Neural signatures of shared subjective affective engagement and disengagement during movie viewing.

When watching a negative emotional movie, we differ from person to person in the ease with which we engage and the difficulty with which we disengage throughout a temporally evolving narrative. We investigated neural responses of emotional processing, by considering inter-individual synchronization in subjective emotional engagement and disengagement. The neural underpinnings of these shared responses are ideally studied in naturalistic scenarios like movie viewing, wherein individuals emotionally engage and disengage at their own time and pace throughout the course of a narrative. Despite the rich data that naturalistic designs can bring to the study, there is a challenge in determining time-resolved behavioral markers of subjective engagement and disengagement and their underlying neural responses. We used a within-subject cross-over design instructing 22 subjects to watch clips of either neutral or sad content while undergoing functional magnetic resonance imaging (fMRI). Participants watched the same movies a second time while continuously annotating the perceived emotional intensity, thus enabling the mapping of brain activity and emotional experience. Our analyses revealed that between-participant similarity in waxing (engagement) and waning (disengagement) of emotional intensity was directly related to the between-participant similarity in spatiotemporal patterns of brain activation during the movie(s). Similar patterns of engagement reflected common activation in the bilateral ventromedial prefrontal cortex, regions often involved in self-referenced evaluation and generation of negative emotions. Similar patterns of disengagement reflected common activation in central executive and default mode network regions often involved in top-down emotion regulation. Together this work helps to better understand cognitive and neural mechanisms underpinning engagement and disengagement from emotionally evocative narratives.

Social network shrinking is explained by active and passive effects but not increasing selectivity with age in wild macaques.

Evidence of social disengagement, network narrowing and social selectivity with advancing age in several non-human animals challenges our understanding of the causes of social ageing. Natural animal populations are needed to test whether social ageing and selectivity occur under natural predation and extrinsic mortality pressures, and longitudinal studies are particularly valuable to disentangle the contribution of within-individual ageing from the demographic processes that shape social ageing at the population level. Data on wild Assamese macaques (Macaca assamensis) were collected between 2013 and 2020 at the Phu Khieo Wildlife Sanctuary, Thailand. We investigated the social behaviour of 61 adult females observed for 13 270 h to test several mechanistic hypotheses of social ageing and evaluated the consistency between patterns from mixed-longitudinal and within-individual analyses. With advancing age, females reduced the size of their social network, which could not be explained by an overall increase in the time spent alone, but by an age-related decline in mostly active, but also passive, behaviour, best demonstrated by within-individual analyses. A selective tendency to approach preferred partners was maintained into old age but did not increase. Our results contribute to our understanding of the driver of social ageing in natural animal populations and suggest that social disengagement and selectivity follow independent trajectories during ageing.

Clinical distinction between cognitive disengagement syndrome and ADHD presentations in a nationally representative sample of Spanish children and adolescents.

BACKGROUND: This study sought to determine whether cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) has different external correlates relative to ADHD-inattentive presentation (INP), ADHD-hyperactive/impulsive presentation (HIP), and ADHD-combined presentation (CP). METHODS: Parents of a nationally representative sample of 5,525 Spanish youth (ages: 5-16, 56.1% boys) completed measures of CDS, ADHD-inattention (IN), and ADHD-hyperactivity/impulsivity (HI) and other measures. Scores greater/less than the top 5% on CDS, ADHD-IN, and ADHD-HI were used to create control (n = 5,013, 90.73%), CDS-only (n = 131, 2.37%), ADHD-INP-only (n = 83, 1.50%), ADHD-HIP-only (n = 113, 2.05%), ADHD-CP-only (n = 48, 0.97%), CDS + ADHD-INP (n = 44, 0.80%), CDS + ADHD-HIP (n = 25, 0.45%), and CDS + ADHD-CP (n = 68, 1.23%) groups. RESULTS: Forty-nine percent of youth with clinically elevated CDS did not qualify for any ADHD presentation, whereas 64% of youth with clinically elevated ADHD did not qualify for CDS. The CDS-only group was higher than the ADHD-INP-only, ADHD-HIP-only, and ADHD-CP-only groups on anxiety, depression, somatization, daytime sleep-related impairment, nighttime sleep disturbance, and peer withdrawal, whereas the CDS-only and ADHD-INP-only groups did not differ on ODD (ADHD-HIP-only and ADHD-CP-only higher) and academic impairment (ADHD-CP-only higher than CDS-only and ADHD-HIP-only lower than CDS-only). The CDS-only group also had higher rates of anxiety, depression, and bipolar disorder diagnoses than the ADHD-only group. CONCLUSIONS: A distinction was found between CDS and each ADHD presentation, thus providing support for CDS as a syndrome that frequently co-occurs with yet is distinct from each ADHD presentation.

Disengagement from Care Among People Co-Infected with HIV and HCV: A Scoping Review.

Disengagement from care among people with HIV (PWH) and hepatitis C (HCV) increases the risks of adverse health outcomes and poses significant barriers to achieving global HIV and HCV elimination goals. In accordance with the Joanna Briggs Institute framework, a scoping review was conducted to synthesize and highlight existing gaps in the literature on (dis)engagement in care among PWH and HCV. We searched for original studies on (dis)engagement in care among PWH and HCV in high-income countries using eight electronic databases from inception to May 2023. Our search yielded 4462 non-duplicated records, which were scoped to 27 studies. Definitions of (dis)engagement in care were diverse, with considerable heterogeneity in how retention was operationalized and temporally measured. Studies identified predictors of (dis)engagement to be related to drug and substance use (n = 5 articles), clinical factors (n = 5), social and welfare (n = 4), and demographic characteristics (n = 2). When engagement in care was treated as an exposure, it was associated with HCV treatment initiation (n = 3), achieving sustained virological response (n = 2), and maintaining HIV viral suppression (n = 1). Interventions to improve care engagement among PWH and HCV were limited to five studies using cash incentives (n = 1) and individual case management (n = 4). (Dis)engagement in care is a dynamic process influenced by shifting priorities that may 'tip the balance' towards or away from regularly interacting with healthcare professionals. However, inconsistent definitions render cross-study comparisons and meta-analyses virtually impossible. Further research needs to establish a standardized definition to identify patients at high risk of disengagement and develop interventions that leverage the nested HIV/HCV care cascades to retain and recover patients lost from care.

The prevalence of occupational burnout and its individual and situational predictors among addiction therapists.

This study assesses the prevalence and individual and organizational predictors of occupational burnout among addiction therapists. A total of 452 addiction therapists from a representative sample of 184 Polish alcohol treatment facilities (outpatient and inpatient) participated in the study (facility response rate = 42%). The Oldenburg Burnout Inventory was used to measure occupational burnout, and 15 subscales of the Copenhagen Psychosocial Questionnaire II were administered to assess psychosocial work conditions. In addition, the Coronavirus Anxiety Scale, the Hospital Anxiety and Depression Scale and the abbreviated six-item De Jong Gierveld Loneliness Scale measured other important dimensions of addiction therapists' psychosocial functioning. Logistic regression was used for the analysis of the data. Occupational burnout was noticeably prevalent in the study group: 62% of respondents experienced exhaustion and 50% experienced disengagement from work, both to at least a moderate degree. Situational (organizational) variables were the most important predictors, explaining much more of the variance in both dimensions of burnout than the individual factors, of which only depression was significantly related to higher levels of exhaustion. Coronavirus anxiety played a marginal role in explaining the severity of burnout. The current study is one of the first attempts to assess the level of occupational burnout among addiction therapists and to comprehensively investigate the factors contributing to it. The findings provide useful information for the development of interventions aimed at preventing or reducing burnout in this professional group.

Relations among lie-telling self-efficacy, moral disengagement, and willingness to tell antisocial lies among children and adolescents.

This study examined a proposed model of relations among lie-telling self-efficacy, moral disengagement, and willingness to tell antisocial lies among children and adolescents. Children and adolescents aged 6 to 15 years completed measures of lie-telling self-efficacy and moral disengagement. They also read vignettes about a character committing a transgression and telling a lie to conceal the transgression. For each vignette, children and adolescents made a hypothetical decision about telling the truth or a lie if they were in the character's position to assess their lie-telling propensity. Lie-telling self-efficacy was related to willingness to tell lies, and this relationship was mediated by moral disengagement. Children and adolescents with higher lie-telling self-efficacy had higher moral disengagement, and those who had higher moral disengagement were more willing to tell antisocial lies. Overall, results support Bandura's social cognitive theory as a framework for understanding the psychosocial mechanisms underlying attitudes toward lie-telling. Moreover, these findings suggest that interventions to address problematic lie-telling behavior should focus on children's and adolescents' use of moral disengagement mechanisms.

Prolonged unemployment is associated with control loss and personal as well as social disengagement.

OBJECTIVE AND BACKGROUND: The need for control is a fundamental human motivation, that when deprived can lead to broad and substantial changes in human behavior. We aimed to assess the consequences of control deprivation in a real-life situation that poses a severe threat to personal control: a prolonged unemployment. METHOD: Using a sample N = 1055 of unemployed (n = 748) versus working (n = 307) individuals, we examined predictions derived from two models of reactions to control deprivation: control-regaining and disengagement/withdrawal. RESULTS AND CONCLUSIONS: We found that length unemployment is correlated with a psychological state strongly interfering with psychological as well as social functioning. While control-regaining models of responding to lack of control have received virtually no support from our findings, our results provide evidence that long-term unemployed individuals are more disengaged than working individuals. They are more apathetic, less likely to engage in control-regaining efforts and in active forms of construing one's own future.

A serial cascade effect of cybervictimization and hostile rumination on the within-person change of moral disengagement.

OBJECTIVE: There is a lack of clarity regarding the developmental mechanisms underlying moral disengagement (a typical moral personality) at the within-person level. To address this issue, we explore the serial cascade effect of cybervictimization and hostile rumination. METHOD: The longitudinal relationships between cybervictimization, hostile rumination, and moral disengagement were explored among 1146 undergraduates, assessed four times (T1-T4) across 2 years. RESULTS: The random intercept cross-lagged panel model (RI-CLPM) analysis revealed that the random intercepts of all variables were positively associated with each other. At the within-person level, cybervictimization at T2 indirectly predicted subsequent changes in moral disengagement at T4 through changes in hostile rumination at T3 (the indirect effect was 0.02); furthermore, moral disengagement at T3 predicted changes in hostile rumination at T4 (ß = 0.091). CONCLUSIONS: The within-person dynamics of moral disengagement should be partly due to the serial effect of cybervictimization and hostile rumination, whereas hostile rumination and moral disengagement may form a developmental cascade to some degree. These findings and the proposed serial cascade model of moral disengagement could expand our understanding of the developmental mechanism of moral personality. Additionally, caution must be exercised as this study exhibits seemingly small effect sizes and inconsistent results.

Moral disengagement in the media discourses on meat and dairy production systems.

Meat and dairy production and consumption are the subject of ongoing public debates that touch on various sustainability issues such as biodiversity loss, climate change, animal welfare, and social and health aspects. Despite extensive discussions specifically relating to the environmental impacts of livestock farming in conjunction with animal welfare aspects, there have been no substantial changes in production or consumption patterns. Moreover, the focus of extant research is usually on consumers' responses to public concerns around livestock production. In this study, we shed light on the discrepancy between the normative discourse and action of relevant value chain actors with the help of Bandura's theory of moral disengagement, which allows us to identify mechanisms that contribute to the perpetuation of unsustainable production and consumption patterns. In particular, we focus on the shifting of responsibility between actors in the normatively charged field of sustainable livestock production. We collected 109 media interviews on meat and dairy production and consumption from the years 2020-2022, including interviews with actors from agriculture, processing industries, and food retail. Using qualitative content analysis, we investigated the role of moral disengagement in the media discourse on meat and dairy production and explored differences between actors in terms of moral disengagement. We found that shifting of responsibility shows a quasi-circular dynamic of being shifted from all actors to all, in our case most frequently to consumers, politics, and (diffuse) economic forces. In addition, our analysis showed the use of social justifications, beneficial comparisons, and euphemistic labelling to be common mechanisms of moral disengagement, constituting a collective problem within agri-food systems.

Perceived discrimination and quality of life for African American and Caucasian American cancer patients: a coping mediation analysis of subtle and overt microaggressions.

OBJECTIVE: Perceived discrimination (PD; e.g. racism, agism, sexism, etc.) negatively impacts quality of life (QOL) among cancer patients. Prior research has established that for African American Cancer Patients (AACPs) only disengagement/denial coping mediated the PD-QOL relationship. In contrast, for Caucasian American Cancer Patients (CACPs), both agentic and disengagement/denial coping were mediators of the PD-QOL relationship. However, according to social constraint theory there may be a difference between subtle and overt PD in terms of the utility of certain coping mechanisms in relation to QOL, especially for AACPs. METHOD: 217 AACPs and 121 CACPs completed measures of PD, coping (agentic, disengagement/denial, adaptive disengagement) and QOL. PD items were classified as subtle or overt microaggressions. PD was mainly attributed to race/ethnicity by AACPs and to income, age, and physical appearance for CACPs. RESULTS: : In both subtle and overt microaggression models with CACPs, agentic coping and disengagement/denial coping were significant mediators of PD-QOL. Like CACPs, for AACPs, agentic and disengagement/denial coping were significant in the context of subtle microaggressions. In contrast, for overt microaggression only disengagement/denial coping was a significant mediator of the PD-QOL relationship for AACPs. Adaptive disengagement was related to QOL only for AACPs. CONCLUSIONS: : Whereas more research is needed, it appears that overt microaggressions for AACPs, that consist mainly of racial and ethnic maltreatment, constitute a class of social contexts that may raise above the threshold for serious threat and harm, and, as a result, disengagement/constraint may reduce negative consequences. This additional burden for AACPs contributes to disparities in QOL. Future research is needed on the utility of adaptive disengagement for AACPs in relation to PD.

Psychopathology of cognitive disengagement syndrome (CDS): a network analysis based on CBCL scales in 72,106 Chinese school students.

Cognitive Disengagement Syndrome (CDS) is a cluster of behavioral problems that severely affect an individual's functioning. Currently, there is no consensus on the main clinical features of CDS, and further exploration in large samples is needed. Using a cluster-stratified random sampling method, 72,106 children and adolescents were recruited from five provinces in mainland China for this study. Using both the traditional two-factor scoring method and the CBCL DSM-oriented scales, we assessed individual behavioral problems from psychopathological and DSM-oriented perspectives. Network analysis was employed to explore the relationship between CDS and behavioral problems. The various networks were compared by gender and age subgroups. Among 72,106 participants (mean age, 11.49 years; minimum age, 5 years; maximum age, 16 years), there were 36,449 males (50.5%) and 35,657 females (49.5%). From a psychopathological perspective, the motor symptoms node was associated with the sad node and the withdrawn node, while the cognitive symptoms node was linked to the nervous node and the self-conscious node. In terms of gender, males had stronger associations of the motor symptoms node with the sad node and the withdrawn node than females (P = 0.043), and weaker associations of the cognitive symptoms node with the nervous node than females (P = 0.027). In terms of growth stage, the adolescent group had stronger associations of the cognitive symptoms node with the nervous node and the self-conscious node than the child group (P = 0.016, 0.001). From DSM perspective, motor symptoms node were associated with sad node, and cognitive symptoms node were related to can't concentrate node, nervous node, and worthless node. With increasing age, there was an upward trend in the strength of the cognitive and motor symptoms node. CDS is closely linked to psychological and behavioral issues, especially internalizing problems, with differences observed by gender and growth stage. The connection between CDS and the affective, anxiety, and ADH symptoms is particularly pronounced.

Support for the 'Pets as Ambassadors' hypothesis in men: Higher animal empathy in Australian pet-owners vs non-owners and farmers.

Human empathy towards non-human animals (Animal Empathy; AE) has shown a strong gender bias, with women demonstrating higher levels than men. This study aimed to investigate the influence of animal experiences on AE in a male-only sample. It was hypothesised that there would be different levels of AE between men with experiences caring for pets, men with experience in animal agriculture, and men with limited animal experiences. Ninety-one Australian men (18yrs+) completed an online survey evaluating their level of AE using the Animal Empathy Scale (AES). Additionally, they were asked what in their experience they think has influenced their beliefs about how animals think and feel. As expected, AE levels differed significantly between groups, with those in the pet ownership experience group demonstrating higher AE levels than the other two groups. All three groups displayed high endorsement for direct interactions with animals in adulthood as being most influential in shaping their beliefs about how animals think and feel. However, our quantitative results support the idea that not all experiences are worth the same, with the responsibility and sacrifice involved in pet caring appearing to be most influential to the development of AE. These findings have implications for the importance of human-animal interactions in understanding animal sentience and the development of AE in males.

Direct and indirect effects of social dominance orientation on hate speech perpetration via empathy and moral disengagement among adolescents: A multilevel mediation model.

Although it is known that social dominance orientation directly affects hate speech perpetration, few studies have explored the mechanisms by which this effect takes place during adolescence. Based on the socio-cognitive theory of moral agency, we aimed to fill this gap in the literature by exploring the direct and indirect effects of social dominance orientation on hate speech perpetration in offline and online settings. The sample included seventh, eigth, and ninth graders (N = 3225) (51.2% girls, 37.2% with an immigrant background) from 36 Swiss and German schools who completed a survey about hate speech, social dominance orientation, empathy, and moral disengagement. A multilevel mediation path model revealed that social dominance orientation had a direct effect on offline and online hate speech perpetration. Moreover, social dominance also had indirect effects via low levels of empathy and high levels of moral disengagement. No gender differences were observed. Our findings are discussed regarding the potential contribution to preventing hate speech during adolescence.

Understanding the moral cognition of aggression: Longitudinal serial effects of personal relative deprivation and hostility on within-person changes in civic moral disengagement.

Moral disengagement is an important aggressive and moral cognition. The mechanisms of changes in moral disengagement remain unclear, especially at the within-person level. We attempted to clarify this by exploring the serial effects of personal relative deprivation and hostility on civic moral disengagement. We conducted a three-wave longitudinal survey with 1058 undergraduates (63.61% women; mean age = 20.97). The results of the random intercept cross-lagged panel model showed that personal relative deprivation at Wave 1 and hostility at Wave 2 formed a serial effect on the within-person changes in civic moral disengagement at Wave 3, and the longitudinal indirect effect test showed that the within-person dynamics in hostility at Wave 2 acted as a mediator. The results of multiple group analysis across genders further showed that the longitudinal indirect role of hostility at Wave 2 was only observed for men, but not for women, which indicates the moderating effect of gender. These findings facilitate an understanding of the mechanisms of aggressive cognitions at the within-person level and offer implications for the prevention and intervention of aggression from the perspective of moral cognition.

Adolescents High in Callous-Unemotional Traits are Prone to be Bystanders: The Roles of Moral Disengagement, Moral Identity, and Perceived Social Support.

Bystanders are the most common role that adolescents play in bullying episodes, they have considerable influence on the formation of the victim's experience and the perpetrator's behavior. Based on the social-cognitive model, the current study examined the mediating role of moral disengagement in the association between callous-unemotional traits and bystander behavior and the moderating roles of moral identity and perceived social support. Participants included 2,286 Chinese adolescents aged 11-16 years (49.3% boys; Mage = 13.46, SDage = 0.93). The study showed callous-unemotional traits were significantly and positively associated with bystander behavior and this relation was partially mediated by moral disengagement. Moral identity moderated the relation between callous-unemotional traits and moral disengagement as well as callous-unemotional traits and bystander behavior. Perceived social support moderated in the direct and indirect associations between callous-unemotional traits and bystander behavior via moral disengagement. The relation between callous-unemotional traits and moral disengagement and the relation between callous-unemotional traits and bystander behavior became weaker for adolescents with high perceived social support. Surprisingly, the relation between moral disengagement and bystander behavior became stronger for adolescents with a high level of perceived social support. The results supported two specific patterns of perceived social support: stress-buffering and reverse stress-buffering. The present study contributes to our understanding of the key mechanisms underlying the association between callous-unemotional traits and adolescents' bystander behavior.

Examining cognitive disengagement syndrome in a psychiatric outpatient sample: Psychometric support and associations with internalizing symptoms and sleep problems.

OBJECTIVE: The internal (structural) and external validity of a self-report measure of cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) relative to a self-report measure of attention-deficit/hyperactivity disorder-inattention (ADHD-IN) was evaluated with adults from university outpatient psychiatric clinics in Turkey. METHODS: A total of 274 outpatients (75.9% women; ages 18-64 years; Mage = 31.06; SDage = 10.84; 50.4% anxiety disorders; 41.6% depressive disorders; 2.9% ADHD; 1.5% sleep disorders; 0.7% eating disorders; 2.9% no mental disorder) completed self-report measures of CDS, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), sleep problems, depression, and stress. RESULTS: All 15 CDS symptoms measured by the Adult Concentration Inventory (ACI) showed convergent (moderate to high loadings on the CDS factor) and discriminant (loading close to zero on the ADHD-IN factor) validity. CDS also showed stronger first-order and unique associations than ADHD-IN with sleep problems, depression, anxiety, and stress, whereas ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-HI. CONCLUSION: This is the first study to provide support for the scores from this 15 item self-report measure of CDS by the ACI in a clinical sample of adults, with findings consistent with previous studies examining parent and teacher rating scale measures with the same 15 CDS symptoms. These findings provide additional support for usefulness of these 15 CDS symptoms as measured by the ACI to study CDS across various cultures.

Shaping Citizenship in the Classroom: Peer Influences on Moral Disengagement, Social Goals, and a Sense of Peer Community.

Despite the important role of peers in the social process of classroom citizenship, the peer influence related to moral disengagement, social goals, and a sense of peer community remain unclear. To this end, it was examined to what extent youth become similar to their friends in moral disengagement, social goals, and a sense of peer community. Participants were 283 South Korean third to sixth graders (Mage = 9.60 years, SD = 0.97; 51.6% girls) who completed an online survey for moral disengagement, social goals, the sense of peer community and friendship network across the beginning (Time 1) and end (Time 2) of the school semester (September to December). Longitudinal social network analyses indicated that youth became more similar to their friends concerning moral disengagement and a sense of peer community, but did not select friends based on these aspects. The strength of these influence effects varied in terms of different levels of these aspects. Specifically, youth were more likely to become similar to their friends at lower levels of moral disengagement. Youth tended to be similar to the friends' level of sense of peer community. This tendency was relatively strong at the lowest and the highest levels of a sense of peer community. Future research should address the role of friendship in shaping classroom citizenship and the importance of classroom daily teaching practice in youth citizenship development.

Moral disengagement, moral identity, and counterproductive work behavior among emergency nurses.

BACKGROUND: Morality is a fundamental component of nurses' daily work. Nurses' cognitive tendencies toward moral disengagement in high-stress work environments can easily lead them to engage in counterproductive work behaviors that are not conducive to the organization. However, there is limited research on how to mitigate the impact of moral disengagement on counterproductive work behavior. OBJECTIVE: The objective was to explore the impact of moral disengagement on counterproductive work behavior, as well as the reverse regulatory mechanism of moral identity on the relationship between moral disengagement and counterproductive work behavior. RESEARCH DESIGN: This was a quantitative, cross-sectional study. PARTICIPANTS AND RESEARCH CONTEXT: From September to October 2023, nurses from emergency departments of major hospitals in Hunan Province were recruited, and 500 questionnaires were distributed and collected using the WeChat app Credamo Seeing Numbers. ETHICAL CONSIDERATION: All study procedures were approved by the Ethics Committee of Hunan Normal University (No. 2023-388). FINDINGS: Moral disengagement had a positive effect on counterproductive work behavior directed at the organization (CWB-O) as well as counterproductive work behavior directed at individuals (CWB-I). Moral identity was not significant in moderating the relationship between moral disengagement and CWB-O. Moral identity had an inverse moderating effect on the mechanism of action between moral disengagement and CWB-I. CONCLUSION: Counterproductive work behavior guided by moral disengagement is detrimental to organizations, and moral identity can inhibit the effect of moral disengagement on CWB-I. Nursing administrators should focus on improving nurses' moral identity and improving the healthcare workplace environment so that moral identity can better exert its inhibitory effect on counterproductive work behavior among nurses.

Morality- and Norm-Based Subgroups of Disability-Sport Athletes Differ on Their Anticipated Guilt and Intentions Toward Doping.

The purpose of this study was to examine whether subgroups of disability-sport athletes exist on morality- and norm-based doping cognitions and whether these groups differ in anticipated guilt or doping intentions. A survey was completed by 186 athletes (Mage = 37.5 years, 78.0% male, 45.1% wheelchair basketball) assessing norms, doping moral disengagement, anticipated guilt, and intentions to dope. Cluster analysis revealed four distinct subgroups of athletes, including one potentially high-risk subgroup characterized by relatively high scores on doping moral disengagement, subjective norms, and descriptive norms. One-way analysis of variance revealed significantly lower anticipated guilt in two athlete subgroups characterized by relatively higher doping moral disengagement than the other two subgroups. Moreover, the potentially high-risk group had a greater proportion of athletes showing some presence of intention to dope. This study suggests there is a small subgroup of disability-sport athletes at elevated risk of doping who might benefit from targeted antidoping interventions.

The Effect of HIV Treatment Interruption on Subsequent Immunological Response.

Recovery of CD4-positive T lymphocyte count after initiation of antiretroviral therapy (ART) has been thoroughly examined among people with human immunodeficiency virus infection. However, immunological response after restart of ART following care interruption is less well studied. We compared CD4 cell-count trends before disengagement from care and after ART reinitiation. Data were obtained from the East Africa International Epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration (2001-2011; n = 62,534). CD4 cell-count trends before disengagement, during disengagement, and after ART reinitiation were simultaneously estimated through a linear mixed model with 2 subject-specific knots placed at the times of disengagement and treatment reinitiation. We also estimated CD4 trends conditional on the baseline CD4 value. A total of 10,961 patients returned to care after disengagement from care, with the median gap in care being 2.7 (interquartile range, 2.1-5.4) months. Our model showed that CD4 cell-count increases after ART reinitiation were much slower than those before disengagement. Assuming that disengagement from care occurred 12 months after ART initiation and a 3-month treatment gap, CD4 counts measured at 3 years since ART initiation would be lower by 36.5 cells/µL than those obtained under no disengagement. Given that poorer CD4 restoration is associated with increased mortality/morbidity, specific interventions targeted at better retention in care are urgently required.