treatment (n=231) and in-person IOP treatment (n=39) between 2021 and mid-2022 within a large ED health care system in the United States were included. The Eating Disorder Examination-Questionnaire (EDE-Q) was used to measure ED symptoms. The Patient Health Questionnaire-9 (PHQ-9) was used to measure depression, and item 9 of the PHQ-9 was used to measure suicidal ideation. Welch t tests on admission, discharge, and raw change scores were conducted. Logistic regressions were conducted predicting treatment program (reference group VIOP vs in-person IOP) from the residualized change in each outcome and were adjusted for all significantly different factors between groups.

RESULTS

VIOP patients were significantly older (mean 28.03, SD 11.09) than in-person IOP patients (mean 19.51, SD 6.98) and displayed significantly different numbers of ED diagnoses and more comorbid psychiatric diagnoses (VIOP: mean 1.23, SD 1.12; in-person IOP: mean 0.33, SD 0.84) but no differences in race (VIOP: 175/231, 75.6% White; in-person IOP: 30/39, 76.9% White), gender (VIOP: 196/231, 84.8% female; in-person IOP: 35/39, 89.7% female), or length of stay (VIOP: mean 58.84, SD 26.69; in-person IOP: mean 57.33, SD 19.67). When compared to in-person IOP patients, controlling for age, diagnosis, number of comorbid diagnoses, and admission scores, VIOP patients did not exhibit significantly different improvements in ED symptom scores (EDE-Q Global: b=0.01, SE 0.18, t=0.04, odds ratio [OR] 1.01, 95% CI 0.71-1.43; P=.97). However, VIOP patients exhibited significantly greater improvements in depression scores (PHQ-9: b=-0.14, SE 0.05, t230=-2.85, OR 0.87, 95% CI 0.79-0.96; P=.004) and the PHQ-9 suicidal ideation item (PHQ-9 item 9: b=-0.72, SE 0.34, t230=-2.13, OR 0.49, 95% CI 0.25-0.93; P=.03).

CONCLUSIONS

ED outcomes were similar for VIOP and in-person IOP patients. Contrary to our hypotheses, depression and suicidal ideation outcomes improved more for VIOP patients than for in-person IOP patients. Furthermore, treatment access for non-White and older adults does not appear descriptively worse for VIOP treatment compared to in-person IOP treatment, though these trends should be further explored. VIOP treatment may improve treatment access in an equitable fashion without reducing treatment quality.

An Epidemiologic Approach for Estimating Risk Reduction and Asymptotic Power on the Log-Difference Scale

When comparing the efficacy or harmfulness of two groups (e.g., drugs, devices, assays, interventions, environmental toxins), it is important to minimize bias by making this comparison with respect to a common referent-control group, assuming random allocation. Under such a scenario, one can estimate risk reduction for a new therapy on a log-difference, relative effect scale. The current manuscript reviews the large-sample framework for this conditionally independent comparison and demonstrates how to estimate test power for a given sample size.

Citronellol protects renal function by exerting anti-inflammatory and antiapoptotic effects against acute kidney injury induced by folic acid in mice

Acute kidney injury (AKI) is characterized by an abrupt cessation of kidney function. Folic acid-induced renal tubular damage is marked by immense inflammation and apoptosis in the kidney. Citronellol is a type of natural monoterpene alcohol commonly used in traditional medicine. Citronellol possesses pharmacological properties such as antioxidants, anti-inflammatory, and analgesic effects. This study aimed to investigate the reno-protective effect of citronellol against folic acid-induced AKI in mice models. Mice were divided into four groups. In addition to control and AKI-induction groups, two treatment groups were mice that received 50 or 100 mg/kg/day of citronellol orally for four consecutive days. On day 4, mice also received a single injection of folic acid (250 mg/kg) and were euthanized after 48 h. Citronellol 50 and 100 mg/kg rescued renal function as indicated by the significant reduction of serum urea, serum creatinine, and gene expression of KIM-1 compared to the non-treated group. In addition, citronellol 50 and 100 mg/kg relieved renal inflammation by significantly downregulating NF-κB, IL-6, and IL-1β gene expressions compared to the non-treated mice. Furthermore, citronellol retarded renal apoptotic events by the significant decline in renal tissue BAX and cleaved caspase-3 levels compared to non-treated mice. Histopathological report of renal tissue provides further evidence that augments the above results. The study highlighted the importance of some natural compounds that could have a place in therapeutic procedures for kidney injury, as observed by the strong renal protective effects of citronellol against AKI and remarkable anti-inflammatory and antiapoptotic actions.

"Invisible Dangers": Unconscious processing of angry vs fearful faces and its relationship to subjective anger

Traditional paradigms for studying the unconscious processing of threatening facial expressions face methodological limitations and have predominantly focused on fear, leaving gaps in our understanding of anger. Additionally, it is unclear how the unconscious perception of anger influences subjective anger experiences. To address this, the current study employed Continuous Flash Suppression (CFS), a robust method for studying unconscious processing, to assess suppression times for angry, fearful and happy facial expressions. Following the administration of CFS, participants underwent an anger induction paradigm, and state anger symptoms were assessed at multiple timepoints. Suppression times for angry faces were compared to those for happy and fearful faces, and their relationship with state anger symptoms post-induction was examined. Results revealed that fearful faces broke suppression significantly faster than happy faces. Anger was slower to break suppression compared to fear, but no significant differences emerged between anger and happiness. In addition, the faster emergence into awareness of fear compared to anger was linked to an increased state anger after the induction, indicating that differences in the unconscious processing of these two emotions can potentially influence symptoms of subjective anger. These findings provide new insights into how angry and fearful faces are processed unconsciously, with implications for understanding the cognitive mechanisms underlying subjective anger.

In Coping with Intimate Partner Violence, Women's Beliefs About Forgiveness Matter

Women who experience intimate partner violence (IPV) often feel pressured to forgive their abusers and remain in dangerous relationships. However, forgiveness does not have to include reconciliation and it may be conceptualized in different ways. This quantitative study surveyed 110 women who experienced IPV from men and separated from their abusers. It then examined (a) the prevalence of 20 different beliefs about forgiveness and (b) the relationship between those beliefs, the women's self-reported practices of forgiveness, and the women's intent to return to their abusers. The study asked whether different beliefs about forgiveness were-in combination with different levels of forgiveness-associated with intent to return to abusers. It found that women's beliefs about forgiveness varied widely, but only 4.6% of the women believed that forgiveness involved reconciliation. In contrast, 80% of the women believed it was simultaneously possible to forgive and to avoid the men who hurt them. When interaction analyses were conducted, significant interactions were found between three beliefs and women's self-reported practices of forgiveness. For two beliefs, the interactions were positively associated with intent to return to abusers (i.e., a belief that forgiveness involves reconciliation, and a belief that forgiveness involves treating a person better than before). For one belief, the interaction was negatively associated with intent to return (i.e., the belief that it is possible both to forgive and to avoid a person). Results suggest that women's beliefs about forgiveness matter. Women are more likely to return to abusers if they believe forgiveness involves reconciliation or treating their abusers better than before. They are less likely to return, if they believe it is possible to forgive their abusers and still avoid them. Interventions targeting women's beliefs about forgiveness may increase their safety.

Functional brain networks predicting sustained attention are not specific to perceptual modality

Sustained attention is essential for daily life and can be directed to information from different perceptual modalities, including audition and vision. Recently, cognitive neuroscience has aimed to identify neural predictors of behavior that generalize across datasets. Prior work has shown strong generalization of models trained to predict individual differences in sustained attention performance from patterns of fMRI functional connectivity. However, it is an open question whether predictions of sustained attention are specific to the perceptual modality in which they are trained. In the current study, we test whether connectome-based models predict performance on attention tasks performed in different modalities. We show first that a predefined network trained to predict adults' visual sustained attention performance generalizes to predict auditory sustained attention performance in three independent datasets (N 1 = 29, N 2 = 60, N 3 = 17). Next, we train new network models to predict performance on visual and auditory attention tasks separately. We find that functional networks are largely modality general, with both model-unique and shared model features predicting sustained attention performance in independent datasets regardless of task modality. Results support the supposition that visual and auditory sustained attention rely on shared neural mechanisms and demonstrate robust generalizability of whole-brain functional network models of sustained attention.

Impact of Gender Identity Field in the Veterans Health Administration Electronic Health Record, 2016‒2023

Objectives. To distinguish differences in physical and mental health between transgender and gender-diverse (TGD) veterans identified via diagnostic codes, self-identification, and their combination. Methods. We used sociodemographic characteristics and physical and mental health diagnoses for TGD veterans receiving care in Veterans Health Administration (VHA). Results. Among the cohort of 12 745 TGD veterans, 69.3% were identified solely using self-reported gender identity data, 23.4% were identified using only TGD-related diagnostic codes, and 7.2% had both TGD-related diagnostic codes and gender identity data in their medical record. TGD veterans identified using self-reported gender identity data were younger and more racially and ethnically diverse compared with those identified with only diagnostic codes. Across nearly all independently examined health conditions, TGD veterans identified via self-reported gender identity were at lower risk compared with those identified via diagnostic codes. Conclusions. Inferences drawn from studies of TGD veteran health may be significantly impacted by choice of methodology for defining the TGD veteran cohort. New analyses using self-reported gender identity data, as opposed to diagnostic codes, are critical to understand the health of this population within VHA. (Am J Public Health. 2025;115(3):403-413. https://doi.org/10.2105/AJPH.2024.307920).

Surfactant protein levels and genetic variants as biomarkers for COVID-19 severity in children

Since its outbreak, the novel coronavirus (COVID-19) has significantly impacted the pediatric population. Pulmonary surfactant dysfunction has been linked to other respiratory diseases in children and COVID-19 in adults, but its role in COVID-19 severity remains unclear. We hypothesized that elevated surfactant protein (SP) levels and single nucleotide polymorphisms (SNPs) of SP genes are associated with severe COVID-19 in children. We enrolled 325 COVID-19 positive children and categorized them as having mild or severe disease. Plasma SP-A, SP-B, and SP-D levels were measured. DNA was extracted and genotyped for SNPs in five SP genes, SFTPA1, SFTPA2, SFTPB, SFTPC, and SFTPD. Quantile regression was used to compare SP levels between groups, and receiver operating curve analysis determined an optimal cutoff value of SP level for predicting severe COVID-19. Logistic regression evaluated the odds ratio (OR) for severe disease and associations between SNPs and COVID-19 severity. We found that increased plasma SP-A levels, but not SP-B or SP-D, were significantly associated with severe COVID-19. No significant correlation was observed between age and SP levels. A plasma SP-A level of 10 ng/mL was identified as the optimal cutoff for predicting severe COVID-19, with an OR of 5.9, indicating that children with SP-A levels above this threshold are nearly six times more likely to develop severe COVID-19 disease. In addition, the rs8192340 of SFTPC was associated with decreased risk of severe COVID-19 before, but not after, Bonferroni correction. These findings suggest that plasma SP-A may serve as a potential biomarker for severe COVID-19 in children.NEW & NOTEWORTHY Surfactant dysfunction is linked to other pulmonary diseases, but its role in pediatric coronavirus (COVID-19) is unclear. We found elevated plasma surfactant protein (SP)-A levels, but not SP-B or SP-D, significantly associated with severe COVID-19. A plasma SP-A threshold of 10 ng/mL predicted severe COVID-19. The rs8192340 of SFTPC was associated with decreased risk of severe COVID-19 before, but not after, Bonferroni correction. These findings suggest plasma SP-A may serve as a potential biomarker for pediatric COVID-19 severity.

One-month outcomes of a culturally tailored alcohol-exposed pregnancy prevention mobile app among urban Native young women: A randomized controlled trial of Native WYSE CHOICES

BACKGROUND

The majority of alcohol-exposed pregnancy (AEP) prevention programs for Native women have focused on at-risk adult women residing in rural tribal communities; however, over 70% of the Native population resides in urban areas. Moreover, Native young women universally-regardless of risk status-may benefit from culturally tailored resources. We hypothesized that urban Native young women who engaged with Native WYSE CHOICES (NWC), a culturally tailored AEP prevention intervention delivered by mobile phone app, would report reduced risk of AEP at the 1-month follow-up compared to those who engaged with a comparison condition.

METHODS

From August 2021 to January 2023, we recruited 439 urban Native young women (ages 16-20) nationally to a randomized controlled trial administered fully virtually including most recruitment, data collection and intervention engagement. Participants were randomly assigned to the NWC app or an alternative app. We used linear and logistic regression analyses to predict scores on 1-month outcome variables by study arm assignment.

RESULTS

Results of regression analyses predicting scores on 1-month outcomes by study arm showed trending intervention effects on measures of AEP knowledge (p = 0.06), alcohol use with sexual activity (p = 0.10), and an AEP risk index (p = 0.12). At 1-month follow-up, intervention group participants reported greater AEP knowledge, lower likelihood of alcohol-involved sexual activity in the past month, and lower scores on an AEP risk index compared to the comparison group.

CONCLUSIONS

The NWC app produced trending changes in key areas of knowledge and behavior that may result in reduced AEP risk among urban Native young women. These findings suggest that the NWC app holds promise for addressing AEP in Native populations. Small changes in these areas may result in lifelong changes in the current generation that impact the health and wellbeing of generations to come.

Clinical features of patients who are admitted under different criteria of the Irish Mental Health Act 2001: a retrospective cohort study

OBJECTIVES

To examine the criteria utilised for detaining individuals under the Irish Mental Health Act 2001 (MHA 2001) and their association with clinical features.

METHODS

Demographic and clinical data of 505 involuntary admissions under the MHA 2001 between 2013 and 2023 were attained. Data included criteria utilised for detention and renewal, sociodemographic and clinical features associated with these criteria, and the use of coercive practices, such as seclusion and restraint.

RESULTS

The majority of patients who were involuntarily admitted (61.4%), or had their admission order affirmed by tribunal (78.2%), were not judged to pose an immediate risk to themselves or others. Patients admitted under the "impaired judgement criterion" were less likely to be secluded (χ2 = 15.8, p < 0.001) or restrained (χ2 = 11.6, p < 0.01). Patients admitted under the "risk criterion" were younger (KW = 12.7, p = 0.02), and less likely to have a psychotic disorder (χ2 = 5.9, p = <0.001) or have a previous involuntary admission (χ2 = 7.7, p = 0.02). Patients who were subject to coercive care were younger (U = 12739, p < 0.001), more likely to be male (χ2 = 4.6, p = 0.03), and have prolonged involuntary admissions (U = 18412, p = 0.02).

CONCLUSIONS

Currently, the majority of the involuntary care provided for patients under the MHA 2001 is not related to the risk criterion of causing immediate and serious harm to themselves or others, but rather to the criterion of impaired judgement. Patients admitted under the risk criterion are more often subjected to restrictive practices, but are less likely to suffer from psychosis, than those receiving involuntary care due to their impaired judgement.

Are alternative variables in a set differently associated with a target variable? Statistical tests and practical advice for dealing with dependent correlations

The analysis of multiple bivariate correlations is often carried out by conducting simple tests to check whether each of them is significantly different from zero. In addition, pairwise differences are often judged by eye or by comparing the p-values of the individual tests of significance despite the existence of statistical tests for differences between correlations. This paper uses simulation methods to assess the accuracy (empirical Type I error rate), power, and robustness of 10 tests designed to check the significance of the difference between two dependent correlations with overlapping variables (i.e., the correlation between X1 and Y and the correlation between X2 and Y). Five of the tests turned out to be inadvisable because their empirical Type I error rates under normality differ greatly from the nominal alpha level of .05 either across the board or within certain sub-ranges of the parameter space. The remaining five tests were acceptable and their merits were similar in terms of all comparison criteria, although none of them was robust across all forms of non-normality explored in the study. Practical recommendations are given for the choice of a statistical test to compare dependent correlations with overlapping variables.

Differences in suicide-specific attentional bias based on stimuli across the suicide Stroop and disengagement tasks

BACKGROUND

Evidence of suicide-specific attentional bias has been mixed, including the effect of specific suicide words (e.g., "suicide" versus "overdose"). The current study examined the psychometric properties and convergent validity of specific suicide words on the Stroop and disengagement tasks.

METHODS

Adults (79.8 % male, mean age = 42.19 ± 12.66) on a psychiatric inpatient unit completed both tasks, as well as clinical and demographic measures, following a recent suicide attempt (SA) (n = 55) or recent suicidal ideation (SI) with (n = 29) or without (n = 26) a SA history.

RESULTS

Mean reaction times (RTs) on both tasks demonstrated good internal consistency and were moderately correlated across tasks, while interference scores demonstrated poor reliability and were not correlated. Attentional bias to specific suicide words did not differentiate SA groups, except for a small, unexpected effect on the Stroop task showing greater interference to the word "funeral" among the recent SA group. Correlations with suicide risk factors differed for males and females.

LIMITATIONS

Participants all endorsed elevated SI, limiting generalizability beyond a recent suicidal crisis. Different suicide words were used on each task limiting direct comparisons. Groups based on SA history and gender were uneven, and correlations need to be replicated. Effects involving interference scores should be interpreted with caution given poor internal consistency.

CONCLUSION

The suicide Stroop and disengagement tasks partially capture distinct aspects of suicide-relevant attentional bias. Greater attention is needed regarding the particular stimuli and scoring methods as well as the role gender plays in suicide-relevant attentional bias.

Rural houselessness among people who use drugs in the United States: Results from the National Rural Opioid Initiative

BACKGROUND

Over the last two decades, houselessness and drug-related epidemics both have expanded from urban to rural regions across the United States (US). However, our understanding of the relationship between rural houselessness, drug use, and drug-related harms has not kept pace. The current study addresses this gap by describing houselessness among a large cohort of people who use drugs (PWUD) from rural communities across 10 states.

DESIGN

PWUD were recruited using modified chain-referral sampling for a cross-sectional survey capturing houselessness in the prior six months, drug use, drug-related harms, stigma, health service access, and sociodemographic characteristics. Using bivariate logistic regressions, we assessed associations between houselessness and participant characteristics. We also compare site-specific houselessness prevalence to Housing and Urban Development Point-in-Time (PIT) estimates, which are based on counts of sheltered and unsheltered people experiencing houselessness on a single night.

RESULTS

Among 3000 PWUD, 53.7 % reported experiencing houselessness. Houselessness was associated with multiple drug-related behaviors that increase the risk of overdose and acquisition of bloodborne infections. Houselessness prevalence was comparable and exceeded PIT estimates for several sites, even though study participants constituted <1 % of each site's adult population and were restricted to PWUD.

CONCLUSIONS

Our findings highlight that houselessness - historically considered an urban issue - is a significant public health concern for PWUD in rural areas. This demonstrates that addressing drug-related HIV, hepatitis C, and overdose epidemics, among others, in the rural US will require the provision of stable housing and harm reduction services as a pathway to treatment and recovery.

Transcellular transport of 18F-deoxyglucose via facilitative glucose channels in experimental peritoneal dialysis

BACKGROUND

Local and systemic side effects of glucose remain major limitations of peritoneal dialysis (PD). Glucose transport during PD is thought to occur via inter-endothelial pathways, but recent results show that phloretin, a general blocker of facilitative glucose channels (glucose transporters [GLUTs]), markedly reduced glucose diffusion capacity indicating that some glucose may be transferred via facilitative glucose channels (GLUTs). Whether such transport mainly occurs into (absorption), or across (trans-cellular) peritoneal cells is as yet unresolved.

METHODS

Here we sought to elucidate whether diffusion of radiolabeled 18F-deoxyglucose ([18F]-DG) in the opposite direction (plasma → dialysate) is also affected by GLUT inhibition. During GLUT inhibition, such transport may either be increased or unaltered (favors absorption hypothesis) or decreased (favors transcellular hypothesis). Effects on the transport of solutes other than [18F]-DG (or glucose) during GLUT inhibition indicate effects on paracellular transport (between cells) rather than via GLUTs.

RESULTS

GLUT inhibition using phloretin markedly reduced [18F]-DG diffusion capacity, improved ultrafiltration (UF) rates and enhanced the sodium dip. No other solutes were significantly affected with the exception of urea and bicarbonate.

CONCLUSION

The present results indicate that part of glucose is transported via the transcellular route across cells in the peritoneal membrane. Regardless of the channel(s) involved, inhibitors of facilitative GLUTs may be promising agents to improve UF efficacy in patients treated with PD.

Childhood maltreatment associated with adolescent peer networks: Withdrawal, avoidance, and fragmentation

BACKGROUND

Childhood maltreatment can affect subsequent social relationships, including different facets of peer relationships. Yet, how prior maltreatment shapes adolescents' connections within school peer networks is unclear, despite the rich literature showing the importance of this structural aspect of social integration in adolescence.

OBJECTIVES

This study examines how childhood physical abuse, emotional abuse, sexual abuse, and physical neglect predict adolescent social network structure as withdrawal, avoidance, and fragmentation among peers.

PARTICIPANTS AND SETTING

Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) Waves I, III, and IV yield a sample of 9154 respondents with valid network data and survey of childhood maltreatment.

METHODS

Models using linear regression examine childhood maltreatment predicting withdrawal, avoidance, and fragmentation in adolescent peer networks. Maltreatment is first measured as ever occurring, then separately by maltreatment type.

RESULTS

Results indicate that experiencing any maltreatment leads to withdrawal (lower sociality, B = -0.214, p = 0.008), avoidance (lower popularity, B = -0.222, p = 0.007), and fragmentation (lower cohesion, B = -0.009, p < 0.001). However, different types of maltreatment are associated with different dimensions of peer networks, with only physical neglect impacting all three dimensions.

CONCLUSIONS

Experiencing any maltreatment in childhood predicts lower integration in the adolescent peer network structure across three dimensions. However, distinct types of maltreatment relate differently to separate network dimensions, with sexual abuse predicting withdrawal, emotional and physical abuse predicting avoidance and fragmentation, and physical neglect predicting lower integration on all three dimensions.

Metabolomics in atrial fibrillation - A review and meta-analysis of blood, tissue and animal models

BACKGROUND

Atrial fibrillation (AF) is a highly prevalent cardiac arrhythmia associated with severe cardiovascular complications. AF presents a growing global challenge, however, current treatment strategies for AF do not address the underlying pathophysiology. To advance diagnosis and treatment of AF, a deeper understanding of AF root causes is needed. Metabolomics is a fast approach to identify, quantify and analyze metabolites in a given sample, such as human serum or atrial tissue. In the past two decades, metabolomics have enabled research on metabolite biomarkers to predict AF, metabolic features of AF, and testing metabolic mechanisms of AF in animal models. Due to the field's rapid evolution, the methods of AF metabolomics studies have not always been optimal. Metabolomics research has lacked standardization and requires expertise to face methodological challenges.

PURPOSE OF THE REVIEW

We summarize and meta-analyze metabolomics research on AF in human plasma and serum, atrial tissue, and animal models. We present the current progress on metabolic biomarkers candidates, metabolic features of clinical AF, and the translation of metabolomics findings from animal to human. We additionally discuss strengths and weaknesses of the metabolomics method and highlight opportunities for future AF metabolomics research.

Profiles of principal stress and coping: Concurrent and prospective correlates

This study utilized latent profile analysis (LPA) to examine patterns of principal stress and coping and its relations with principal (n = 125), teacher (n = 3671), and student (n = 19,390) outcomes. LPA analysis of school principals based on their reports of stress and coping showed that most principals were classified as having high stress and high coping (74%) whereas 19% of principals were classified as high stress and low coping. Only a small percentage of principals (7%) were characterized by low stress and high coping. We also examined whether stress and coping profiles of school principals predicted concurrent and prospective measures of principal and teacher well-being and efficacy, principal and teacher perceptions of school climate, and measures of student behavior and dispositions. The principal latent profiles significantly predicted concurrent and prospective measures of principal and teacher well-being, with large effect sizes for prospective principal health (Cohen's d = 1.93) and satisfaction (d = 0.94), and a medium effect size for prospective teacher health (d = 0.68). Changes in principal health (d = 1.30) and satisfaction (d = 0.49) over time were also significant. However, the latent profiles did not predict prospective measures of principal and teacher efficacy, perceptions of school climate, and student classroom behaviors. The results of this study show that examining patterns of principal stress and coping together is important to understand and improve principal and teacher well-being.

Interoception, emotion regulation strategies and skin-picking behaviors - Results of an intensive longitudinal study

Compulsive skin-picking is associated with emotion regulation difficulties, whose origins remain unclear. Interoception, plays an important role in effective emotion regulation. This study examined the relationship between interoception, emotion regulation strategies, and skin-picking in 136 individuals (85% women, aged 18-41), including 71 engaging in skin-picking and 65 psychologically healthy controls. We were interested in between-group differences in maladaptive and adaptive emotion regulation and aspects of interoception as well as associations of the latter with skin-picking symptoms and use of emotion regulation strategies. At baseline, we assessed habitual emotion regulation strategies (rumination, suppression, distraction, engagement, arousal control, reappraisal) and Interoceptive Sensibility (e.g., emotional awareness, body listening, self-regulation, noticing) through self-report questionnaires. Moreover, Interoceptive Accuracy (IAc) was measured via a Heartbeat Counting Task. Additionally, Ecological Momentary Assessment (EMA) over seven days was used to register use of emotion regulation strategies and the occurrence and severity of skin-picking episodes during that period. At baseline, the skin-picking group exhibited lower IAc, emotional awareness, and higher habitual use of rumination than control group. Lower IAc was associated with higher odds of reporting skin-picking episodes assessed during EMA. Body listening correlated with a reduced sense of control over skin-picking during EMA. In total sample, self-regulation was related to lower odds of using rumination during EMA and noticing with less use of cognitive reappraisal. The study highlights the complex relationship between interoception, emotion regulation, and skin-picking, offering new insights into the mechanisms underlying skin picking disorder.

Early mother-infant interactions within the context of childbirth-related posttraumatic stress symptoms

BACKGROUND

Childbirth may lead to perinatal mental health issues, such as childbirth-related posttraumatic stress symptoms (CB-PTSS), depression, and anxiety. Despite well explored mother-infant interactions in the context of maternal depression and anxiety, only limited studies investigated mother-infant interactions in the context of CB-PTSS, which is the aim of the present study.

METHODS

One-hundred mother-infant dyads in the French speaking part of Switzerland were classified into three groups: birth-related symptoms (BRS, i.e., symptoms of re-experiencing and avoidance) (n = 20), general symptoms (GS, i.e., symptoms of negative cognition and mood and hyperarousal) (n = 46), and non-symptomatic (NS) (n = 34) based on maternal report on PTSD Checklist for DSM-5 (PCL-5). At six months postpartum, mother-infant interactions were video-recorded and their quality was assessed using the Global Rating Scale. Data was analyzed using ordinal logistic and negative binomial regressions.

RESULTS

In the adjusted model, mothers in BRS group engaged in more frequent coercions compared to the NS group (B = -1.46, p = 0.01, 95%CI = -2.63, -0.36) and showed lower reciprocity in their interactions with their infants compared to the GS group (B = 1.21, p = 0.03, 95%CI = 0.05, 2.37).

LIMITATIONS

The use of a cross-sectional design limited the exploration of how consistent these findings are regarding mother-infant interactions between groups over time.

CONCLUSIONS

Mothers with higher BRS may need support to improve interactions with their infants. Future studies should consider longitudinal design to observe mother-infant interaction changes between CB-PTSS groups over time.

Why do undergraduate medical students choose medical humanities? A cross-sectional study at an Italian University

BACKGROUND

Medical humanities can contribute positively to clinical practice and medical education. Therefore, in many countries, medical schools have been progressively incorporating medical humanities into their curriculum. In Italy, only a few medical schools offer a variety of medical humanities courses, often as elective. What induces Italian medical students to take a medical humanities course has not yet been explored. The aim of this study is to fill this gap by investigating whether academic performance, sociodemographic and psychological variables may influence student motivation.

METHODS

We conducted a cross-sectional study in a medical school and collected data from 260 medical students, from the 3rd to the 6th year of the degree course. The students who chose to take a course in Medical Humanities were compared with those who chose not to take such a course, analysing numeric variables (age, grade point average, psychometric scores) and categorical variables (gender, nationality, educational level, living conditions). Motivations were investigated by open-ended questions and categorized prior to analyses.

RESULTS

The two subgroups showed no significant differences in sociodemographic characteristics, except for age, which was lower for the students who chose to take a medical humanities course (p < 0.001). Among the psychometric scores, only the anxiety score differed significantly between the groups, being lower for the students who chose a medical humanities course (p < 0.05). Regarding academic performance, the number of examinations passed was similar between the groups, while the average grade was lower for the students taking the course (p < 0.01). Interest in the humanities and their educational potential were the main reasons for choosing to take a course in medical humanities (76.2%). Concurrent commitments and lack of time were the major obstacles to this choice (39%).

CONCLUSIONS

Age, anxiety levels and academic performance seem to be inversely associated with the choice to take a medical humanities course. Considering the workload due to curricular activities when planning elective courses could increase student participation.

Reciprocal self-disclosure makes children feel more loved by their parents in the moment: A proof-of-concept experiment

Feeling loved by one's parents is critical for children's health and well-being. How can such feelings be fostered? A vital feature of loving interactions is reciprocal self-disclosure, where individuals disclose intimate information about themselves. In a proof-of-concept experiment, we examined whether encouraging reciprocal self-disclosure in parent-child dyads would make children feel more loved during the conversation. Participants were 218 children (ages 8-13, 50% girls, 94% Dutch) and one of their parents (ages 28-56, 62% women, 90% Dutch). Parent-child dyads received a list of 14 questions and took turns asking them each other for 9 min. Dyads were assigned randomly to engage in self-disclosure (questions invoking escalated intimacy) or small talk (questions invoking minimal intimacy). Before and after, children reported how loved they felt by their parent during the conversation. Self-disclosure made children feel more loved during the conversation than did small talk. Compared to small talk, self-disclosure did not instigate conversations that were lengthier or more positive; rather, it instigated conversations that were more emotionally charged (reflecting anger, anxiety, and sadness), social (discussing family and friends), reflective (creating insight), and meaningful (addressing deeply personal topics, including the passing of loved ones). The dyad's gender composition did not significantly moderate these effects. Our research suggests that reciprocal self-disclosure can make children feel more loved in the moment, uncovers linguistic signatures of reciprocal self-disclosure, and offers developmental scientists a tool to examine causal effects of reciprocal self-disclosure in parent-child dyads. Future work should examine long-term effects in everyday parent-child interactions. RESEARCH HIGHLIGHTS: How can parents make children feel more loved by them in the moment? We theorize that these feelings can be cultivated through reciprocal self-disclosure. In a proof-of-concept experiment, we examined effects of reciprocal self-disclosure versus small talk in 218 parent-child dyads, with children aged 8-13. Self-disclosure (vs. small talk) made children feel more loved during the conversation. Linguistically, self-disclosure instigated conversations that were more emotionally charged, social, reflective, and meaningful. This research provides an experimental method to study self-disclosure in parent-child dyads and suggests that self-disclosure can make children feel more loved in the moment.

Witnessing their mother's acute and prolonged stress affects executive functioning in children

Stress can detrimentally affect physical and mental health, especially during childhood. During this critical period, parental bonds can foster resilience or amplify stress. This study explored whether mothers' everyday stress can act as a source of childhood stress, affecting children's executive functioning. 76 healthy mother-child dyads participated, with mothers assigned to a stress-inducing or stress-free condition. Children observed their mothers and were subsequently tested for cognitive flexibility and working memory. Subjective stress, heart rate, and cortisol were measured repeatedly in mothers and children, alongside everyday stress perceptions. Linear mixed models showed that children's acute stress response was associated with impaired cognitive flexibility. Maternal stress, both acute and past-month, was a better predictor of children's cognitive performance than children's own stress. Quadratic relationships indicated the highest error rates at very low and high maternal stress. We found no evidence that children's working memory was impaired by their own or their mothers' stress. Although expected covariations of acute or prolonged stress between mothers and children were not observed, an interaction between maternal past-month stress and acute stress condition provided insights into adaptive mechanisms in children. These findings underscore the significant impact of maternal stress on children's executive functioning, illustrating how parental experiences shape children's everyday outcomes.

The effects of trauma-focused treatment on painful temporomandibular disorders, awake bruxism and sleep bruxism in patients with severe post-traumatic stress disorder

BACKGROUND

Chronic painful temporomandibular disorders (TMD), awake bruxism and sleep bruxism are often comorbid with post-traumatic stress disorder (PTSD), but the implications for treatment are unknown.

OBJECTIVE(S)

To explore the effects of PTSD treatment on these conditions. We hypothesized that chronic painful TMD, pain intensity, pain interference, awake bruxism and sleep bruxism would decrease after evidence-based trauma-focused treatment and that this decrease would be maintained at the 6-month follow-up.

METHODS

Individuals referred for PTSD treatment were assessed for chronic painful TMD (temporomandibular disorder pain screener), pain intensity, pain interference (Graded Chronic Pain Scale 2.0), awake bruxism and sleep bruxism (oral behaviours checklist) pre-, post-treatment and at the 6-month follow-up. Hypotheses were tested using the Friedman test, followed by a post hoc Wilcoxon signed-rank test. Effect sizes (Cohen's r) are reported. Barely any pain interference was reported, therefore these outcomes were not analysed.

RESULTS

In individuals with chronic painful TMD (n = 98), pain intensity, awake bruxism and sleep bruxism decreased across the three time points. Post hoc tests showed that chronic painful TMD (r = 0.59), pain intensity (r = 0.28), awake bruxism (r = 0.51) and sleep bruxism (r = 0.35) decreased between pre- and post-treatment. Between pre-treatment and the 6-month follow-up, chronic painful TMD (r = 0.58), awake bruxism (r = 0.30) and sleep bruxism (r = 0.39) decreased as well.

CONCLUSION

The results provide preliminary support for a trauma-sensitive approach for patients with chronic painful TMD and PTSD and suggest that trauma-focused treatment may be beneficial for chronic painful TMD, awake bruxism and sleep bruxism in patients with PTSD and chronic painful TMD.

Exploring the Efficacy of a Dynamic Harness System on Gross Motor Development and Motivation for Infants With Down Syndrome: A Pilot Study

PURPOSE

To explore the benefits of a Partial Body Weight Support (PBWS) harness system within a play enriched environment on gross motor development and mastery motivation of infants with Down Syndrome (DS).

METHODS

A randomized crossover study with 17 pre-walking infants with DS in two conditions-play with or without the harness engaged-each for 3×/week over 3 weeks with a 1-week washout. Assessments took place at baseline, crossover, and completion.

RESULTS

Statistically and clinically significant changes were evident on the Gross Motor Function Measure-88; however, there were no significant changes in parent-reported mastery motivation.

CONCLUSION

The combination of PBWS harness system support and high frequency-facilitated play within an enriched play environment positively affected gross motor development. The intervention did not impact mastery motivation skills, and the direct impact of the harness remains unclear.

Structural Learning in Autistic and Non-Autistic Children: A Replication and Extension

The hippocampus is involved in many cognitive domains which are difficult for autistic individuals. Our previous study using a Structural Learning task that has been shown to depend on hippocampal functioning found that structural learning is diminished in autistic adults (Ring et al., 2017). The aim of the present study was to examine whether those results can be replicated in and extended to a sample of autistic and non-autistic children. We tested 43 autistic children and 38 non-autistic children with a subsample of 25 autistic and 28 non-autistic children who were well-matched on IQ. The children took part in a Simple Discrimination task which a simpler form of compound learning, and a Structural Learning task. We expected both groups to perform similarly in Simple Discrimination but reduced performance by the autism group on the Structural Learning task, which is what we found in both the well-matched and the non-matched sample. However, contrary to our prediction and the findings from autistic adults in our previous study, autistic children demonstrated a capacity for Structural Learning and showed an overall better performance in the tasks than was seen in earlier studies. We discuss developmental differences in autism as well as the role of executive functions that may have contributed to better than predicted task performance in this study.

Empathic stress is decreased by prior stressor experience and increased in a position of power

The observation of a stressed individual can trigger a stress response in a passive observer. Little is known about the mechanisms of this so-termed empathic stress, including the observer's empathic involvement with the stressful situation. In 108 opposite-sex stranger dyads, we expected to increase the observer's empathic involvement with a stressed target performing a standardized laboratory stressor (Trier Social Stress Test, TSST; Kirschbaum et al., 1993) by exposing observers themselves to the TSST one week earlier. Conversely, we intended to decrease empathic involvement by granting observers a powerful position over the targets (by asking them to evaluate the targets' TSST performance and allegedly decide on their financial compensation). A control group without any manipulation was also included. In the preregistered data analysis, two types of empathic stress were investigated: vicarious stress, which evolves irrespective of the target's stress response, and stress resonance, which is proportional to the target's stress response. Irrespective of manipulation, observers exhibited vicarious stress in subjective and high-frequency heart rate variability (HF-HRV), and synchronized with the targets' stress reactivity in cortisol release. Prior TSST experience unexpectedly decreased observers' self-reported empathy and vicarious cortisol stress reactivity. The power manipulation, conversely, led to stronger observer vicarious stress in overall heart rate and HF-HRV reactivity. Based on Wondra and Ellsworth's (2015) appraisal theory, we propose that, due to their prior stressor exposure, observers habituated to said stressor, and consequently changed their evaluation of the target's stressful situation. In contrast, observers in the powerful position may have felt responsible for the targets, triggering a stronger vicarious stressful experience.

Registered report protocol: Stress testing predictive models of ideological prejudice

In this registered report, we propose to stress-test existing models for predicting the ideology-prejudice association, which varies in size and direction across target groups. Previous models of this relationship use the perceived ideology, status, and choice in group membership of target groups to predict the ideology-prejudice association across target groups. These analyses show that models using only the perceived ideology of the target group are more accurate and parsimonious in predicting the ideology-prejudice association than models using perceived status, choice, and all of the characteristics in a single model. Here, we stress-test the original models by testing the models' predictive utility with new measures of explicit prejudice, a comparative operationalization of prejudice, the Implicit Association Test, and additional target groups. In Study 1, we propose to directly test the previous models using an absolute measure of prejudice that closely resembles the measure used in the original study. This will tell us if the models replicate with distinct, yet conceptually similar measures of prejudice. In Study 2, we propose to develop new ideology-prejudice models for a comparative operationalization of prejudice using both explicit measures and the Implicit Association Test. We will then test these new models using data from the Ideology 2.0 project collected by Project Implicit. We do not have full access to this data yet, but upon acceptance of our Stage 1 registered report, we will gain access to the complete dataset. Currently, we have access to an exploratory subset of the data that we use to demonstrate the feasibility of the study, but its limited number of target groups prevents conclusions from being made.

Recalling and anticipating positive events to improve the positive affect and mental health of adolescents: A cluster randomized controlled trial in secondary schools

This cluster randomized controlled trial examined the effectiveness of Positive Events Training (PET), a combined group training aimed at simultaneously improving positive autobiographical memory (AM) and episodic future thinking (EFT) among adolescents (12-16 years). Delivered as a universal school-based program, PET was compared with an active (creative writing) control group (CREAT). Effects on resilience, wellbeing, positive emotions, emotional response styles towards positive emotions (savoring, dampening), anhedonia, depressive symptoms, and multiple AM and EFT indices were examined. Adolescents (NPET = 95, NCREAT = 93) completed self-report scales at baseline, post-training and two-month follow-up. Multilevel models revealed that PET led to significant improvements in certain AM and EFT skills. Moreover, a decrease in anhedonia was observed at post-training. However, this effect did not withstand correction for multiple testing. Absence of changes in the other outcomes should be interpreted within the context of the universal school-based approach and the potential limited scope for detectable changes. Exploratory analyses suggest the importance of further investigating PET's potential in addressing positive affect dysregulations in indicated samples, and exploring perceived likelihood of generated future events and dampening as potential underlying mechanisms. Study limitations and future directions to maximize the demonstrated potential of PET are discussed.

Comparative study of perceived invalidating environment and stress coping strategies between patients with drug resistant epilepsy and functional dissociative seizures

BACKGROUND AND OBJECTIVES

We investigated perceived invalidating environment during childhood and stress-coping strategies in patients with; functional dissociative seizures (FDS, n=26), drug-resistant epilepsy patients with no psychiatric comorbidity (DREnc, n=23), and drug-resistant epilepsy patients with psychiatric comorbidity (DREpc, n=34).

DESIGN/METHODS

We performed a cross-sectional study. Patients underwent Video Electroencephalography to confirm the diagnosis and completed a psychiatric assessment supported by clinical instruments. Invalidating environment and stress coping were studied through the ICES and CAE questionaries, respectively. A series of multinomial logistic regression analyses were performed with the explored variables.

RESULTS

The maternal negative response model predicted a higher probability of FDS condition. A chaotic family type increased the likelihood of DREpc instead of FDS. DREpc and FDS patients displayed many different behaviors to cope with stress other than trying to solve the problem, the most used strategy in the DREnc group. Parental invalidation was higher in DREpc than in FDS.

CONCLUSIONS

Our results deepen the data provided by previous studies indicating that multiple variables of biosocial origin have significant effects on these groups of patients. The presence of an invalidating environment may predict FDS but also the presence of psychiatric disorders among DRE. Psychotherapeutic strategies to enhance these variables might be necessary for this population.

Insomnia symptoms and neurofunctional correlates among adults receiving buprenorphine for opioid use disorder

OBJECTIVES

Insomnia symptoms are negatively related to opioid use disorder (OUD) treatment outcomes, possibly reflecting the influence of sleep on neurofunctional domains implicated in addiction. Moreover, the intersection between OUD recovery and sleep represents an area well-suited for the development of novel, personalized treatment strategies. This study assessed the prevalence of clinically significant insomnia symptoms and characterized its neurofunctional correlates among a clinical sample of adults with OUD receiving buprenorphine.

METHODS

Adults (N = 129) receiving buprenorphine for OUD from an outpatient clinic participated in a cross-sectional survey. Participants completed an abbreviated version of NIDA's Phenotyping Assessment Battery, which assessed 6 neurofunctional domains: sleep, negative emotionality, metacognition, interoception, cognition, and reward. Bivariate descriptive statistics compared those with evidence of clinically significant insomnia symptoms (Insomnia Severity Index [ISI] score of ≥11) to those with minimal evidence of clinically significant insomnia symptoms (ISI score of ≤10) across each of the neurofunctional domains.

RESULTS

Roughly 60% of participants reported clinically significant insomnia symptoms (ISI score of ≥11). Experiencing clinically significant insomnia symptoms was associated with reporting greater levels of depression, anxiety, post-traumatic stress, stress intolerance, unhelpful metacognition, and interoceptive awareness (ps<0.05). Participants with evidence of clinically significant insomnia were more likely to report that poor sleep was interfering with their OUD treatment and that improved sleep would assist with their treatment (ps<0.05).

CONCLUSIONS

Insomnia was prevalent among adults receiving buprenorphine for OUD. Insomnia was associated with neurofunctional performance, which may impact OUD treatment trajectories. Our findings indicate potential targets in the development of personalized treatment plans for patients with co-morbid insomnia and OUD. To inform the development of novel treatment strategies, more research is needed to understand the potential mechanistic links between sleep disturbances and substance use.

Role of parental educational level as psychosocial factor in a sample of inpatients with anorexia nervosa and bulimia nervosa

Introduction

Evidence on parental educational level (PEL) as a risk factor for Eating Disorders (EDs) is mixed, and no study has assessed its role in relation to the compliance and outcomes of treatments in EDs. Further, no study differentiated from the educational level of mothers and fathers, nor considered the possible mediation of perfectionism in fostering EDs.

Methods

A clinical sample of 242 first-ever admitted inpatients with EDs provided information on PEL and completed the following questionnaires: the Eating Disorder Examination Questionnaire (EDE-Q) and the Frost Multidimensional Perfectionism Scale (F-MPS). Clinicians also provided information on the Hamilton Rating Scale for Anxiety (HAM-A) and the Hamilton Rating Scale for Depression (HAM-D) for each participant.

Results

Individuals with high PEL (whether mothers, fathers, or both parents) showed significantly higher scores on depressive symptoms and lower on parental criticism, were younger, had an earlier age of onset, had fewer years of illness, more were students and employed, and fewer had offspring. Individuals with fathers or both parents with high educational levels suffered more from Anorexia Nervosa rather than Bulimia Nervosa, had a longer length of stay during the current hospitalization, had less dietary restraint, and had higher personal standards. Individuals with mothers with high educational levels showed a lower rate of previous substance or alcohol addiction. Personal standards partially mediated the relationship between higher PEL and lower dietary restraint.

Discussion

PEL emerged to be a twofold psychosocial risk factor, being associated with higher depressive symptoms and a longer length of stay, but also with a shorter duration of illness and better scholar and working involvement. Higher PEL was related to higher personal standards but not to global perfectionism. Patterns of eating psychopathology emerged based on the high PEL of mothers or fathers.

Determining the Innovativeness of Nurses Who Engage in Activities That Encourage Innovative Behaviors

BACKGROUND

We sought to understand the innovativeness of nurses engaging in innovative behaviors and quantify the associated characteristics that make nurses more able to innovate in practice. We first compared the innovativeness scores of our population; then we examined those who self-identified as an innovator versus those who did not to explore differences associated with innovativeness between these groups.

METHODS

A cross-sectional survey study of nurses in the US engaging in innovative behaviors was performed. We performed an exploratory factor analysis (EFA) to determine the correlates of innovative behavior.

RESULTS

Three-hundred and twenty-nine respondents completed the survey. Respondents who viewed themselves as innovators had greater exposure to HCD/DT workshops in the past year (55.8% vs. 36.6%, p = 0.02). The mean innovativeness score of our sample was 120.3 ± 11.2 out of a score of 140. The mean innovativeness score was higher for those who self-identified as an innovator compared with those who did not (121.3 ± 10.2 vs. 112.9 ± 14.8, p =< 0.001). The EFA created four factor groups: Factor 1 (risk aversion), Factor 2 (willingness to try new things), Factor 3 (creativity and originality) and Factor 4 (being challenged).

CONCLUSION

Nurses who view themselves as innovators have higher innovativeness scores compared with those who do not. Multiple individual and organizational characteristics are associated with the innovativeness of nurses.

Development of a Dyad-Focused Intervention for Stroke Survivors and Their Family Caregivers: A Feasibility Study

IMPORTANCE

Transitioning from the hospital to the community poses significant challenges for stroke survivors and their caregivers.

OBJECTIVE

To examine the feasibility and preliminary effects of a dyad-focused strategy training intervention.

DESIGN

Single-arm trial with data collection at baseline, postintervention, and 3-mo follow-up.

SETTING

Rehabilitation settings in Taiwan.

PARTICIPANTS

Sixteen stroke survivor-caregiver dyads.

INTERVENTIONS

Dyad-focused strategy training was provided to stroke survivor-caregiver dyads twice a week over 6 wk. The training included shared decision-making, goal setting, performance evaluation, strategy development and implementation, and therapeutic guided discovery.

OUTCOMES AND MEASURES

Feasibility indicators were Goal Attainment Scaling, Dyadic Relationship Scale, Participation Measure-3 Domains, 4 Dimensions, Activity Measure for Post-Acute Care, Montreal Cognitive Assessment, Trail Making Test, Stroop Color and Word Test, Preparedness for Caregiving Scale, and Zarit Burden Interview.

RESULTS

In total, 15 dyads completed all intervention sessions with full attendance. Both stroke survivors and their caregivers demonstrated high engagement and comprehension and reported moderate to high satisfaction with the intervention. From baseline to postintervention, the effects on goal attainment, frequency and perceived difficulty of community participation, executive function, mobility function, and caregiver preparedness were significant and positive.

CONCLUSIONS AND RELEVANCE

Our study supports the feasibility and preliminary efficacy of dyad-focused strategy training for stroke survivor-caregiver dyads transitioning from the hospital to the community in Taiwan. Our preliminary evidence indicates that dyads who receive strategy training exhibit advancement toward their goals and experience considerable enhancements in their individual outcomes. Plain-Language Summary: This study addresses the scarcity of interventions catering to both stroke survivors and their caregivers. By demonstrating the feasibility of our dyad-focused intervention, the research offers preliminary evidence that supports the potential advantages of involving both stroke survivors and their caregivers in the intervention process.

Exploratory focused pharmacogenetic testing reveals novel markers associated with risperidone pharmacokinetics in Saudi children with autism

Background: Autism spectrum disorders (ASDs) encompass a broad range of phenotypes characterized by diverse neurological alterations. Genomic studies have revealed considerable overlap between the molecular mechanisms implicated in the etiology of ASD and genes involved in the pharmacokinetic (PK) and pharmacodynamic (PD) pathways of antipsychotic drugs employed in ASD management. Given the conflicting data originating from candidate PK or PD gene association studies in diverse ethnogeographic ASD populations, dosage individualization based on "actionable" pharmacogenetic (PGx) markers has limited application in clinical practice. Additionally, off-label use of different antipsychotics is an ongoing practice, which is justified given the shortage of approved cures, despite the lack of satisfactory evidence for its safety according to precision medicine. This exploratory study aimed to identify PGx markers predictive of risperidone (RIS) exposure in autistic Saudi children. Methods: This prospective cohort study enrolled 89 Saudi children with ASD treated with RIS-based antipsychotic therapy. Plasma levels of RIS and 9-OH-RIS were measured using a liquid chromatography-tandem mass spectrometry system. To enable focused exploratory testing, genotyping was performed with the Axiom PharmacoFocus Array, which included a collection of probe sets targeting PK/PD genes. A total of 720 PGx markers were included in the association analysis. Results: A total of 27 PGx variants were found to have a prominent impact on various RIS PK parameters; most were not located within the genes involved in the classical RIS PK pathway. Specifically, 8 markers in 7 genes were identified as the PGx markers with the strongest impact on RIS levels (p < 0.01). Four PGx variants in 3 genes were strongly associated with 9-OH-RIS levels, while 5 markers in 5 different genes explained the interindividual variability in the total active moiety. Notably, 6 CYP2D6 variants exhibited strong linkage disequilibrium; however, they significantly influenced only the metabolic ratio and had no considerable effects on the individual estimates of RIS, 9-OH-RIS, or the total active moiety. After correction for multiple testing, rs78998153 in UGT2B17 (which is highly expressed in the brain) remained the most significant PGx marker positively adjusting the metabolic ratio. For the first time, certain human leukocyte antigen (HLA) markers were found to enhance various RIS exposure parameters, which reinforces the gut-brain axis theory of ASD etiology and its suggested inflammatory impacts on drug bioavailability through modulation of the brain, gastrointestinal tract and/or hepatic expression of metabolizing enzymes and transporters. Conclusion: Our hypothesis-generating approach identified a broad spectrum of PGx markers that interactively influence RIS exposure in ASD children, which indicated the need for further validation in population PK modeling studies to define polygenic scores for antipsychotic efficacy and safety, which could facilitate personalized therapeutic decision-making in this complex neurodevelopmental condition.

School Racial Composition as a Moderator of the Effect of Discrimination on Mental Health and Substance use Among American Indian Adolescents

PURPOSE

To examine the relationships between individual-level perceived racial/ethnic discrimination and mental health and substance use outcomes by school-level racial composition among American Indian (AI) adolescents.

METHOD

Self-reported survey data on individual-level variables come from a sample of AI adolescents (n = 510) living in or near the Cherokee Nation during the fall of 2021. School-level data come from publicly available databases. Multilevel linear and logistic regression analyses were performed to test for and examine the interaction between perceived racial/ethnic discrimination and school racial composition in relation to symptoms of anxiety and depression, past 30-day use of alcohol and marijuana, and misuse of prescription opioids.

RESULTS

Adjusted analyses showed a significant interaction effect between discrimination and racial composition on anxiety symptoms, such that the effect of discrimination was more pronounced at lower % AI (10th percentile) than at more equivalently mixed (50th percentile) or higher % AI (90th percentile) school settings. No significant interactions were observed with depressive symptoms or substance use outcomes.

DISCUSSION

School racial compositions of higher percentage AI may buffer the adverse effect of racial/ethnic discrimination on anxiety symptoms among AI adolescents.

Peri-Saccadic Orientation Identification Performance and Visual Neural Sensitivity Are Higher in the Upper Visual Field

Visual neural processing is distributed among a multitude of sensory and sensory-motor brain areas exhibiting varying degrees of functional specializations and spatial representational anisotropies. Such diversity raises the question of how perceptual performance is determined, at any one moment in time, during natural active visual behavior. Here, exploiting a known dichotomy between the primary visual cortex (V1) and superior colliculus (SC) in representing either the upper or lower visual fields, we asked whether peri-saccadic orientation identification performance is dominated by one or the other spatial anisotropy. Humans (48 participants, 29 females) reported the orientation of peri-saccadic upper visual field stimuli significantly better than lower visual field stimuli, unlike their performance during steady-state gaze fixation, and contrary to expected perceptual superiority in the lower visual field in the absence of saccades. Consistent with this, peri-saccadic superior colliculus visual neural responses in two male rhesus macaque monkeys were also significantly stronger in the upper visual field than in the lower visual field. Thus, peri-saccadic orientation identification performance is more in line with oculomotor, rather than visual, map spatial anisotropies.SIGNIFICANCE STATEMENT Different brain areas respond to visual stimulation, but they differ in the degrees of functional specializations and spatial anisotropies that they exhibit. For example, the superior colliculus (SC) both responds to visual stimulation, like the primary visual cortex (V1), and controls oculomotor behavior. Compared with the primary visual cortex, the superior colliculus exhibits an opposite pattern of upper/lower visual field anisotropy, being more sensitive to the upper visual field. Here, we show that human peri-saccadic orientation identification performance is better in the upper compared with the lower visual field. Consistent with this, monkey superior colliculus visual neural responses to peri-saccadic stimuli follow a similar pattern. Our results indicate that peri-saccadic perceptual performance reflects oculomotor, rather than visual, map spatial anisotropies.