Attachment has a fundamental role in the development of empathy, which helps people interact with others and prevents aggressive behaviors. It is believed that having a secure attachment can promote empathy. However, there is no clear evidence about the relationship between insecure attachment styles and empathy. Therefore, a meta-analysis was performed to clarify the relation between different types of attachment and empathy from late children to adults (9-47 years). It was conducted using 14 studies (11542 participants) for the secure attachment, 7 studies (3115 participants) for the avoidant, and 8 studies (3479 participants) for the anxious-ambivalent. Results indicated that secure attachment was positively correlated with empathy, avoidant attachment was negatively correlated, and anxious-ambivalent attachment had an inconclusive relationship. Whereas the results obtained for the secure and avoidant attachment with empathy are consistent with literature, the inconsistencies in anxious-ambivalent style may be due to a duality of feelings experienced by these individuals, who go from high levels of empathy (to be accepted) to low levels of empathy (to avoid distressing emotions). We suggest broadening the limit in age, include the multidirectional nature of empathy, as well as the effect of gender and different sorts of affiliations (parents, couples) for future studies.
El apego tiene un papel fundamental en el desarrollo de la empatía, la cual ayuda a las personas a interactuar y previene conductas agresivas. Aunque se cree que tener un apego seguro puede promover la empatía, no existe evidencia clara sobre la relación entre los apegos inseguros y la empatía. Consecuentemente, se realizó un metaanálisis para aclarar la relación entre los diferentes tipos de apego y la empatía desde infantes tardíos hasta adultos (9-47 años). Se incluyeron 14 estudios (11542 participantes) para el apego seguro, 7 estudios (3115 participantes) para el evitativo y 8 estudios (3479 participantes) para el ansioso-ambivalente.Los resultados indicaron que el apego seguro se correlacionó positivamente con la empatía, el apego evitativo se correlacionó negativamente y el apego ansioso-ambivalente tuvo una relación no concluyente. Mientras que los resultados obtenidos para el apego seguro y evitativo con empatía concuerdan con la literatura, las inconsistencias en el ansioso-ambivalente pueden deberse a una dualidad de sentimientos experimentados por estos individuos, experimentando desde altos niveles de empatía (buscando aceptación) a bajos niveles de empatía (evitando emociones estresantes).Sugerimos ampliar el límite de edad, incluir la multidireccionalidad de la empatía, el efecto del género y diferentes afiliaciones (padres, parejas) para futuros estudios.

An increasing number of research has documented the positive associations between psychological inflexibility (PI) and mental health problems (i.e., depressive, anxiety, and stress symptoms) during the COVID-19 pandemic. However, the documented associations have been inconsistent. This review thus aimed to quantitatively summarize primary research to gain better estimates of these associations.
A systematic literature review was conducted in six databases and three-level meta-analytic models were used to statistically synthesize effect sizes and to examine moderators of the associations between PI and depressive, anxiety, and stress symptoms.
A total of 22 studies yielded 63 effect sizes on associations between PI and depressive, anxiety, or stress symptoms. The results of three separate meta-analyses revealed a large and significant association between PI and depressive (r = 0.580, 95 % CI [0.549; 0.775]), anxiety (r = 0.548, 95 % CI [0.468; 0.761]), and stress symptoms (r = 0.548, 95 % CI [0.506; 0.725]). The association between PI and depressive symptoms is stronger for males than for females, and the association between PI and stress symptoms varies by type of measure that primary studies use to assess PI and stress symptoms.
Temporal or causal conclusions are not allowed due to cross-sectional nature of the associations included in meta-analyses. Clinical samples with high levels of stress were underrepresented.
PI seems an important risk factor for symptoms of depression, anxiety, and stress, and should therefore be targeted in interventions addressing mental health problems during the COVID-19 pandemic and beyond.

Introduction: To use a quantitative approach to examine the effects of family interventions on physical activity (PA) and sedentary behavior (SB) in children aged 2. 5-12 years. Methods: PubMed, OVID, Web of Science, and others were searched from their inception to May 2020. Intervention studies that examined the effects of family interventions on PA among children aged 2.5-12 years were included in this meta-analysis. Lastly, subgroup analyses were conducted to examine the potential modifying effects of family intervention\'s characteristics and study quality. Results: Eleven articles met the inclusion criteria for this review. Studies investigated a range of PA outcomes, including moderate-to-vigorous PA (MVPA), total PA (TPA), daily steps, and SB levels. Meta-analysis showed that family intervention had a significant effect on PA [standardized mean difference (SMD) = 0.10; 95% CI = 0.01-0.19], especially for daily steps [weight means difference (WMD) = 1,006; 95% CI = 209-1,803], but not for SB (WMD = -0.38; 95% CI = -7.21-6.46). Subgroup analyses indicated the improvements in PA occurred when children were 6-12 years old, intervention focused on PA only, intervention duration ≤ 10 weeks, and \"low risk of bias\" study performed. Conclusions: Family intervention may be a promising way to promote children\'s PA levels, especially for daily steps. Trial Registration: Meta-analysis protocol was registered on PROSPERO: CRD42020193667.

This study aimed to evaluate the effectiveness of physical activity (PA) interrupting prolonged sitting (PS) on postprandial glycemia and insulin responses among adults.
PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, PsycINFO, and the China National Knowledge Infrastructure databases were searched through September 30, 2020. Randomized controlled trials (RCTs) that examined the effect of all forms of PA interrupting PS on postprandial glycemia and/or insulin responses among adults without chronic diseases were included in this study. The risk of bias of included studies was evaluated based on the Cochrane tool. A network meta-analysis was performed to estimate the summary standardized mean differences (SMDs) with 95% confidence intervals (95%CIs) with random effects.
Thirty crossover RCTs were included in our review. These RCTs included 9 types of interventions that interrupted PS. When compared to PS by itself, light-intensity PA intermittent interrupting (LPA-INT) PS and moderate-intensity PA intermittent interrupting (MPA-INT) PS significantly lowered postprandial glycemia (SMD = -0.46, 95%CI: -0.70 to -0.21; SMD = -0.69, 95%CI: -1.00 to -0.37, respectively) and significantly reduced postprandial insulin response (SMD = -0.46, 95%CI: -0.66 to -0.26; SMD = -0.47, 95%CI: -0.77 to -0.17, respectively). Results of the clustered ranking plot indicated that MPA-INT was the most effective intervention in lowering postprandial glycemia and insulin responses.
Replacing PS with MPA-INT or LPA-INT has a positive effect in reducing postprandial glycemia and insulin responses, with MPA-INT being the optimal intervention strategy.

The extent to which walking pace is associated with a reduced risk for stroke remains unclear. This study examined the association between walking pace and stroke risk based on prospective cohort studies.
Databases of PubMed, EMBASE, Web of Science, Scopus, and China National Knowledge Internet were searched from the inception dates to January 31, 2019, for prospective cohort studies focusing on walking pace and risk of stroke in adults. Two reviewers independently extracted data and assessed the quality of the studies. The dependent measure was stroke incidence. Using random-effects models, a meta-analysis was performed to estimate the overall relative risks (RR) of stroke incidence and 95% confidence intervals (CIs) for the individuals with the fastest walking paces vs. individuals with the slowest walking paces. A dose-response relationship was also examined.
After screening 1294 titles/abstracts and 14 full-text studies identified in the search, 7 studies (from 8 cohorts) were included in the meta-analysis. The 7 studies included a total of 135,645 participants (95.2% women; mean age 63.6 years) and 2229 stroke events (median follow-up time = 8.0 years). Compared to individuals in the slowest walking-pace category (median = 1.6 km/h), individuals in the fastest walking-pace category (median = 5.6 km/h) had a 44% lower risk of stroke (pooled RR = 0.56, 95%CI: 0.48-0.65). There was also a linear dose-response relationship (RR = 0.87; 95%CI: 0.83-0.91), with the risk of stroke decreased by 13% for every 1 km/h increment in baseline walking pace. We observed similar results across walking-pace assessment, type of stroke ascertainment, stroke subtypes, sex, sample size, and duration of follow-up.
Findings from this meta-analysis indicate that walking pace is inversely associated with the risk of stroke.

BACKGROUND: Several studies have shown an association of acne vulgaris with depression and anxiety, but a quantitative review has not yet been conducted.
OBJECTIVE: We sought to conduct a systematic review and meta-analysis that elucidates the association of acne vulgaris with depression and anxiety.
METHODS: A systematic review and meta-analysis of literature published before October 1, 2019 from the PubMed, PsycINFO, MEDLINE, and Cochrane databases was conducted. We used a metaanalytic approach to perform a random effects analysis comparing individuals with and without acne. Subgroup analyses between studies included age, study setting, and geographic region.
RESULTS: Forty-two studies were included. We found a significant association of acne vulgaris with depression (r = 0.22 [95% confidence interval 0.17-0.26, P < .00001]) and anxiety (r = 0.25 [95% confidence interval 0.19-0.31, P < .00001]). Subgroup analyses and comparisons showed moderating influences based on factors including age, study setting, and geographic region.
CONCLUSIONS: Inconsistency between publications regarding acne and outcome ascertainment, data reporting, and studies with no control group posed considerable barriers to synthesizing all available published literature.
CONCLUSIONS: Because of an increased risk for depression and anxiety, clinicians should pursue aggressive treatment of acne and consider psychiatric screening or referrals.

OBJECTIVE: This meta-analytic review aimed to estimate the magnitude of health-related quality of life (HrQoL) impairments, as assessed by the KIDSCREEN questionnaires, both self- and parent-reported, in 8- to 18-years-old children/adolescents with chronic health conditions.
METHODS: To identify studies using the KIDSCREEN questionnaires, three electronic databases (PubMed, PsycINFO, EBSCOhost Psychology & Behavioral Sciences) were searched. The final search (February 14-15, 2018) revealed 528 non-duplicated articles, of which 23 papers (21 studies) directly compared the HrQoL of pediatric patients to community/healthy controls and were included in the meta-analysis. Pooled mean differences (MD) with 95% CIs were estimated using the inverse-variance random-effects method.
RESULTS: Of the 21 studies, 16 used self-reports, one used parent-reports and four adopted a multi-informant approach. Self-reported data were retrieved from 20 studies (4852 cases/28,578 controls), and parent-reported data were retrieved from four studies (511 cases/433 controls). Pediatric patients presented significant HrQoL impairments in the domains of physical well-being (MD = - 4.84, 95% CI - 6.44/- 3.24 for self-reports; MD = - 6.86, 95% CI - 10.42/- 3.29 for parent-reports) and peers and social support (MD = - 1.29, 95% CI - 2.25/- 0.34 for self-reports; MD = - 3.90, 95% CI - 5.28/- 2.52 for parent-reports), compared to community/healthy peers. Between-studies heterogeneity was explained by diagnostic categories, instrument version and informants.
CONCLUSIONS: The identification of significant HrQoL impairments among pediatric patients, specifically in the physical and social domains, highlights the importance of routine psychosocial assessment and intervention in primary pediatric healthcare services. Specific recommendations include the use of profile measures, both self- and parent-reports, and the prioritization of oncology, endocrinology and neurology services.

BACKGROUND: There is a growing amount of single-case research literature on the benefits of tablet-mediated interventions for individuals with autism spectrum disorder (ASD). With the development of tablet-based computers, tablet-mediated interventions have been widely utilized for education and treatment purposes; however, the overall quality and evidence of this literature-base are unknown.
OBJECTIVE: This article aims to present a quality review of the single-case experimental literature and aggregate results across studies involving the use of tablet-mediated interventions for individuals with ASD.
METHODS: Using the Tau nonoverlap effect size measure, the authors extracted data from single-case experimental studies and calculated effect sizes differentiated by moderator variables. The moderator variables included the ages of participants, participants\' diagnoses, interventions, outcome measures, settings, and contexts.
RESULTS: Results indicate that tablet-mediated interventions for individuals with ASD have moderate to large effect sizes across the variables evaluated. The majority of research in this review used tablets for video modeling and augmentative and alternative communication.
CONCLUSIONS: To promote the usability of tablet-mediated interventions for individuals with ASD, this review indicates that more single-case experimental studies should be conducted with this population in naturalistic home, community, and employment settings.

A substantial literature suggests that abnormal cortisol reactivity may be a vulnerability for deleterious mental health outcomes, including ADHD. ADHD has been linked with difficulty in emotion regulation and increased risk of experiencing stressors, both of which may be related to psychobiological abnormalities (e.g., abnormal cortisol reactivity). Research has been mixed regarding the association between cortisol reactivity and ADHD. Therefore, the present meta-analytic review (k = 12) sought to quantify this association and review the relevant methodological issues and theoretical implications of this area of research. Overall, no effect was found between cortisol reactivity and ADHD (r = 0), although significant heterogeneity in the analyses suggested that there might be moderators of this association, if one does exist. Results highlight the importance of addressing limitations of the current literature on cortisol reactivity and ADHD and exploring additional indices of emotion regulation that may be associated with ADHD. Implications for future research efforts are discussed.

BACKGROUND: Many individuals with autism spectrum disorders (ASD) show deficits in functional living skills, leading to low independence, limited community involvement, and poor quality of life. With development of mobile devices, utilizing video modeling has become more feasible for educators to promote functional living skills of individuals with ASD.
OBJECTIVE: This article aims to review the single-case experimental literature and aggregate results across studies involving the use of video modeling to improve functional living skills of individuals with ASD.
METHODS: The authors extracted data from single-case experimental studies and evaluated them using the Tau-U effect size measure. Effects were also differentiated by categories of potential moderators and other variables, including age of participants, concomitant diagnoses, types of video modeling, and outcome measures.
RESULTS: Results indicate that video modeling interventions are overall moderately effective with this population and dependent measures. While significant differences were not found between categories of moderators and other variables, effects were found to be at least moderate for most of them.
CONCLUSIONS: It is apparent that more single-case experiments are needed in this area, particularly with preschool and secondary-school aged participants, participants with ASD-only and those with high-functioning ASD, and for video modeling interventions addressing community access skills.