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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.

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.

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.

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).

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.

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.

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.

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.

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

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.

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.

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.

Author(s): Wessells, K Ryan; Arnold, Charles D; Stewart, Christine P; Prado, Elizabeth L; Abbeddou, Souheila; Adu-Afarwuah, Seth; Arnold, Benjamin F; Ashorn, Per; Ashorn, Ulla; Becquey, Elodie; Brown, Kenneth H; Byrd, Kendra A; Campbell, Rebecca K; Christian, Parul; Fernald, Lia CH; Fan, Yue-Mei; Galasso, Emanuela; Hess, Sonja Y; Huybregts, Lieven; Jorgensen, Josh M; Kiprotich, Marion; Kortekangas, Emma; Lartey, Anna; Le Port, Agnes; Leroy, Jef L; Lin, Audrie; Maleta, Kenneth; Matias, Susana L; Mbuya, Mduduzi NN; Mridha, Malay K; Mutasa, Kuda; Naser, Abu Mohd; Paul, Rina R; Okronipa, Harriet; Ouedraogo, Jean-Bosco; Pickering, Amy J; Rahman, Mahbubur; Schulze, Kerry; Smith, Laura E; Weber, Ann M; Zongrone, Amanda; Dewey, Kathryn G | Abstract: ABSTRACTBackgroundSmall-quantity lipid-based nutrient supplements (SQ-LNS) have been shown to reduce the prevalence of anemia and iron deficiency among infants and young children, but effects on other micronutrients are less well known. Identifying subgroups who may experience greater benefits from SQ-LNS, or who are more likely to respond to the intervention, may facilitate the development of public health policies and programs.ObjectiveOur objective was to identify study-level and individual-level modifiers of the effect of SQ-LNS on child hematological and micronutrient status outcomes.MethodsWe conducted a two-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNS provided to children 6 to 24 months of age in low- and middle-income countries (n = 15,946). Outcomes were hemoglobin (Hb), inflammation-adjusted plasma ferritin, soluble transferrin receptor, zinc, retinol and retinol binding protein (RBP), and erythrocyte zinc protoporphyrin, and respective dichotomous outcomes indicative of anemia and micronutrient deficiency. We generated study-specific estimates of SQ-LNS vs. control, including main effects and subgroup estimates for individual-level effect modifiers, and pooled the estimates using fixed-effects models. We used random effects meta-regression to examine potential study-level effect modifiers.ResultsProvision of SQ-LNS decreased the prevalence of anemia (Hb l 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin l 12 µg/L) by 56% and iron deficiency anemia (IDA; Hb l 110 g/L and plasma ferritin l 12 µg/L) by 64%. We observed positive effects of SQ-LNS on hematological and iron status outcomes within all subgroups of the study-level and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNS on anemia and iron status were greater in trials that provided SQ-LNS for g 12 months and provided 9 mg/d vs. l 9 mg iron/d, and among later-born (vs. first-born) children. There was no effect of SQ-LNS on plasma zinc or retinol, but there was a 7% increase in plasma RBP and a 56% reduction in vitamin A deficiency (RBP l 0.70 µmol/L), with little evidence of effect modification by individual-level characteristics.ConclusionsSQ-LNS provided to infants and young children 6-24 months of age can substantially reduce the prevalence of anemia, iron deficiency, and IDA across a range of individual, population and study design characteristics. Policy-makers and program planners should consider SQ-LNS within intervention packages to prevent anemia and iron deficiency. This study was registered at www.crd.york.ac.uk/PROSPERO as CRD42020156663.

Background: Heart failure (HF) is a heterogeneous disease characterized by significant metabolic disturbances; however, the breadth of metabolic dysfunction before the onset of overt disease is not well understood. The purpose of this study was to determine the association of circulating metabolites with incident HF to uncover novel metabolic pathways to disease. Methods: We performed targeted plasma metabolomic profiling in a deeply phenotyped group of Black adults from the JHS (Jackson Heart Study; n=2199). We related metabolites associated with incident HF to established etiological mechanisms, including increased left ventricular mass index and incident coronary heart disease. Furthermore, we evaluated differential associations of metabolites with HF with preserved ejection fraction versus HF with reduced ejection fraction. Results: Metabolites associated with incident HF included products of posttranscriptional modifications of RNA, as well as polyamine and nitric oxide metabolism. A subset of metabolite-HF associations was independent of well-established HF pathways such as increased left ventricular mass index and incident coronary heart disease and included homoarginine (per 1 SD increase in metabolite level, hazard ratio, 0.77; P =1.2×10 −3 ), diacetylspermine (hazard ratio, 1.34; P =3.4×10 −3 ), and uridine (hazard ratio, 0.79; P , 3×10 −4 ). Furthermore, metabolites involved in pyrimidine metabolism (orotic acid) and collagen turnover ( N -methylproline) among others were part of a distinct metabolic signature that differentiated individuals with HF with preserved ejection fraction versus HF with reduced ejection fraction. Conclusions: The integration of clinical phenotyping with plasma metabolomic profiling uncovered novel metabolic processes in nontraditional disease pathways underlying the heterogeneity of HF development in Black adults.

Objective: We conducted a meta-analysis to examine whether numeric decision-making in law is susceptible to the effect of (possibly arbitrary) values present in the decision contexts (anchoring effect) and to investigate which factors might moderate this effect. Hypotheses: We predicted that the presence of numeric anchors would bias legal decision-makers' judgment in the direction of the anchor value. We hypothesized that the effect size of anchoring would be moderated by several variables, which we grouped into three categories: methodological (type of stimuli; type of sample), psychological (standard vs. basic paradigm; anchor value; type of scale on which the participants assessed the target value), and legal (relevance of the anchor; type of the anchor; area of law to which the presented case belonged; presence of any salient numeric values other than the main anchor). Method: Twenty-nine studies (93 effect sizes; N = 8,549) met the inclusion criteria. We divided them into two groups, depending on whether they included a control group, and calculated the overall effect size using a random-effects Model with robust variance estimation. We assessed the influence of moderators using random effects metaregression. Results: The overall effect sizes of anchoring for studies with a control group (z = .27, 95% CI [.21, .33], d = .58, 95% CI [.44, .73]) and without a control group (z = .39, 95% CI [.31, .47], d = .91, 95% CI [.69, 1.12]) were both significant, although we provide some evidence of possible publication bias. We found preliminary evidence of a potential moderating effect of some legally relevant factors, such as legal expertise or the anchor relevance. Conclusions: Existing research indicates anchoring effects exist in legal contexts. The influence of anchors seems to depend on some situational factors, which paves the way for future research on countering the problematic effect in legal settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Key Points Question What are modifiable preoperative factors associated with developing chronic pain after distal radius fracture surgery? Findings In this secondary analysis of a randomized clinical trial with 146 participants, each 10-point increase in preoperative pain score was associated with 17% increased odds of chronic pain, and a 1-week delay in surgical intervention was associated with more than triple the odds of experiencing chronic pain. Internal fixation was associated with decreased risk of chronic pain compared with external fixation or pinning. Meaning In this study, earlier time to surgery, adequate preoperative pain control, and internal fixation were associated with lower risk of chronic pain development among patients with distal radius fracture who were treated surgically., This secondary analysis identifies modifiable preoperative factors that are significantly associated with developing chronic pain among patients with distal radius fractures who are treated surgically., Importance Despite appropriate treatment, many patients who sustain distal radius fractures (DRFs) report persistent wrist pain. Chronic musculoskeletal pain is among the leading health problems in the elderly population associated with significant personal and societal burden. Objective To identify modifiable preoperative factors that are significantly associated with developing chronic pain. Design, Setting, and Participants This is a secondary analysis of the Wrist and Radius Injury Surgical Trial (WRIST), a randomized multicenter clinical trial of 24 study sites in the United States, Canada, and Singapore that enrolled patients from April 10, 2012, to December 31, 2016. Adults older than 60 years who sustained closed extra-articular DRFs, were treated operatively, and completed 12-month Michigan Hand Outcomes Questionnaires (MHQs) were included in this study. Analysis was conducted from September to December 2019. Interventions Volar locking plate internal fixation, external fixation, or percutaneous pinning. Main Outcomes and Measures 12-month MHQ pain domain score. Inverse probability weighted logistic regression was used to identify factors associated with of chronic pain. Results A total of 146 patients with DRF who were treated operatively and had 12-month MHQ scores met inclusion criteria. The mean (SD) patient age was 68.9 (7.2) years, 128 (87.6%) were women, and 93 (63.7%) were retired. Chronic pain was present in 87 patients (59.6%) and absent in 59 patients (40.4%) at 1-year follow-up. A 1-week delay in surgery was associated with more than triple the odds of developing chronic pain (odds ratio [OR], 3.65; 95% CI, 1.48-9.00), and each 10-point increase in preoperative pain was associated with a 17% increase in the odds of experiencing chronic pain (OR, 1.17; 95% CI, 1.02-1.34). Internal fixation was associated with decreased odds of developing chronic pain compared with the other 2 procedures (OR, 0.29; 95% CI, 0.10-0.90). Conclusions and Relevance In this study, preoperative pain, time to surgery, and procedure type were modifiable factors associated with chronic pain 1 year after DRF treated with surgery. Adequate pain control in patients with acute DRFs even before definitive surgical management and earlier fixation for patients requiring surgery may decrease the risk of developing chronic pain. Internal fixation may decrease the risk of chronic pain after DRF surgery, compared with percutaneous pinning or external fixation. Trial Registration ClinicalTrials.gov Identifier: NCT01589692

Background/Purpose Most studies examining the components of the fear-avoidance model have examined processes at the group level. The current study used ecological momentary assessments to: (a) investigate the group and intraindividual relationships between pain fear, avoidance, and pain severity, (b) identify any heterogeneity between these relationships, and (c) explore the role of moderators to explain such heterogeneity. Methods Seventy-one pediatric patients with chronic abdominal pain (M = 13.34 years, standard deviation = 2.67 years) reported pain fear, avoidance, and pain severity four times per day over 14 days. Results Results indicated significant individual differences in the relationship between pain fear and pain avoidance predicting pain severity. Child age helped explain the heterogeneity in the relationships between pain avoidance and pain severity such that older children had a stronger and more positive relationship between these variables. The random effect between pain fear and pain severity also indicated a moderator trend of child age such that older children were likely to have a stronger and more positive relationship. Conclusions The present study extends the fear-avoidance model by highlighting the importance of identifying potential individual differences when examining pain fear, avoidance, and pain severity. Furthermore, the current study suggests that child development should be considered in the model. However, future randomized control designs are necessary to explore the causal relationships between pain fear and avoidance on pain severity and potential developmental differences.

Despite extensive evidence that time perspective is associated with a range of important outcomes across a variety of life domains (e.g., health, education, wealth), the question of why time perspective has such wide-reaching effects remains unknown. The present review proposes that self-regulatory processes can offer insight into why time perspective is linked to outcomes. To test this idea we classified measures of time perspective according to the dimension of time perspective that they reflected (e.g., past, present-hedonistic, future) and measures of self-regulation according to the self-regulatory process (i.e., goal setting, goal monitoring, and goal operating), ability, or outcome that they reflected. A systematic search identified 378 studies, reporting 2,000 tests of the associations between measures of time perspective and self-regulation. Random-effects meta-analyses with robust variance estimation found that a future time perspective had small-to-medium-sized positive associations with goal setting (r+ = 0.25), goal monitoring (r+ = 0.19), goal operating (r+ = 0.24), self-regulatory ability (r+ = 0.35), and outcomes (r+ = 0.18). Present time perspective, including being present-hedonistic and present-fatalistic, was negatively associated with self-regulatory processes, ability, and outcomes (r+ ranged from -0.00 to -0.27). Meta-analytic mediation models found that the relationship between future time perspective and outcomes was mediated by goal monitoring, goal operating, and self-regulatory ability, but not goal setting. As the first test of why time perspective is associated with key outcomes, the findings highlight the central role of self-regulation processes and abilities for understanding why people with certain time perspectives experience better outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background The Hawthorne Effect is the change in behaviour by subjects due to their awareness of being observed and is evident in both research and clinical settings as a result of various forms of observation. When the Hawthorne effect exists, it is short-lived, and likely leads to increased productivity, compliance, or adherence to standard protocols. This study is a qualitative component of an ongoing multicentre study, examining the role of Incisional Negative Pressure Wound Therapy after vascular surgery (INVIPS Trial). Here we examine the factors that influence hygiene and the role of the Hawthorne effect on the adherence of healthcare professionals to standard hygiene precautions. Methods This is a qualitative interview study, investigating how healthcare professionals perceive the observation regarding hygiene routines and their compliance with them. Seven semi-structured focus group interviews were conducted, each interview included a different staff category and one individual interview with a nurse from the Department for Communicable Disease Control. Additionally, a structured questionnaire interview was performed with environmental services staff. The results were analysed based on the inductive qualitative content analysis approach. Results The analysis revealed four themes and 12 subthemes. Communication and hindering hierarchy were found to be crucial. Healthcare professionals sought more personal and direct feedback. All participants believed that there were routines that should be adhered to but did not know where to find information on them. Staff in the operating theatre were most meticulous in adhering to standard hygiene precautions. The need to give observers a clear mandate and support their work was identified. The staff had different opinions concerning the patient’s awareness of the importance of hygiene following surgery. The INVIPS Trial had mediated the Hawthorne effect. Conclusion The results of this study indicate that the themes identified, encompassing communication, behaviour, rules and routines, and work environment, influence the adherence of healthcare professionals to standard precautions to a considerable extent of which many factors could be mediated by a Hawthorne effect. It is important that managers within the healthcare system put into place an improved and sustainable hygiene care to reduce the rate of surgical site infections after vascular surgery.

Background Home visits by paraprofessional community health workers (CHWs) has been shown to improve maternal and child health outcomes in research studies in many countries. Yet, when these are scaled or replicated, efficacy disappears. An effective CHW home visiting program in peri-urban Cape Town found maternal and child health benefits over the 5 years point but this study examines if these benefits occur in deeply rural communities. Methods A non-randomized, two-group comparison study evaluated the impact of CHW in the rural Eastern Cape from August 2014 to May 2017, with 1310 mother-infant pairs recruited in pregnancy and 89% were reassessed at 6 months post-birth. Results Home visiting had limited, but important effects on child health, maternal wellbeing and health behaviors. Mothers reported fewer depressive symptoms, attended more antenatal visits and had better baby-feeding practices. Intervention mothers were significantly more likely to exclusively breastfeed for 6 months (OR: 1.8; 95% CI: 1.1, 2.9), had lower odds of mixing formula with baby porridge (regarded as detrimental) (OR: 0.4; 95% CI: 0.2, 0.8) and were less likely to consult traditional healers. Mothers living with HIV were more adherent with co-trimoxazole prophylaxis (p Conclusion The impact of CHWs in a rural area was less pronounced than in peri-urban areas. CHWs are likely to need enhanced support and supervision in the challenging rural context.

Context Studies in mice and humans suggest that melanocortin-4 receptor (MC4R) deficiency affects body weight in a sex-/gender-dependent manner. However, similar evidence for type 2 diabetes (T2D) is scarce. Objective and Design We investigated whether sex/gender modifies the association between the loss-of-function MC4R p.Ile269Asn mutation and T2D in 6929 Mexican adults (3175 T2D cases and 3754 normal glucose tolerance [NGT] controls). The 2003 American Diabetes Association criteria were used to define NGT and T2D. The MC4R p.Ile269Asn mutation was genotyped in all participants using TaqMan technology. Results The MC4R p.Ile269Asn mutation was associated with T2D in 6929 Mexican adults (Ncontrols = 3754, Ncases = 3175, odds ratio [OR] = 2.00, 95% confidence interval [CI], 1.35-2.97; P = 5.7 × 10-4). The MC4R p.Ile269Asn mutation had a frequency of 0.86 and 1.05% in women with NGT and T2D, and 0.78 and 1.32% in men with NGT and T2D, respectively. We identified a significant interaction between the MC4R p.Ile269Asn mutation and sex/gender on T2D risk (P = 0.049). Although a strong association between the mutation and T2D was observed in men (Ncontrols = 2418, Ncases = 1807, OR = 2.63, 95% CI, 1.62-4.28, P = 9.3 × 10-5), results were not significant in women (Ncontrols = 1336, Ncases = 1368, OR = 1.16, 95% CI, 0.60-2.26, P = 0.65). Further adjustment for body mass index in the logistic regression model did not alter the sex-/gender-specific pattern of association (men: OR = 2.22, 95% CI, 1.34-3.67, P = 0.0019; women: OR = 1.02, 95% CI, 0.51-2.02, P = 0.95). Conclusion This is the first report of a male-specific association between the MC4R p.Ile269Asn loss-of-function mutation and T2D in the Mexican population.

Numerous studies demonstrate that the Hawthorne effect (behaviour change caused by awareness of being observed) increases health workers' hand hygiene adherence but it is not clear whether they are methodologically robust, what the magnitude of the effect is, how long it persists or whether it is the same across clinical settings. The objective of this review was to determine the rigour of the methods used to assess the Hawthorne effect on hand hygiene, effect size estimation, variations between clinical settings and persistence. To this end, a systematic literature review with meta-analysis was conducted. Nine studies met the criteria for the review. Methodological quality was variable. The Hawthorne effect ranged from -6.9% to 65.3%. It was 4.2% in one study conducted in intensive care and 16.4% in transplant units. It was most marked when data were collected across an entire hospital and in a group of general hospitals. Differences between wards in the same hospital were apparent. In the two studies where duration was estimated, the Hawthorne effect appeared transient. Despite methodological shortcomings, the review indicates clear evidence of a Hawthorne effect on general wards. There is evidence that it may vary between clinical speciality and across departments. The review identifies a need for standardized methodologies to measure the Hawthorne effect to overcome the dilemma of reporting the potentially inflated rates of adherence obtained through overt audit. Occasional covert audit could give a better estimation of true hand hygiene adherence but its acceptability and feasibility to health workers need to be explored.

[Correction Notice: An Erratum for this article was reported online in Psychological Methods on Sep 24 2020 (see record 2020-72092-001). In the article "Do Simple Slopes Follow-Up Tests Lead Us Astray? Advancements in the Visualization and Reporting of Interactions," by Megan C. Finsaas and Brandon L. Goldstein (Psychological Methods, advance online publication. April 20, 2020. http://dx.doi.org/10.1037/ met0000266), Figure 5 contained an error. The second sentence of the caption of Figure 5 should read: "The left plot depicts the region of significance when life stress is acting as the moderator, and the right when neuroticism is acting as the moderator." All versions of this article have been corrected.] Statistical interactions between two continuous variables in linear regression are common in psychological science. As a follow-up analysis of how the moderator impacts the predictor-outcome relationship, researchers often use the pick-a-point simple slopes method. The simple slopes method requires researchers to make two decisions: (a) which moderator values should be used for plotting and testing simple slopes, and (b) which predictor should be considered the moderator. These decisions are meant to be driven by theory, but in practice researchers may use arbitrary conventions or theoretical reasons may not exist. Even when done thoughtfully, simple slopes analysis omits important information about the interaction. Consequently, it is problematic that the simple slopes approach is the primary basis for interpreting interactions. A more nuanced alternative is to utilize the Johnson-Neyman technique in conjunction with a regression plane depicting the interaction effect in three-dimensional space. This approach does not involve picking points but rather shows the slopes at all possible values of the predictor variables and gives both predictors equal weight instead of selecting a de facto moderator. Because this approach is complex and user-friendly implementation tools are lacking, we present a tutorial explaining the Johnson-Neyman technique and how to visualize interactions in 3-D space along with a new open-source tool that completes these procedures. We discuss how this approach facilitates interpretation and communication as well as its implications for replication efforts, transparency, and clinical applications. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

OBJECTIVE To find prevalence of preterm birth in Pakistan and to explore its related risk factors. METHODS This analytical cross-sectional study was conducted from October 1, 2016, to September 30, 2017, at Hajvery University, Lahore, Pakistan, and data was collected from Obstetrics and Gynaecology departments of various hospitals in four provinces of the country. To find risk factors of preterm birth, data was divided into two groups: Group-1 consisted cases with preterm birth defined as gestational age

ObjectiveThis study examined the association of anxiety alone, depression alone and the presence of both anxiety and depression with preterm birth (PTB) and further examined whether neighbourhood socioeconomic status (SES) modified this association.DesignCohort study using individual-level data from two community-based prospective pregnancy cohort studies (All Our Families; AOF) and Alberta Pregnancy Outcomes and Nutrition (APrON) and neighbourhood SES data from the 2011 Canadian census.SettingCalgary, Alberta, Canada.ParticipantsOverall, 5538 pregnant women who were 15 years old were enrolled in the cohort studies between 2008 and 2012. 3341 women participated in the AOF study and 2187 women participated in the APrON study, with 231 women participated in both studies. Women who participated in both studies were only counted once.Primary and secondary outcome measuresPTB was defined as delivery prior to 37 weeks of gestation. Depression was defined as an Edinburgh Postnatal Depression Scale (EPDS) score of ≥13, anxiety was defined as an EPDS-anxiety subscale score of ≥6, and the presence of both anxiety and depression was defined as meeting both anxiety and depression definitions.ResultsOverall, 7.3% of women delivered preterm infants. The presence of both anxiety and depression, but neither of these conditions alone, was significantly associated with PTB (OR 1.6, 95% CI 1.1 to 2.3) and had significant interaction with neighbourhood deprivation (p=0.004). The predicted probability of PTB for women with both anxiety and depression was 10.0%, which increased to 15.7% if they lived in the most deprived neighbourhoods and decreased to 1.4% if they lived in the least deprived neighbourhoods.ConclusionsEffects of anxiety and depression on risk of PTB differ depending on where women live. This understanding may guide the identification of women at increased risk for PTB and allocation of resources for early identification and management of anxiety and depression.

BACKGROUND: Air pollution has been associated with various health outcomes. Its effect on hand-grip strength, a measurement of the construct of muscle strength and health status, remains largely unknown. METHODS: We used the survey data from 31,209 adults ≥ 50 years of age within Wave 1 of the Study on Global AGEing and Adult Health in six low- and middle-income countries. The outdoor concentration of fine particulate matter pollution (PM2.5) was estimated using satellite data. Domestic fuel type and ventilation were used as indicators of indoor air pollution. We used multilevel linear regression models to examine the association between indoor and outdoor air pollution and hand-grip strength, as well as the potential effect modifiers. RESULTS: We found inverse associations between both indoor and outdoor air pollution and hand-grip strength. Each 10 μg/m3 increase in 3 years' averaged concentrations of outdoor PM2.5 corresponded to 0.70 kg (95% CI: -1.26, -0.14) lower hand-grip strength; and compared with electricity/liquid/gas fuel users, those using solid fuels had lower hand-grip strength (β = -1.25, 95% CI: -1.74, -0.75). However, we did not observe a statistically significant association between ventilation and hand-grip strength. We further observed that urban residents and those having a higher education level had a higher association between ambient PM2.5 and hand-grip strength, and men, young participants, smokers, rural participants, and those with lower household income had higher associations between indoor air pollution and hand-grip strength. CONCLUSION: This study suggests that both indoor and outdoor air pollution might be important risk factors of poorer health and functional status as indicated by hand-grip strength.

In 2015, the FDA formally warned Santa Fe Natural Tobacco Company that their “natural” and “additive-free” claims for its Natural American Spirit cigarettes conveyed reduced harm to consumers. In a settlement, Santa Fe was allowed to continue using the word “natural” in the brand name and the phrase “tobacco and water”. The company also uses eco-friendly language and plant imagery and these tactics have also been shown to communicate reduced product harm. In this study, we propose the health halo effect as an overarching framework for explaining how these ad tactics mislead consumers in an effort to provide more comprehensive guidance for regulatory action. In a between-subjects experiment, 1,577 US young adults, ages 18–24, were randomly assigned to view one of five Natural American Spirit cigarette ads featuring either: 1) eco-friendly language; 2) plant imagery; 3) the phrase “tobacco and water”; 4) all of these tactics; or 5) a control condition featuring none of these tactics. In line with past research, ads with the phrase “tobacco and water” or with all the tactics together (vs. control) created a health halo effect, increasing perceptions that Natural American Spirit cigarettes were healthier and had less potential to cause disease; these tactics also had an indirect positive effect on smoking intentions through reduced perceptions of the brand’s potential to cause disease and perceived absolute harm. Inconsistent with prior work, the eco-friendly language and plant imagery (vs. control) reduced healthfulness perceptions, increased perceptions of absolute harm, and had an indirect negative effect on smoking intentions. We contribute to past research showing that Natural American Spirit cigarette ad tactics mislead consumers. Inconsistent findings are explained in terms of stimuli design and processing of message features, indices of relative message persuasiveness, and multiple versus single-message designs.

BACKGROUND AND OBJECTIVES: Genome Wide Association Studies (GWAS) have identified genetic polymorphisms associated with bronchodilator response (BDR), but it is unknown how these associations change across life stages. We examined the impact of genetic variants on BDR from childhood to adulthood in asthmatics to uncover potential effect modification by age. METHODS: We searched the National Human Genome Research Institute (NHGRI) catalog of published GWAS to obtain a list of genetic associations with BDR, and tested them for effect modification by age in 604 subjects from the Childhood Asthma Management Program (CAMP), a clinical trial with longitudinal measures of BDR (age range 5 to 30 years). We performed longitudinal analyses using linear mixed models and visualized longitudinal changes in BDR using generalized additive models with repeated measures, adjusting for treatment group, sex, and main effects of age and additive genotype. RESULTS: Increasing age was associated with decreased BDR (−0.24 % per year). Polymorphisms rs295137 near SPATS2L and rs2626393 near ASB3 demonstrated their strongest associations with BDR in early childhood through adolescence, with a large decrease in their magnitude of effect from adolescence onward. The effect estimate for % BDR associated with rs295137 genotype (Beta=1.3; 95% CI 0.6 to 2.1) was diminished by age (interaction term=−0.06, p=0.004). The effect estimate for rs2626393 (Beta=−0.92 (95% CI −1.7 to −0.2) was also modified by age (interaction term= 0.05, p = 0.0004). CONCLUSIONS: Polymorphisms associated with BDR in childhood may not be relevant for predicting adolescent and adult BDR, which could reflect age-related changes in asthma phenotypes. TRIAL REGISTRATION: This work uses data from the previous clinical trial of asthma, the Childhood Asthma Management Program (CAMP), registered at ClinicalTrials.gov, #