The current systematic and meta-analytic review sought to integrate a growing number of studies examining dimensions of psychological flexibility as treatment mechanisms for Acceptance and Commitment Therapy (ACT). Analyses of 77 records (67 unique studies; Ntotal = 9123 participants) from comprehensive searches of multiple databases suggested that ACT interventions led to reduced inflexibility (i.e., lowered global inflexibility, lack of present moment awareness, cognitive fusion, experiential avoidance, self-as-content, & inaction) and increased flexibility (i.e., committed action/contact with values, global flexibility/acceptance, & defusion). Those changes remained significant when ACT was compared with waitlist or active treatments and were significantly linked to corresponding drops in psychological distress, supporting their roles as ACT treatment mechanisms. Moderation analyses revealed that the use of student samples, exclusion of clinically symptomatic individuals, and comparisons of ACT with other active treatments weakened these effects whereas offering ACT as an individual therapy and excluding individuals in extreme crisis (i.e., with suicidal ideation) strengthened them. The meta-analytic findings and systematic review suggested specific recommendations for future clinical work and research on ACT mechanisms: (1) Evaluate both psychological flexibility and inflexibility as distinct treatment mechanisms, (2) Evaluate specific dimensions of psychological flexibility/inflexibility as mechanisms with multidimensional scales (CompACT, MPFI), (3) Broaden treatment outcomes to include forms of wellbeing (peace of mind, vitality, connectedness), (4) Assess mechanisms and outcomes repeatedly throughout treatment to model the process of therapeutic change, (5) Investigate non-specific factors (therapeutic alliance, treatment adherence) as mechanisms, and (6) Explore treatment mechanisms in effectiveness studies.

Complex trauma is associated with complex-posttraumatic stress disorder (CPTSD). While dissociative processes, developmental factors and systemic factors are implicated in the development of CPTSD, there are no existing systematic reviews examining the underlying pathways linking complex trauma and CPTSD. This study aims to systematically review evidence of mediating factors linking complex trauma exposure in childhood (birth to eighteen years of age) and subsequent development of CPTSD (via self-reports and diagnostic assessments). All clinical, at-risk and community-sampled articles on three online databases (PsycINFO, MedLine and Embase) were systematically searched, along with grey literature from ProQuest. Fifteen articles were eligible for inclusion according to pre-determined eligibility criteria and a search strategy. Five categories of mediating processes were identified: 1) dissociative processes; 2) relationship with self; 3) emotional developmental processes; 4) social developmental processes; and 5) systemic and contextual factors. Further research is required to examine the extent to which targeting these mediators may act as mechanisms for change in supporting individuals to heal from complex trauma.
UNASSIGNED: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022346152.

Personal Comfort Systems (PCS) are equipments that heat and/or cool occupants without affecting surrounding environments, ranging from commonly used devices to innovative technologies, and that tend to be controlled by people. These systems aim to address energy consumption and occupant satisfaction issues related to centralised air-conditioning. Although there are systematic studies on these systems, there is a lack of documentation regarding mediation characteristics between people and the built environment. This article presents a systematic review of PCS using a search of academic literature and patents, classifying PCS based on thermal categories and device typologies while introducing post-phenomenological mediation categories. The results show that most PCS fall into the thermal categories of \'Heating\' and \'Cooling and ventilation\'. The review also presents a view of the PCS territory based on mediation attributes and technological complexity. Finally, the PCS\' characteristics are discussed based on the post-phenomenological concepts of Embodiment, Hermeneutic, and Background providing insights for future research opportunities and PCS development.
Practitioner summary: This study presents a systematic review of Personal Comfort Systems (PCS) found in patents and academic databases, integrating post-phenomenological concepts into PCS discussion. It visualises the PCS territory using a matrix based on mediation relations and technological complexity, providing insights into PCS development and research opportunities.

There has been extensive research on the relationship between hearing and cognitive impairment in older adults but little examination of the role of mediating factors. Social isolation is a potential mediator, occurring because of hearing loss, and contributing to accelerated cognitive decline. Previous systematic reviews on this topic area have not considered the temporal nature of hearing loss and cognitive impairment exclusively or examined potential mediators within a longitudinal study design.
A systematic review was conducted. Electronic searches were performed in Web of Science, PubMed (Medline), Scopus, EMBASE, PsychInfo, and ProQuest (PsychArticles and ProQuest Dissertation and Theses) based on a search string of keywords relating to hearing loss, social isolation, and cognitive impairment/dementia in June 2023. Papers were critically appraised using the CASP checklists for cohort studies. Risk of bias in the selected studies was assessed using the Item Bank for Assessment of Risk of Bias and Precision for Observational Studies of Interventions or Exposures.
Eleven of the 15 included studies provide evidence of a dose-dependent association between hearing threshold (40 dB HL or greater) and later cognitive impairment or incident dementia. Only one study included social isolation as a mediator, which was found to not be a significant contributing factor. The meta-analysis of 5 studies pooled hazard ratio for cognitive impairment due to hearing loss is 1.11 (95% CI: 1.06 to 1.15, p < 0.001). The pooled hazard ratio for incident dementia due to hearing loss was HR 1.21 (95% CI: 1.11 to 1.31, p = 0.002).
The analysis of included studies indicate that hearing threshold level affects later cognitive status or dementia diagnosis. There is not enough evidence to determine the role of social isolation as a mediator. Future epidemiology studies need to measure different elements of social isolation and ensure that hearing and cognition are measured at multiple time points.

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is), while developed as antihyperglycaemic medications for the treatment of type 2 diabetes, have proven to reduce major cardiovascular adverse events (MACEs) and hospitalization for heart failure (especially for SGLT2is) in dedicated cardiovascular outcome trials. The contribution of the glucose-lowering effect in the cardiovascular protection is uncertain and may differ between the two drug classes.
METHODS: This narrative review compares the relative effects of glycated hemoglobin (HbA1c) reduction on the cardiovascular protection provided by GLP-1RAs and SGLT2is in placebo-controlled cardiovascular outcome trials by using the results of either post-hoc mediation analyses or meta-regression studies.
RESULTS: Both mediation and meta-regression analyses suggest that the lower cardiovascular risk with GLP-1RAs partially but substantially tracks with their glucose-lowering effect, especially when considering the reduction in nonfatal strokes. In contrast, similar analyses fail to demonstrate any significant contribution of the glucose-lowering effect with SGLT2is, not only on MACEs but also on heart failure issues.
CONCLUSIONS: The contribution of improved glucose control in cardiovascular protection is limited, but is much greater for GLP-1RAs than for SGLT2is. Of note, such mediation or meta-regression analyses are exploratory and can only be viewed as hypothesis generating.

Early adverse experience is related to psychiatric illness that occurs decades later. The mechanisms underlying this phenomenon have not been fully identified. There is a translational and clinical literature linking early adversity with Major Depressive Disorder (MDD) and inflammation. We reviewed articles that examine whether inflammation mediates this relationship.
Literature review of PUB MED, CINAHL and APA Psycinfo articles that explicitly examine inflammation as a mediator between early adversity and depression using ((((((((((adversity) OR (trauma)) OR (maltreatment)) OR (child abuse)) AND (inflammation)) OR (inflammatory cytokines)) OR (crp)) OR (il-6)) OR (tnf)) AND (mediates)) AND (depression))))))))) as key words.
2842 articles were initially identified. 1338 non-human studies were excluded and 512 more were filtered out as reviews. The remaining 992 titles and, when necessary, abstracts and manuscripts were reviewed and 956 were removed as being of other non-related phenomena. Four additional studies were added by hand searching the references of remaining studies. Out of these 40, 15 explicitly examined inflammation as a mediator of the relationship between early adversity and later depression. Approximately half (8/15) showed evidence that inflammation mediated the relationship between early adversity and depression. Sensitivity analyses showed that studies taking place in clinical populations, in youth and those that used the Adverse Childhood Events Scale to measure adversity, and IL-6 and TNF-α (as opposed to CRP) to measure inflammation were most likely to show mediation.
There is evidence to support the model of inflammation mediating the relationship between early adversity and depression. Certain measures in clinical populations appear more likely to support this model. Further study with more standardized, robust methods will help to answer this question more definitively and may elucidate a subtype of depression related to early adversity by alterations in immune function.

Understanding how treatments for alcohol use disorder (AUD) facilitate behavior change has long been recognized as an important area of research for advancing clinical care. However, despite decades of research, the specific mechanisms of change for most AUD treatments remain largely unknown because most prior work in the field has focused only on statistical mediation. Statistical mediation is a necessary but not sufficient condition to establish evidence for a mechanism of change. Mediators are intermediate variables that account statistically for the relationship between independent and dependent variables, whereas mechanisms provide more detailed explanations of how an intervention leads to a desired outcome. Thus, mediators and mechanisms are not equivalent. To advance mechanisms of behavior change research, in this critical review we provide an overview of methodological shortfalls of existing AUD treatment mechanism research and introduce an etiologically informed precision medicine approach that facilitates the testing of mechanisms of behavior change rather than treatment mediators. We propose a framework for studying mechanisms in alcohol treatment research that promises to facilitate our understanding of behavior change and precision medicine (i.e., for whom a given mechanism of behavior change operates and under what conditions). The framework presented in this review has several overarching goals, one of which is to provide a methodological roadmap for testing AUD recovery mechanisms. We provide two examples of our framework, one pharmacological and one behavioral, to facilitate future efforts to implement this methodological approach to mechanism research. The framework proposed in this critical review facilitates the alignment of AUD treatment mechanism research with current theories of etiologic mechanisms, precision medicine efforts, and cross-disciplinary approaches to testing mechanisms. Although no framework can address all the challenges related to mechanisms research, our goal is to help facilitate a shift toward more rigorous and falsifiable behavior change research.

The systematic review by Alpert and colleagues (Clinical Psychology Reviews, https://doi.org/10.1016/j.cpr.2023.102300) suggests methodological standards for mediation analysis and evaluates the evidence for mediation of PTSD treatment effects in published research. Although the article articulates important methodological guidelines related to timing of treatment, mediator, and outcome, it fails to incorporate the insights of causal mediation analysis into the methodological standards. In particular, the systematic review does not recognize the limitations of using time, rather than PTSD treatment type, in mediation analyses and does not include an assessment of the potential impact of uncontrolled confounding between the mediator and the outcome in the included studies. The conclusions about mediators of PTSD treatments from this systematic review should be considered carefully.

Absence from school is more frequent for children with chronic health conditions (CHCs) than their peers and may be one reason why average academic attainment scores are lower among children with CHCs.
We determined whether school absence explains the association between CHCs and academic attainment through a systematic review of systematic reviews of comparative studies involving children with or without CHCs and academic attainment. We extracted results from any studies that tested whether school absence mediated the association between CHCs and academic attainment.
We identified 27 systematic reviews which included 441 unique studies of 7, 549, 267 children from 47 jurisdictions. Reviews either covered CHCs generally or were condition-specific (e.g., chronic pain, depression, or asthma). Whereas reviews found an association between a range of CHCs (CHCs generally, cystic fibrosis, hemophilia A, end-stage renal disease (pre-transplant), end-stage kidney disease (pre-transplant), spina bifida, congenital heart disease, orofacial clefts, mental disorders, depression, and chronic pain) and academic attainment, and though it was widely hypothesized that absence was a mediator in these associations, only 7 of 441 studies tested this, and all findings show no evidence of absence mediation.
CHCs are associated with lower academic attainment, but we found limited evidence of whether school absence mediates this association. Policies that focus solely on reducing school absence, without adequate additional support, are unlikely to benefit children with CHCs.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285031, identifier: CRD42021285031.

BACKGROUND: Malaria remains a major burden in sub-Saharan Africa (SSA). While an association between poverty and malaria has been demonstrated, a clearer understanding of explicit mechanisms through which socioeconomic position (SEP) influences malaria risk is needed to guide the design of more comprehensive interventions for malaria risk mitigation. This systematic review provides an overview of the current evidence on the mediators of socioeconomic disparities in malaria in SSA.
METHODS: We searched PubMed and Web of Science for randomised controlled trials, cohort, case-control and cross-sectional studies published in English between January 1, 2000 to May 31, 2022. Further studies were identified following reviews of reference lists of the studies included. We included studies that either (1) conducted a formal mediation analysis of risk factors on the causal pathway between SEP and malaria infections or (2) adjusted for these potential mediators as confounders on the association between SEP and malaria using standard regression models. At least two independent reviewers appraised the studies, conducted data extraction, and assessed risk of bias. A systematic overview is presented for the included studies.
RESULTS: We identified 41 articles from 20 countries in SSA for inclusion in the final review. Of these, 30 studies used cross-sectional design, and 26 found socioeconomic inequalities in malaria risk. Three formal mediation analyses showed limited evidence of mediation of food security, housing quality, and previous antimalarial use. Housing, education, insecticide-treated nets, and nutrition were highlighted in the remaining studies as being protective against malaria independent of SEP, suggesting potential for mediation. However, methodological limitations included the use of cross-sectional data, insufficient confounder adjustment, heterogeneity in measuring both SEP and malaria, and generally low or moderate-quality studies. No studies considered exposure mediator interactions or considered identifiability assumptions.
CONCLUSIONS: Few studies have conducted formal mediation analyses to elucidate pathways between SEP and malaria. Findings indicate that food security and housing could be more feasible (structural) intervention targets. Further research using well-designed longitudinal studies and improved analysis would illuminate the current sparse evidence into the pathways between SEP and malaria and adduce evidence for more potential targets for effective intervention.