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Relatively few studies focused on the coping strategies adopted by the healthcare workers during the second phase of the pandemic. The present study compared the coping strategies between Italian nurses working in Covid-19 and in other units and it explored whether socio-demographic and work-related variables moderate the relation between the type of unit and coping strategies.A web-based questionnaire that included sociodemographic and work-related questions and the Coping Orientation to Problem Experienced-New Italian Version-25 item was administered. Moderation effects between variables and coping strategies were analyzed using generalized linear models.253 nurses participated. Nurses who worked in a Covid-19 unit had significantly lower scores on Avoidance Strategies subscale and higher scores on Positive Attitude and Social Support subscales than nurses working in other units.Gender differences emerged only on the social support coping dimension, with women being more likely to adopt social support than men. No association between the type of unit and the other coping strategies was found.Nurses working in Covid-19 units showed better coping strategies than their colleagues: this suggests that support interventions aimed to promote coping strategies should be offered also to Covid-19-free units' nurses.

Background As COVID-19 continues to spread globally, it is important to understand psychological factors that may influence compliance with social distancing. Purpose The present study examined whether Theory of Planned Behavior (TPB) constructs were associated with social distancing, with a focus on exploring moderators of the intention–behavior relationship. Methods Using a longitudinal design, U.S. adults (N = 507) self-reported TPB constructs and social distancing behavior at baseline and 3 months later. Participants were from 48 U.S. States and the District of Columbia and were on average 50.39 years old (SD = 15.32, range = 18–80). The majority were Non-Hispanic White (71.6%), had a bachelor’s degree or higher (55.3%), and resided in suburban areas (55.8%). Results While positive attitudes toward social distancing increased over time (p = .002), subjective norms weakened (p < .001) and perceived behavioral control (PBC) remained stable (p = .22). Interestingly, despite an increase in intentions from baseline to follow-up (p < .001), there was a significant decrease in social distancing behavior over time (p < .001). Consistent with the TPB, baseline attitudes (p < .001), subjective norms (p < .001), and PBC (p < .001) for social distancing were all associated with baseline intentions to social distance. In turn, baseline intentions were significantly associated with social distancing behavior at follow-up (p < .001). Younger adults (p < .001) and non-White participants (p = .002) displayed a greater intention–behavior gap relative to older and White participants. In contrast, participants with more stable intentions over time displayed a stronger intention–behavior relationship (p < .001). Conclusions Targeting individuals’ attitudes, norms, and PBC may effectively promote protective behaviors intended to mitigate the spread of COVID-19 and similar viral outbreaks. Future research should examine effective strategies for translating social distancing intentions into actions., Social distancing attitudes, norms, perceived behavioral control, and intentions were associated with social distancing behavior at 3-month follow-up. Racial minorities and younger adults displayed larger intention-behavior gaps.

Background The Hawthorne Effect occurs when participants alter their behavior when they are aware that they are being examined. The effect has been reported in many experiments, including gait analysis, and is considered an important source of bias that might impact both clinical and research results. Cognitive distraction is one potential solution to reducing the Hawthorne effect during gait analysis, but it is challenging in children, and can, in itself, alter gait. This study investigated the carryover effect of an alternative low-immersion avatar-based intervention on gait and subjective feelings in typically developing children. Research Question Will a low-immersion avatar-based intervention change feelings and indicators of temporospatial and kinematic outcomes in children in a laboratory setting, potentially reducing the Hawthorne Effect? Methods Typically developing children aged 5–13 participated in a standard laboratory gait analysis before experiencing a game in which they viewed their motion on monitors around the lab as that of a cartoon avatar in a 3D virtual environment. Following this intervention, standard walking trials were repeated. In addition, participants completed a survey of their feelings about the study both before onset and after completion. Results Thirty-one children participated in the study, 16 females and 15 males, mean aged 9.1 years. Arm swing, proposed as a measure of how relaxed and natural gait was, increased significantly following the intervention, while temporospatial parameters did not. The effect was more pronounced in females and younger children. Participants felt significantly happier, more excited, less scared, and less sad after the intervention. Changes in feelings were not closely associated with changes in gait. Significance This study suggests that gamification may reduce the Hawthorne effect and potentially produce more natural gait in children. The game intervention had a carryover effect, producing changes in gait even after the intervention was removed.

Statistical analyses of randomized controlled trials (RCTs) yield a causally valid estimate of the overall treatment effect, which is the contrast between the outcomes in two randomized treatment groups commonly accompanied by a confidence interval. In addition, the trial investigators may want to examine whether the observed treatment effect varies across patient subgroups (also called 'heterogeneity of treatment effects'), i.e. whether the treatment effect is modified by the value of a variable assessed at baseline. The statistical approach for this evaluation of potential effect modifiers is a test for statistical interaction to evaluate whether the treatment effect varies across levels of the effect modifier. In this article, we provide a concise and nontechnical explanation of the use of simple statistical tests for interaction to identify effect modifiers in RCTs. We explain how to calculate the test of interaction by hand, applied to a dataset with simulated data on 1,000 imaginary participants for illustration. (C) 2021 The Author(s). Published by Elsevier Inc.

OBJECTIVE According to the pristine conditions hypothesis, high-confidence identifications will be "remarkably accurate" when identification procedures (i.e., system variables, e.g., fair filler selection, double-blind administration, unbiased lineup instructions) are optimal, even if estimator variables (e.g., weapon presence, lighting, distance) are suboptimal (Wixted & Wells, 2017, p. 10). This has led some to conclude that estimator variables are not of much importance under those conditions. HYPOTHESIS We hypothesized that when multiple estimator variables are deficient, even high-confidence identifications will be less accurate than they would be when multiple estimator variables are optimal. METHOD With a sample of 2,191 college students (Mage = 20.14, 73% women), we conducted a strong test of this hypothesis by comparing a situation in which estimator variables were manipulated to produce either very good or very poor memory performance. RESULTS High-confidence suspect identifications were made significantly less frequently under poor viewing conditions than under good viewing conditions, and these differences are substantial if one assumes low base rates of guilt. CONCLUSIONS Estimator variables can be important for evaluating even high-confidence suspect identifications and establish some important boundary conditions for the pristine conditions hypothesis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

OBJECTIVE We quantitatively reviewed the construct validity evidence for all cognitively based indirect measures of sexual interest in prepubescent children (pedophilic interest) and pubescent children (hebephilic interest) using meta-analysis. METHOD Studies were included if they presented scores on a cognitively based indirect measure of pedohebephilic interest for a sample of adolescent or adult males who had committed a sexual offense against a child 16 years of age or younger, or who reported sexual interest in children, and for a comparison group. Studies were also included if they reported on the strength of association between scores on an indirect measure and an independent indicator of pedohebephilic interest in a sample of males. We used meta-analysis with robust variance estimation to summarize effect sizes and metaregression to test potential moderators. RESULTS Cognitively based indirect measures of pedohebephilic interest showed a moderate difference between pedohebephilic (n = 2,552) and nonpedohebephilic males (n = 2,434), d = 0.61, 95% CI [0.46, 0.76], k = 39. A small-to-moderate correlation was also observed between indirect measures and independent indicators of pedohebephilic interest, r = .23, 95% CI [0.17, 0.28], k = 23, n = 3,623. These effects were qualified by substantial heterogeneity; however, most moderators we tested did not account for a significant amount of heterogeneity. CONCLUSIONS Findings suggest that publication bias did not substantially distort the results. However, the lack of significant moderators suggests more research is needed to understand the conditions under which indirect measures best reflect pedohebephilic interest. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

We aimed to assess whether high-density lipoprotein (HDL) cholesterol modifies the association between adiponectin and incident cardiovascular (CV) morbidity and mortality in Type 2 Diabetes Mellitus (T2DM) and vice versa. At baseline, 106 T2DM participants with various degrees of renal function were enrolled and followed up over a period of 7 years with fatal/nonfatal CV events as outcome. During the follow-up, 49 participants experienced incident CV events (28 fatal, 21 nonfatal). On univariate Fine and Gray sub-hazard models, HDL cholesterol was a strong modifier of the association between adiponectin and CV outcomes both on crude (P = 0.011) and gender- and eGFR-adjusted models (P = 0.010). The protective effect for CV events portended by a fixed increase in adiponectin (1 μg/ml) was progressively higher across increasing values of HDL cholesterol. Moreover, plasma adiponectin also modified the protective effect of HDL on CV outcomes both in crude and multivariate analyses. We found a mutual effect modification between adiponectin and HDL as risk factors of CV events in participants with T2DM. Our results are coherent with the hypothesis that HDL cholesterol might play a pivotal role in the interpretation of the association between adiponectin and the risk of adverse CV outcomes in this population.

Age-at-onset (AAO) affects psychiatric disorder outcome; substance (SUDs) or alcohol use disorders (AUDs) may influence their onset. Affective temperaments may affect early AAO and drug-use proneness.

A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (e.g., warmer environments1, younger populations2–4) have yet to be framed within a comprehensive analysis accounting for factors that may offset the effects of climate and demography. Here, we synthesize factors hypothesized to shape the pace of this pandemic and its burden as it moves across SSA, encompassing demographic, comorbidity, climatic, healthcare and intervention capacity, and human mobility dimensions of risk. We find large scale diversity in probable drivers, such that outcomes are likely to be highly variable among SSA countries. While simulation shows that extensive climatic variation among SSA population centers has little effect on early outbreak trajectories, heterogeneity in connectivity is likely to play a large role in shaping the pace of viral spread. The prolonged, asynchronous outbreaks expected in weakly connected settings may result in extended stress to health systems. In addition, the observed variability in comorbidities and access to care will likely modulate the severity of infection: We show that even small shifts in the infection fatality ratio towards younger ages, which are likely in high risk settings, can eliminate the protective effect of younger populations. We highlight countries with elevated risk of ‘slow pace’, high burden outbreaks. Empirical data on the spatial extent of outbreaks within SSA countries, their patterns in severity over age, and the relationship between epidemic pace and health system disruptions are urgently needed to guide efforts to mitigate the high burden scenarios explored here.

Prehabilitation is a new field of research that aims to optimize modifiable surgical risk factors before surgery to improve patient-oriented outcomes preoperatively and postoperatively. As with any new intervention, the pressing questions that arise include what interventions work, for whom they work, and when do they work best? Given that prehabilitation can be resource intensive, and that preoperative patient characteristics are likely to produce variation in response to treatment, establishing answers to these questions is critical for successful implementation of prehabilitation in clinical practice. The objective of this review article is to describe the illuminating potential of including "third-variable effects" into the integration of research design; by planning for and including measurements of mediators, moderators, and confounders in the design and analysis of prehabilitation research, we can begin to answer practical, clinically relevant questions.

Responses to survey questions about abortion are affected by a wide range of factors, including stigma, fear, and cultural norms. However, we know little about how interviewers might affect responses to survey questions on abortion. The aim of this study is to assess how interviewers affect the probability of women reporting abortions in nationally representative household surveys: Demographic and Health Surveys (DHS). We use cross-classified random intercepts at the level of the interviewer and the sampling cluster in a Bayesian framework to analyze the impact of interviewers on the probability of reporting abortions in 22 DHS conducted worldwide. Household surveys are the only available data we can use to study the determinants and pathways of abortion in detail and in a representative manner. Our analyses are motivated by improving our understanding of the reliability of these data. Results show an interviewer effect accounting for between 0.2% and 50% of the variance in the odds of a woman reporting ever having had an abortion, after women's demographic characteristics are controlled for. In contrast, sampling cluster effects are much lower in magnitude. Our findings suggest the need for additional effort in assessing the causes of abortion underreporting in household surveys, including interviewers' skills and characteristics. This study also has important implications for improving the collection of other sensitive demographic data (e.g., gender-based violence and sexual health). Data quality of responses to sensitive questions could be improved with more attention to interviewers—their recruitment, training, and characteristics. Future analyses will need to account for the role of interviewer to more fully understand possible data biases.

We investigate the relationship of morality and political orientation by focusing on the influential results showing that liberals and conservatives rely on different moral foundations. We conducted a comprehensive literature search from major databases and other sources for primary studies that used the Moral Foundations Questionnaire and a typical measure of political orientation, a political self-placement item. We used a predefined process for independent extraction of effect sizes by two authors and ran both study-level and individual-level analyses. With 89 samples, 605 effect sizes, and 33,804 independent participants, in addition to 192,870 participants from the widely used YourMorals.org website, the basic differences about conservatives and liberals are supported. Yet, heterogeneity is moderate, and the results may be less generalizable across samples and political cultures than previously thought. The effect sizes obtained from the YourMorals.org data appear inflated compared with independent samples, which is partly related to political interest and may be because of self-selection. The association of moral foundations to political orientation varies culturally (between regions and countries) and subculturally (between White and Black respondents and in response to political interest). The associations also differ depending on the choice of the social or economic dimension and its labeling, supporting both the bidimensional model of political orientation and the findings that the dimensions are often strongly correlated. Our findings have implications for interpreting published studies, as well as designing new ones where the political aspect of morality is relevant. The results are primarily limited by the validity of the measures and the homogeneity of the included studies in terms of sample origins. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Household chaos-characterized by disorganization and instability within the home-is inversely associated with child executive functioning and effortful control, although a quantitative synthesis of the findings is currently lacking. This meta-analysis incorporated 35 studies with 36 independent effect sizes including 16,480 children. Several moderators were assessed, the most fundamental involving method (i.e., informant-completed questionnaire vs. direct assessment) of assessing executive functions. The analyses revealed a significant overall effect of r = .16. Only measurement approach of executive functions significantly moderated this association: Informant-completed questionnaires yielded an effect of r = .23, as compared with direct assessment, r = .11; however, both effects were significant. Based on substantive and statistical considerations, questionnaire and direct assessment effects were then meta-analyzed separately. Although effect sizes proved heterogeneous in the context of questionnaires, analyses revealed no significant moderators. Within direct assessment effects, both household chaos dimensions were significantly related to child executive functions, but instability was a stronger correlate (r = .17) than disorganization (r = .06). Results highlight the need for fuller investigation of differences in construct measurement presented by questionnaire and direct assessment approaches to child executive functions. At present, it appears prudent to adopt a multimethod approach to assessment. Ultimately, a greater focus on quasi-experimental designs examining the mechanisms by which events destabilize child executive functions is essential to a rigorous understanding of the relation between environmental features and child cognitive function. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychological Bulletin has long enjoyed a reputation as a source for what research has revealed about psychological phenomena; it maintains a prestigious position of leadership in psychological science and for science at large; it publishes evidence syntheses that are the most comprehensive and rigorous reviews available; it informs theorists and practitioners. I am duly honored to be selected as its editor; accordingly, my goal is to guard this tradition and, to the greatest extent possible, improve the rigor and transparency of submissions. Incorporating advances in evidence synthesis methods will help ensure that the Bulletin retains its esteemed position. Thus, I encourage the strongest possible scholarly evidence syntheses addressing central psychological issues. It is important to use contemporary methods for evidence synthesis because evidence syntheses are a form of metascience, using science to understand trends in science. Stronger methods have the potential to reduce error and the play of chance, making conclusions more trustworthy. Importantly, therefore, carefully conducted evidence syntheses offer the hope of transforming particular domains of research. Accordingly, this editorial will focus on some strategies that deserve, in my opinion, greater use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The beta-interferons are widely prescribed platform therapies for patients with multiple sclerosis (MS). We accessed a cohort of patients with relapsing-onset MS from British Columbia, Canada (1995–2013), to examine the potential survival advantage associated with beta-interferon exposure using a marginal structural model. Accounting for potential treatment-confounder feedback between comorbidity, MS disease progression, and beta-interferon exposure, we found an association between beta-interferon exposure of at least 6 contiguous months and improved survival (hazard ratio (HR) = 0.63, 95% confidence interval 0.47, 0.86). We also assessed potential effect modifications by sex, baseline age, or baseline disease duration, and found these factors to be important effect modifiers. Sparse follow-up due to variability in patient contact with the health system is one of the biggest challenges in longitudinal analyses. We considered several single-level and multilevel multiple imputation approaches to deal with sparse follow-up and disease progression information; both types of approach produced similar estimates. Compared to ad hoc imputation approaches, such as linear interpolation (HR = 0.63), and last observation carried forward (HR = 0.65), all multiple imputation approaches produced a smaller hazard ratio (HR = 0.53), although the direction of effect and conclusions drawn concerning the survival advantage remained the same.

Researchers have identified that experiences of body-related shame significantly contribute to heightened depressive symptoms, and therefore it is valuable to identify and understand potential factors that buffer this relationship. The present study examined the cross-sectional relationship between body-related shame and depressive symptoms separately among women and men, and tested self-compassion as a potential moderator. Data from a sample of 520 adults (42.3 % women; Mage = 35.43, SD = 10.09 years) recruited through MTurk were analyzed using moderated regression analysis. Results indicated that body-related shame was positively and significantly associated with frequency of depressive symptoms. Additionally, self-compassion moderated the relationship between body-related shame and depression among women, but not men, even after controlling for self-esteem. Specifically, women with lower levels of self-compassion reported a significantly stronger relationship between body-related shame and depressive symptoms, and at higher levels of self-compassion, there was no relationship between body shame and depressive symptoms. These findings have practical implications and suggest that low levels of self-compassion may increase the risk of depressive symptoms, and high levels of self-compassion may be protective among women that experience body-related shame.

To date, a number of studies have reported an association between body appreciation and body mass index (BMI), but the findings are not consistent. Using a meta-analytic approach, the current study aimed to clarify this association as well as to explore what factors might have contributed to the inconsistency across previous studies. By searching and screening potential studies published up to June 2019 in four databases, we identified 26 articles that reported an association between body appreciation and BMI among males, and 59 articles among females. Under a random-effects model, among males the overall estimate of the association between body appreciation and BMI was negative and small, with the pooled r = -.20 (95 % CI: -.25, -.14) and an adjusted (for publication bias) pooled r = -.11 (95 % CI: -.16, -.06). Among females, the overall estimate of the association was negative and small (but close to moderate), with r = -.27 (95 % CI: -.30, -.24). A mixed-effects model identified several moderators that contributed to the inconsistency across previous studies. These results indicate that the overall negative association between body appreciation and BMI is weak among males, and slightly larger among females. Potential explanations, implications, and future research directions are discussed.

Whether ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers modify colorectal cancer risk remains controversial. We aimed to determine association between their use and colorectal cancer risk after a negative baseline colonoscopy. This is a territory-wide retrospective cohort study recruiting patients aged ≥40 who had undergone colonoscopy between 2005 and 2013. Exclusion criteria included colorectal cancer detected 3years (adjusted hazard ratio, 1.18 [95% CI, 0.88–1.57]); every single year increase in the drug use was associated with 5% reduction in adjusted hazard ratio risk. ACE inhibitors/angiotensin receptor blocker were associated with a lower colorectal cancer risk in a duration-response manner.

To address growing concerns about the role of pornography use in adolescents’ sexual socialization, we explored the role of callousness, relative to pornography use, in male adolescents’ self-reported sexual aggressiveness. Two competing conceptualizations of this role were tested using data from a larger longitudinal research project on sexualized media use and adolescent well-being. Considering that callousness was assessed at only two waves (T2 and T4), 381 male Croatian adolescents ( Mage = 15.88, SD = 0.49) who participated in both waves were included in the study. Generalized mixed effects regression modeling indicated that callousness, but not pornography use, significantly predicted sexual aggressiveness 11 months later. Callousness also moderated the association between pornography use and sexual aggressiveness, so that among participants who scored high in callousness, more frequent pornography use was related to lower odds of reporting sexual aggressiveness. High callousness is a risk factor for male adolescents’ sexual aggression and should be addressed in prevention programs.

Various psychological and biological pathways have been proposed as mediators between childhood adversity (CA) and psychosis. A systematic review of the evidence in this domain is needed. Our aim is to systematically review the evidence on psychological and biological mediators between CA and psychosis across the psychosis spectrum. This review followed PRISMA guidelines. Articles published between 1979 and July 2019 were identified through a literature search in OVID (PsychINFO, Medline and Embase) and Cochrane Libraries. The evidence by each analysis and each study is presented by group of mediator categories found. The percentage of total effect mediated was calculated. Forty-eight studies were included, 21 in clinical samples and 27 in the general population (GP) with a total of 82 352 subjects from GP and 3189 from clinical studies. The quality of studies was judged as ‘fair’. Our results showed (i) solid evidence of mediation between CA and psychosis by negative cognitive schemas about the self, the world and others (NS); by dissociation and other post-traumatic stress disorder symptoms; and through an affective pathway in GP but not in subjects with disorder; (iii) lack of studies exploring biological mediators. We found evidence suggesting that various overlapping and not competing pathways involving post-traumatic and mood symptoms, as well as negative cognitions contribute partially to the link between CA and psychosis. Experiences of CA, along with relevant mediators should be routinely assessed in patients with psychosis. Evidence testing efficacy of interventions targeting such mediators through cognitive behavioural approaches and/or pharmacological means is needed in future.

Although the association between stress and poor reproductive health is well established, this association has not been examined from a life course perspective. Using data from the National Longitudinal Survey of Youth 1997 cohort (N = 1652), we fit logistic regression models to test the association between stressful life events (SLEs) (e.g., death of a close relative, victim of a violent crime) during childhood, adolescence, and early adulthood and later experiences of infertility (inability to achieve pregnancy after 12 months of intercourse without contraception) reported by female respondents. Because reactions to SLEs may be moderated by different family life experiences, we stratified responses by maternal responsiveness (based on the Conger and Elder Parent-Youth Relationship scale) in adolescence. After adjusting for demographic and environmental factors, in comparison to respondents with one or zero SLEs, those with 3 SLEs and ≥ 4 SLEs had 1.68 (1.16, 2.42) and 1.88 (1.38, 2.57) times higher odds of infertility, respectively. Respondents with low maternal responsiveness had higher odds of infertility that increased in a dose–response manner. Among respondents with high maternal responsiveness, only those experiencing four or more SLEs had an elevated risk of infertility (aOR = 1.53; 1.05, 2.25). In this novel investigation, we demonstrate a temporal association between the experience of SLEs and self-reported infertility. This association varies by maternal responsiveness in adolescence, highlighting the importance of maternal behavior toward children in mitigating harms associated with stress over the life course.

Research has revealed a significant prevalence of sexual problems in adulthood among child sexual abuse (CSA) survivors, yet many survivors do not report such difficulties. This study examined the moderator role of relationship satisfaction in the association between CSA and sexual difficulties in adulthood. Questionnaires assessing history of CSA, sexual difficulties, and relationship satisfaction were completed by 320 adults in intimate relationships. Analyses indicated that CSA survivors who were highly dissatisfied with their relationships reported more sexual difficulties than those who were satisfied with their relationships. Results highlight the importance of positive intimate relationships when working with CSA survivors.

Despite being one of the least studied components of social influence, positive peer associations have much to offer social learning theories of crime. The purpose of the current investigation was to determine whether positive peer associations moderate the peer influence effect central to social learning theory. Data provided by 3869 (1970 boys, 1899 girls) members of the Longitudinal Study of Australian Children (LSAC) were used to test the hypothesis that positive peer associations interact with components of peer influence to protect adolescents against future delinquency. A simple mediation analysis confirmed the existence of a significant indirect effect running from peer delinquency, to low empathy, to participant delinquency. When positive peer associations were added to the model as moderators, they achieved a significant negative moderating effect on the peer delinquency-low empathy path and a significant positive moderating effect on the low empathy-participant delinquency path. In this study, positive peer associations increased empathy in children with fewer delinquent peer associations and decreased offending in children with lower levels of empathy. Given evidence of their ability to inhibit negative peer influence and promote empathy in the service of reduced delinquency, positive peer associations deserve more attention from social learning theories of crime than they have thus far received.

Background The ABCG2 rs2231142 single nucleotide polymorphism (SNP) is one of the most significant genetic variants associated with hyperuricemia (HUA) in Asian populations. However, the risk of ABCG2 rs2231142 variants for HUA could interact with other important HUA risk variants and cardiovascular factors. This study investigated the effects of the combined association among ABCG2 rs2231142 and multiple HUA genetic variants or cardiovascular risk factors on HUA risk and serum uric acid (sUA) levels in an elderly Chinese population. Methods A total of 1206 participants over 65 years old were enrolled in this study. Physical and laboratory examinations were performed for all participants. The ABCG2 rs2231142, SLC2A9 rs3733591, and SLC22A12 rs893006 SNPs were assayed using a standardized protocol. Logistic regression analysis and liner regression were adjusted respectively to account for the association between ABCG2 rs2231142 and other genetic variants, as well as between cardiovascular risk factors and HUA risk and sUA levels. Results The prevalence of HUA was 14.71% in the elderly community-dwelling population. The ABCG2 rs2231142 risk T allele was associated with HUA risk (odds ratio (OR) = 1.63, 95% confidence interval (CI): 1.27–2.11; p = 1.65 × 10− 4) and with increased sUA levels (Beta = 0.16, p = 6.75 × 10− 9) in the whole study population. Linear regression analysis showed that the mean sUA level increased linearly with the number of risk alleles of the three candidate genetic variants (Beta = 0.18, p = 1.94 × 10− 12) The joint effect of the ABCG2 rs2231142 T allele and cardiovascular risk factors (obesity, hypertension and dyslipidemia) was also associated with increased HUA risk and sUA levels. Each copy of the risk T allele was significantly associated with enhanced HUA risk in patients with hypertriglyceridemia (OR = 2.52, 95% CI: 1.33–4.60; p = 0.003) compared to controls. Conclusion Our findings reinforce the importance of the ABCG2 rs2231143 variant as a crucial genetic locus for HUA in Chinese populations and demonstrated the combined effects of multiple genetic risk variants and cardiovascular risk exposures on HUA risk and increased sUA level.

ObjectivesGroup-based pain management programs (GPMPs) have been found to significantly improve quality of life and other pain outcome measures in patients with chronic musculoskeletal pain. The aims of this meta-analysis were to reevaluate the overall effect of GPMPs on various pain outcomes for individuals experiencing chronic musculoskeletal conditions and to explore moderator variables that potentially contribute to the overall efficacy of GPMPs.MethodsUsing the R package called metaphor and RevMan, we estimated the overall effectiveness of GPMPs on various pain outcome measures. The differential effectiveness of GPMPs was examined by conducting a mixed-effects meta-analytic model using various study-level characteristics. Moderator analyses included three content moderator variables and seven format moderator variables. Receiver operating characteristic curves investigated optimal points in some of the moderator variable analysis results.ResultsSignificant overall main effects of GPMPs were found on all the explored outcome measures in this study (P Discussion and Clinical RelevanceGPMPs have a statistically significant overall effect on all explored pain outcome measures. The investigation into content and structural moderators suggests that certain GPMP design factors have a greater effect on pain outcomes than do content factors. Therefore, GPMP structural designs appear to be important in reducing pain and improving quality of life for patients with chronic pain and warrant further investigation.

This study investigates whether children's preschool experiences are associated with later achievement via enhanced learning behaviors using data from a German longitudinal study following children (N = 554) from age 3 in preschool to age 8 in second grade. There were two main findings. First, results suggest that more positive learning behaviors at school entry mediate effects of teacher-child interactions in preschool on second-grade achievement. Second, these effects varied by parental socioeconomic status (SES) indicating that low-SES children benefited the most. The findings highlight the role of preschool classroom environments in shaping the school readiness of children with socioeconomic risk factors.

Objectives: To describe the compliance to the practices of hand hygiene and hub disinfection before manipulation of the central venous catheter in two moments: before and after educational intervention. Adherence to hand hygiene was assessed with two methods: direct observation and video camera. Methods: Before and after study conducted with the nursing team in an adult intensive care unit, in São Paulo, Brazil, including 180 observations using video cameras and direct observation. Hand hygiene compliance before catheter manipulation and compliance with the correct technique and the hub disinfection for five seconds were observed. Results: When video cameras recording was observed, hand hygiene compliance increased from 46% to 66% and the use of the proper technique increased from 23% to 46% (p < 0.05). Regarding hub disinfection compliance, no difference was observed between the periods. Hand hygiene compliance in direct observation increased from 83% to 87% and in indirect observation, from 46% to 66% after the intervention. Conclusion: After the educational intervention, hand hygiene compliance before CVC manipulation and the use of the correct technique improved. When observed indirectly, the adherence to these practices was lower, reinforcing the Hawthorne effect. RESUMO Objetivos: Descrever o cumprimento das práticas de higienização das mãos e desinfecção dos conectores antes da manipulação do cateter venoso central antes e após intervenção educativa. A adesão à higienização das mãos foi avaliada por observação direta e câmera de vídeo. Métodos: Estudo antes e depois realizado com a equipe de enfermagem em unidade de terapia intensiva para adultos, em São Paulo, Brasil, com 180 observações com câmeras de vídeo e observação direta. A adesão à higienização das mãos antes da manipulação do cateter e à técnica correta e desinfecção do conector por cinco segundos foram observadas. Resultados: Quando as câmeras de vídeo foram observadas, a adesão à higiene das mãos aumentou de 46% para 66% e o uso da técnica adequada aumentou de 23% para 46% (p < 0,05). Em relação à adesão à desinfecção do conector, não foi observada diferença entre os períodos. A adesão à higienização das mãos na observação direta aumentou de 83% para 87% e na indireta, de 46% para 66% após a intervenção. Conclusão Após a intervenção educativa, houve melhora na adesão à higienização das mãos antes da manipulação do cateter venoso central e no uso da técnica correta. Quando observada indiretamente, a adesão a essas práticas foi menor, reforçando o efeito Hawthorne. RESUMEN Objetivo: Describir el cumplimiento de las prácticas de higiene de manos y desinfección del hub antes de la manipulación del catéter venoso central en dos momentos: antes y después de la intervención educativa. La adherencia a la higiene de manos se evaluó con dos métodos: observación directa y cámara de video. Métodos: Estudio antes-después realizado con el equipo de enfermería en una unidad de cuidados intensivos de adultos, en São Paulo, Brasil, que incluye 180 observaciones utilizando cámaras de video y observación directa. Se observaron el cumplimiento de la higiene de manos antes de la manipulación del catéter y el cumplimiento de la técnica correcta y la desinfección del hub durante cinco segundos. Resultados: Cuando se observó la grabación de cámaras de video, el cumplimiento de la higiene de manos aumentó del 46% al 66% y el uso de la técnica adecuada aumentó del 23% al 46% (p

Objectives Catastrophic health expenditure (CHE) has considerable effects on household living standards, but little is known regarding the relationships between CHE and people’s mental health. Using China as an example, this study examines the association between CHE and mental health and investigates whether the association differs between those with and without social health insurance (SHI). Methods The data came from 3 waves of the China Health and Retirement Longitudinal Study (2011, 2013, and 2015, N = 13,166). We focused on older people aged 60 and older. We built panel data regression and quantile regression models to analyze the data. Results Incurring CHE is significantly associated with poor mental health. The association is weakened among older people receiving SHI, which indicates that SHI has a protective effect. Moreover, the association between CHE and mental health and the protective effect of SHI are stronger among those with mild or moderate mental health problems. Discussion Our findings provide empirical evidence that encourages the integration of psychologically informed approaches in health services. We also urge governments in low- and middle-income countries to consider more generous health financing mechanisms for older people with greater health care needs.

Objective\ud To better characterize differences in interictal sensory experience in adults with migraine and more comprehensively describe the relevance of anxiety to these experiences.\ud \ud Background\ud Evidence suggests that sensitivity to sensory input may not be limited to migraine attacks but continues between them. However, there is a need to better understand whether this is the case across senses, and to clearly distinguish sensory experience from measured sensory threshold, which are not straightforwardly related. Previous literature also indicates a co-occurrence between sensory sensitivity, migraine, and anxiety, but this relationship remains to be fully elucidated.\ud \ud Methods\ud The present cross-sectional study used online questionnaires to investigate how self-reported sensory experiences relate to migraine in a large community sample including 117 individuals with probable migraine and 827 without. Mediation analyses were also used to determine whether any relationship between migraine and sensory sensitivity was mediated by anxiety.\ud \ud Results\ud Significant increases in subjective reports of sensory sensitivity (d = 0.80) and sensory avoidance (d = 0.71) were found in participants with migraine. Anxiety symptoms partially mediated the relationship between subjective sensory sensitivity and migraine. Finally, visual, movement, and auditory subscales were found to provide unique explanatory variance in analyses predicting the incidence of migraine (area under the curve = 0.73, 0.69, 0.62 respectively).\ud \ud Conclusion\ud Subjective sensory sensitivities are present between attacks and across senses in individuals with migraine. Anxiety symptoms are relevant to this relationship; however, sensory sensitivities appear to exist independent of this affective influence. The implications of interictal sensitivities for the daily lives of those with migraine should, therefore, be considered in clinical management wherever appropriate.

A rater's overall impression of a ratee's essay (or other assessment) can influence ratings on multiple criteria to yield excessively similar ratings (halo effect). However, existing analytic methods fail to identify whether similar ratings stem from homogeneous criteria (true halo) or rater bias (illusory halo). Hence, we introduce and test a mixture Rasch facets model for halo effects (MRFM-H) that distinguishes true halo versus illusory halo effects to classify normal versus halo raters. In a simulation study, when raters assessed enough ratees, MRFM-H accurately identified halo raters. Also, more rating criteria increased classification accuracy. A simpler model ignored halo effects and biased the parameters for evaluation criteria and for rater severity but not for ratee assessments. MRFM-H application to three empirical datasets showed that (a) experienced raters were subject to illusory halo effects, (b) illusory halo effects were less likely with greater numbers of criteria, and (c) more informative survey responses were more distinguishable from less informative responses.

Our meta-epidemiological study aimed to describe the prevalence of reporting effect modification only on relative scale outcomes and inappropriate interpretations of the coefficient of interaction terms in nonlinear models on categorical outcomes. Our study targeted articles published in the top 10 high-impact-factor journals between 1 January and 31 December 2021. We included two-arm, parallel-group, interventional superiority randomized controlled trials to evaluate the effects of modifications on categorical outcomes. The primary outcomes were the prevalence of reporting effect modifications only on relative scale outcomes and that of inappropriately interpreting the coefficient of interaction terms in nonlinear models on categorical outcomes. We included 52 articles, of which 41 (79%) used nonlinear regression to evaluate effect modifications. At least 45/52 articles (87%) reported effect modifications based only on relative scale outcomes, and at least 39/41 (95%) articles inappropriately interpreted the coefficient of interaction terms merely as indices of effect modifications. The quality of the evaluations of effect modifications in nonlinear models on categorical outcomes was relatively low, even in randomized controlled trials published in medical journals with high impact factors. Researchers should report effect modifications of both absolute and relative scale outcomes and avoid interpreting the coefficient of interaction terms in nonlinear regression analyses.

Background Given the important repercussions that sociodemographic factors can have on physical activity, especially in the field of leisure, and cardiometabolic risk, it seems relevant to analyze the implications of these variables on the relationship between physical activity in leisure time (LTPA) and cardiometabolic risk. In this sense, the present study aims to verify the moderating role of biologic and socioeconomic factors in the relationship between LTPA and cardiometabolic risk in adolescents in southern Brazil. Methods Cross-sectional study that included 1596 adolescents selected at random (58.2% girls), aged between 10 and 17 years. LTPA, biological and socioeconomic factors were assessed using a self-reported questionnaire and the cardiometabolic risk score (total cholesterol/HDL-c ratio, triglycerides, fasting glucose, systolic blood pressure, and waist circumference, considering the participant’s age and sex) was included as an outcome. Associations and moderations were tested by multiple linear regression models. Results It was observed a positive interaction of LTPA and sex (p = 0.048) and LTPA and school system (p = 0.037), and negative interaction of LTPA and skin color (p = 0.040), indicating that these factors were moderators in the relationship between LTPA and clustered cardiometabolic risk score (cMetS) in adolescents. A reduction in cardiometabolic risk was observed according to the increase in weekly minutes of LTPA among boys, non-white adolescents, and students from municipal schools. Conclusions The association between LTPA and cardiometabolic risk was moderated by sex, skin color, and school system in adolescents from southern Brazil.

Introduction Face-to-face surveys are applied frequently when conducting research in older populations. Interviewers play a decisive role in data quality, may affect measurement and influence results. This study uses survey data about pain in nursing home residents and analyses, whether affiliation-of-interviewer (internal vs. external to nursing home) and gender-of-interviewer affect residents’ responses in terms of interviewer variance and systematically varying pain reports. Methods Overall, 258 nursing home residents with up to moderate cognitive impairment were examined by 61 interviewers about pain intensity and interference applying the Brief Pain Inventory. Interviewer variance was measured using intra-interviewer correlation coefficients (ρ). Two-factorial covariance analysis was applied to analyse whether pain intensity and interference scores differ by interviewer characteristics. Results Interviewer heterogeneity accounts for almost one quarter of total variance on average. Interviewer variance is higher for internal and male interviewers than for external and female interviewers. Covariance analyses show significant effects of interviewer characteristics on pain reports. Average pain intensity and interference scores vary considerably by interviewer gender and affiliation. Highest pain intensity was reported towards female internal and male external interviewers; highest pain interference was reported towards male external interviewers. Conclusion Residents’ answers substantially differ in relation to who is assessing pain. There is a risk of imprecise and biased survey estimates on sensitive topics like pain in nursing homes. Interviewer gender and affiliation seem to evoke gender-specific and status-related expectations and attributions which influence residents’ response process. Interviewer effects pose a considerable threat to survey data quality in institutionalised older populations.

With single-level data, Yuan, Cheng and Maxwell developed a two-level regression model for more accurate moderation analysis. This article extends the two-level regression model to a two-level moderated latent variable (2MLV) model, and uses a Bayesian approach to estimate and test the moderation effects. Monte Carlo results indicate that: 1) the new method yields more accurate estimate of the interaction effect than those via the product-indicator (PI) approach and latent variable interaction (LVI) with single-level model, both are also estimated via Bayesian method; 2) the coverage rates of the credibility interval following the 2MLV model are closer to the nominal 95% than those following the other methods; 3) the test for the existence of the moderation effect is more reliable in controlling Type I errors than both PI and LVI, especially under heteroscedasticity conditions. Moreover, a more interpretable measure of effect size is developed based on the 2MLV model, which directly answers the question as to what extent a moderator can account for the change of the coefficient between the predictor and the outcome variable. A real data example illustrates the application of the new method.

BACKGROUND ANDAIMS The commodity purchase task is a simulated demand procedure that is easy and quick to complete (

Empathy has an important role in promoting proper societal functions. Those who violate societal functions, such as those convicted of having committed a criminal offense, are theorized to possess deficits in their empathic capacity. This assumption has been adopted by many criminological models, including for individuals convicted of a sexual offense (ICSO). However, contradictory research results have resulted in conflicting theories regarding the level of empathy within ICSO. This meta-analysis compiled available data to provide empirical clarity in a divided theoretical field. Results of the meta-analysis indicate that ICSO have lower levels of cognitive (Hedges’s g = −.303, p = .007) and general empathy (Hedges’s g = −.188, p = .020) than those in the general population but do not have significantly lower levels of affective empathy (Hedges’s g = .023, p = .849). Several moderator analyses were conducted, including type of sexual offense, assessment instrument used, and age at conviction.

In medicine, the positive Hawthorne effect is defined as decreased symptom expression due to being observed. This effect occurs in addition to the decrease in symptom experience due to the placebo effect. Symptom overexpression, in contrast, whether related to conscious or to unconscious factors, defines the negative Hawthorne effect, which should be distinguished from the nocebo effect, defined as an increase in symptom experience. For instance, the negative Hawthorne effect can result in patients who seem fully relaxed evaluating their pain intensity at 11 on a 10-point Scale. The negative Hawthorne effect stems from multiple factors including a wish to receive greater consideration or priority management status; concern about failing to meet criteria for receiving a new treatment or being included in a therapeutic trial; conformism related to cultural factors or to circumstance (e.g., avoiding the canceling of a surgical procedure in the event of a last-minute improvement); disease mongering; a desire to be taken seriously by family and friends; a quest for secondary benefits; use of the evaluation to express frustration about being ill or bitterness at receiving a lower level of support; a gap between the expectation of complete relief and the true effectiveness of treatments; and pain exacerbation, with loss of reliability of pain intensity measurements, due to anxiety, guilt, depression, nervosity, catastrophizing, kinesiophobia, or repeated evaluations using methods that involve negative suggestions such as considering the worst pain imaginable. A sequence of a strong negative Hawthorne effect before treatment prescription followed by a strong positive Hawthorne effect after treatment initiation may make a greater contribution than the placebo effect to the improvements produced by treatments for pain.

Background Growing evidence shows that clinical and molecular subtypes of prostate cancer (PCa) have specific risk factors. Observational studies suggest that physical activity may lower the risk of aggressive PCa. To our knowledge, the association between physical activity and PCa defined by TMPRSS2:ERG has not been evaluated. Objective To prospectively examine the association between physical activity and risk of PCa defined by clinical features and TMPRSS2:ERG. Design, setting, and participants We studied 49 160 men aged 40–75 yr in the Health Professionals Follow-up Study from 1986 to 2012. Data was collected at baseline and every 2 yr with >90% follow-up. Total and vigorous physical activity were measured in metabolic equivalent of task (MET)-h/wk. Outcome measures and statistical analysis Advanced PCa was defined as stage T3b, T4, N1, or M1 at diagnosis and lethal PCa as distant metastases or death due to disease over follow-up. Presence of TMPRSS2:ERG was estimated by immunohistochemistry of ERG protein expression. Cox proportional hazards models were used to obtain multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for incidence of subtype-specific PCa. Results and limitations During 26 yr of follow-up, 6411 developed PCa overall and 888 developed lethal disease. There were no significant associations between total physical activity and risk of PCa in the overall cohort. In multivariable-adjusted models, men in the highest quintile of vigorous activity had a significant 30% lower risk of advanced PCa (HR: 0.70, 95% CI: 0.53–0.92) and 25% lower risk of lethal PCa (HR: 0.75, 95% CI: 0.59–0.94) than men in the lowest quintile of vigorous activity. The association was independent of screening history. Vigorous activity was not associated with total PCa in the overall cohort but was inversely associated among highly screened men (top vs bottom quintile, HR: 0.83, 95% CI: 0.70–0.97). Of all cases, 945 were assayed for ERG (48% ERG-positive). Men with higher vigorous activity had a lower risk of ERG-positive PCa (top vs bottom quintile, HR: 0.71, 95% CI: 0.52–0.97). There was no significant association with the risk of ERG-negative disease (p heterogeneity = 0.09). Conclusions Our study confirms that vigorous physical activity is associated with lower risk of advanced and lethal PCa and provides novel evidence for a lower risk of TMPRSS2:ERG-positive disease. Patient summary The identification of modifiable lifestyle factors for prevention of clinically important prostate cancer (PCa) is needed. In this report, we compared risk of PCa in men with different levels of physical activity. Men with higher vigorous activity had a lower risk of developing advanced and lethal PCa and PCa with the common TMPRSS2:ERG gene fusion.

Objectives Observational cohort studies in early RA are a key source of evidence, despite inconsistencies in methodological approaches. This narrative review assesses the spectrum of methodologies used in addressing centre-level effect and case-mix adjustment in early RA observational cohort studies. Methods An electronic search was undertaken to identify observational prospective cohorts of >100 patients recruited from two or more centres, within 2 years of an RA or early inflammatory arthritis diagnosis. References and author publication lists of all studies from eligible cohorts were assessed for additional cohorts. Results Thirty-four unique cohorts were identified from 204 studies. Seven percent of studies considered centre in their analyses, most commonly as a fixed effect in regression modelling. Reporting of case-mix variables in analyses varied widely. The number of variables considered in case-mix adjustment was higher following publication of the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement in 2007. Conclusion Centre effect is unreported or inadequately accounted for in the majority of RA observational cohorts, potentially leading to spurious inferences and obstructing comparisons between studies. Inadequate case-mix adjustment precludes meaningful comparisons between centres. Appropriate methodology to account for centre and case-mix adjustment should be considered at the outset of analyses.

Objective: This study aimed to investigate whether the association between a validated genetic profile risk score for BMI (GPRS‐BMI) (based on 93 single‐nucleotide polymorphisms) and phenotypic obesity (BMI) was modified by the combined categories of physical activity (PA) and sedentary behaviors in a large population‐based study. Methods: This study included cross‐sectional baseline data from 338,216 white European adult men and women aged 37 to 73 years. Interaction effects of GPRS‐BMI with the combined categories of PA and sedentary behaviors on BMI were investigated. Results: There was a significant interaction between GPRS‐BMI and the combined categories of objectively measured PA and total sedentary behavior (P[interaction] = 3.5 × 10−6); among physically inactive and highly sedentary individuals, BMI was higher by 0.60 kg/m2 per 1‐SD increase in GPRS‐obesity (P = 8.9 × 10−50), whereas the relevant BMI difference was 38% lower among physically active individuals and those with low sedentary time (β: 0.37 kg/m2; P = 2.3 × 10−51). A similar pattern was observed for the combined categories of objective PA and TV viewing (inactive/high TV viewing β: 0.60 vs. active/low TV viewing β: 0.40 kg/m2; P[interaction] = 2.9 × 10−6). Conclusions: This study provides evidence that combined categories of PA and sedentary behaviors modify the extent to which genetic predisposition to obesity results in higher BMI.

Although young onset dementia (YOD) causes high levels of burden and distress, factors that contribute to its onset are not well understood. Identifying relevant modifiable risk and protective factors for YOD can inform efforts to prevent or delay onset of symptoms to later in life.Studies of modifiable factors for YOD have increased in frequency in recent years. Poor educational attainment and low socioeconomic status, a history of heavy alcohol use, and poor cardiovascular health may be key targets for YOD prevention or delay. Traumatic brain injury has attracted significant attention but evidence of its importance is limited except in cases occurring secondarily to the injury.A growing body of evidence suggests that modifiable risk factors have a role in modulating the age of dementia onset. Clinicians should be aware that many people with YOD will present with complex histories of multifactorial (including modifiable and nonmodifiable) risk exposure. Exploring trajectories of risk and gene-environment interactions is an important future research direction and will inform targeted prevention efforts.

Objectives This study examined the longitudinal relationships between subjective age (SA) and future functional status in later life, via depressive symptoms. Additionally, we assessed the role of subjective nearness to death (SNtD) as a potential moderator within these pathways. Methods Older adults (average age 81.14 years at T1) were interviewed once a year for 3 consecutive years (N = 224 at T1, N = 178 at T2, and N = 164 at T3). Participants reported their SA, SNtD, depressive symptoms, and functional status. Additionally, grip strength was employed as an objective measure of functional status. Results Data analysis revealed distinct pathways leading from T1 SA to T3 functional status through T2 depressive symptoms. Moreover, T1 SNtD was found to significantly moderate most of these indirect pathways, so that the mediation model of T1 SA–T2 depressive symptoms–T3 functional status was mostly significant among those who felt closer to death. Discussion The findings contribute to our understanding of the underlying mechanism through which SA predicts long-term functioning sequelae by underscoring the indirect effect of depressive symptoms. They further indicate the importance of gauging the effects of SNtD on these longitudinal relationships. Present results may further contribute to establishing an integrative model for predicting long-term functional outcomes based on older adults’ earlier subjective views of aging.

The Halo Effect is a widely studied phenomenon that interests multiple disciplines. The relationship between Aesthetics Appearance and perceived Trustworthiness has especially gathered the attention of social scientists. While experimental works compared the strength of the Halo Effect in different situations (e.g. different genders’ faces), little is known about the stability of the Halo. During the COVID-19 pandemic, we have been urged to distance ourselves from others. Similar suggestions may alter the relationship between Aesthetic Appearance and Perceived Trustworthiness. Moreover, previous works reported that individuals’ attachment styles affected their emotional responses to the pandemic. Individuals’ attachment styles may influence the magnitude of change of the Halo. Here we investigate how priming (Social Distancing or Contact with others) affects the strength of the Halo Effect, with respect to individuals’ attachment styles. Participants (N = 298) rated the Aesthetics and Perceived Trustworthiness of strangers’ faces (N = 96) presented twice, before and after the presentation of a prime. Results revealed that individuals’ attachment styles affect the strength of the Halo. However, we found no evidence supporting the fact that different attachment styles lead to differences in the magnitude of changes after priming. Results help shed light on how attachment styles influence individuals’ impression formation. Ministry of Education (MOE) Published version This research was supported by grants from the NAP SUG to GE (M4081597, 2015-2021). Ministry of Education, Singapore, under its Academic Research Fund Tier 1 (RT10/19 and RG55/18). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Background: Treatment with sacubitril-valsartan reduces mortality and heart failure (HF) events in HF with reduced ejection fraction and may reduce HF hospitalization in women with HF with preserved ejection fraction. Methods: EVALUATE-HF randomized 464 participants (109 women) with HF with reduced ejection fraction to sacubitril-valsartan or enalapril for 12 weeks. Documented left ventricular ejection fraction (LVEF) ≤0.40 within the prior 12 months was required, although core laboratory LVEF>0.40 was permitted. Assessments of aortic stiffness (pulse pressure and characteristic impedance, Z c ) were performed at baseline and at trough and 4 hours postdose at weeks 4 and 12. Results: In models of change from baseline adjusted for baseline value, treatment with sacubitril-valsartan produced greater overall reductions in mean arterial pressure (treatment group difference, −3.0±0.8 mm Hg, P P c were greater in the sacubitril-valsartan group (−16±6 dyne×second/cm 5 , P =0.012). Post hoc analyses found evidence of effect modification by LVEF (interaction P =0.036). With LVEFc were greater in the sacubitril-valsartan group (trough, −3±8 dyne×second/cm 5 versus post-dose, −17±8 dyne×second/cm 5 ; interaction P =0.024) with no sex difference (treatment×sex interaction, P =0.3). With LVEF≥0.40, treatment with sacubitril-valsartan was associated with greater overall reductions in Z c in women (women, −80±21 dyne×second/cm 5 versus men, −20±13 dyne×second/cm 5 ; interaction P =0.019). Conclusions: In prespecified analyses that include pre- and postdose assessments at 4 and 12 weeks, treatment with sacubitril-valsartan was associated with greater postdose reductions in aortic Z c . In a post hoc analysis, sacubitril-valsartan was associated with sustained reductions in Z c in women with LVEF≥0.40. Registration: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02874794.

BackgroundNo versatile web app exists that allows epidemiologists and managers around the world to comprehensively analyze the impacts of COVID-19 mitigation. Thehttp://covid-webapp.numerusinc.com/web app presented here fills this gap.MethodsOur web app uses a model that explicitly identifies susceptible, contact, latent, asymptomatic, symptomatic and recovered classes of individuals, and a parallel set of response classes, subject to lower pathogen-contact rates. The user inputs a CSV file of incidence and, if of interest, mortality rate data. A default set of parameters is available that can be overwritten through input or online entry, and a user-selected subset of these can be fitted to the model using maximum-likelihood estimation (MLE). Model fitting and forecasting intervals are specifiable and changes to parameters allow counterfactual and forecasting scenarios. Confidence or credible intervals can be generated using stochastic simulations, based on MLE values, or on an inputted CSV file containing Markov chain Monte Carlo (MCMC) estimates of one or more parameters.ResultsWe illustrate the use of our web app in extracting social distancing, social relaxation, surveillance or virulence switching functions (i.e., time varying drivers) from the incidence and mortality rates of COVID-19 epidemics in Israel, South Africa, and England. The Israeli outbreak exhibits four distinct phases: initial outbreak, social distancing, social relaxation, and a second wave mitigation phase. An MCMC projection of this latter phase suggests the Israeli epidemic will continue to produce into late November an average of around 1500 new case per day, unless the population practices social-relaxation measures at least 5-fold below the level in August, which itself is 4-fold below the level at the start of July. Our analysis of the relatively late South African outbreak that became the world’s fifth largest COVID-19 epidemic in July revealed that the decline through late July and early August was characterised by a social distancing driver operating at more than twice the per-capita applicable-disease-class (pc-adc) rate of the social relaxation driver. Our analysis of the relatively early English outbreak, identified a more than 2-fold improvement in surveillance over the course of the epidemic. It also identified a pc-adc social distancing rate in early August that, though nearly four times the pc-adc social relaxation rate, appeared to barely contain a second wave that would break out if social distancing was further relaxed.ConclusionOur web app provides policy makers and health officers who have no epidemiological modelling or computer coding expertise with an invaluable tool for assessing the impacts of different outbreak mitigation policies and measures. This includes an ability to generate an epidemic-suppression or curve-flattening index that measures the intensity with which behavioural responses suppress or flatten the epidemic curve in the region under consideration.

Clinical case formulations (CCFs) can be organized and communicated in several ways but one of the most effective is through CCF causal diagrams (CCFCDs). Haynes et al., Psychological Assessment, 2020, 32, 541 illustrated how the psychometric evaluation of CCFCDs could be facilitated by assigning quantitative values to the clinician's judgments in a CCF. Although quantification could facilitate the psychometric evaluation CCFCDs, it is less clear that it can help clinicians make decisions about the best treatment foci. This article presents an open-source computer program (Clinical Case Formulation Causal Diagram Calculator, CCFCDC) for the path analyses of quantified CCFCDs, based on the free computing language Python, to assist in clinical decision making. The operation, examples, assets, and limitations of the CCFCDC are discussed in the context of measurement principles, precision, and uncertainty in clinical judgments. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background Proteomic biomarkers related to cardiovascular disease risk factors may offer insights into the pathogenesis of cardiovascular disease. We investigated whether modifiable lifestyle risk factors for cardiovascular disease are associated with distinctive proteomic signatures. Methods and Results We analyzed 1305 circulating plasma proteomic biomarkers (assayed using the SomaLogic platform) in 897 FHS (Framingham Heart Study) Generation 3 participants (mean age 46±8 years; 56% women; discovery sample) and 1121 FOS (Framingham Offspring Study) participants (mean age 52 years; 54% women; validation sample). Participants were free of hypertension, diabetes mellitus, and clinical cardiovascular disease. We used linear mixed effects models (adjusting for age, sex, body mass index, and family structure) to relate levels of each inverse‐log transformed protein to 3 lifestyle factors (ie, smoking, alcohol consumption, and physical activity). A Bonferroni‐adjusted P value indicated statistical significance (based on number of proteins and traits tested, P −6 in the discovery sample; P −4 in the validation sample). We observed statistically significant associations of 60 proteins with smoking (37/40 top proteins validated in FOS), 30 proteins with alcohol consumption (23/30 proteins validated), and 5 proteins with physical activity (2/3 proteins associated with the physical activity index validated). We assessed the associations of protein concentrations with previously identified genetic variants (protein quantitative trait loci) linked to lifestyle‐related disease traits in the genome‐wide‐association study catalogue. The protein quantitative trait loci were associated with coronary artery disease, inflammation, and age‐related mortality. Conclusions Our cross‐sectional study from a community‐based sample elucidated distinctive sets of proteins associated with 3 key lifestyle factors.