Hostile interpretation as a transdiagnostic factor for cooccurring anxiety in boys with aggressive behavior problems

Many children with aggressive behavior problems also suffer from anxiety. This cooccurrence may perhaps be explained by transdiagnostic factors. Identifying these factors seems crucial, as they may be important targets to treat these cooccurring problems effectively. This two-study paper investigates whether hostile interpretation of others’ intentions is a transdiagnostic factor for cooccurring aggression and anxiety problems, examining two samples of boys in middle childhood. We assessed boys’ aggression and anxiety using teacher-report in Study 1 (N = 84, Mage = 10.10), and parent-report in Study 2 (N = 115, Mage = 10.55). In both studies, we assessed hostile interpretation using vignettes describing ambiguous provocations by peers. Both studies revealed a strong association between aggression and anxiety problems, underscoring the necessity to examine factors that can explain this cooccurrence. However, in neither study was this association reduced when we added hostile interpretation to the model, suggesting that hostile interpretation did not function as a transdiagnostic factor in our samples. One possible explanation for these findings is that hostile interpretation predicts both aggression and anxiety problems, but in different children. We, therefore, encourage scholars to conduct more research to explain the high comorbidity of aggression and anxiety problems in children. Future research should also examine hostile interpretation as predictor or transdiagnostic factor for aggression and anxiety problems in more diverse population, including girls and other age groups

To disclose or not? Children’s tendency to disclose peer victimisation in elementary school

This study aimed to shed light on the prevalence of chronic peer victimisation among Dutch elementary school children and factors associated with (non-)disclosure of such experiences by victims. 5,961 students from 73 schools participated (51.5% male; Mage 9.96; 77.7% native Dutch). Results showed that 12.3% of all children were victimised chronically, of which 29.4% did not disclose. Multilevel logistic regressions indicated that girls, older and native Dutch children were more likely to disclose. Moreover, experiencing depressive symptoms prompts disclosing victimisation. Anxiety, high emotion regulation skills, and perceptions of cohesion in the classroom were negatively associated with disclosure. The disclosure was not related to frequency or duration of victimisation, self-perceived social acceptance, self-worth, impulse control, or perceived classroom climate. Our study reveals information on the prevalence of peer victimisation and its disclosure, based on a nationwide study conducted in 2016–2017. It gives important insights into factors associated with disclosing victimisation experiences

Treating children's aggressive behavior problems using cognitive behavior therapy with virtual reality: A multicenter randomized controlled trial

This multicenter randomized controlled trial investigated whether interactive virtual reality enhanced effectiveness of Cognitive Behavioral Therapy (CBT) to reduce children's aggressive behavior problems. Boys with aggressive behavior problems (N = 115; Mage = 10.58, SD = 1.48; 95.7% born in Netherlands) were randomized into three groups: CBT with virtual reality, CBT with roleplays, or care-as-usual. Bayesian analyses showed that CBT with virtual reality more likely reduced aggressive behavior compared to care-as-usual for six of seven outcomes (ds 0.19–0.95), and compared to CBT with roleplays for four outcomes (ds 0.14–0.68). Moreover, compared to roleplays, virtual reality more likely enhanced children's emotional engagement, practice immersion, and treatment appreciation. Thus, virtual reality may be a promising tool to enhance CBT effectiveness for children with aggressive behavior problems

Does Being Defended Relate to Decreases in Victimization and Improved Psychosocial Adjustment Among Victims?

School bullying is a clear violation of children’s rights to a safe education and is a major concern among school professionals and parents. Many antibullying interventions focus on enhancing peer defending of victims to combat bullying and to promote victims’ psychosocial functioning. However, longitudinal studies on the effects of being defended on (a) diminishing victimization and (b) enhancing victims’ psychosocial adjustment are lacking, and the role of the broader peer context has been largely unexplored. Therefore, this study examined whether being defended decreases victimization and improves victims’ psychosocial adjustment, and whether defending peer norms moderate these effects. Data were derived from a nationwide Dutch study on the effectiveness of antibullying interventions, with N = 5,415 students (Mage = 9.93; 48.3% girls) from 238 classrooms (54.2% control classrooms) in 68 elementary schools. Findings indicate that victims with at least one defender at the start of the school year (Time 1) experienced higher feelings of belonging at the end of the school year (Time 2) compared with nondefended victims, but experienced lower feelings of belonging compared with nonvictims. Defended victims did not differ from nondefended victims in self-esteem, depressive symptoms, and severity of victimization at Time 2. Nonvictims were significantly better adjusted than defended and nondefended victims regarding these outcomes. Descriptive and popularity norms for defending did not moderate the links between being defended and victims’ adjustment and severity of victimization at Time 2. Thus, being defended only partly relieves victims’ plight, irrespective of how normative defending behaviors are in classrooms. </p

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake