BACKGROUND: Opioid use disorder (OUD) poses a global health challenge, and despite medications for opioid use disorder (MOUD) and psychosocial interventions, relapse remains a significant concern. Comorbid psychiatric disorders, including attention deficit hyperactivity disorder (ADHD), are one of the major factors associated with poor OUD treatment outcome. We aimed to estimate the frequency of probable ADHD (in childhood and in adulthood) in patients with OUD; to assess the factors associated with this comorbidity; and to explore the factors that mediate the relationship between ADHD and OUD treatment outcome.
METHODS: We conducted an observational study using a sample of 229 patients aged 18 years and older who were diagnosed with OUD and had received MOUD for at least six months. Participants were assessed through a structured interview and self-report questionnaires. Multivariate logistic regressions and a mediation analysis were performed.
RESULTS: Almost half of the participants reported probable ADHD in childhood, and ADHD persisted into adulthood among two-thirds of the patients. The factors associated with poor OUD treatment outcome included earlier onset of OUD, lower education, and greater impulsivity. There was no direct effect of probable ADHD in childhood on OUD treatment outcome, but there was an indirect effect through negative urgency, the tendency to respond impulsively to negatively connoted emotional experiences.
CONCLUSIONS: The findings suggest that ADHD symptoms, particularly impulsivity, may contribute to vulnerability in opioid use and play a crucial role in treatment outcomes for this population.
BACKGROUND: ClinicalTrials identifier NCT01847729.

Most perpetrators of terrorist violence have had some level of post-secondary school education, with many enrolled in education at the time of their attacks. Exploring this premise in the context of prevention, this article draws from data gathered on a purposive sample (N = 206) of radicalized individuals from Europe and North America, half of whom became involved in terrorist violence at the end of their radicalization trajectories. Through a lens of educational participation, we propose novel, non-linear frameworks for understanding radicalization outcomes. To do so, two factors are explored that uniquely intersect when an individual enters a school setting: Adverse childhood experiences (ACE) and the human capital provided by education. As hypothesized, exposure to ACE was found to be associated with radicalization trajectories culminating in terrorist violence at the bivariate level (OR = 2.08). Consistent with the developmental-assets framework, it was further hypothesized that this relationship would be mediated by enrollment in education; however, results did not support this hypothesis. Instead, consistent with resiliency-based models, it was found that the relationship between ACE and involvement in terrorist violence was significant for those who abandoned education during radicalization (OR = 2.07). As well as contributing to theoretical models of radicalization to terrorist violence, identifying the furtherance of education as a moderator of risk may signal an important preventative strategy for violent extremism. Keeping enrolled students engaged in their programs, even if only nominally, may also forego the need for educators to engage in potentially controversial practices such as alerting the authorities to students who display signs of radicalization.

UNASSIGNED: The coronavirus disease 2019 (COVID-19) pandemic impact on infant sleep (IS) is understudied. The purpose of this study was to examine the relationships between family impact and distress from COVID-19 pandemic stressors, parental insomnia symptoms, infant temperamental negative affectivity, and parent-reported IS.
UNASSIGNED: Parents from the Phoenix metropolitan area with a full-term healthy infant (<1 year) were recruited from February 27, 2021, to August 7, 2021. A sample of 70 parents (baby age 5.5 ± 3.5 months; parental age: 31.7 ± 5.0 years) completed the COVID-19 Exposure and Family Impact Survey (CEFIS) Impact and Distress scales, the Insomnia Severity Index (ISI), the Infant Behavioral Questionnaire-Revised Negative Affectivity subscale (IBQ-R-NA), and the Brief Infant Sleep Questionnaire-Revised (BISQ-R). Based on the transactional model of IS, path analyses were conducted to identify the direct effect of CEFIS scores and the indirect effects of parental ISI and infant IBQ-R-NA scores on BISQ-R scores.
UNASSIGNED: The parent sample was predominantly female (94.3%), white (72.9%), and married or in a domestic partnership (98.6%). Although COVID-19 pandemic impact and distress were not directly related to parent-reported IS, pandemic distress was negatively related to parent-reported IS indirectly through infant negative affectivity, including BISQ-R total score (β = -0.14, 95% CI [-0.32, -0.01]) and IS subscale score (β = -0.12, 95% CI [-0.27, -0.01]).
UNASSIGNED: Heightened COVID-19 pandemic family distress was related to poorer parent-reported IS through greater parent-reported infant negative affectivity, suggesting the importance of addressing family stress and emotional regulation during crises.

Depression is a major public health problem worldwide and is closely related with systemic inflammatory responses. Additionly, physical activity (PA) is thought to be associated with lower levels of depression and inflammatory markers. This study aimed to elucidate the complex interactions between PA, depression, and inflammatory markers. Based on the National Health and Nutrition Examination Survey (NHANES), various logistic regression were applied to analyze the pairwise correlations among the three. Restrictive cubic splines were constructed to explore the nonlinear relationship between PA and depression. Mediation models were used to identify the mediating role of inflammatory markers. The findings revealed a positive link between depression and inflammatory marker, whereas PA was inversely correlated with both inflammatory marker and depression. Particularly, we noticed the greatest reduction in the risk of depression when the level of PA was between 1200 and 1722 MET-min/week. Besides, we demonstrated that inflammatory markers mediate the potential effects of physical inactivity on depression, ranging from 1.72 % to 6.25 %. In conclusion, PA appear to protect against depression, in which inflammatory markers may play a mediating role. Moreover, we determined the optimal dosage of PA to minimize the likelihood of depression, thereby offering valuable guidance for managing depression.

BACKGROUND: Labor market inactivity is common among young adults with a history of childhood abuse, which might be attributable to elevated psychopathology in adolescence.
OBJECTIVE: We examined and decomposed the effect of adolescent psychopathology in the association between frequent or severe childhood abuse and labor market inactivity in young adulthood.
METHODS: This study used data from the population and high-risk samples of the Dutch prospective TRacking Adolescents\' Individual Lives Survey (N = 2172).
METHODS: Childhood abuse included measures of emotional, physical and sexual abuse. We operationalized adolescent psychopathology using the broadband emotional and behavioral problem scales. Labor market inactivity in young adulthood was defined as being neither in education, employment nor training or receiving benefits. We applied causal mediation analysis combined with a four-way decomposition approach to estimate our effects of interest.
RESULTS: Individuals who reported frequent or severe childhood abuse were 1.51 (95 % CI: 1.13 to 2.22) times more likely to report labor market inactivity, constituting an excess relative risk (ERR) of 0.51. Most of this excess relative risk is due to mediation by psychopathology at 64.7 % (ERR: 0.33, 95 % CI: 0.16 to 0.50). We found no evidence for a mediated interactive effect (ERR: -0.04, 95 % CI: -0.24 to 0.24).
CONCLUSIONS: Adolescent psychopathology largely explains the association between frequent and severe childhood abuse and labor market inactivity in young adulthood. Intervening in the occurrence of adolescent psychopathology following frequent and severe childhood abuse may reduce the risk of subsequent labor market inactivity.

BACKGROUND: Emotional abuse is one of the important risk factors for adolescent loneliness. However, there is a shortage of information regarding protective factors and potential mediating mechanisms between emotional abuse and adolescent loneliness, which require further investigation.
OBJECTIVE: The present study explored the chain mediating role of self-compassion and rejection sensitivity on the pathway from childhood emotional abuse to adolescent loneliness, based on attachment theory and a stress process model.
METHODS: Five hundred sixty-seven Chinese adolescents aged 12 to 17 years participated in this study.
METHODS: An online questionnaire was utilized to assess a variety of variables including childhood emotional abuse, physical abuse, sexual abuse, self-compassion, rejection sensitivity, and loneliness. To increase the validity of the results, physical and sexual abuse were included as covariates since emotional abuse may co-occur with these types of abuse.
RESULTS: Emotional abuse in childhood is significantly positively correlated with adolescent loneliness. Emotional abuse in childhood can affect adolescent loneliness not only directly, but also indirectly through self-compassion (including its components of self-warmth and self-coldness) and rejection sensitivity.
CONCLUSIONS: This study sheds further light on the chain mediating role of self-compassion and rejection sensitivity in the relationship between emotional abuse in childhood and loneliness in adolescence, suggesting that intervention programs targeting increased self-compassion and decreased rejection sensitivity may be effective to reduce loneliness in adolescents.

UNASSIGNED: In the use of medical device procedures, learning effects have been shown to have a significant impact on the outcome, and are a critical component of medical device safety surveillance. To support estimation of these effects, we evaluated our methods for modeling these rates within several different actual datasets representing patients treated by physicians clustered within institutions to show the flexibility of this method across applications.
UNASSIGNED: In order to estimate the learning curve effects, we employed our unique modeling for the learning curves to incorporate the learning hierarchy between institution and physicians, and then modeled them within established methods that work with hierarchical data such as generalized estimating equations (GEE). Within the actual datasets, we looked at two device types and also two procedure types which had not been observed before: off pump coronary artery bypass (CABG) experience, and radial access experience. We also tried mediation analyses within the GEE framework for these various devices/procedures as well.
UNASSIGNED: We found that the choice of shape used to produce the \"learning-free\" dataset would still be dataset specific depending upon needs for modeling fast or slow learning but that in general the power series or logarithmic shapes would be better for modeling slower learning while exponential may be better for faster learning. Mediation analysis also showed promise in adapting the modeling of the learning curve.
UNASSIGNED: In showing the flexibility of using our method in various applications; this time utilizing more than one possible procedure done per patient so that each physician had more volume, we were able to show the flexibility of applying our method in different data applications to allow for more accurately capturing the learning curve rates in physicians nested within institutions. This can, therefore, be used across the board for device and procedure safety.

This study explored the interplay of executive functions (EFs), social interactions, and theory of mind (ToM) in middle childhood. The first aim was to examine how specific EFs-shifting, inhibition, and working memory (WM)-predict social-perceptual and social-cognitive ToM. The second aim was to explore the potential mediating role of social interactions in the EF-ToM relationship. A total of 98 children aged 8 to 11 years completed three computerized EF tasks (task switching, flanker, and running span) and two ToM tasks (Strange Stories and Reading the Mind in the Eyes). The quality and quantity of social interactions were self-reported by using questionnaires. First, multiple regression analyses with age-adjusted scores examined how specific EFs predict ToM scores. The regression model was significant for social-cognitive ToM, but not for social-perceptual ToM. WM accuracy was the only significant, positive predictor for performance on the Strange Stories task. Second, mediation analyses assessed whether social interactions mediate this EF-ToM relationship. There were no significant mediation effects of the quality and quantity of social interactions on the relationship between WM and social-cognitive ToM. In conclusion, EFs play a significant role in explaining social-cognitive ToM variability in middle childhood. WM is relevant for understanding others\' mental states, in contrast to shifting and inhibition that lacked predictive value. The results also suggest different cognitive processes associated with social-perceptual versus social-cognitive ToM in this developmental stage.

Objective: This study tries to investigate the association between two measures of poverty (subjective poverty and material deprivation) with depression and its underlying mechanism(s). Method: A total sample of 28,723 older adults aged 60 years and above was included from the Longitudinal Aging Study in India. Multivariable logistic regression models were used to estimate the association between poverty measures and depression after adjustment of control variables. The Karlson-Holm-Breen (KHB) method was used for mediation analysis to assess the indirect effect of functional, behavioral, and psycho-social factors between poverty measures and depression. Results: The findings suggested that \"subjective poverty\" has a significantly stronger impact on depression in comparison to material deprivation. Further, functional and psycho-social factors have significantly mediated the relationship between subjective poverty, material deprivation, and depression but are not favorable for behavioral components. Discussion: We believe that policymakers should reconsider the mental health aspects of poverty to promote healthy aging in India.

UNASSIGNED: Expanding on previous investigations, this study aims to elucidate the role of lipid metabolism disorders in the development of intracranial atherosclerotic stenosis (ICAS) and the determination of stroke risk. The primary objective is to explore the connections between lipid parameters and acute ischemic stroke (AIS), while also examining the potential mediating influence of fasting glucose levels.
UNASSIGNED: Retrospectively, we collected data from symptomatic ICAS patients at the First Affiliated Hospital of Soochow University, including their baseline information such as medical histories and admission blood biochemical parameters. Stenotic conditions were evaluated using magnetic resonance imaging, computed tomography angiography, or digital subtraction angiography. The associations between lipid parameters and AIS risks were investigated via multivariate logistic regression analysis.
UNASSIGNED: A total of 1103 patients with symptomatic ICAS were recruited, among whom 441 (40.0%) suffered new ischemic events during hospitalization. After adjusting for confounding factors, the RCS curves exhibited a dose-response relationship between the atherogenic index of plasma (AIP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and AIS. Further multivariate analysis revealed significant associations between these parameters and AIS. Furthermore, mediation analysis indicated that fasting blood glucose (FBG) acted as a mediator in the association between lipid parameters (AIP, TC, and TG) and AIS.
UNASSIGNED: Higher lipid parameters in ICAS patients, particularly AIP, TC, and TG, were associated with an increased AIS risk. Additionally, FBG may mediate stroke risk in ICAS patients, highlighting the need for further exploration of underlying mechanisms.