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Our objective was to explore the association between weight status and behavioral problems in children before school age. We examined whether the association between weight status and behavioral problems varied by age and sex.

The pattern of structural brain alterations associated with major depressive disorder (MDD) remains unresolved. This is in part due to small sample sizes of neuroimaging studies resulting in limited statistical power, disease heterogeneity and the complex interactions between clinical characteristics and brain morphology. To address this, we meta-analyzed three-dimensional brain magnetic resonance imaging data from 1728 MDD patients and 7199 controls from 15 research samples worldwide, to identify subcortical brain volumes that robustly discriminate MDD patients from healthy controls. Relative to controls, patients had significantly lower hippocampal volumes (Cohen's d=-0.14, % difference=-1.24). This effect was driven by patients with recurrent MDD (Cohen's d=-0.17, % difference=-1.44), and we detected no differences between first episode patients and controls. Age of onset ⩽21 was associated with a smaller hippocampus (Cohen's d=-0.20, % difference=-1.85) and a trend toward smaller amygdala (Cohen's d=-0.11, % difference=-1.23) and larger lateral ventricles (Cohen's d=0.12, % difference=5.11). Symptom severity at study inclusion was not associated with any regional brain volumes. Sample characteristics such as mean age, proportion of antidepressant users and proportion of remitted patients, and methodological characteristics did not significantly moderate alterations in brain volumes in MDD. Samples with a higher proportion of antipsychotic medication users showed larger caudate volumes in MDD patients compared with controls. This currently largest worldwide effort to identify subcortical brain alterations showed robust smaller hippocampal volumes in MDD patients, moderated by age of onset and first episode versus recurrent episode status.

BackgroundNumerous studies have examined associations between air pollution and pregnancy outcomes, but most have been restricted to urban populations living near monitors.ObjectivesWe examined the association between pregnancy outcomes and fine particulate matter in a large national study including urban and rural areas.MethodsAnalyses were based on approximately 3 million singleton live births in Canada between 1999 and 2008. Exposures to PM2.5 (particles of median aerodynamic diameter ≤ 2.5 μm) were assigned by mapping the mother's postal code to a monthly surface based on a national land use regression model that incorporated observations from fixed-site monitoring stations and satellite-derived estimates of PM2.5. Generalized estimating equations were used to examine the association between PM2.5 and preterm birth (gestational age < 37 weeks), term low birth weight (< 2,500 g), small for gestational age (SGA; < 10th percentile of birth weight for gestational age), and term birth weight, adjusting for individual covariates and neighborhood socioeconomic status (SES).ResultsIn fully adjusted models, a 10-μg/m(3) increase in PM2.5 over the entire pregnancy was associated with SGA (odds ratio = 1.04; 95% CI 1.01, 1.07) and reduced term birth weight (-20.5 g; 95% CI -24.7, -16.4). Associations varied across subgroups based on maternal place of birth and period (1999-2003 vs. 2004-2008).ConclusionsThis study, based on approximately 3 million births across Canada and employing PM2.5 estimates from a national spatiotemporal model, provides further evidence linking PM2.5 and pregnancy outcomes.

Children and adults can use cross-situational information toidentify words’ referents. What do learners retain about thepotential referents that occur with a word: do they encodemultiple referents or a single guess? We tested this questionusing novel mouse tracking and finger tracking paradigms.Adults were exposed to novel words in a series of ambiguoustraining trials and then tested on the words’ referents. In sometest trials, participants saw the target and three referents thathad never occurred with the word; other test trials included ahigh-probability competitor that had repeatedly occurred withthe word. Participants’ mouse movements were slower, lessaccurate, and took a more complex path to the selectedreferent when the competitor was present, indicating thatparticipants were aware that both the target and competitorhad previously occurred with the word. This suggests thatlearners can accrue information about multiple potentialreferents for a word, and that mouse tracking provides apromising way of assessing this knowledge. However, thisknowledge was not evident in participants’ finger movements,suggesting that the dynamics of finger movements might notcapture real-time competition between referents.

Scalar implicatures—inferences from a weak description (“Iate some of the cookies”) that a stronger alternative is true(“I didn’t eat all”)—are paradigm cases of pragmatic infer-ence. Children’s trouble with scalar implicatures is thus animportant puzzle for theories of pragmatic development, giventheir communicative competence in other domains. Previousresearch has suggested that access to alternatives might be key.Here, we explore children’s reaction times in a new paradigmfor measuring scalar implicature processing. Alongside fail-ures on scalar implicatures with “some,” we replicate previ-ous reports of failures with “none,” and find evidence of aspeed-accuracy trade-off for both quantifiers. Motivated bythese findings, we explore the relationship between accuracyand reaction time with a Drift Diffusion Model. We find evi-dence consistent with the hypothesis that preschoolers lack ac-cess to the alternatives for scalar implicature computation, al-though this set of alternatives may be broader than previouslyassumed.

When tested appropriately, infants appear to demonstratefalse-belief understanding in the first year of life. Some haveargued that this is inconsistent with the well-establishedrelationship between social experience and preschoolers’false-belief performance. We argue that these two sets offindings are not inconsistent because the ability to attributefalse beliefs to others is necessary but not sufficient for false-belief performance, and we propose several ways that onesocial factor, hearing and using mental-state language, mightrelate to false-belief performance throughout the lifespan. Wetested this account by examining the relationship betweenadults’ use of mental-state language and their false-beliefunderstanding. Participants’ use of mental-state language wasrelated to how quickly they could accurately predict thebehavior of agents on the basis of desires and beliefs. Thesefindings provide the first evidence that mental-state talk andfalse-belief performance are related into adulthood.

It was long assumed that the capacity to represent false beliefs did not emerge until at least age four, as evidenced by children's performance on elicited-response tasks. However, recent evidence that infants appear to demonstrate false-belief understanding when tested with alternative, non-elicited-response measures has led some researchers to conclude that the capacity to represent beliefs emerges in the 1st year of life. This mentalistic view has been criticized for failing to offer an explanation for the well-established positive associations between social factors and preschoolers' performance on elicited-response false-belief tasks. In this paper, we address this criticism by offering an account that reconciles these associations with the mentalistic claim that false-belief understanding emerges in infancy. We propose that rather than facilitating the emergence of the capacity to represent beliefs, social factors facilitate the use of this ability via effects on attention, inference, retrieval, and response production. Our account predicts that the relationship between social factors and false-belief understanding should not be specific to preschoolers' performance in elicited-response tasks: this relationship should be apparent across the lifespan in a variety of paradigms. We review an accumulating body of evidence that supports this prediction.

Adults routinely make sense of others' actions by inferring the mental states that underlie these actions. Over the past two decades, developmental researchers have made significant advances in understanding the origins of this ability in infancy. This evidence indicates that when infants observe an agent act in a simple scene, they infer the agent's mental states and then use these mental states, together with a principle of rationality (and its corollaries of efficiency and consistency), to predict and interpret the agent's subsequent actions and to guide their own actions toward the agent. In this review, we first describe the initial demonstrations of infants' sensitivity to the efficiency and consistency principles. We then examine how infants identify novel entities as agents. Next, we summarize what is known about infants' ability to reason about agents' motivational, epistemic, and counterfactual states. Finally, we consider alternative interpretations of these findings and discuss the current controversy about the relation between implicit and explicit psychological reasoning.

Are infants capable of representing false beliefs, as the mentalistic account of early psychological reasoning suggests, or are they incapable of doing so, as the minimalist account suggests? The present research sought to shed light on this debate by testing the minimalist claim that a signature limit of early psychological reasoning is a specific inability to understand false beliefs about identity: because of their limited representational capabilities, infants should be unable to make sense of situations where an agent mistakes one object for another, visually identical object. To evaluate this claim, three experiments examined whether 17-month-olds could reason about the actions of a deceptive agent who sought to implant in another agent a false belief about the identity of an object. In each experiment, a thief attempted to secretly steal a desirable rattling toy during its owner's absence by substituting a less desirable silent toy. Infants realized that this substitution could be effective only if the silent toy was visually identical to the rattling toy (Experiment 1) and the owner did not routinely shake her toy when she returned (Experiment 2). When these conditions were met, infants expected the owner to be deceived and to mistake the silent toy for the rattling toy she had left behind (Experiment 3). Together, these results cast doubt on the minimalist claim that infants cannot represent false beliefs about identity. More generally, these results indicate that infants in the 2nd year of life can reason not only about the actions of agents who hold false beliefs, but also about the actions of agents who seek to implant false beliefs, thus providing new support for the mentalistic claim that an abstract capacity to reason about false beliefs emerges early in human development.

Introduction Despite decreases in the overall US smoking rate, tobacco use remains more common in some areas and by some groups. Deeper understanding of group differences is needed in order to tailor public health campaigns to the interests, perceptions and experiences of targeted audiences. Although some differences have been identified across African American and Caucasian smokers in the United States, additional insight is needed regarding factors that differentiate these groups. This study examined tobacco related perceptions and practices, with an emphasis on identifying differences across African American and Caucasian smokers. Toward this goal, we examined key demographic variables of race and age, and tobacco use characteristics. Methods The sample consisted of 284 people from the Jackson, Mississippi area who participated in focus groups and completed surveys addressing a variety of tobacco related topics, including knowledge and perceptions of products as well as use and health information seeking behavior. The selection criteria and recruitment approach ensured a balance across race (black, white), age (18–34, >35 years), sex, and cigarette smoking status (current, former, never). Statistical analyses were performed using SAS (v.9.4). Results Differences were observed across demographic subgroups regarding type and pattern of tobacco products used (e.g. mentholated, markers of nicotine dependence, hookah). Differences in preferred sources of health information based on age as well as perceptions of risk as a function of age, smoking status and race were also noted. Exposure to secondhand smoke and perceptions of its risks, quitting efforts and cessation methods differed by race. Conclusions Study findings suggest key differences across important subgroups. Knowledge of such differences has the potential to improve strategic public health messaging, allowing health campaigns to more effectively prevent tobacco product uptake as well as promote interest in quitting tobacco.

Alexander Obbarius,1 Felix Fischer,1 Gregor Liegl,1 Nina Obbarius,1 Jan van Bebber,1 Tobias Hofmann,1 Matthias Rose1,2 1Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Berlin, Germany; 2Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, MA, USACorrespondence: Alexander ObbariusDepartment of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, GermanyTel +4930450653890Email alexander.obbarius@charite.dePurpose: The number of non-responders to treatment among patients with chronic pain (CP) is high, although intensive multimodal treatment is broadly accessible. One reason is the large variability in manifestations of CP. To facilitate the development of tailored treatment approaches, phenotypes of CP must be identified. In this study, we aim to identify subgroups in patients with CP based on several aspects of self-reported health.Patients and Methods: A latent class analysis (LCA) was carried out in retrospective data from 411 patients with CP of different origins. All patients experienced severe physical and psychosocial consequences and were therefore undergoing multimodal inpatient pain treatment. Self-reported measures of pain (visual analogue scales for pain intensity, frequency, and impairment; Pain Perception Scale), emotional distress (Patient Health Questionnaire, PHQ-9; Generalized Anxiety Disorder Scale, GAD-7) and physical health (Short Form Health Survey; SF-8) were collected immediately after admission and before discharge. Instruments assessed at admission were used as input to the LCA. Resulting classes were compared in terms of patient characteristics and treatment outcome.Results: A model with four latent classes demonstrated the best model fit and interpretability. Classes 1 to 4 included patients with high (54.7%), extreme (17.0%), moderate (15.6%), and low (12.7%) pain burden, respectively. Patients in class 4 showed high levels of emotional distress, whereas emotional distress in the other classes corresponded to the levels of pain burden. While pain as well as physical and mental health improved in class 1, only the levels of depression and anxiety improved in patients in the other groups during multimodal treatment.Conclusion: The specific needs of these subgroups should be taken into account when developing individualized treatment programs. However, the retrospective design limits the significance of the results and replication in prospective studies is desirable.Keywords: chronic pain, phenotyping, patient-reported outcomes, latent class analysis, multimodal treatment

BackgroundInherited retinal diseases (IRDs) are a leading cause of blindness in children and working age adults in the United Kingdom and other countries, with an appreciable socioeconomic impact. However, by definition, IRD data are individually rare, and as a result, this patient group has been underserved by research. Researchers need larger amounts of these rare data to make progress in this field, for example, through the development of gene therapies. The challenge has been how to find and make these data available to researchers in the most productive way. MyEyeSite is a research collaboration aiming to design and develop a digital platform (the MyEyeSite platform) for people with rare IRDs that will enable patients, doctors, and researchers to aggregate and share specialist eye health data. A crucial component of this platform is the MyEyeSite patient application, which will provide the means for patients with IRD to interact with the system and, in particular, to collate, manage, and share their personal specialist IRD data both for research and their own health care. ObjectiveThis study aims to test the acceptability and feasibility of the MyEyeSite platform in the target IRD population through a collaborative patient-centered study. MethodsQualitative data were generated through focus groups and workshops, and quantitative data were obtained through a survey of patients with IRD. Participants were recruited through clinics at Moorfields Eye Hospital National Health Service (NHS) Foundation Trust and the National Institute for Health Research (NIHR) Moorfields Biomedical Research Centre through their patient and public involvement databases. ResultsOur IRD focus group sample (n=50) highlighted the following themes: frustration with the current system regarding data sharing within the United Kingdom’s NHS; positive expectations of the potential benefits of the MyEyeSite patient application, resulting from increased access to this specialized data; and concerns regarding data security, including potentially unethical use of the data outside the NHS. Of the surveyed 80 participants, 68 (85%) were motivated to have a more active role in their eye care and share their data for research purposes using a secure technology, such as a web application or mobile app. ConclusionsThis study demonstrates that patients with IRD are highly motivated to be actively involved in managing their own data for research and their own eye care. It demonstrates the feasibility of involving patients with IRD in the detailed design of the MyEyeSite platform exemplar, with input from the patient with IRD workshops playing a key role in determining both the functionality and accessibility of the designs and prototypes. The development of a user-centered technological solution to the problem of rare health data has the potential to benefit not only the patient with IRD community but also others with rare diseases.

Background Firearm violence remains a persistent public health threat. Comparing the impact of targeted high-risk versus population-based approaches to prevention may point to efficient and efficacious interventions. We used agent-based modeling to conduct a hypothetical experiment contrasting the impact of high-risk (disqualification) and population-based (price increase) approaches on firearm homicide in New York City (NYC). Methods We simulated 800,000 agents reflecting a 15% sample of the adult population of NYC. Three groups were considered and disqualified from all firearm ownership for five years, grouped based on prevalence: low prevalence (psychiatric hospitalization, alcohol-related misdemeanor and felony convictions, 0.23%); moderate prevalence (drug misdemeanor convictions, domestic violence restraining orders, 1.03%); and high prevalence (all other felony/misdemeanor convictions, 2.30%). Population-level firearm ownership was impacted by increasing the price of firearms, assuming 1% price elasticity. Results In this hypothetical scenario, to reduce firearm homicide by 5% in NYC, 25% of the moderate prevalence group, or 12% of the high prevalence group needed to be effectively disqualified; even when all of the low prevalence group was disqualified, homicide did not decrease by 5%. An 18% increase in price similarly reduced firearm homicide by 5.37% (95% CI 4.43–6.31%). Firearm homicide declined monotonically as the proportion of disqualified individuals increased and/or price increased. A combined intervention that both increased price and effectively disqualified “high-risk” groups achieved approximately double the reduction in homicide as any one intervention alone. Increasing illegal firearm ownership by 20%, a hypothetical response to price increases, did not meaningfully change results. Conclusion A key takeaway of our study is that adopting high-risk versus population-based approaches should not be an “either-or” question. When individual risk is variable and diffuse in the population, “high-risk approaches” to firearm violence need to focus on relatively prevalent groups and be highly efficacious in disarming people at elevated risk to achieve meaningful reductions in firearm homicide, though countering issues of social justice and stigma should be carefully considered. Similar reductions can be achieved with population-based approaches, such as price increases, albeit with fewer such countering issues.

Abstract Background Perinatal mental health problems affect up to one in five women worldwide. Mental health problems in the perinatal period are a particular challenge in low- and middle-income countries (LMICs) where they can be at least twice as frequent as in higher-income countries. It is thus of high priority to develop new low-cost, low-resource, non-stigmatising and culturally appropriate approaches to reduce symptoms of anxiety and depression perinatally, for the benefit of both mother and child. Music-centred approaches may be particularly useful in The Gambia since a range of musical practices that specifically engage pregnant women and new mothers already exist. Methods This protocol is for a study to examine the feasibility of undertaking a stepped wedge trial to test how a Community Health Intervention through Musical Engagement (CHIME) could be beneficial in alleviating perinatal mental distress in The Gambia. In this study, we plan to recruit 120 pregnant women (n = 60 intervention, n = 60 control) at four antenatal clinics over two 6-week stepped sequences. Women in the intervention will participate in weekly group-singing sessions, led by local Kanyeleng singing groups, for 6 weeks. The control group will receive standard care. We will assess symptoms of anxiety and depression using the Edinburgh Postnatal Depression Scale (EPDS) and the Self-Reporting Questionnaire (SRQ-20). The feasibility of the design will be assessed through recruitment, retention and attrition rates of participants, clinics' adherence to the schedule and completeness of data by site. Qualitative interviews and video and audio recordings will be used to evaluate the acceptability of the intervention. Discussion This feasibility trial will allow us to determine whether a larger trial with the same intervention and target group is feasible and acceptable in The Gambia. Trial registration Retrospectively registered (24/01/2019) with Pan African Clinical Trials Registry (PACTR): PACTR201901917619299.