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Bullying is a peer relational problem that can inflict psychological harm onto both those who are victimized and those who witness it occur. Fostering a positive classroom environment is an important protective factor in preventing bullying. Authoritative classroom climates may protect victimized and bystander youth from negative mental health outcomes associated with bullying involvement. The current study examined how dimensions of authoritative classrooms -- disciplinary structure and teacher support -- moderate the relationship between bullying involvement (e.g., victimization, witnessing) and students' psychological functioning (e.g., psychosocial wellbeing, emotional problems). We explored how authoritative classroom climate may protect victimized and bystander youth across different cultural contexts. Multilevel regression analyses were conducted on two separate samples of youth, from China (2,395 students in grades 5-9, from 58 classrooms across 5 schools), and Canada (538 students in grades 5-8, from 31 classrooms across 5 schools). Findings indicated that both victimization and witnessing were associated with lower psychosocial wellbeing and higher levels of emotional problems among Chinese and Canadian youth. For Chinese youth, witnessing was less strongly associated with lower psychosocial wellbeing in classrooms with higher disciplinary structure. In contrast, witnessing was more strongly related to emotional problems and lower psychosocial wellbeing in Chinese classrooms with higher teacher support. Collectively, these findings suggest that bullying negatively affects the mental health of the broader school community across both Chinese and Canadian contexts. In more collectivist cultures, promoting classroom climates that regulate student's behaviors by enforcing discipline fairly and consistently may help lower distress among students who witness bullying.

Background: Transversus abdominis plane blocks are an established method of postoperative analgesia for abdominopelvic surgeries. Liposomal bupivacaine is an extended‐release formulation of bupivacaine providing up to 72 h of analgesia. This study aims to determine if transversus abdominis plane blocks performed with liposomal bupivacaine are associated with reduced opioid consumption and level of pain intensity compared to conventional bupivacaine in patients undergoing lower abdominal surgery. Methods: This retrospective cohort study was conducted at a single institution between December 2020 and December 2021. After institutional review board approval, we identified patients who underwent lower abdominopelvic surgery with transversus abdominis plane blocks done with liposomal or conventional bupivacaine and collected demographic, clinical, and procedural information for analysis. We compared total opioid consumption over 72‐h postoperatively in milligram morphine equivalents (MME), frequency of opioid utilization, and average level of pain intensity between groups. These outcomes were also evaluated after adjusting for covariates. Data were presented as mean ± SD, median [IQR] or frequency (%), as appropriate; p < 0.05 was accepted as significant. Results: A total of 178 patients met inclusion criteria, with 79 patients receiving an admixture of liposomal bupivacaine and conventional bupivacaine and 99 patients receiving conventional bupivacaine. The liposomal bupivacaine group had a median opioid consumption 72‐h postoperatively of 47.5 [18–91.8] MME compared to 88 [43.8–160] MME in the conventional bupivacaine group, p = 0.045. Differences in opioid consumption between the groups did not reach statistical significance after adjustment for demographic and clinical characteristics, p = 0.11. There was no significant difference in frequency of opioid use or average pain intensity. Conclusion: Transversus abdominis plane blocks using an admixture of liposomal bupivacaine conventional bupivacaine are not associated with decreased opioid consumption or reduced pain up to 72 h following elective abdominopelvic surgery. [ABSTRACT FROM AUTHOR]

Different patterns of sexting behaviors were examined to provide a more nuanced understanding of the context in which sexting occurs among adolescents. Participants were 1,000 Canadian adolescents (50.2% girls) between 12 and 18 years (M age = 15.21, SD = 2.00) who completed measures of sexting, cyber bullying and victimization, problematic social media use, self-regulation, and demographics. Contrary to our hypotheses, three latent profiles of sexting represented the frequency of sexting rather than whether the sexting was consensual versus non-consensual or with a partner versus non-partner. Participants in the moderate and high sexting profiles representing one fifth of youth, reported less self-regulation, experienced more cyber victimization, and engaged in more cyber bullying and problematic social media use than those in the no/low sexting profile. Our findings support the normalcy approach to education, which considers some sexting among healthy developmental behaviors. [ABSTRACT FROM AUTHOR]

Although there is evidence to suggest that adolescents with autism spectrum disorder (ASD) have difficulty interpreting complex social situations, little is known about their understanding of bullying. Given the high rates of victimization in this population, it is important to investigate how adolescents with ASD comprehend bullying. Male adolescents with ASD and IQ-matched typically-developing (TD) controls (M[subscript age] = 14.62, SD = 1.91) watched six videos portraying bullying scenarios and were interviewed after each video. The interviews were coded for the participants' understanding of the bullying scenarios. Results indicated that adolescents with ASD had significantly lower bullying understanding scores than TD adolescents. These novel findings suggest that male adolescents with ASD understand bullying differently than their TD peers. Implications for experiences with victimization are discussed.

This preliminary study explored a person-group dissimilarity hypothesis in the context of adolescent sexual harassment. Theory suggests that victimized youth are expected to experience worse outcomes if they perceive victimization to be a rare experience among their peers. This study comprised 435 middle school students who reported on their experiences of sexual harassment (victimization and witnessing), shame, and depressive symptoms. We tested a cross-sectional conditional indirect-effects model, with shame mediating the relationship between victimization and depressive symptoms (the indirect effect) and with witnessing as a moderator of the indirect effect. For all students, shame mediated the relationship between victimization and depressive symptoms. For female students, there was a buffering effect of witnessing, whereby the indirect effect was weaker at high levels of witnessing. These findings have potential implications for theory and intervention, suggesting the importance of examining young people's social contexts to better understand their responses to sexual harassment.

Emotional reactions to peer victimization may increase risk for subsequent peer victimization. In the present study, we investigated whether shame mediated the development of chronic peer victimization, i.e., young people's experiences of being bullied persistently across time. We used a multiple mediation model to test the indirect effects of Time-1 victimization on Time-3 victimization (1 year later) through 4 Time-2 shame-related variables (characterological, bodily, and behavioral shame; shame proneness) for 396 youth (10-13 years of age). The total indirect effect of Time-1 victimization on Time-3 victimization through the 4 shame-related mediators was statistically significant. Analyses revealed specific indirect positive effects for bodily shame and shame proneness. Findings suggest that shame may be an emotional mechanism underlying chronic peer victimization. Impact and Implications: Chronic, or persistent, peer victimization is a destructive relationship problem prevalent in youth and associated with a range of negative mental health, social, and academic consequences. This study found that the painful emotion of shame plays a critical role in explaining why youth who are victimized by their peers continue to experience chronic victimization. These findings and continued research in the area may contribute to effective prevention and intervention programs to alleviate the experience of shame in peer-victimized youth and ultimately prevent a cycle of victimization.

Background: Total knee arthroplasty (TKA) is a commonly performed procedure to alleviate pain and improve functional limitations caused by end-stage joint damage. Effective management of postoperative pain following TKA is crucial to the prevention of complications and enhancement of recovery. Adductor canal blocks (ACB) with conventional bupivacaine (CB) provide adequate analgesia after TKA, but carry a risk of rebound pain following block resolution. Liposomal bupivacaine (LB) is an extended-release local anesthetic that can provide up to 72 h of pain relief. The objective of this study was to compare postoperative outcomes between ACBs using LB and CB after TKA. Methods: This single institution, prospective, randomized, clinical trial enrolled patients scheduled for TKA. Participants were randomized to receive ACB with either LB or CB. Pain scores up to 72 h postoperatively were assessed as the primary outcome. Opioid consumption and length of stay were evaluated as secondary outcomes. Results: A total of 80 patients were enrolled. Demographic and clinical characteristics were similar between the two groups. LB group showed significantly lower cumulative opioid use during the 72 h evaluated (P = 0.016). There were no differences in pain scores or length of stay between the groups. Conclusion: The study demonstrated that LB ACBs led to significantly lower opioid consumption in the days following TKA without affecting pain scores or length of stay. This finding has important implications for improving postoperative outcomes and reducing opioid use in TKA patients. Previous studies have reported inconsistent results regarding the benefits of LB, highlighting the need for further research. Trial registration: This project was retrospectively registered with clinicaltrials.gov (NCT05635916) on 2 December 2022. [ABSTRACT FROM AUTHOR]

Although there is evidence to suggest that adolescents with autism spectrum disorder (ASD) have difficulty interpreting complex social situations, little is known about their understanding of bullying. Given the high rates of victimization in this population, it is important to investigate how adolescents with ASD comprehend bullying. Male adolescents with ASD and IQ-matched typically-developing (TD) controls (M.sub.age = 14.62, SD = 1.91) watched six videos portraying bullying scenarios and were interviewed after each video. The interviews were coded for the participants' understanding of the bullying scenarios. Results indicated that adolescents with ASD had significantly lower bullying understanding scores than TD adolescents. These novel findings suggest that male adolescents with ASD understand bullying differently than their TD peers. Implications for experiences with victimization are discussed., Author(s): Zoe Hodgins [sup.1] [sup.2] , Elizabeth Kelley [sup.1] , Patricia Kloosterman [sup.1] [sup.3] , Layla Hall [sup.1] , Chloe C. Hudson [sup.1] , Rosaria Furlano [sup.1] , Wendy Craig [...]

Objectives Universal screening for substance use during pregnancy, brief intervention, and referral to treatment (SBIRT) is recommended by ACOG and the USPSTF. Here we present the implementation of SBIRT into the electronic health record (EHR) to inform clinical intervention and collect data on the prevalence of substance use during pregnancy at three prenatal clinics. Methods A literature-based SBIRT instrument was developed. The tool was integrated into the EHR of a resident Ob/Gyn clinic, an MFM practice, and an Ob/Gyn generalist practice at our institution, an academic, tertiary care medical center in an urban area, and automated reports of aggregate retrospective EHR data were used to monitor patient responses to SBIRT over time. Data reports included patient responses to screening for substance use, brief intervention, and referral to treatment from January to December 2018 Results An interprofessional team of health care providers and systems analysts guided the SBIRT implementation process. As of December 2018, overall SBIRT performance during prenatal care encounters was 1797/2619 (69%), 432/1350 (32%), and 1290/1518 (85%) in the resident clinic, MFM practice, and generalist practice, respectively. Eighty (5.1%) women in the resident clinic, 2 (0.5%) in the MFM practice and 14 (1%) in the generalist practice reported past or present substance use. Conclusions for Practice Integrating universal SBIRT into prenatal care using the EHR requires a multi-disciplinary approach. The SBIRT tool facilitates reportable substance use screening, brief intervention, and referral to treatment during prenatal care. Future reports will further characterize substance use in our prenatal practices and inform intervention strategies in this population., Author(s): Jean C. Hostage [sup.1] , Julia Brock [sup.1] , Wendy Craig [sup.2] , Debra Sepulveda [sup.1] Author Affiliations: (1) grid.240160.1, Department of Obstetrics and Gynecology, Maine Medical Center, , [...]

Peer victimization is associated with increased risk for mental health problems. These adverse psychological outcomes are linked with altered cognitive and emotional processes and their related neural functioning. In the present study, by using functional magnetic resonance imaging (fMRI), we examined whether peer victimization was associated with heightened neural response to social exclusion. Participants (N = 45; M[subscript age] = 17.7 years, SD = 0.60; 36 women) included three mutually exclusive groups: peer-victimized individuals (targets of bullying), cyberdefenders (defended peers who were being cyberbullied), and controls (not involved as targets or cyberdefenders). All participants underwent an fMRI scan while playing "Cyberball," an experimental paradigm that simulates social exclusion. Peer victimization was associated with increased neural response in the left amygdala, left parahippocampal gyrus, left inferior frontal operculum, and right fusiform gyrus. Understanding the acute neural response to social exclusion in peer-victimized individuals may provide insight into their increased risk for poor mental health.

The number of patients maintained on buprenorphine is steadily increasing. To date, no study has reported buprenorphine management practices for these patients during critical illness, nor its relationship with supplemental full‐agonist opioid administration during their hospital stay. In this single‐center retrospective study, we have explored the incidence of buprenorphine continuation during critical illness among patients receiving buprenorphine for the treatment of opioid use disorder. Additionally, we investigated the relationship between nonbuprenorphine opioid exposure and buprenorphine administration during the intensive care unit (ICU) and post‐ICU phases of care. Our study included adults maintained on buprenorphine for opioid use disorder admitted to the ICU between December 1, 2014, and May 31, 2019. Nonbuprenorphine, full agonist opioid doses were converted to fentanyl equivalents (FEs). Fifty‐one (44%) patients received buprenorphine during the ICU phase of care, with an average dose of 8 (8–12) mg/day. During the post‐ICU phase of care, 68 (62%) received buprenorphine, with an average dose of 10 (7–14) mg/day. Lack of mechanical ventilation and acetaminophen use were also associated with buprenorphine use. Full agonist opioid use was more frequent on days when buprenorphine was not given (odds ratio [OR], 6.2 [95% CI, 2.3–16.4]; P <.001). Additionally, the average cumulative dose of opioids given on nonbuprenorphine administration days was significantly higher both in the ICU (OR, 1803 [95% CI, 1271–2553] vs OR, 327 [95% CI, 152–708] FEs/day; P < 0.001) and after ICU discharge (OR, 1476 [95% CI, 962–2265] vs OR, 238 [95% CI, 150‐377] FEs/day; P <.001). Given these findings, buprenorphine continuation during critical illness should be considered, as it is associated with significantly decreased full agonist opioid use. [ABSTRACT FROM AUTHOR]

The current study explored online preventive coping (privacy settings) and reactive coping (reporting tools) among youth and how the use of these online safety tools related to the frequency of cybervictimization. Surveys were administered to youth in elementary, secondary, and post-secondary school. Results indicated that the prevalence of cybervictimization decreased with grade and did not vary by gender. Gender differences emerged in the use of coping mechanisms, with females more likely to use privacy settings than males. In addition, older females were more likely to use privacy settings compared with younger females. Compared with older females, younger females were more likely to use informal reporting tools (i.e., contacting the person responsible for posting inappropriate content). Only limiting the visibility of posts and comments was uniquely associated with a lower frequency of cybervictimization. Younger adolescents were less likely to engage in the only behaviour that was associated with less frequent cybervictimization. These findings suggest that younger youth may lack the skills and knowledge necessary to cope effectively with cybervictimization.

Longitudinal data from 746 adolescents in Toronto, Canada (54% females), was gathered in eight waves over seven years (1995 through 2001), beginning when the youths were 10 to 12 years old (mean age = 11.8, SD = 1.2 years). Five trajectories of substance use were identified: chronic-high, childhood onset-rapid high, childhood onset-moderate, adolescent onset-moderate, and non-use groups. Late childhood risk factors for substance use included delinquency, academic disengagement, low parental monitoring, and associating with substance-using peers. Externalizing problems emerged as an additional risk factor for the most severe substance-using group during adolescence. Of note, the childhood onset-moderate group reported only moderate levels of substance use during adolescence despite high levels of risk during late childhood. Implications for prevention of and intervention for substance use are discussed.

For emerging adults, high-quality friendships can be an important source of companionship and support. The most commonly studied negative interaction between friends is conflict, yet work with youth suggests more serious victimization also occurs in friendship. In the current study, we developed and obtained preliminary psychometric evidence for the Friendship Victimization Scale, a measure that assesses physical, sexual, relational, and verbal forms of victimization in the friendships of emerging adults, as well as coercive and controlling behaviors. Emerging adults (N = 316, M age = 21.27 years, SD = 1.47; 60.4% women, 37.0% men; 59.2% White) completed the Friendship Victimization Scale along with measures to examine construct validity. The majority of the sample reported experiencing at least one act of victimization by a friend, and men reported more victimization than did women. Results supported a 2-factor structure, with relational and verbal victimization loading on one factor and physical and sexual victimization and controlling behaviors loading on the other. Cronbach's alphas exceeded.90 for the total score and both subscales. Greater friendship victimization was predicted by negative features in each of a best and a challenging friendship, even after accounting for negative features in a dating relationship, and was unrelated to positive features in any of these relationships. Overall, results indicate that victimization is common in emerging adults' friendships. The findings provide preliminary evidence for the utility of the Friendship Victimization Scale as a measure of this understudied source of risk in the interpersonal lives of emerging adults. [ABSTRACT FROM AUTHOR]

Introduction: The study objective was to compare the mental health and risk-taking behaviour of Canadian youth in military-connected families to those not in militaryconnected families in a contemporary sample. We hypothesized that youth in militaryconnected families have worse mental health, lower life satisfaction and greater engagement in risk-taking behaviours than those not in military-connected families. Methods: This cross-sectional study used 2017/18 Health Behaviour in School-aged Children in Canada survey data, a representative sample of youth attending Grades 6 to 10. Questionnaires collected information on parental service and six indicators of mental health, life satisfaction and risk-taking behaviour. Multivariable Poisson regression models with robust error variance were implemented, applying survey weights and accounting for clustering by school. Results: This sample included 16 737 students; 9.5% reported that a parent and/or guardian served in the Canadian military. After adjusting for grade, sex and family affluence, youth with a family connection to the military were 28% more likely to report low well-being (95% CI: 1.17-1.40), 32% more likely to report persistent feelings of hopelessness (1.22-1.43), 22% more likely to report emotional problems (1.13-1.32), 42% more likely to report low life satisfaction (1.27-1.59) and 37% more likely to report frequent engagement in overt risk-taking (1.21-1.55). Conclusion: Youth in military-connected families reported worse mental health and more risk-taking behaviours than youth not in military-connected families. The results suggest a need for additional mental health and well-being supports for youth in Canadian military-connected families and longitudinal research to understand underlying determinants that contribute to these differences. [ABSTRACT FROM AUTHOR]