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Attention-Deficit/Hyperactivity Disorder Traits in Childhood and Physical Health in Midlife
No full textImportance: Although attention-deficit/hyperactivity disorder (ADHD) has been associated with various health risks, most research has focused on children and young adults, leaving long-term physical health outcomes of ADHD traits underexplored. Objective: To investigate the association between childhood ADHD traits and physical health outcomes in midlife and the role health risk factors play in this association. Design, Setting, and Participants: This cohort study included data from the nationally representative, population-based 1970 British Cohort Study. The cohort included people born in England, Scotland, and Wales during the same week in 1970, with follow-up data collected over 46 years. Participants were excluded from the analysis if missing data on 1 or more key variables (sex, ADHD traits, social class, and ethnicity) assessed. The data analysis was performed between February and July 2025. Exposure: Attention-deficit/hyperactivity disorder traits at age 10 years as assessed using a validated measure derived from childhood behavior questionnaires. Main Outcomes and Measures: Outcomes were self-reported health conditions, multimorbidity (2 or more co-occurring physical health conditions), and physical health-related disability by age 46 years. Cox proportional hazards models were used to test whether ADHD traits at age 10 years were associated with hazards of multimorbidity up to age 46 years. Health risk factors, including smoking, alcohol use, psychological distress, higher body mass index, and lower educational attainment from age 26 to 46 years, were examined using path models. Results: A total of 10 930 participants were included in the main analyses (all aged 46 years; 51.0% women). Higher childhood ADHD traits were associated with more physical health conditions (b = 0.10; 95% CI, 0.07-0.13), increased odds of physical multimorbidity (odds ratio, 1.14, 95% CI, 1.08-1.19), and greater physical health-related disability (b = 3.17; 95% CI, 2.27-4.07) by age 46 years. There were no sex interactions for physical health conditions and multimorbidity. However, the association between ADHD traits and physical health-related disability showed a larger effect size in women (b = 4.07; 95% CI, 2.67-5.48) than in men (b = 2.37; 95% CI, 1.24-3.51). Participants who had a high likelihood of meeting ADHD criteria in childhood (5.5%) had an estimated probability of 42.1% (95% CI, 38.2%-46.1%) of physical multimorbidity by age 46 years compared with 37.5% (95% CI, 36.6%-38.4%) for those without high ADHD traits. Indirect associations were observed through smoking, psychological distress, and body mass index. Conclusions and Relevance: This cohort study found that high ADHD traits in childhood were associated with poorer physical health outcomes in midlife, with health risk factors explaining part of this association. Addressing modifiable risk factors may help mitigate long-term health disparities in people with ADHD. Intervention is needed across the life course to support the health and well-being of people with ADHD.</p
Autistic traits and suicidality in midlife and old age:investigating mediating effects of mental health and social connectedness
Get PDFSuicidality is increased among middle-aged and older autistic adults, but little is known about the underlying factors linking autism with suicidality in midlife and older age. Here we report a cross-sectional observational study of 9,979 adults (76% female) aged 50+ years who completed questionnaires measuring autistic traits, current mental health, social connections and suicidality (suicidal ideation and suicidal self-harm). We use path analysis to explore the relationship between autistic traits and suicidality and the mediating effects of current mental health, social connectedness and male/female sex. Our results find that depression, anxiety, post-traumatic stress disorder (PTSD), loneliness and social isolation all significantly mediate the relationship between autistic traits and suicidal ideation, with small effect sizes. For suicidal self-harm, male sex, depression, PTSD and social isolation were found to be mediators. We conclude that mental health difficulties and social isolation mediate higher rates of suicidality in 50+-year-olds with high autistic traits. Targeted and individually tailored interventions for people on the autism spectrum across the lifespan are important.</p
Skin cancer in inflammatory arthritis:should we advise screening?
No full textInflammatory arthritis refers to a group of related clinical entities marked mainly by inflammation of the joints, the spine, or both. Rheumatoid arthritis and spondyloarthritis (which includes psoriatic arthritis and axial spondyloarthritis) are the most common forms of inflammatory arthritis. As more studies are conducted, there are accumulating data suggesting the elevated risk of skin cancer, including both melanoma and non-melanoma skin cancer, in inflammatory arthritis compared with the general population. In this context, the question of whether screening for skin cancer should be recommended in individuals with inflammatory arthritis is more relevant than ever. In this Review, we discuss the current knowledge on the risk and possible associations of melanoma and non-melanoma skin cancer in inflammatory arthritis with the aim of raising awareness within the rheumatology community about the risk of skin cancer, screening, and guidance.</p
Disparities in the access to and use of biologic and targeted synthetic treatments in patients with inflammatory rheumatic and musculoskeletal diseases: a scoping review
Get PDFObjectivesTo identify disparities in the access to and use of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in inflammatory rheumatic and musculoskeletal diseases (iRMDs).MethodsA systematic search of literature was conducted in Embase, Medline (to 30 May 2023), and relevant congress databases (to June 2023). Interventional and observational studies reporting measures of disparity in access to, receipt of, or utilisation of b/tsDMARDs in iRMDs were eligible. Outcomes included access to b/tsDMARDs, likelihood to receive treatment, time to first initiation, treatment adherence, and treatment persistence. Disparities across these outcomes are reported. Reporting follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews guidance.ResultsOf 4218 publications identified, 104 were included in this scoping review. All studies were observational; 70% reported data from patients with rheumatoid arthritis, and 65% were from North America or Europe. Gender (58%) and age (54%) were commonly investigated factors. Lower gross domestic product/capita (n = 7 publications) was associated with reduced access to b/tsDMARDs, whereas older age (n = 20 publications) and receiving government-funded health insurance (eg, Medicare/Medicaid) (n = 6 publications) were negatively associated with the likelihood of receiving b/tsDMARDs. No clear association was identified for any disparity factors and time to the initiation of b/tsDMARDs.ConclusionsDisparities in access to and use of b/tsDMARDs are reported in the literature along with the role of commonly studied social determinants of health (SDoH). More research is needed to identify the full spectrum of existing disparities and to reveal the role of SDoH, including the lesser-studied ones
Disclosure experiences in LGBTQ+ healthcare staff:a systematic review and meta-synthesis
Get PDFObjective: Workplace disclosure of LGBTQ+ identity by healthcare employees is an understudied area and existing reviews of LGBTQ+ disclosure in the healthcare sector focus on patient perspectives, overlooking the unique challenges that healthcare professionals encounter. The aim of this study was to conduct a systematic review and meta-synthesis of existing qualitative studies exploring disclosure experiences of LGBTQ+ healthcare employees.Method: The literature search integrated current research from 2011 to March 2023 and focused on qualitative studies exploring disclosure experiences of LGBTQ+ healthcare professionals. Ovid served as the primary platform for literature searches, supplemented by forward and backward citation tracking and additional searches in academic databases such as Google Scholar and Scopus. The studies underwent quality evaluation using the CASP 2022 checklist and were synthesised using thematic analysis.Results: The findings revealed seven studies with five prominent themes: (1) risk associated with disclosure, (2) making the decision to disclose, (3) cost of non-disclosure, (4) cost of disclosure, and (5) benefit of disclosure. Additionally, five critical factors of disclosure were identified: level, scope, time, elements, and method. Finally, the risk-benefit analysis underscored the dilemma and balance between authenticity and conformity, largely influenced by pervasive heteronormativity, resulting in a significant mental toll. Conclusion: The findings must be interpreted considering certain limitations, such as the lack of generalisability of studies. However, the findings emphasise the critical need for cultivating trusting and accepting healthcare work environments for LGBTQ+ staff.<br/
A Study of Library Usage in Agent-Authored Pull Requests
Get PDFCoding agents are becoming increasingly capable of completing end-to-end software engineering workflows that previously required a human developer, including raising pull requests (PRs) to propose their changes. However, we still know little about how these agents use libraries when generating code, a core part of real-world software development. To fill this gap, we study 26,760 agent-authored PRs from the AIDev dataset to examine three questions: how often do agents import libraries, how often do they introduce new dependencies (and with what versioning), and which specific libraries do they choose? We find that agents often import libraries (29.5% of PRs) but rarely add new dependencies (1.3% of PRs); and when they do, they follow strong versioning practices (75.0% specify a version), an improvement on direct LLM usage where versions are rarely mentioned. Generally, agents draw from a surprisingly diverse set of external libraries, contrasting with the limited "library preferences" seen in prior non-agentic LLM studies. Our findings offer an early empirical view on how AI coding agents interact with today's software ecosystems
Timing structures in live comedy:A matched-sequence approach to mapping performance dynamics
Get PDFLive performance is a ubiquitous cultural and social behavior that has not yet benefited from systematic scientific study. We present a computational methodology that visualizes and describes timing structures in live performance, showcasing their engineering. This novel analysis framework, Topology Analysis of Matching Sequences (TAMS), automatically detects matching sequences and maps their timing. Locating material that is repeated across performances reveals the skill behind apparently effortless communication between performer and audience. Applying TAMS to two stand-up comedy tours uncovered structural features at the macro- and microlevels, including consistently placed novel material at the beginning of shows and sections dedicated to tightly timed repeated material. TAMS also provides a new frame of reference for examining audience–performer dynamics through speech microtiming and laughter. TAMS can be applied to other forms of repeated speech, such as political stump speeches, as well as extended to other types of performance, such as dance
The Meaning of Agency in Contexts of Everyday Life for Mental Health Recovery in Young Adulthood:A Thematic Analysis
Get PDFObjectivesFor young adults, experiences of life-disruptive mental distress often involve social isolation, stigma and reduced self-worth, which can impede recovery during a critical period of identity formation. This study explores how six young adults in Denmark, recruited through the OPUS early psychosis intervention program, retrospectively assessed how, where and why they were enabled to act within everyday contexts to catalyse recovery.Research Design and MethodsAn abductive thematic analysis was conducted using life story interviews followed by intensive interviews focused on youth recovery.ResultsTwo themes were generated. First, overcoming isolation in safe and inclusive communities: participants sought belonging through repaired parental relationships or, when parental support was insufficient, by visiting trusted networks abroad. Second, gaining competence and recognition in self-chosen physical and creative activities: these contexts enabled participants to develop skills, experience recognition and, in some cases, reframe aspects of mental distress as personal resources. Together, the themes suggest that experiences of safety were a necessary basis for attuned exploration, self-challenge and identity formation fostering greater hope for the future.DiscussionThe analysis illuminates the relational and contextual dynamics of agency, belonging and meaning making in youth recovery, showing that agency was co-created through interactions with people, environments, activities and norms.ConclusionEveryday contexts aligning with young adults’ interests hold substantial potential to foster belonging, participation, competence and hope, supporting meaningful engagement in life while preparing young people for adulthood
The US-Sino Tech War Through the Eyes of Secondary States:An Analysis of the Reactions of the US Five Eyes Allies to Huawei’s 5G
Get PDFThis paper contributes to the scholarly debate on secondary states’ agency in the context of US–China technological competition by examining how members of the Five Eyes (FVEY) intelligence alliance, excluding the United States, responded to perceived security risks posed by Huawei’s 5G infrastructure. While all FVEY states ultimately excluded Huawei from national networks, the pathways to this outcome diverged markedly, reflecting differences in threat perception, institutional processes, political priorities, and strategic cultures. Australia acted decisively, leveraging established mechanisms to implement a hardline stance; Canada and New Zealand proceeded cautiously, balancing domestic politics and trade concerns; and the United Kingdom initially resisted US pressure before reversing course amid domestic scrutiny. These variations show that alliance cohesion cannot be assumed, even among long-standing intelligence partners, and that convergence in policy outcomes does not imply convergence in underlying rationale, though all members ultimately reached a de facto similar outcome. The study underscores the limits of US influence over allied interpretations of asymmetric technological threats and highlights the critical role of secondary states in shaping technological geopolitics. By illuminating how liberal democracies navigate security, economic, and political imperatives in asymmetric competition, it provides insights into the challenges of multilateral coordination over emerging technologies