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Peers are present for most bullying episodes. Peers who witness bullying can play an important role in either stopping or perpetuating the behavior. Defending can greatly benefit victimized peers. Empathy is strongly associated with defending. Yet, less is known about defenders' neural response to witnessing social distress, and how this response may relate to the link between empathy and defending. Forty-six first-year undergraduate students (

BACKGROUND: The frequency with which physicians are injured or killed in acute care hospital shootings has more than tripled during the past two decades. Moreover, physicians may be exposed to firearm violence outside of hospital settings. Objective: To characterize physician-involved workplace-related firearms violence to inform risk identification and mitigation strategies. Methods: Quantitative content analysis of physician-involved workplace-related firearm violence resulting in injury or death. Two investigators independently abstracted web-based reports for each year from 2008-2017 with differences resolved by consensus. Data were summarized using descriptive statistics, and analyzed using chi-square, Fisher exact, or Kruskal Wallis test, as appropriate. Results: Twenty-six incidents, 10 (38.5%) perpetrated by physicians and 16 (61.5%) perpetrated by nonphysicians, resulted in 83 casualties. All physician-perpetrated shootings represented either type III or IV violence motivated by grudges. Significantly more crimes perpetrated by nonphysicians were type II violence (11/16, 68.8%), P

OBJECTIVE: We aimed to quantify the effect of opioid agonist pharmacotherapy on pain management after cesarean delivery, compared with patients not on these medications. METHODS: Patients undergoing cesarean delivery at our institution between January 2016—December 2018 were stratified by peripartum use of opioid agonist pharmacotherapy versus no agonist therapy. We compared 24-hour post-operative opioid consumption not including buprenorphine and methadone, in milligram morphine equivalents (MME) (primary outcome), highest pain score on a 0–10 numerical rating scale in the first 24 post-operative hours, and post-operative length of stay in hours (secondary outcomes) between groups. These outcomes were also compared after covariate adjustment using logistic regression. RESULTS: We identified 123 patients on opioid agonist pharmacotherapy- in the form of buprenorphine or methadone and 2856 patients not on these medications. The groups differed in demographic characteristics, including age, smoking, and marital status. Opioid consumption during the first 24 post-operative hours (median [interquartile range]) was 99 [75,120] MME for patients on agonist therapy and 30 [0, 64] MME among parturients not taking these medications (p

OBJECTIVES: Postdischarge phone calls can identify discharge errors and gather information following hospital-to-home transitions. This study used the multisite Project IMPACT (Improving Pediatric Patient Centered Care Transitions) dataset to identify factors associated with postdischarge phone call attempt and connectivity. METHODS: This study included 0- to 18-year-old patients discharged from 4 sites between January 2014 and December 2017. We compared demographic and clinical factors between postdischarge call attempt and no-attempt and connectivity and no-connectivity subgroups and used mixed model logistic regression to identify significant independent predictors of call attempt and connectivity. RESULTS: Postdischarge calls were attempted for 5528 of 7725 (71.6%) discharges with successful connection for 3801 of 5528 (68.8%) calls. Connection rates varied significantly among sites (52% to 79%, P < .001). Age less than 30 days (P = .03; P = .01) and age 1 to 6 years (P = .04; P = .04) were independent positive predictors for both call attempt and connectivity, whereas English as preferred language (P < .001) and the chronic noncomplex clinical risk group (P = .02) were independent positive predictors for call attempt and connectivity, respectively. In contrast, readmission within 3 days (P = .004) and federal or state payor (P = .02) were negative independent predictors for call attempt and call connectivity, respectively. CONCLUSIONS: This study suggests that targeted interventions may improve postdischarge call attempt rates, such as investment in a reliable call model or improvement in interpreter use, and connectivity, such as enhanced population-based communication.

A substantial minority of adolescents experience and use dating violence in their sexual and/or romantic relationships. Limited attention has been paid to exploring theory-driven questions about use and experience of adolescent dating violence (ADV), restricting knowledge about promising prevention targets for diverse groups of youth. To address this gap, this paper investigates whether factors tied to power imbalances (bullying, risk of social marginalization) are associated with patterns of ADV victimization and perpetration in a large sample of Canadian mid-adolescents. We used data from the 2017/2018 Health-Behavior in School-Aged Children (HBSC) study, a nationally representative sample of Canadian youth. Our study was comprised of adolescents who were in grades 9 or 10, and who had dated in the past 12 months (N = 3779). We assessed multiple forms of ADV and bullying victimization and perpetration. We also included six variables assessing adolescents’ risk of social marginalization: gender, race/ethnicity, immigration status, family structure, food insecurity, and family affluence. We used latent class analysis to explore the ways adolescents experience and use different forms of ADV, and then examined whether factors tied to power imbalances (bullying, social marginalization) were associated with classes of ADV. Three ADV classes emerged in our sample: uninvolved (65.7%), psychological and cyber victimization only (28.9%), and mutual violence (5.4%). Bullying was most strongly associated with the mutual violence class, suggesting a transformation of power from peer to romantic contexts. Social marginalization variables were associated with ADV patterns in different ways, highlighting the need to use a critical and anti-oppressive lens in ADV research and prevention initiatives.

Using data from two methodologically independent youth research studies in Canada, the Health Behaviour in School-aged Children (HBSC) study and the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study, the objective of this study was to compare associations between youth's mental health and cannabis use across samples. Using similar indicators in both studies, our goal was to affirm the potential for nationally representative cross-sectional analyses (HBSC) to replicate findings found in a longitudinal non-representative data source (COMPASS), enhancing opportunity for causal inferences.Data were collected from grade 9 and 10 Canadian students participating in the 2017/18 HBSC (n=8462) and 2017/18 to 2018/19 waves of COMPASS (n=32,023). Using multivariable Poisson regression models, the strength and statistical significance of the effects of mental health indicators on cannabis use outcomes were estimated within both studies and compared for consistency. Using a 2-year linked sample of students participating in COMPASS, models examining the impact of mental health indicators on cannabis use initiation and maintenance over time were similarly fit using Poisson regression to estimate relative risk.Similar associations between mental health problems and cannabis use were observed in both data sources. The direction, magnitude, and precision of the estimates for restless sleep, loneliness, poor wellbeing, and cannabis use were highly comparable across both studies. Worse mental health was consistently associated with current and lifetime cannabis use among youth.Cross-sectional and longitudinal findings from two large methodologically diverse studies in Canada demonstrate a replicable association between indicators of mental health and youth cannabis use. Similarities were identified and two generalizations may be concluded: 1) potentially causal etiological relationships inferred from HBSC data were supported in longitudinal findings based on COMPASS, and 2) longitudinal COMPASS data aligns with nationally representative data from HBSC.

The development of healthy relationships and connections is of fundamental importance to adolescent well-being. The use of social media plays a vital role in the lives of young Canadians, yet the association between different types of social media use and the quality of relationships and connections remains unknown, and most existing analyses on this topic are based on modest and non-representative samples.Using 2017/2018 reports from the nationally representative Health Behaviour in School-aged Children study (n=17,149; ages 11 to 15 years), the strength, consistency and significance of associations was examined between intensive (frequent use to connect with other people) and problematic (use that depicts addictive qualities) social media use and available measures of adolescent relationships and connections.Overall, intensive use (online communication with others almost all of the time) and problematic use (potential addiction to social media) were more common in girls than boys (38% of girls versus 30% of boys and 7.7% of girls versus 5.2% of boys, respectively), with prevalence levels that rose with age. Intensive use was associated with more positive social relationships with friends, especially among girls (relative risk [RR] = 1.40 [95% confidence interval (CI) 1.28 - 1.54]), while problematic use was consistently and negatively associated with strong relationships and connections in all groups in the study. Notably, problematic use was negatively associated with strong family relationships in boys (RR = 0.58 [95% CI 0.42 to 0.79]) and girls (RR=0.48 [95% CI 0.36 to 0.63]).Intensive use of social media has the potential to strengthen relationships and connections in adolescents. However, when social media use becomes addictive or "problematic", it is highly correlated with weaker relationships and a sense of social disconnection. Public health initiatives related to social media use should consider how different types of social media use have the potential to impact on different aspects of health.

Social patterns in bullying show consistent gender differences in adolescent perpetration and victimization with large cross-national variations. Previous research shows associations between societal gender inequality and gender differences in some violent behaviors in adolescents. Therefore, there is a need to go beyond individual associations and use a more social ecological perspective when examining gender differences in bullying behaviors. The aim of the present study was twofold: (1) to explore cross-national gender differences in bullying behaviors and (2) to examine whether national-level gender inequality relates to gender differences in adolescent bullying behaviors.Traditional bullying and cyberbullying were measured in 11-year-olds to 15-year-olds in the 2017/18 Health Behaviour in School-aged Children study (n = 200,423). We linked individual data to national gender inequality (Gender Inequality Index, 2018) in 46 countries and tested their association using mixed-effects (multilevel) logistic regression models.Large cross-national variations were observed in gender differences in bullying. Boys had higher odds of perpetrating both traditional and cyberbullying and victimization by traditional bullying than girls. Greater gender inequality at country level was associated with heightened gender differences in traditional bullying. In contrast, lower gender inequality was associated with larger gender differences for cyber victimization.Societal gender inequality relates to adolescents' involvement in bullying and gendered patterns in bullying. Public health policy should target societal factors that have an impact on young people's behavior.

Pre‐market/prospective environmental risk assessments (ERAs) contribute to risk analyses performed to facilitate decisions about the market introduction of regulated stressors. Robust ERAs begin with an explicit problem formulation, which involves among other steps: (1) formally devising plausible pathways to harm that describe how the deployment of a regulated stressor could be harmful; (2) formulating risk hypotheses about the likelihood and severity of such events; (3) identifying the information that will be useful to test the risk hypotheses; and (4) developing a plan to acquire new data for hypothesis testing should tests with existing information be insufficient for decision‐making. Here, we apply problem formulation to the assessment of possible adverse effects of RNA interference‐based insecticidal genetically modified (GM) plants, GM growth hormone coho salmon, gene drive‐modified mosquitoes and classical biological weed control agents on non‐target organisms in a prospective manner, and of neonicotinoid insecticides on bees in a retrospective manner. In addition, specific considerations for the problem formulation for the ERA of nanomaterials and for landscape‐scale population‐level ERAs are given. We argue that applying problem formulation to ERA maximises the usefulness of ERA studies for decision‐making, through an iterative process, because: (1) harm is defined explicitly from the start; (2) the construction of risk hypotheses is guided by policy rather than an exhaustive attempt to address any possible differences; (3) existing information is used effectively; (4) new data are collected with a clear purpose; (5) risk is characterised against well‐defined criteria of hypothesis corroboration or falsification; and (6) risk assessment conclusions can be communicated clearly. However, problem formulation is still often hindered by the absence of clear policy goals and decision‐making criteria (e.g. definition of protection goals and what constitutes harm) that are needed to guide the interpretation of scientific information. We therefore advocate further dialogue between risk assessors and risk managers to clarify how ERAs can address policy goals and decision‐making criteria. Ideally, this dialogue should take place for all classes of regulated stressors, as this can promote alignment and consistency on the desired level of protection and maximum tolerable impacts across regulated stressors.

Anyone working in biosafety capacity enhancement faces the challenge of ensuring that the impact of a capacity enhancing activity continues and becomes sustainable beyond the depletion of funding. Many training efforts face the limitation of one-off events: they only reach those people present at the time. It becomes incumbent upon the trainees to pass on the training to colleagues as best they can, whilst the demand for the training never appears to diminish. However, beyond the initial effort to establish the basic content, repeating capacity enhancement events in different locations is usually not economically feasible. Also, the lack of infrastructure and other resources needed to support a robust training programme hinder operationalizing a “train-the-trainer” approach to biosafety training. One way to address these challenges is through the use of eLearning modules that can be delivered online, globally, continuously, at low cost, and on an as-needed basis to multiple audiences. Once the modules are developed and peer-reviewed, they can be maintained on a remote server and made available to various audiences through a password-protected portal that delivers the programme content, administers preliminary and final exams, and provides the administrative infrastructure to register users and track their progress through the modules. Crucial to the implementation of such an eLearning programme is an approach in which the modules are intentionally developed together as a cohesive curriculum. Once developed, such a curriculum can be released as a stand-alone programme for the training of governmental risk assessors and regulators or used as accredited components in post-graduate degree programmes in biosafety, at minimal cost to the government or university. Examples from the portfolio of eLearning modules developed by the International Centre for Genetic Engineering and Biotechnology (ICGEB) are provided to demonstrate these key features.

Knowledge mobilization supports research collaborations between university and community partners which can maximize the impacts of research beyond the academy; however, models of knowledge mobilization are complex and create challenges for monitoring research impacts. This inability to sufficiently evaluate is particularly problematic for large collaborative research networks involving multiple partners and research institutions. The Co-produced Pathway to Impact simplifies many of the complex models of knowledge mobilization. It is a logic model based framework for mapping the progress of research -> dissemination -> uptake -> implementation -> impact. This framework is illustrated using collaborative research projects from Promoting Relationships and Eliminating Violence Network (PREVNet), a pan-Canadian community-university network engaging in knowledge mobilization to promote healthy relationships among children and youth and prevent bullying. The Co-produced Pathway to Impact illustrates that research impact occurs when university researchers collaborate with non-academic partners who produce the products, policies, and services that have impacts on the lives of end beneficiaries. Research impact is therefore measured at the level of non-academic partners and identified by surveying research partners to create narrative case studies of research impact.

Cross-national analyses explore the consistency of the relationship between negative school experiences and involvement in bullying across 40 European and North American countries, using the 2006 (40 countries n = 197,502) and 2002 (12 countries, n = 57,007) WHO-HBSC surveys. Measures include two Cumulative Negative School Perception (CNSP) scales, one based on 6 mandatory items (2006) and another including an additional 11 items (2002). Outcome measures included bullying perpetration, victimization and involvement as both bully and victim. Logistic regression analyses suggested that children with only 2-3 negative school perceptions, experience twice the relative odds of being involved in bullying as compared with children with no negative school perceptions. Odds Ratios (p < 0.001) increase in a graded fashion according to the CNSP, from about 2.2 to over 8.0. Similar consistent effects are found across gender and almost all countries. Further research should focus on the mechanisms and social context of these relationships.

The intentional introduction into the environment or market of genetically modified organisms (GMOs) is nearly always governed by a framework of science-based risk assessment and risk management measures. This is usually implemented through the integration of hazard identification and characterisation of all of the elements of risk associated with a new GM crop or derived product. Typical categories of hazards arising from the introduction of transgenic crops include: possible unintended negative health effects in a susceptible subgroup of the consumer (target) population; the evolution of resistance in the targeted pest/pathogen populations when the transgene confers resistance to a pest or pathogen; non-target hazards associated directly or indirectly with the transgenic plant or transgene product outside the plant; and those associated with the integration and subsequent expression of the transgene in a different organism or species following gene flow. The consequences of likely exposure to these and other hazards are considered in this introduction to the main issues raised when evaluating the possible risks arising from the importation or cultivation of genetically modified crops.

Background Although approved for commercialisation in a number of countries since the 1990s, the potential environmental, human/animal health, and socio-economic impacts of genetically modified (GM) crops are still widely debated. One category of human health impacts (designated in this review as non-food health impacts) focuses on indirect effects of GM crop cultivation; amongst which the most prominent are health benefits via: (1) reduced use of pesticides, and (2) an increase in income. Both of these pathways have raised a lot of interest in the developing world, especially in areas experiencing high rates of pesticide poisonings and low agricultural incomes. However, evidence to support such benefits has been relatively scarce in comparison to that of GM food health impacts. Non-food health impacts of GM crop cultivation on farmers deserve more attention, not just because of an apparent knowledge gap, but also because of, potential economic and environmental implications, involving for example CO2 emissions, underground water contamination and improved sanitation. Methods/Design The primary research question was: What are the non-food impacts of GM crop cultivation on farmers’ health? To address this primary question, the study focused on two related secondary questions: (1) Does the cultivation of GM crops result in a lower number of pesticide-related poisonings as compared to the cultivation of their non-GM counterparts?, and; (2) Does the cultivation of GM crops allow for higher financial resources to be used by farmers to improve the health status of themselves and their family, as compared to the cultivation of the non-GM counterpart? The extent to which information relevant to the two secondary questions was freely-available was also evaluated. The search and assessment methodologies were adapted following experience gained during a scoping exercise, and followed the published protocol. Results The 20 databases and 10 reviews searched returned 4,870 hits, with 19 identified as relevant for data extraction. It was apparent that the 19 articles were derived from only 9 original studies, of which 7 were relevant to the first research question, whilst the remaining 2 were relevant to the second question. The studies showed both an overall decrease in the amount of pesticides applied and an increase in household income from GM crop cultivation as compared to the cultivation of the non-GM counterpart. Conclusion In the absence of additional confounding variables or statistical analyses to support these findings, any correlation from these studies should be considered circumstantial at best. Even though the cultivation of GM crops appears to increase household income, evidence to demonstrate that farmers invested this extra income in improving their health remained inconclusive. Further research is therefore needed to clarify the possible correlation between GM crop cultivation and (1) pesticide poisonings, and (2) overall health improvements. Future impact evaluations should include: both written records and surveys; statistical correlations between independent and dependent variables; testing the characteristics of the samples for statistical significance to indicate their representativeness of a particular population, and; increasing the importance of confounding variables in research design (by identifying specific variables and selecting sample and control groups accordingly).

International audience; In tackling agricultural challenges, policy-makers in sub-Saharan Africa (SSA) have increasingly considered genetically modified (GM) crops as a potential tool to increase productivity and to improve product quality. Yet, as elsewhere in the world, the adoption of GM crops in SSA has been marked by controversy, encompassing not only the potential risks to animal and human health, and to the environment, but also other concerns such as ethical issues, public participation in decision-making, socio-economic factors and intellectual property rights. With these non-scientific factors complicating an already controversial situation, disseminating credible information to the public as well as facilitating stakeholder input into decision-making is essential. In SSA, there are various and innovative risk communication approaches and strategies being developed, yet a comprehensive analysis of such data is missing. This gap is addressed by giving an overview of current strategies, identifying similarities and differences between various country and institutional approaches and promoting a way forward, building on a recent workshop with risk communicators working in SSA.

Recent controversies over peer-reviewed papers on potential impacts of genetically modified organisms underline the necessity for an explicit, transparent and unbiased reviewing of published results. Evidence synthesis approaches represent powerful tools to collect, evaluate and summarize such research results in a transparent, reproducible and unbiased manner. The EU-funded project GRACE (GMO Risk Assessment and Communication of Evidence) aims to explore, adapt, apply, and promote these tools to enhance accountability in decision-making by providing policy makers with comprehensive, science-based information on potential impacts (scenarios) of genetically modified plants and their derived products. Furthermore, GRACE will establish an open-access database in order to support the review process, to mirror the evidence synthesis, to assist the dissemination of results and conclusions, as well as to act, in more general terms, as an information resource on biosafety of genetically modified plants.

When applying risk assessment and the broader process of risk analysis to decisions regarding the dissemination of genetically modified organisms (GMOs), the process has a tendency to become remarkably complex. Further, as greater numbers of countries consider authorising the large-scale dissemination of GMOs, and as GMOs with more complex traits reach late stages of development, there has been increasing concern about the burden posed by the complexity of risk analysis. We present here an improved approach for GMO risk analysis that gives a central role to problem formulation. Further, the risk analysis strategy has been clarified and simplified in order to make rigorously scientific risk assessment and risk analysis more broadly accessible to diverse stakeholder groups.

This contribution describes the risk assessment principles and the regulatory framework for transgenic (genetically modified (GM)) crops in the European Union (EU). While the global cropping area of GM crops reached 148 million hectares in 2010, the total area cultivated with GM crops in the EU was less than 100,000 ha. Most GM crops are thus cultivated outside the EU, but might subsequently be imported and eventually further processed in the EU, mostly for animal feed purposes. It is globally accepted that agro-food biotechnology could contribute to achieving the objectives (conservation of biological diversity, sustainable use of its components, fair and equitable sharing of the benefits arising out of the utilization of genetic resources) laid down in the Convention on Biological Diversity, if developed and used with adequate safety measures for both the environment and human health. Generally, ...