Nomogram incorporating prognostic immune-inflammatory-nutritional score for survival prediction in pancreatic cancer: a retrospective study.

BACKGROUND: Prognosis prediction for pancreatic cancer has always been difficult in clinical practice because of its high heterogeneity and mortality. The aim of the study was to assess the value of prognostic immune-inflammatory-nutritional (PIIN) score on overall survival (OS) in postoperative patients with pancreatic cancer and to develop a nomogram incorporating PIIN score. METHODS: This study retrospectively analyzed the clinic pathological data of 155 patients with pancreatic cancer who underwent radical surgery. PIIN score was calculated by measuring the fibrinogen (FIB), neutrophil to lymphocyte ratio (NLR), systemic immune-inflammation index (SII), albumin-bilirubin (ALBI) score, and prognostic nutritional index (PNI). Patients were divided into two groups by PIIN score levels over a threshold of 37.2. Univariate and multivariate analysis were performed using the Cox regression analysis model. The time-dependent receiver operating characteristic (ROC) curve was plotted to compare the prognostic values of the scoring systems. Finally, a nomogram based on PIIN score was constructed and validated. RESULTS: Multivariate regression analysis showed that PIIN score (hazard ratio (HR) = 2.171, 95% confidence interval (CI) = 1.207-3.906, P = 0.010), lymphovascular invasion (HR = 1.663, 95% CI = 1.081-2.557, P = 0.021), poor tumor grade (HR = 2.577, 95% CI = 1.668-3.982, P < 0.001), bad TNM stage (I vs. II: HR = 1.791, 95% CI = 1.103-2.906, P = 0.018; I vs. III: HR = 4.313, 95% CI = 2.365-7.865, P < 0.001) and without adjuvant chemotherapy (HR = 0.552, 95% CI = 0.368-0.829, P = 0.004) were independent risk factors for OS. The time-dependent ROC curves revealed that PIIN score was better than the other scoring systems in predicting survival prognosis. And last, the nomogram established from independent factors such as PIIN score had good predictive power for OS. The ROC curve results showed that the AUC values for 1, 3 and 5 years were 0.826, 0.798 and 0.846, respectively. The calibration plots showed the superior clinical applicability of the nomogram. CONCLUSION: The nomogram model based on PIIN score can be utilized as one of the prognosis stratifications as well as postoperative follow-up for the development of individual treatment for pancreatic cancer.

Construction of a combined prognostic model for pancreatic ductal adenocarcinoma based on deep learning and digital pathology images.

BACKGROUND: Deep learning has made significant advancements in the field of digital pathology, and the integration of multiple models has further improved accuracy. In this study, we aimed to construct a combined prognostic model using deep learning-extracted features from digital pathology images of pancreatic ductal adenocarcinoma (PDAC) alongside clinical predictive indicators and to explore its prognostic value. METHODS: A retrospective analysis was conducted on 142 postoperative pathologically confirmed PDAC cases. These cases were divided into training (n = 114) and testing sets (n = 28) at an 8:2 ratio. Tumor whole-slide imaging features were extracted and screened to construct a pathological risk model based on a pre-trained deep learning model. Clinical and pathological data from the training set were used to select independent predictive factors for PDAC and establish a clinical risk model using LASSO, univariate, and multivariate Cox regression analyses. Based on the pathological and clinical risk models, a combined model was developed. The Harrell concordance index (C-index) was computed to assess the predictive performance of each model for PDAC survival prognosis. RESULTS: For the training and testing sets, the C-index values for the clinical risk model were 0.76 and 0.75, respectively; for the pathological risk model, they were 0.82 and 0.73, respectively; and for the combined model, they were 0.86 and 0.77, respectively. The combined model exhibited appropriate calibration at 1-, 3-, and 5-year time points, as well as a superior area under the curve of the receiver operating characteristic curve and clinical net benefit compared to the single models. CONCLUSIONS: Integrating the pathological and clinical risk models may provide a higher predictive value for survival prognosis.

The value of the preoperative Naples prognostic score in predicting prognosis in gallbladder cancer surgery patients.

PURPOSE: The Naples prognostic score (NPS) is a comprehensive prognostic model that includes inflammatory and nutrition-related indicators and is increasingly used as a prognostic score for various malignant tumors. Given its predictive effect on prognosis in patients with gallbladder cancer, it is currently unclear. This study aimed to investigate the role of preoperative NPS in predicting prognosis in gallbladder cancer surgery patients. PATIENTS AND METHODS: A retrospective analysis was performed for 135 patients who underwent radical surgery for gallbladder cancer without preoperative treatment between March 2011 and January 2020. NPS was calculated by measuring the preoperative total cholesterol value, serum albumin value, neutrophil-lymphocyte ratio (NLR), and lymphocyte-monocyte ratio (LMR). They were then divided into 3 groups (groups 0, 1, and 2) based on NPS scores. Survival analysis was performed using the Kaplan-Meier method and log-rank test. Univariate and multivariate Cox proportional hazards models were used to identify independent prognostic factors. Plot time-dependent receiver operating characteristic (ROC) curves to compare the prognostic value of scoring systems. Finally, a nomogram model was developed with independent prognostic factors. RESULTS: Multivariate analysis showed that NPS was an independent risk factor affecting OS (HR = 3.417, p < 0.05). The time-dependent ROC curve results showed that NPS had a better predictive value on survival prognosis than other indicators. The nomogram constructed according to independent factors such as NPS has a good predictive ability for OS. CONCLUSION: As a simple and reliable tool, the NPS has important predictive value in the survival prognosis of gallbladder cancer patients. The nomogram model constructed by NPS will help determine prognosis and make individualized treatment decisions.

Machine learning-based nomogram for 30-day mortality prediction for patients with unresectable malignant biliary obstruction after ERCP with metal stent: a retrospective observational cohort study.

BACKGROUND: This study aimed to investigate the risk factors for 30-day mortality in patients with malignant biliary obstruction (MBO) after endoscopic retrograde cholangiopancreatography (ERCP) with endobiliary metal stent placement. Furthermore, we aimed to construct and visualize a prediction model based on LASSO-logistic regression. METHODS: Data were collected from 245 patients who underwent their first ERCP with endobiliary metal stent placement for unresectable MBO between June 1, 2013, and August 31, 2021. Univariable and multivariable logistic regression analyses were conducted to identify the risk factors for 30-day mortality. We subsequently developed a logistic regression model that incorporated multiple parameters identified by LASSO regression. The model was visualized and the nomogram was plotted. Risk stratification was performed based on nomogram-derived scores. RESULTS: The 30-day mortality rate was 10.7% (23/245 patients). Distant metastasis, total bilirubin, post-ERCP complications, and successful drainage were independent risk factors of 30-day mortality. The variables screened by LASSO regression, including distant metastasis, total bilirubin, post-ERCP complications, and successful drainage, were incorporated into the logistic model. The results were visualized through a nomogram based on the model. To assess the model's performance, discrimination was evaluated using the area-under-the-curve values obtained from receiver operating characteristic analyses with 10-fold cross-validation in the training group and validated in the testing group. The calibration curve showed the good predictive ability of the model. Decision curve analysis is used to evaluate the clinical application of nomogram. Finally, we performed risk stratification based on the risk calculated using the nomogram. Patients were assigned to the low-, moderate-, and high-risk groups based on their probability scores. The Kaplan-Meier survival curves for the different nomogram-based groups were significantly different (p < 0.001). CONCLUSIONS: We developed a nomogram using the LASSO-logistic regression model to forecast the 30-day mortality rate in patients who had undergone ERCP with endobiliary metal stent placement due to MBO. This nomogram can assist in identifying individuals at high-risk of 30-day mortality following ERCP.

Profiles, Transitions, and Resilience Factors of Suicide Risk in Early Chinese Adolescents.

As a severe public health concern directly endangering life safety, adolescent suicide has been extensively investigated in variable-centered studies. However, gaps remain in the knowledge of heterogeneous suicide risk patterns and their developmental nature. Additionally, little is known about protective factors associated with suicide risk patterns and changes. This study applied person-centered approaches to explore suicide risk profiles and transitions over time in early Chinese adolescents, along with their protective factors. A total of 1518 junior high school students (49.6% girls, Mage = 13.57, SD = 0.75) participated in two surveys within a 12-month interval. Latent Profile Analysis and Latent Transition Analysis were used to model the profiles and transitions of suicide risk. Three risk profiles were identified at both time points: low risk profile (73.9, 78.3%), medium risk-high threat profile (16.2, 10.2%), and high risk profile (9.9, 10.2%). Low risk profile was stable, while medium risk-high threat and high risk profiles showed great transitions over 12 months. Sense of control, meaning in life, and regulatory emotional self-efficacy served as protective factors against suicide risk profiles and transitions. Findings underscore the importance of comprehensively illustrating suicide risk states from multiple aspects, as well as understanding the fluid nature of transitions between different risk states. Prevention and intervention strategies aimed at enhancing resilience, such as increasing sense of control, perceived meaningfulness, and belief in emotional regulation, may contribute to reducing the risk of suicide among adolescents.

Prevalence of congenital heart disease among school children in Qinghai Province.

OBJECTIVES: This study aimed to investigate the prevalence of congenital heart disease (CHD) among school children in Qinghai province, a high-altitude region in China. METHODS: A cross-sectional study was conducted among school-aged children in 2019. All subjects completed a survey with a structure questionnaire and underwent CHD screening. CHD was screened by standard physical examination and further confirmed by echocardiography. Multivariate logistic regression were used to estimate the association of CHD prevalence with gender, nationality, and altitude. RESULTS: A total of 43,562 children aged 3-19 years participated in the study. The mean (SD) age was 11.2 (3.3) years. 49.7% were boys, and 80.0% were of Tibetan. CHD was identified in 293 children, with an overall prevalence of 6.73 ‰. Among them, 239 were unrecognized CHD, yielding a prevalence of 5.49 ‰. Atrial septal defect accounted for 51.9% of the CHD, followed by patent ductus arteriosus (31.1%), ventricular septal defect (9.9%). The CHD prevalence was significantly higher in female (8 ‰), Han race (18 ‰), children lived in Qumalai county (13 ‰), and children lived in a higher altitude (13 ‰). Female had greater prevalence of total CHD, atrial septal defect, and patent ductus arteriosus, but insignificant difference was observed in ventricular septal defect prvalence than male. In multivariable logistic regression analyses, female (OR, 1.48; 95% CI, 1.17-1.87, P = 0.001), Han population (OR, 3.28; 95% CI, 1.67-6.42, P = 0.001), and higher altitudes (OR, 2.28; 95% CI, 1.74-3.00, P < 0.001) were shown to be independently association with CHD prevalence. CONCLUSIONS: The prevalence of CHD in Qinghai province was 6.73 ‰. Altitude elevation, female, and Han population were independently association with CHD prevalence.

Prognostic Significance of Microvascular Invasion in Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis.

BACKGROUND The incidence, pathogenesis, and prognostic effect of microvascular invasion on pancreatic ductal adenocarcinoma (PDAC) remain controversial. This study aimed to summarize the incidence, pathogenesis, role in clinical management, recurrence, and prognostic significance of microvascular invasion in PDAC. MATERIAL AND METHODS A literature review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Systematic literature searches were conducted using PubMed and Google Scholar up to February 2021. RESULTS Seventeen studies were included in the meta-analysis. The incidence of microvascular invasion was 49.0% (95% confidence interval [CI], 43.8-54.5%) among PDAC patients who underwent surgery. The weighted multivariate Cox proportional hazards model hazard ratio for disease-free survival of 8 studies was 1.78 (95% CI 1.53-2.08, P<0.001), and there was no statistically significant difference between the subgroups (P=0.477). The hazard ratio for overall survival of 14 studies was 1.49 (95% CI 1.27-1.74, P<0.001), and there was no statistically significant difference between the subgroups (P=0.676). CONCLUSIONS Microvascular invasion occurred in nearly half of PDAC patients after surgery and was closely related to disease-free and overall survival. Understanding the role of microvascular invasion in PDAC will help provide more personalized and effective preoperative or postoperative strategies to achieve better survival outcomes.

Correction to: Parental Phubbing and Adolescents' Depressive Symptoms: Self-Esteem and Perceived Social Support as Moderators.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Parental Phubbing and Adolescents' Depressive Symptoms: Self-Esteem and Perceived Social Support as Moderators.

Parental phubbing refers to the extent to which parents use or are distracted by their cell phone when they interact with their children. There has been growing scholarly interest in understanding the adverse effects of parental phubbing on adolescents' development. However, it is less clear whether parental phubbing potentially increases adolescents' depressive symptoms, to date, and the understanding of the factors which may affect this relationship is also limited. The current study, therefore, examined the relationship between parental phubbing and adolescents' depressive symptoms and sought to determine whether self-esteem and perceived social support simultaneously moderated this relationship. The participants included 2407 students (1202 girls; Mage = 12.75, SD = 0.58) from seven middle schools in China. They completed the questionnaires regarding their experience with parental phubbing, self-esteem, perceived social support, and depressive symptoms. Results indicated that adolescents with a high level of parental phubbing were likely to have a high level of depressive symptoms, after controlling age, gender, and perceived economic stress. Low self-esteem adolescents who experienced higher levels of parental phubbing were more likely to be depressed than high self-esteem adolescents. Furthermore, higher levels of parental phubbing significantly predicted increases in adolescents' depressive symptoms when their self-esteem and perceived social support were both low, or one was low. In contrast, this effect became nonsignificant when adolescents' self-esteem and perceived social support were both high. Parents who are concerned about adolescents' depressive symptoms should pay closer attention to adolescents' self-esteem, as well as their perceived social support, in order to provide appropriate interventions.

Prognostic Nomogram for Disease-Specific Survival in Patients with Non-metastatic Ampullary Carcinoma After Surgery.

OBJECTIVE: The aim of this study was to establish and validate an individualized nomogram for predicting disease-specific survival (DSS) in patients with non-metastatic ampullary carcinoma after surgery. METHODS: The nomogram was prepared using retrospective data from the Surveillance, Epidemiology, and End Results database, and included 2022 patients (training dataset: 1276; validation dataset: 746 patients) with non-metastatic ampullary carcinoma who were surgically treated between 2004 and 2014. Cox multivariate regression was performed to identify independent risk factors. The predictive accuracy was determined using the concordance index (C-index) and calibration curves. Results were validated internally using bootstrap resampling, and externally against the validation dataset. RESULTS: The median follow-up for the training dataset was 25.5 months (range 1-143), the median survival time was 52 months [95% confidence interval (CI) 41.67-62.33], and the postoperative 1-, 3-, and 5-year DSS rates were 86.7%, 57.3%, and 47.2%, respectively. Univariate and multivariate regression analysis demonstrated that age, grade, tumor size, lymph node ratio, extension range, and histology were independent risk factors for DSS. The C-index of the internal validation dataset for predicting DSS was 0.70 (95% CI 0.68-0.72), which was superior to that of the American Joint Committee on Cancer staging, i.e. 0.64 (95% CI 0.62-0.66; p < 0.001). The 5-year DSS and median DSS time for the low-risk group were significantly greater than those for the high-risk group (p < 0.001). CONCLUSION: Our nomogram reliably and accurately predicted DSS in patients with non-metastatic ampullary carcinoma after surgery. This model may help clinicians in their decision making.

A Prognostic Nomogram for Disease-Specific Survival in Patients with Pancreatic Ductal Adenocarcinoma of the Head of the Pancreas Following Pancreaticoduodenectomy.

BACKGROUND This study developed and validated a nomogram to predict patient prognosis for pancreatic ductal adenocarcinoma (PDAC) of the head of the pancreas following pancreaticoduodenectomy. MATERIAL AND METHODS Retrospective data were obtained from 4,383 patients with PDAC of the head of the pancreas who underwent pancreaticoduodenectomy between 2004-2013 from 11 Registries Research Data of the Surveillance, Epidemiology,and End Results (SEER) database. Cox proportional hazards model was used to identify independent risk factors. The predictive accuracy of the nomogram was determined by the concordance index (C-index) and calibration curve. The results were externally validated by comparison with data from 1,743 patients from 7 other Registries Research Data. RESULTS Of the 4,383 patients in the training dataset, median disease-specific survival (DSS) was 17.0 months (range, 1.0-131 months), and postoperative 1-year, 3-year, and 5-year DSS rates were 70.3%, 26.1%, and 16.8%, respectively. Multivariate analysis showed that patient sex, age, tumor grade, regional lymph nodes examined, positive regional lymph nodes, tumor size, extent of local invasion, and tumor metastases were independent risk factors for DSS. The C-index of the internal validation dataset for prediction of DSS was 0.64 (95% CI, 0.63-0.65), which was superior to the American Joint Committee on Cancer (AJCC) staging, 0.57 (95% CI, 0.56-0.58) (P<0.001). The 5-year DSS rates and median DSS time for patients in the low-risk group were significantly greater compared with high-risk group (P<0.001). CONCLUSIONS A validated prognostic disease-specific nomogram for patient survival in PDAC of the head of the pancreas following pancreaticoduodenectomy was developed.

Moral Disengagement as Mediator and Moderator of the Relation Between Empathy and Aggression Among Chinese Male Juvenile Delinquents.

The link between empathy and aggression is well documented; yet, studies examining potential mechanisms that explain this association are limited. In the present study, we tested the relation between empathy and aggression and examined both the mediating and moderating effects of moral disengagement on this relation among Chinese male juvenile delinquents. Three hundred and fifty-seven male juvenile delinquents from one Chinese juvenile correctional facility completed the interpersonal reactivity index, the moral disengagement scale and the aggression questionnaire. The results indicated that moral disengagement partially mediated the influence of empathy on aggression. Moreover, moral disengagement moderated the relation between empathy and aggression. Specifically, there was a significant negative relation between empathy and aggression at low levels of moral disengagement. However, at high levels of moral disengagement, the relation between empathy and aggression was non-significant. The significance and limitations of the results are discussed.

How Is Rejection Sensitivity Linked to Non-Suicidal Self-Injury? Exploring Social Anxiety and Regulatory Emotional Self-Efficacy as Explanatory Processes in a Longitudinal Study of Chinese Adolescents.

Early adolescents are at high risk for non-suicidal self-injurious behavior (NSSI). Based on the Rejection Sensitivity Model, the Experiential Avoidance Model, and the Affect Regulation Model of Self-Injury, this study aimed to explain how rejection sensitivity was related to NSSI among adolescents by unraveling the mediating role of social anxiety and the moderating role of regulatory emotional self-efficacy (RESE) in this relationship. A three-wave longitudinal investigation with a three-month interval was conducted among 726 adolescents (Mage = 13.47, SD = 0.95; 46.0% girls) from a middle school in North China. The Cross-Lagged Panel Models (RI-CLPMs) were utilized to estimate the associations among the study variables. The results indicated that the incidence rates of NSSI in the three measurements among adolescents were 33.3%, 30.3%, and 24.1%, respectively. Adolescents' rejection sensitivity and NSSI showed a declining trend over time. Furthermore, rejection sensitivity predicted NSSI through the longitudinal mediating effect of social anxiety. RESE played a protective role in adolescents' NSSI, but its moderating effect was not significant. The findings increase our understanding of the association between rejection sensitivity and NSSI in adolescents, and they benefit educators in conducting targeted interventions through improving adolescents' rejection sensitivity and social anxiety to reduce the risk of NSSI.

Gendered Parenting: Maternal Son Preference and Depressive Symptoms in Chinese Early Adolescents.

This study focused on the nuanced phenomenon of gendered parenting by exploring how maternal son preference is associated with depressive symptoms among Chinese early adolescents. Focusing on 1093 junior high school students from a relatively affluent city in Western China, this study examined the mediating roles of mother-child attachment and father-child attachment as well as the moderating role of school connectedness in the relationship between maternal son preference and depressive symptoms. The results revealed a noteworthy positive correlation between maternal son preference and depressive symptoms among female adolescents, with no significant association observed in males. In addition, mother-child attachment and father-child attachment mediated the relationship between maternal son preference and girls' depressive symptoms, supporting the "spillover effect" and "crossover effect". Moreover, a moderation effect analysis indicated that a higher level of school connectedness can buffer the effect of maternal son preference on girls' depressive symptoms, while a lower level of school connectedness can enhance the effect of maternal son preference on girls' depressive symptoms. In addition, maternal son preference was negatively correlated with boys' depressive symptoms in relation to high school connectedness. These insights help enhance people's understanding of gendered parenting, emphasizing the enduring necessity of addressing son preference within the broader context of promoting gender equality.

Psychological maltreatment and adolescent internet harassment perpetration: The mediating role of deviant peer affiliation and the moderating role of self-compassion.

BACKGROUND: Psychological maltreatment has been regarded as a risk factor for adolescent internet harassment. However, previous studies failed to take family, peer, and individual factors into account comprehensively when comes to adolescent internet harassment perpetration. OBJECTIVE: Based on the Social-Ecological Diathesis-Stress Model, the present study established a moderated mediation model to investigate the mediating role of deviant peer affiliation in the association between psychological maltreatment and adolescent internet harassment perpetration, as well as the moderating role of self-compassion. PARTICIPANTS AND SETTING: A total of 1,592 Chinese adolescents (51.07 % girls, Mage = 13.23 years) participated in the current study. METHOD: The participants completed questionnaires regarding demographics, psychological maltreatment, internet harassment perpetration, deviant peer affiliation, and self-compassion. RESULTS: Psychological maltreatment was positively related to adolescent internet harassment perpetration. Mediation analyses revealed that deviant peer affiliation partially mediated this relationship (indirect effect = 0.14, 95 % CI = [0.09, 0.20]). Moderated mediation analyses further indicated that self-compassion not only moderated the link between psychological maltreatment and adolescent internet harassment perpetration, with the effect being significant only for adolescents with low levels of self-compassion, but also moderated the indirect association between psychological maltreatment and internet harassment perpetration via deviant peer affiliation, with the association being much more potent for adolescents with low levels of self-compassion. CONCLUSIONS: This study highlights the importance of considering multiple circumstantial and individual factors to understand the development of adolescents' externalizing problems.

Nursing Method of Patients with Severe Traumatic Brain Injury and Fracture in the Ambulance.

Craniocerebral injury accounts for 9%-21% of the injuries in all parts of the body, and the incidence rate ranks first in all types of trauma or only lower than limb fractures. This study mainly discusses the nursing methods of patients with severe traumatic brain injury and fractures in ambulances. This study is based on risk factors with moderate-to-higher association strength from retrospective studies. According to the regression coefficients of the logistic regression model, the risk factors were assigned, and the early warning score table of craniocerebral injury complicated with hyponatremia was established. The energy efficiency of the early warning score table was evaluated by case diagnostic test and ROC analysis. At the same time, risk grading is carried out, and the chi-square test is used to test the reliability of the grading standard, so as to identify the risk of hyponatremia in patients with craniocerebral injury early and screen out high-risk patients as the key observation objects of nurses. Based on the early warning score table of craniocerebral injury complicated with hyponatremia, different systematic nursing intervention measures were taken for low-risk patients and high-risk patients, and their application effects were evaluated. The clinical application effect of the systematic nursing intervention program was evaluated by the historical control research method, which provided a reference for the nursing in the ambulance to prevent other complications of patients with craniocerebral injury. The positive rate of prehospital operation can reach 64.44%, and the specific rate can reach 84.44%. 60% of the sample sought better metastatic care in terms of the purpose of using an ambulance. The systematic nursing intervention program has a certain effect on reducing the incidence of hyponatremia in patients with craniocerebral injury and shortening the hospitalization time of patients with craniocerebral injury. The early warning score of craniocerebral injury complicated with hyponatremia developed in this study is concise and practical and can provide a basis for clinical assessment of the risk of hyponatremia in patients with craniocerebral injury.

Childhood Emotional Abuse and Depression Among Adolescents: Roles of Deviant Peer Affiliation and Gender.

Adolescent depression is a significant concern around the world. There is a pressing need to explore risk factors for this disorder to develop better interventions. Based on an integration of attachment theory, Bronfenbrenner's ecological systems theory, and relational theory, the current study aimed to examine (a) whether childhood emotional abuse (CEA) would be significantly and positively related to adolescents' depression, (b) whether deviant peer affiliation would mediate the relation between CEA and depression, and (c) whether gender would moderate the direct and indirect relations between CEA and adolescent's depression via deviant peer affiliation. Participants were 961 Chinese adolescents (Mage = 15.21 years, SD = 1.57). They completed questionnaires regarding demographics, CEA, other types of childhood maltreatment (i.e., physical abuse, sexual abuse, physical neglect, and emotional neglect), deviant peer affiliation, and depression. Results showed that CEA was positively related to adolescent depression even after controlling for other types of childhood maltreatment, and this relation was mediated by deviant peer affiliation. Furthermore, moderated mediation analyses indicated that gender moderated the relation between CEA and deviant peer affiliation, with the relation being stronger for girls than for boys. However, gender did not moderate the relation between deviant peer affiliation and depression, as well as the direct relation between CEA and depression. Results highlight that interventions aimed at reducing CEA may protect adolescents, especially girls from the risks of deviant peer affiliation and depression.

The Association between Coparenting Behavior and Internalizing/Externalizing Problems of Children and Adolescents: A Meta-Analysis.

This study aimed to determine the association between coparenting behavior and children's externalizing and internalizing problems and possible factors that may moderate their associations. A meta-analysis of 93 studies involving 41,207 participants found that coparenting behavior was slightly and significantly related to externalizing problems, r = -0.17, 95% CI [-0.194, -0.15], and internalizing problems, r = -0.16, 95% CI [-0.18, -0.14]. In addition, coparenting integrity, cooperation, conflict, competitiveness, and triangulation were significantly related to externalizing and internalizing problems. Moderation analyses revealed the following findings: (a) data reporter moderated the association between coparenting and internalizing problems, with children-report coparenting showing a significantly stronger relation with internalizing symptom than father-report coparenting; (b) developmental stage was found to moderate the association between coparenting behavior and externalizing problems, with stronger association found in childhood than in toddlerhood; (c) female percentage, individualism-collectivism culture, research methods, and publication year were not found to moderate the association between coparenting behavior and externalizing or internalizing problems. These findings help summarize the previous studies and provide an empirical basis for the relation between coparenting and child externalizing/internalizing problems, and benefits targeted interventions towards coparenting behaviors.

Difficulties in Emotion Regulation and Cyberbullying Among Chinese Adolescents: A Mediation Model of Loneliness and Depression.

Recent research has ascertained some risk factors for cyberbullying. However, few studies have investigated the potential influence of difficulties in emotion regulation (DER) on cyberbullying, and there is little knowledge about the mediating mechanisms underlying this association. This study investigated whether DER would be significantly related to adolescent cyberbullying and whether loneliness and depression would sequentially mediate the link between DER and adolescent cyberbullying. A sample of 719 Chinese middle school students completed measures regarding demographics, DER, loneliness, depression, and cyberbullying. After controlling for the demographic covariates, the results showed that (a) DER was positively associated with adolescent cyberbullying; (b) loneliness and depression sequentially mediated the relation between DER and adolescent cyberbullying. This study emphasizes the underlying mediating mechanisms between DER and adolescent cyberbullying, which is of great significance for the prevention and intervention of adolescent cyberbullying in the digital age.

School Climate and Adolescents' Cyberbullying Perpetration: A Moderated Mediation Model of Moral Disengagement and Friends' Moral Identity.

Based on an integration of the positive youth development model and the social cognitive theory, friends' moral identity was examined as a moderator of the direct and indirect relations between school climate and adolescent's cyberbullying perpetration via moral disengagement. Participants were 404 Chinese adolescents (Mage = 13.53 years, SD = 0.92). They completed the Perceived School Climate Scale and the Moral Identity Scale and nominated up to three friends whom they considered to be their "best friend" in their classroom at Time 1. After 6 months, they completed the Moral Disengagement Scale and the Cyberbullying Scale at Time 2. Results showed that adolescents who experienced positive school climate were less likely to cyberbully others, which was mediated by their moral disengagement. Friends' moral identity moderated the direct and indirect relations between school climate and cyberbullying perpetration. Specifically, the indirect relationship between school climate and cyberbullying perpetration through moral disengagement became nonsignificant for adolescents interacting with high moral identity friends. The direct association between school climate and cyberbullying perpetration was moderated by friends' moral identity.