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Background and Aims: Black drinkers compared with White drinkers experience more alcohol‐related problems. Examination of social determinants of inequities in alcohol problems is needed. The current study measured (1) associations between acute stress and alcohol craving in the naturalistic environment for self‐identified Black and White individuals who drink alcohol and (2) whether a history of attention deficit hyperactivity disorder (ADHD) moderated these associations. Design and Setting: Observational study using ecological momentary assessment (EMA) to collect data from participants at six semi‐random time‐points throughout the day during a 10‐day period. A series of three‐level multi‐level models examined between‐ and within‐person associations for stress and alcohol and tested if these associations differed for Black and White adults. Participants: Participants were 229 adult drinkers (aged 21–35 years) who completed a larger study examining alcohol response for Black and White adults with and without a history of childhood ADHD. Measurements Momentary stress and alcohol craving, ADHD history and socio‐demographic characteristics (i.e. racial identity, sex, age, current education level, household income) were assessed. Participants were required to self‐identify as either 'African American or Black' or 'European American or White'. Findings Significant racial identity × stress interactions indicated that associations between stress and craving were stronger for Black compared with White adults across the 10‐day period (between‐person: B = 0.14, P = 0.007), concurrently within a given EMA time‐point (within‐person: B = 0.04, P = 0.001) and prospectively from time‐point to time‐point (within‐person: B = 0.05, P = 0.001). Results remained while accounting for income × stress interactions. Conclusions: Acute stress appears to be more strongly related to alcohol craving in self‐identified Black compared with self‐identified White individuals. This provides support for policy changes to eliminate structural inequities that increase stress exposure and the development of just‐in‐time culturally responsive interventions focused on coping with acute stress for Black individuals. [ABSTRACT FROM AUTHOR]

Profiling provider performance for the assessment of quality involves a number of issues related to selection of appropriate quality measures, subsequent data collection and analysis, and selection of standards of comparison. This article emphasizes the limitations of current data systems for this purpose and discusses hierarchical modeling as the optimal analytic approach for analyzing resulting data. Mention is made of the difficulties of achieving large enough sample sizes for statistical significance at the individual provider level. Finally, the article discusses feasible options for profiling quality.

This Viewpoint positions the contemporary UK parenting website Mumsnet within the wider history of mothers' organisations' interactions with politics and politicians over the last 100 years. While the politicisation of motherhood is nothing new, and Mumsnet follows its predecessors in insisting on an apolitical stance, Mumsnet users are unusual in their willingness to embrace an identity as feminists and to engage in debate on controversial contemporary issues. Mumsnet has been attacked by some for allowing such conversations to happen, and praised by others for its commitment to a policy of freedom of speech. In this way, it has continued the historical role of the media in the creation and support of organised women's voices on contemporary political issues. [ABSTRACT FROM AUTHOR]

Background: Although widely used in the evaluation of the diseased, normal intracranial pressure and lumbar cerebrospinal fluid pressure remain sparsely documented. Intracranial pressure is different from lumbar cerebrospinal fluid pressure. In addition, intracranial pressure differs considerably according to the body position of the patient. Despite this, the current reference values do not distinguish between intracranial and lumbar cerebrospinal fluid pressures, and body position-dependent reference values do not exist. In this study, we aim to establish these reference values. Method: A systematic search was conducted in MEDLINE, EMBASE, CENTRAL, and Web of Sciences. Methodological quality was assessed using an amended version of the Joanna Briggs Quality Appraisal Checklist. Intracranial pressure and lumbar cerebrospinal fluid pressure were independently evaluated and subdivided into body positions. Quantitative data were presented with mean ± SD, and 90% reference intervals. Results: Thirty-six studies were included. Nine studies reported values for intracranial pressure, while 27 reported values for the lumbar cerebrospinal fluid pressure. Reference values for intracranial pressure were − 5.9 to 8.3 mmHg in the upright position and 0.9 to 16.3 mmHg in the supine position. Reference values for lumbar cerebrospinal fluid pressure were 7.2 to 16.8 mmHg and 5.7 to 15.5 mmHg in the lateral recumbent position and supine position, respectively. Conclusions: This systematic review is the first to provide position-dependent reference values for intracranial pressure and lumbar cerebrospinal fluid pressure. Clinically applicable reference values for normal lumbar cerebrospinal fluid pressure were established, and are in accordance with previously used reference values. For intracranial pressure, this study strongly emphasizes the scarcity of normal pressure measures, and highlights the need for further research on the matter. [ABSTRACT FROM AUTHOR]

Emerging evidence suggests impulsive states may be reliably measured in the moment using ecological momentary assessment (EMA); however, research has not investigated whether the multi-factor structure of impulsive traits also characterizes impulsive states. In two independent samples spanning adolescence through young adulthood (n = 211, n = 222), we adapted global self-report measures of impulsive traits to EMA and conducted multilevel confirmatory factor analyses to characterize the within- and between-person factor structure of five impulsive traits (negative urgency, planning, persistence, sensation seeking, and positive urgency). Across both studies, factor models with one factor for each UPPS-P facet fit the data well at both levels, though some latent factors were highly correlated. Aggregated impulsive states, especially negative urgency, predicted oppositional defiant disorder symptoms, emotional problems, alcohol problems, and attention deficit hyperactivity disorder symptoms. Our results suggest that EMA measures can capture a range of impulsive states that mirrors the heterogeneity seen in the trait literature. [ABSTRACT FROM AUTHOR]

Diversion of stimulant medications for ADHD is a prevalent problem. Pediatric primary care providers (PCPs) are well-positioned to reduce diversion risk among adolescents prescribed stimulants, but little is known about their use of prevention strategies. The objectives of this study were to describe the frequency with which pediatric PCPs use diversion prevention strategies and examine potential determinants (facilitators and barriers) of strategy use. Participants were pediatric PCPs (N = 76) participating in a randomized controlled trial of stimulant diversion prevention strategies. At baseline, before randomization, PCPs rated the frequency with which they used specific strategies in each of four categories: patient/family education, medication management/monitoring, assessment of mental health symptoms/functioning, and assessment of risky behaviors. They completed measures of attitudes toward diversion prevention, subjective norms (i.e., implementation climate), and perceived behavioral control (i.e., knowledge/skill, resource constraints). Associations between determinants and strategy use were tested with correlational and regression analyses. PCPs used strategies for assessing mental health symptoms/functioning most frequently and patient/family education strategies least frequently. Attitudes about the effectiveness of diversion prevention, implementation climate, knowledge/skill, and resource constraints were positively correlated with the use of at least one category of strategies. In regression analysis, PCP knowledge/skill was positively associated with patient/family education, medication management, and risk assessment strategies. Findings suggest that improving knowledge and skill may increase the use of diversion prevention strategies by PCPs. Identifying provider-level determinants of strategy use informs implementation efforts in pediatric primary care and can facilitate efforts to prevent stimulant diversion among adolescents. [ABSTRACT FROM AUTHOR]

Research on attention-deficit/hyperactivity disorder (ADHD) points to the possibility that contextual factors (e.g., time of day, school vs. home) may be related to symptoms and impairment. This prior research has relied on laboratory-based or retrospective, global approaches which has limited ecological validity. The present study substantively contributes to the extant literature by examining adolescents' ADHD symptoms in the real world across the day on both school and non-school days to test whether symptoms worsened throughout the day and were higher on school days relative to non-school days. As part of a larger study, 83 adolescents taking stimulant medication for ADHD (Mage = 14.7, 66% identified as boys/men, 78% White) completed a 17-day ecological momentary assessment protocol that included wake-up and bedtime reports and two reports in the afternoon and evening. These assessments asked about ADHD symptoms and stimulant medication usage since the last report. Hypotheses were tested using multilevel modeling. Accounting for demographic covariates and medication usage, ADHD symptoms worsened quadratically, peaking by the afternoon report and subsequently declining, across school days but not non-school days. Mean-level ADHD symptoms were also worse on school days relative to non-school days. Results did not differ across gender. In conclusion, our study is the first to examine important environmental factors (school, time of day) in real time in relation to level of naturalistically occurring ADHD symptoms. Our findings highlight the importance of advancing treatments to support adolescents with ADHD on school days and in the afternoon. [ABSTRACT FROM AUTHOR]