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Background: Kratom is taken to self-treat pain and symptoms of psychiatric disorders, including substance-use disorders (SUDs) and opioid withdrawal. Before COVID-19, kratom use was increasing in the US, however, there are few published data on whether that trend continued during the COVID-19 pandemic, which could have affected kratom use in multiple ways. Aim: To examine COVID-19-related changes in kratom use and how these changes were experienced, relative to changes in other commonly used substances. Methods: Using Amazon Mechanical Turk, 2615 evaluable surveys were completed between September 2020 and March 2021. Responses from past-month and past-year kratom-using adults (N = 174) indicating changes for the better or worse were examined using generalized linear mixed effects models, and relevant open-text responses (n = 85) were thematically coded. Results: For kratom 33% (n = 58) reported a Covid-related increase and 24% (n = 42) reported a Covid-related decrease. Controlling for changes in amount used, alcohol (OR = 5.02), tobacco (OR = 4.72), and nonmedical opioid use (OR = 3.42) were all more likely to have changed for the worse, compared with kratom use. Relative to decreases in kratom use, decreases in alcohol (OR = 3.21) and tobacco (OR = 6.18) use were more likely to be changes for the better. Cannabis use was the only substance to display a probability lower than 50% of being a decrease for the better, and of the increases, cannabis use displayed the highest probability of being for the better. Conclusions: Increases in kratom and cannabis use were less likely than alcohol and tobacco to be reported as changes for the worse, and decreases in kratom and cannabis use were more likely than alcohol and tobacco to be reported as changes for the better. These findings indicate that people differently conceptualize their relationships with kratom and cannabis, compared to their relationships with alcohol and tobacco. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic is a mass bereavement event which has profoundly disrupted grief experiences. Understanding support needs and access to support among people bereaved at this time is crucial to ensuring appropriate bereavement support infrastructure. Aim: To investigate grief experiences, support needs and use of formal and informal bereavement support among people bereaved during the pandemic. Design: Baseline results from a longitudinal survey. Support needs and experiences of accessing support are reported using descriptive statistics and thematic analysis of free-text data. Setting/participants: 711 adults bereaved in the UK between March and December 2020, recruited via media, social media, national associations and community/charitable organisations. Results: High-level needs for emotional support were identified. Most participants had not sought support from bereavement services (59%, n = 422) or their General-Practitioner (60%, n = 428). Of participants who had sought such support, over half experienced difficulties accessing bereavement services (56%, n = 149)/General-Practitioner support (52%, n = 135). About 51% reported high/severe vulnerability in grief; among these, 74% were not accessing bereavement or mental-health services. Barriers included limited availability, lack of appropriate support, discomfort asking for help and not knowing how to access services. About 39% (n = 279) experienced difficulties getting support from family/friends, including relational challenges, little face-to-face contact and disrupted collective mourning. The perceived uniqueness of pandemic bereavement and wider societal strains exacerbated their isolation. Conclusions: People bereaved during the pandemic have high levels of support needs alongside difficulties accessing support. We recommend increased provision and tailoring of bereavement services, improved information on support options and social/educational initiatives to bolster informal support and ameliorate isolation. [ABSTRACT FROM AUTHOR]

Autistic children have difficulties in adapting their language for particular listeners and contexts. We asked whether these difficulties are more prominent when children are required to be cognitively flexible, when changing how they have previously referred to a particular object. We compared autistic (N = 30) with neuro-typical 5- to 7-year-olds. Each child participated in two conditions. In the switch condition, the same animal had to be re-described across trials to be appropriately informative (e.g. a participant could appropriately describe a picture as 'dog' on one trial but later the participant needed to re-describe the same picture as 'spotty dog' to differentiate it from a co-present black dog). In the no-switch condition, no picture needed to be re-described. Nonetheless, the conditions were matched regarding the requirement to use both complex (e.g. spotty cat) versus simple expressions (e.g. horse). Autistic children were more over-informative than peers even prior to the requirement to re-describe an animal. Overall, we found a main effect of the switch condition and no interaction with group. Switching a description hinders the ability of children to be appropriately informative. As autistic children are generally less appropriately informative, the requirement to switch leads to particularly poor performance in autism. The way autistic individuals use language often gives the impression that they are not considering how much information listeners need in a given context. The same child can give too much information in one context (e.g. saying 'the big cup' with only one cup present) and too little information in another context (e.g. entering a room and announcing 'the red one' when the listener has no prior knowledge regarding what this refers to). We asked whether many autistic children particularly struggle to tailor their language appropriately in situations where this means changing how they have previously described something. That is, if a speaker has recently described an object as 'the cup', the need to switch to describing it as 'the big cup' could hinder the speaker's ability to use language in a context-appropriate way. We found that switching descriptions indeed makes it more difficult for children to use language in a context-appropriate way, but that this effect did not play out differently for autistic versus neuro-typical children. Autistic children were, however, less likely to provide a context-appropriate amount of information overall than were neuro-typical peers. The combination of these effects meant that when object re-description was required, autistic children only produced an appropriate description half the time. In contrast, without a requirement to re-describe, autistic children could indeed take listener informational needs into account. Applied professionals should consider whether a requirement to change the way the child has previously said something may hinder a child's ability to communicate effectively. [ABSTRACT FROM AUTHOR]