Association between maternal and fetal inflammatory biomarkers and offspring weight and BMI during the first year of life in pregnancies with GDM: MySweetheart study.

Background: Gestational Diabetes Mellitus (GDM) is frequently associated with chronic, low-grade inflammation. Whether this environment affects offspring anthropometry during early childhood remains to be elucidated. The aim of this study was to investigate the associations between maternal and fetal (cord blood-umbilical artery) inflammatory biomarkers and offspring weight and BMI up to 1 year in pregnancies with GDM. Methods: In this prospective secondary analysis of the MySweetheart study, we included 193 women with GDM and their offspring. Maternal and fetal (N=39) predictors included serum levels of inflammatory biomarkers including CRP, IL-6, and TNF-α at 24-32 weeks of gestational age (GA) and in the cord blood. Offspring outcomes were small and large for gestational age (SGA, LGA), sex- and age-adjusted weight, and BMI at birth and at 1 year. Univariate and multivariate regression models were performed. Associations were adjusted for maternal pre-pregnancy BMI, age, and ethnicity. Results: Mean maternal age was 33.6 ± 4.8 years, and pre-pregnancy BMI 25.9 ± 5.6 kg/m2. Their mean gestational age at the 1st GDM visit was 29 ± 2.4 weeks. Gestational age at delivery was 39.7 ± 1.1 weeks, with a mean birthweight of 3.4 ± 0.46 kg; 11.8% of offspring were LGA and 10.8% were SGA. At 1 year of age, mean offspring weight was 9.8 ± 1.2 kg and BMI z-score 0.23 ± 1.1 kg/m2. In the models including only maternal predictors, TNF-α at 24-32 weeks of GA was positively associated with SGA and inversely with offspring weight and BMI at birth and at 1 year (p ≤0.034). In the models including only fetal predictors and the combined model, CRP was inversely associated with BMI at 1 year (p ≤0.020). Conclusions: In women with GDM, maternal and fetal inflammatory biomarkers distinctively influenced offspring anthropometry during the first year of life, independent of maternal age, prepregnancy BMI and ethnicity. These results suggest that low-grade inflammation during pregnancy may affect the developing offspring by leading to a decrease in weight and BMI and may have implications for future personalized follow-up of women with GDM and their offspring.

Effect of a prepartum and postpartum, complex interdisciplinary lifestyle and psychosocial intervention on metabolic and mental health outcomes in women with gestational diabetes mellitus (the MySweetheart trial): randomised, single centred, blinded, controlled trial.

Objective: To test the effect of a complex, interdisciplinary, lifestyle and psychosocial intervention on metabolic and mental health outcomes in women with gestational diabetes mellitus during pregnancy and in the post partum. Design: Single centred, single blinded, randomised, controlled trial (the MySweetheart trial). Setting: Lausanne University Hospital, Switzerland, from 2 September 2016 to 25 October 2021. Participants: 211 women aged at least 18 years with a diagnosis of gestational diabetes mellitus at 24-32 gestational weeks were randomly assigned (1:1) to the intervention (n=105) or to usual care (n=106). Interventions: In addition to a comparator based on active guidelines for prepartum and postpartum usual care, the intervention consisted of four individual lifestyle visits during pregnancy and four interdisciplinary visits in the postpartum group, a peer support group workshop in pregnancy and post partum, and a bimonthly lifestyle coach support through telemedicine. The intervention focused on tailored behavioural and psychosocial strategies to improve diet, physical activity, mental health, social support, and adherence to gestational weight gain during pregnancy and weight retention recommendations. Main outcome measures: Primary outcomes were between-group differences in the decrease in maternal weight and depression symptom scores between baseline and one year post partum. Secondary outcomes included changes in total and central body fat, anxiety, wellbeing, glycaemic parameters (homeostatic model assessment for insulin resistance (known as HOMA-IR) and Matsuda indices), aerobic fitness (maximal oxygen uptake), gestational weight gain, and weight retention. Assessors were blinded to primary and secondary outcomes. Results: 84 (80%) of 105 women in the intervention and 95 (90%) of 106 in the usual care completed the study. There was not enough evidence of a difference in the decrease in weight (mean difference -0.38 kg (95% confidence interval -2.08 to 1.30)) or depression scores (-0.67 (-1.84 to 0.49)). The intervention led to an increase in fat-free mass (0.02 kg (0.01 to 0.03)). The intervention also decreased gestational weight gain since the first gestational diabetes mellitus visit (-1.20 kg (-2.14 to -0.26)) and weekly weight gain throughout the entire pregnancy (-0.14 kg (-0.25 to -0.03)), and led to a higher proportion of women without weight retention at one year post partum (34.1% (28/82) v 20.8% (20/96), P=0.034). Conclusions: Compared with active usual care based on guidelines, there was not enough evidence to conclude that the intervention led to decrease in weight or depression symptoms. However, the intervention decreased gestational weight gain and increased the proportion of women without weight retention. Trial registration: Clinicaltrials.gov NCT02890693.

Effect of the MySweetheart randomized controlled trial on birth, anthropometric and psychobehavioral outcomes in offspring of women with GDM.

Introduction: Gestational diabetes mellitus (GDM) may negatively affect offspring outcomes. A lifestyle intervention may therefore not only improve maternal, but also offspring outcomes. The effects of lifestyle interventions on birth, anthropometric, and psychobehavioral outcomes in offspring of women with GDM need further evidence. Design: The MySweetheart trial is a monocentric single-blind randomized controlled trial in 211 women with GDM. It tested the effect of a pre- and postpartum multidimensional interdisciplinary lifestyle and psychosocial intervention focusing on both the mothers and their infants and its effects on maternal (primary outcomes) and offspring (secondary outcomes) metabolic and psychobehavioral outcomes compared with guidelines-based usual-care. This paper focuses on offspring's birth, anthropometric, and maternal report of psychobehavioral outcomes at singular timepoints. Methods: Women with GDM aged ≥18 years, between 24-32 weeks of gestation, speaking French or English were included and randomly allocated to either the intervention or to an active guidelines-based usual-care group using a 1:1 allocation ratio. The intervention lasted from pregnancy until 1 year postpartum and focused on improving diet, physical activity, and mental health in the mother. For the offspring it focused on supporting breastfeeding, delaying the timing of introduction of solid foods, reducing the consumption of sweetened beverages, increasing physical activity of the family, and improving parental responsiveness to infant distress, hunger, satiety and sleeping cues, and difficult behavior. Results: Adverse birth and neonatal outcomes rarely occurred overall. There were no differences between groups in offspring birth, neonatal, anthropometric, or psychobehavioral outcomes up to one year. After adjustments for maternal age and the offspring's sex and age, there was a borderline significant between-group difference in birth length (ß:-0.64, CI:-1.27; -0.01, p: 0.05), i.e., offspring of mothers in the intervention group were born 0.64 cm shorter compared to those in the usual-care group. Conclusion: This is the first pre- and postpartum multidimensional interdisciplinary lifestyle and psychosocial intervention in GDM focusing on both the mother and the offspring. It did not lead to a significant improvement in most birth, anthropometric, and psychobehavioral outcomes in offspring of women with GDM. ClinicalTrials.gov Identifier: NCT02890693.

Maternal and fetal predictors of anthropometry in the first year of life in offspring of women with GDM.

Introduction: Gestational Diabetes Mellitus (GDM) carries an increased risk for adverse perinatal and longer-term cardiometabolic consequences in offspring. This study evaluated the utility of maternal anthropometric, metabolic and fetal (cord blood) parameters to predict offspring anthropometry up to 1 year in pregnancies with GDM. Materials and methods: In this prospective analysis of the MySweetheart study, we included 193/211 women with GDM that were followed up to 1 year postpartum. Maternal predictors included anthropometric (pre-pregnancy BMI, gestational weight gain (GWG), weight and fat mass at the 1st GDM visit), and metabolic parameters (fasting insulin and glucose, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Quantitative insulin-sensitivity check index (QUICKI), HbA1c, triglycerides, and high-density lipoprotein (HDL) at the 1st visit and HbA1c at the end of pregnancy). Fetal predictors (N=46) comprised cord blood glucose and insulin, C-Peptide, HOMA-IR, triglycerides and HDL. Offspring outcomes were anthropometry at birth (weight/weight z-score, BMI, small and large for gestational age (SGA,LGA)), 6-8 weeks and 1 year (weight z-score, BMI/BMI z-score, and the sum of 4 skinfolds). Results: In multivariate analyses, birth anthropometry (weight, weight z-score, BMI and/or LGA), was positively associated with cord blood HDL and HbA1c at the 1st GDM visit, and negatively with maternal QUICKI and HDL at the 1st GDM visit (all p ≤ 0.045). At 6-8 weeks, offspring BMI was positively associated with GWG and cord blood insulin, whereas the sum of skinfolds was negatively associated with HDL at the 1st GDM visit (all p ≤0.023). At 1 year, weight z-score, BMI, BMI z-score, and/or the sum of skinfolds were positively associated with pre-pregnancy BMI, maternal weight, and fat mass at the 1st GDM visit and 3rd trimester HbA1c (all p ≤ 0.043). BMI z-score and/or the sum of skinfolds were negatively associated with cord blood C-peptide, insulin and HOMA-IR (all p ≤0.041). Discussion: Maternal anthropometric, metabolic, and fetal metabolic parameters independently affected offspring anthropometry during the 1st year of life in an age-dependent manner. These results show the complexity of pathophysiological mechanism for the developing offspring and could represent a base for future personalized follow-up of women with GDM and their offspring.

A longitudinal study investigating positive body image, eating disorder symptoms, and other related factors among a community sample of men in the UK.

Emerging research suggests that positive body image-an overall love and respect for one's body- may be a protective factor for eating disorder (ED) symptoms. This study aimed to explore the relationships between positive body image, ED symptoms, and related factors among men across time. A community sample of 440 British men completed questionnaires at Time 1 and Time 2 (1 year later). Linear models showed that, unexpectedly, positive body image at Time 1 did not predict change in ED symptoms at Time 2, and ED symptoms at Time 1 did not predict change in positive body image at Time 2. However, positive body image at Time 1 did predict increased appearance satisfaction and decreased appearance-ideal internalisation at Time 2. Increased positive body image at Time 2 was only predicted by appearance satisfaction at Time 1. Although no evidence for a longitudinal relationship between positive body image and ED symptoms was found, positive body image did predict change in established risk factors for disordered eating among men. Future research on positive body image and eating behaviour among men could be improved by including assessments of muscularity-oriented and adaptive eating behaviours.

Longitudinal national-level monitoring of on-farm broiler welfare identifies consistently poorly performing farms.

A range of welfare outcome measures relating to on-farm welfare are monitored in UK slaughterhouses to check compliance with the European Broiler Directive. A national dataset from 438,155 batches of chickens between 2010 and 2014 and from 228,795 batches between 2016 and 2018 was analysed. The data contained information about 3.1 billion chickens. The highest mean proportion for a single condition was for ascites/oedema in 2016-2018 at 0.384%, affecting 3.9 million chickens/year sent to slaughter during that time, followed by abnormal colour/fevered at 0.324%, affecting 3.4 million chickens/year. Identifying farms most likely to have poor welfare is an important strategy for improving animal welfare overall, and for maximising the capacity for checking regulatory compliance when resources are limited. We found a greater proportion of broiler farms overall remained consistently in the best quartile (16.4%) rather than the worst quartile (6.6%). Farms that exceeded a Government 'trigger' threshold for poor welfare were significantly more likely to subsequently improve than 'non-trigger' farms, although they usually remained in the worst performing quartile of farms.

Anxiety-Related Attention Bias in Four- to Eight-Year-Olds: An Eye-Tracking Study.

(1) Background: There is evidence of an attention bias-anxiety relationship in children, but lack of appropriate methods has limited the number of studies with children younger than eight years old. This study used eye tracking as a measure of overt attention in young children. The aim of this study was to assess anxiety-related attention bias in children aged four to eight years. Age was considered a moderator, and the influence of effortful control was investigated. (2) Method: A community sample of 104 children was shown pairs of happy-neutral and angry-neutral faces. Growth curve analyses were used to examine patterns of gaze over time. (3) Results: Analyses revealed moderation by age and anxiety, with distinct patterns of anxiety-related biases seen in different age groups in the angry-neutral face trials. Effortful control did not account for age-related effects. (4) Conclusions: The results support a moderation model of the development of anxiety in children.

Trajectories of anxiety when children start school: The role of behavioral inhibition and attention bias to angry and happy faces.

Extensive research has examined attention bias to threat in the context of anxiety in adults, but little is understood about this association in young children, and there is a dearth of longitudinal research examining whether attention bias to threat predicts anxiety over time in childhood. In the current study, a sample of 180 children participated in a longitudinal study, first as preschoolers and again as they transitioned to formal schooling. At baseline, children aged 3-4 years completed a free-viewing eye-tracking task with angry-neutral and happy-neutral face pairs and an assessment of behavioral inhibition (BI). At follow-up, parents provided daily reports of their child's state anxiety over a 2-week period as their child started school and completed a measure of their child's anxiety symptoms. Results indicated that, on average, preschool-aged children exhibit a bias for emotional faces that is stronger for angry than happy faces. There was little evidence that this bias was associated with anxiety symptoms. However, BI interacted with dwell bias for angry faces to predict trajectories of anxiety over the transition to school. An unexpected interaction between BI and dwell bias for happy faces was also found, with dwell for happy faces associated with lower anxiety for children higher in BI. The findings are consistent with recent developmental models of the BI-anxiety relationship and indicate that attention bias modification may not be suitable for young children, for whom attention bias to threat may be normative. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Antimicrobial resistance associations with national primary care antibiotic stewardship policy: Primary care-based, multilevel analytic study.

BACKGROUND: Recent UK antibiotic stewardship policies have resulted in significant changes in primary care dispensing, but whether this has impacted antimicrobial resistance is unknown. AIM: To evaluate associations between changes in primary care dispensing and antimicrobial resistance in community-acquired urinary Escherichia coli infections. METHODS: Multilevel logistic regression modelling investigating relationships between primary care practice level antibiotic dispensing for approximately 1.5 million patients in South West England and resistance in 152,704 community-acquired urinary E. coli between 2013 and 2016. Relationships presented for within and subsequent quarter drug-bug pairs, adjusted for patient age, deprivation, and rurality. RESULTS: In line with national trends, overall antibiotic dispensing per 1000 registered patients fell 11%. Amoxicillin fell 14%, cefalexin 20%, ciprofloxacin 24%, co-amoxiclav 49% and trimethoprim 8%. Nitrofurantoin increased 7%. Antibiotic reductions were associated with reduced within quarter same-antibiotic resistance to: amoxicillin, ciprofloxacin and trimethoprim. Subsequent quarter reduced resistance was observed for trimethoprim and amoxicillin. Antibiotic dispensing reductions were associated with increased within and subsequent quarter resistance to cefalexin and co-amoxiclav. Increased nitrofurantoin dispensing was associated with reduced within and subsequent quarter trimethoprim resistance without affecting nitrofurantoin resistance. CONCLUSIONS: This evaluation of a national primary care stewardship policy on antimicrobial resistance in the community suggests both hoped-for benefits and unexpected harms. Some increase in resistance to cefalexin and co-amoxiclav could result from residual confounding. Randomised controlled trials are urgently required to investigate causality.

Evidence for causal effects of lifetime smoking on risk for depression and schizophrenia: a Mendelian randomisation study.

BACKGROUND: Smoking prevalence is higher amongst individuals with schizophrenia and depression compared with the general population. Mendelian randomisation (MR) can examine whether this association is causal using genetic variants identified in genome-wide association studies (GWAS). METHODS: We conducted two-sample MR to explore the bi-directional effects of smoking on schizophrenia and depression. For smoking behaviour, we used (1) smoking initiation GWAS from the GSCAN consortium and (2) we conducted our own GWAS of lifetime smoking behaviour (which captures smoking duration, heaviness and cessation) in a sample of 462690 individuals from the UK Biobank. We validated this instrument using positive control outcomes (e.g. lung cancer). For schizophrenia and depression we used GWAS from the PGC consortium. RESULTS: There was strong evidence to suggest smoking is a risk factor for both schizophrenia (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.67-3.08, p < 0.001) and depression (OR 1.99, 95% CI 1.71-2.32, p < 0.001). Results were consistent across both lifetime smoking and smoking initiation. We found some evidence that genetic liability to depression increases smoking (ß = 0.091, 95% CI 0.027-0.155, p = 0.005) but evidence was mixed for schizophrenia (ß = 0.022, 95% CI 0.005-0.038, p = 0.009) with very weak evidence for an effect on smoking initiation. CONCLUSIONS: These findings suggest that the association between smoking, schizophrenia and depression is due, at least in part, to a causal effect of smoking, providing further evidence for the detrimental consequences of smoking on mental health.

Considering self or others across two cultural contexts: How children's resource allocation is affected by self-construal manipulations.

Most humans share to some degree. Yet, from middle childhood, sharing behavior varies substantially across societies. Here, for the first time, we explored the effect of self-construal manipulation on sharing decisions in 7- and 8-year-old children from two distinct societies: urban India and urban United Kingdom. Children participated in one of three conditions that focused attention on independence, interdependence, or a control. Sharing was then assessed across three resource allocation games. A focus on independence resulted in reduced generosity in both societies. However, an intriguing societal difference emerged following a focus on interdependence, where only Indian children from traditional extended families displayed greater generosity in one of the resource allocation games. Thus, a focus on independence can move children from diverse societies toward selfishness with relative ease, but a focus on interdependence is very limited in its effectiveness to promote generosity.

Food portion size influences accompanying beverage selection in adults.

When trying to reduce food portion size, it is important that meal satisfaction is, as far as possible, preserved. Otherwise, individuals may select accompaniments to the meal (e.g., snacks, beverages) to achieve satisfaction and, in doing so, negate any benefit of the original portion size reduction. This study investigated whether varying portion sizes of food would influence choice of accompanying beverages. That is, when presented with a food portion size that is smaller or larger than their ideal, an individual may compensate by choosing a beverage based on its satiating and/or orosensory properties to balance the expected satiation and satisfaction of a meal. Data from an online interactive study (n = 93) was analysed using multilevel ordinal logistic regression models. Food portion size (100, 300, 500, 700, or 900 kcal) predicted beverage choice (water, low-energy sweetened beverage, high-energy sweetened beverage). For example, the sweetened beverages were more likely to be selected with small food portion sizes (p < .001). Participant ideal food portion size did not interact with this relationship. Participants appear to have recognised that sweetened beverages provide flavour and/or energy, and used them to compensate for a smaller meal. While switching to a low-energy beverage with an increased food portion size is advantageous for energy balance, choosing a high-energy beverage with a decreased food portion size is likely to be detrimental for those attempting to reduce energy intake and body weight.

More than my RA: A randomized trial investigating body image improvement among women with rheumatoid arthritis using a functionality-focused intervention program.

OBJECTIVE: Negative body image is prevalent in women with rheumatoid arthritis and can affect other areas of well-being. Patients have expressed desire for body image to be addressed in treatment. Yet, it is not routinely addressed and no experimental intervention research has been conducted, until now. This randomized trial evaluated a brief online body image intervention for women with rheumatoid arthritis, with a focus on body functionality (everything the body is capable of doing) as the primary technique. METHOD: Women with rheumatoid arthritis and who wanted to feel better about their body (N = 84; Mage = 44.82) were randomized to the Expand Your Horizon intervention (comprising 3 writing exercises focusing on body functionality) or a waitlist control group. Primary outcomes concerned body image and secondary outcomes related to rheumatoid arthritis; these outcomes were assessed at pretest, posttest, and at 1-week and 1-month follow-up. RESULTS: Multilevel modeling analyses showed that, relative to control, participants in the intervention experienced improvements in various aspects of body image (functionality appreciation, body appreciation, body satisfaction, body-self alienation) and decreases in depression, with effects persisting at 1-week and 1-month follow-up. No intervention effects were found for body-self harmony, rheumatoid arthritis-specific disability, pain-related disability, and anxiety. CONCLUSIONS: Focusing on body functionality can improve body image and reduce depression in women with rheumatoid arthritis. The intervention technique is easy and affordable to deliver and could be a fruitful addition to extant treatments for rheumatoid arthritis. (PsycINFO Database Record

Volumetric image interpretation in radiology: scroll behavior and cognitive processes.

The interpretation of medical images is a primary task for radiologists. Besides two-dimensional (2D) images, current imaging technologies allow for volumetric display of medical images. Whereas current radiology practice increasingly uses volumetric images, the majority of studies on medical image interpretation is conducted on 2D images. The current study aimed to gain deeper insight into the volumetric image interpretation process by examining this process in twenty radiology trainees who all completed four volumetric image cases. Two types of data were obtained concerning scroll behaviors and think-aloud data. Types of scroll behavior concerned oscillations, half runs, full runs, image manipulations, and interruptions. Think-aloud data were coded by a framework of knowledge and skills in radiology including three cognitive processes: perception, analysis, and synthesis. Relating scroll behavior to cognitive processes showed that oscillations and half runs coincided more often with analysis and synthesis than full runs, whereas full runs coincided more often with perception than oscillations and half runs. Interruptions were characterized by synthesis and image manipulations by perception. In addition, we investigated relations between cognitive processes and found an overall bottom-up way of reasoning with dynamic interactions between cognitive processes, especially between perception and analysis. In sum, our results highlight the dynamic interactions between these processes and the grounding of cognitive processes in scroll behavior. It suggests, that the types of scroll behavior are relevant to describe how radiologists interact with and manipulate volumetric images.

Fooled by savouriness? Investigating the relationship between savoury taste and protein content in familiar foods.

Selecting savoury foods after consuming a protein depleted diet has been suggested to reflect protein seeking behaviour. The modern diet contains a large number of processed foods, many of which are highly savoury to taste, but not necessarily high in protein. The present two studies aimed to investigate the relationship between savoury taste and protein content (actual and participant estimated). Participants (S1 n = 20, S2 n = 37) completed 100 mm VAS ratings of sensory and nutritional qualities of 18 familiar foods, categorised as sweet low protein, savoury low protein and savoury high protein. In study 2, the individual foods were blended to a fine consistency to disguise their identity and ensure ratings were based primarily on taste. Multilevel linear regression was used to test associations between savoury taste and actual protein content. Protein content did not predict savoury taste rating, irrespective of category. The results also indicated that participants were generally accurate at estimating the protein content of foods, although there was a tendency towards overestimation. The magnitude of this error was increased in low protein savoury foods. Specifically, there was a shift in the spread of estimation scores which showed a greater level of overestimation in some blended compared to unblended foods, and predominantly in savoury foods which participants could not identify. These results provide evidence that savoury taste and protein content are not well linked in the current food environment, but taste may guide nutrient estimations about certain unidentified foods.

A randomised-controlled trial investigating potential underlying mechanisms of a functionality-based approach to improving women's body image.

Focusing on body functionality is a promising technique for improving women's body image. This study replicates prior research in a large novel sample, tests longer-term follow-up effects, and investigates underlying mechanisms of these effects (body complexity and body-self integration). British women (N = 261) aged 18-30 who wanted to improve their body image were randomised to Expand Your Horizon (three online body functionality writing exercises) or an active control. Trait body image was assessed at Pretest, Posttest, 1-week, and 1-month Follow-Up. To explore whether changes in body complexity and body-self integration 'buffer' the impact of negative body-related experiences, participants also completed beauty-ideal media exposure. Relative to the control, intervention participants experienced improved appearance satisfaction, functionality satisfaction, body appreciation, and body complexity at Posttest, and at both Follow-Ups. Neither body complexity nor body-self integration mediated intervention effects. Media exposure decreased state body satisfaction among intervention and control participants, but neither body complexity nor body-self integration moderated these effects. The findings underscore the value of focusing on body functionality for improving body image and show that effects persist one month post-intervention.

Diminishing covariation bias in women with a negative body evaluation and the potential roles of outcome aversiveness and interpretation of social feedback.

Women with a more negative body evaluation perceive that their body is associated with more negative social feedback. This covariation bias could reinforce negative body evaluation. We investigated whether covariation bias could be diminished and explored the potential roles of outcome aversiveness and interpretation of negative social feedback associated with one's body. Ninety-seven undergraduate women completed a computer task wherein photos of their body, a control woman's body, and a neutral object were followed by negative social feedback or nothing. When the relation between each category and the negative feedback was random, women with a more negative body evaluation perceived more negative feedback following their body. They also experienced negative feedback following their body and the control woman's body as more aversive. After a manipulation block, women with a more negative body evaluation no longer perceived more negative feedback for their body. These effects coincided with improvements in state body evaluation.

Impact of variation in functions and delivery on the effectiveness of behavioural and mood management interventions for smoking cessation in people with depression: protocol for a systematic review and meta-analysis.

INTRODUCTION: Tobacco is the world's leading preventable cause of disease and death. People with depression are twice as likely to smoke and are less responsive to standard tobacco treatments as compared with the general population. A Cochrane systematic review of randomised controlled trials of smoking cessation treatment for smokers with current or historical depression found that adding mood management to usual smoking treatment improved quit rates. However, the review did not examine if variation in intervention delivery or intervention functions impacted on treatment effectiveness.With the aim of providing information to develop tailored approaches to treating smoking for people with current depression, we will add-on to the Cochrane review in three ways: (1) use the Template for Intervention Description and Replication checklist to determine if variations in mood management delivery have impact on intervention effectiveness, (2) use the Taxonomy of Behaviour Change techniques for smoking cessation to examine which behaviour change functions are most effective for smoking cessation in people with current depression and (3) examine the difference in change in depression scores between intervention and control arms. METHODS AND ANALYSIS: We will include randomised controlled trials of smokers with current depression as identified by a previous Cochrane review and the in-progress update of this Cochrane review. We will use meta-regression to examine (1) if variations in delivery of mood management impact on smoking cessation intervention effectiveness, (2) determine which behaviour change functions are most effective for smoking cessation and (3) use meta-analysis of the difference in change in depression scores between treatment arms from baseline to follow-up to determine if offering smoking cessation treatment causes psychological harm. ETHICS AND DISSEMINATION: Ethical approval is not required for this study. We will disseminate the findings of this work at national and international conferences, and to relevant patient panels. PROSPERO REGISTRATION NUMBER: CRD42017070741.

Do you think I should be scared? The effect of peer discussion on children's fears.

This study investigated whether close friends affect each other's fear responses (fear beliefs and avoidance) when they discuss fear-related issues together. Children (N = 242) aged 7-10 years were first presented with ambiguous and threatening information about two novel animals respectively, after which their fear responses towards each animal were assessed (T1). Next, dyads of close friends had a discussion about their feelings regarding the animals, and their fear responses were measured again (T2). Results showed that children influenced each other's cognitions following the discussion; from T1 to T2 their fear responses became more similar and close friends' fear responses at T1 significantly predicted children's fear responses at T2. Gender pair type predicted change in children's fear responses over time. Children in boy-boy pairs showed a significant increase in fear responses following the discussion; their fear level became more in line with that of other gender pairs at T2, while those in girl-girl pairs showed a significant decrease in their fear beliefs, at least when threatening information was given. Differences in anxiety level between close friends did not affect change in fear responses over time. Altogether, the results indicate that children may affect each other's fears.