Jeremy Morris as a pioneer of behavioural epidemiology, social medicine and public health.

Seventy years ago, the Scottish epidemiologist Jeremy Morris published his seminal papers in exercise epidemiology, providing evidence of the positive relationship between physical activity levels and reduced mortality. Today, we may remember Morris's pivotal role in establishing physical activity as a key factor in preventive medicine and public health. The roots of the role of behavioural epidemiology in modern public health lay in Morris's research on the association of coronary heart disease with physical activity at work. In consequence, a new focus for public health emerged, with an emphasis on chronic disease as well as modification of lifestyle and individual behaviour. While the immense value of his research on the health benefits of exercise is widely recognised, his influence on the teaching of social medicine is generally less well-known. Morris was involved in the pioneering course of MSc in Social Medicine at the London School of Hygiene, which was emblematic of the redefining of public health in the late 1960s. Morris gave legitimacy to a wide range of issues regarded at that time as soft and second class, including health promotion, sociology and the care of people with disability and chronic conditions. In consequence of his observation of a relationship between socioeconomic status and individual behaviour patterns in regard to exercise, nutrition and smoking, Morris urged that greater attention be paid to inequalities.

Nutrition in the Management of ADHD: A Review of Recent Research.

PURPOSE OF REVIEW: Various nutrients and diet quality have been suggested to be involved in the pathophysiology of ADHD. The purpose of this review was to examine data from recent cohort studies and dietary interventions to determine whether nutrition may play a role in the management of ADHD. RECENT FINDINGS: Preliminary evidence suggests that minerals might have beneficial effects on ADHD symptomatology. Probiotics might offer novel strategies to prevent or treat ADHD. Inverse associations between adherence to "healthy" diets and ADHD symptoms have been observed. Children with ADHD responding to the few-foods diet (or oligoantigenic diet) with an elimination of individually identified food items show substantially improved behavior and cognitive functioning. Evidence from recent research does not allow any recommendations regarding the use of micronutrients or probiotics in the management of ADHD. The few-foods diet may become an additional therapeutic option for children with ADHD.

Sport and physical exercise in sustainable mental health care of common mental disorders: Lessons from the COVID-19 pandemic.

The large-scale disruptions to physical activity during the coronavirus pandemic have been found to be a leading predictor of common mental disorders. In addition, regular physical exercise has been found to alleviate anxiety, sadness and depression during the pandemic. These findings, together with numerous studies published before the pandemic on the effects of physical activity on mental health, should be considered in the provision of mental health care following the pandemic. Cross-sectional research has revealed that all types of exercise and sport are associated with a reduced mental health burden. Therefore, the effectiveness of exercise and sport participation in sustainable mental health care as well as the causal relationship between exercise, psychosocial health and common mental disorders merit further investigation. Physical activity and sport, with their global accessibility, significant and clinically meaningful efficacy as well as virtual absence of adverse effects, offer a promising option for the promotion of mental health, including the prevention and treatment of common mental disorders. Physical exercise and sport are likely to become valuable public mental health resources in the future.

The role of loneliness in university students' pathological Internet use - a web survey study on the moderating effect of social web application use.

The present study investigated the role of social web application use in the association between loneliness and pathological Internet use. A sample of university students (n = 445) completed an online survey of their loneliness and Internet use, including an assessment of pathological Internet use level. Based on existing theory and empirical findings, loneliness was expected to be indirectly associated with pathological Internet use through social-compensatory Internet use motives. The strength of this indirect effect was hypothesized to be moderated by levels of social web application use. Results pointed to the specificity of social-compensatory use motives in mediating loneliness effects on pathological Internet use, while the size of these effects was moderated by quantity of social web application use. Findings suggest that lonely people with higher levels of social web activity show a stronger social-compensatory use orientation, which translates to higher levels of pathological Internet use. Implications and limitations of these findings are discussed and several suggestions for future studies are made.

The role of state feelings of loneliness in the situational regulation of social affiliative behavior: Exploring the regulatory relations within a multilevel framework.

Previous empirical evidence suggests that the engagement in social interactions across different everyday contexts occurs in a manner highly responsive to a person's social affiliation needs. As has been shown repeatedly, social engagement (as well as disengagement) can be predicted from earlier situational need states, implying that homeostatic principles underlie a person's social affiliative behaviors. However, little is known about the role of emotion in these regulative processes. For this reason, the present exploratory study investigated the predictive role of state feelings of loneliness in subsequent engagement in social interaction. Since loneliness is conceptually associated with both the need to reaffiliate as well as self-protecting tendencies potentially hindering engagement in social contact, the study investigated the possibility of both increases and decreases in social contacts resulting from state feelings of loneliness. Adopting an experience sampling methodology (ESM), a sample of 65 participants was recruited from a local university and was followed for 14 days. Subjects were prompted several times a day to rate their feeling states and the quantity of social interactions, using a fixed interval assessment schedule. Statistical analyses using multilevel analysis indicated that state feelings of loneliness had complex quadratic effects upon subsequent social interaction, leading to both increases and decreases in subsequent social interaction. Moreover, these effects were contingent upon previous engagement in social interaction, implying spillover effects across social contexts that are conditionally mediated by feelings of loneliness. These findings clearly imply an important, albeit complex role of state feelings of loneliness in the regulation of social affiliation, both as a predictor and a consequence of social interaction. These exploratory findings are discussed against the background of methodological and conceptual limitations, and several recommendations for future studies are made.

Coronavirus disease 2019 (COVID-19) and global mental health.

The mental health effects of the coronavirus disease 2019 (COVID-19) pandemic may shape population health for many years to come. Failure to address the mental health issues stemming from the pandemic is likely to prolong its impact. The COVID-19 pandemic has created a significant global challenge and, in lower-income countries, even a disruption of mental health services. Given our experience with previous pandemics, the present COVID-19 crisis can be expected to cause psychological trauma, and steps are needed to address this issue proactively. Policies focusing on the long-term mental health consequences of COVID-19 may equal the importance of those currently seeking to mitigate its physical effects. The implications of the COVID-19 pandemic for mental health call for a greater focus on the needs of those with mental disorders and on mental health issues affecting health care workers and the general public. Timely preventive and therapeutic mental health care is essential in addressing the psychosocial needs of populations exposed to the pandemic. In addition to specialist care, "task-shifting" and digital technologies may provide cost-effective means of providing mental health care in lower-income countries worldwide as well as in higher-income countries with mental health services overwhelmed by the effects of the COVID-19 pandemic. In view of the ever-increasing pressure on global health systems resulting from the COVID-19 pandemic, adopting and adapting "task-shifting", i.e., the delegation of psychotherapeutic interventions to trained non-specialists, as an element of the provision of mental health services, is overdue. Digital technologies can be used to enhance social support and facilitate resilience to the detrimental mental health effects of the pandemic; they may also offer an efficient and cost-effective way to provide easy access to mental health care.

Effect of classroom-based physical activity interventions on attention and on-task behavior in schoolchildren: A systematic review.

Physical activity in children is associated with several cognitive benefits. Since children and adolescents spend an increasing amount of time engaged in sedentary behavior both at school and in their free time, movement breaks during class hours, in which students are physically active, may be beneficial for effective learning. The aim of this systematic research is to provide an overview of prospective studies investigating the influence of classroom-based physical activity (CB-PA) interventions on attention and on-task behavior in school-aged children and adolescents aged between 4 and 18 years. A systematic search of electronic databases (PubMed, Science Direct, PsycINFO, Ovid), according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, was performed from July 2020 to March 2021. Study characteristics data were analyzed and a methodological quality assessment, using a modified Downs and Black checklist, of both randomized and non-randomized studies was conducted. Overall, the available evidence points to a beneficial effect of exercise on attention and on-task behavior in a classroom setting. However, methodological differences concerning participants and duration and type of physical activity should be considered when comparing the results. Further studies with more comparable methodology are needed to provide a better understanding of the effect of CB-PA on attention and on-task behavior.

Food science and COVID-19.

Theories proposing a role of specific dietary components or food supplements in the prevention or treatment of COVID-19 have received extensive social media coverage. A multitude of scientific publications have also pointed to the importance of food and nutrition in combating the COVID-19 pandemic. The present perspective critically addresses the question of what food science can actually contribute in this context. Animal studies suggest that micronutrients, food bioactives or functional foods may carry the potential to augment viral defense. However, the specific roles of food components in viral infectious diseases in humans remain unclear. Rigorous research assessing the efficacy of food compounds in counteracting infections would require long-term randomized controlled trials in large samples. While no foods, single nutrients or dietary supplements are capable of preventing infection with COVID-19, a balanced diet containing sufficient amounts of macronutrients and diverse micronutrients is a prerequisite of an optimally functioning immune system. High-energy diets and obesity are major risk factors for a more severe course of COVID-19. Therefore, population-wide body weight control and weight reduction in overweight people are important preventive measures. Diet may play a beneficial role in maintaining a healthy body weight and preventing non-communicable conditions.

The effects of video racing games on risk-taking in consideration of the game experience.

In the present study, we attempted to investigate whether it is the game experience that underlies processes leading to increased risk-taking while playing video racing games (VRGs). The aim of the study was to examine the indirect effect of playing VRGs on risky driving behaviour through various dimensions of the game experience. Thus, we examined the subjective experience of participants playing various VRGs and questioned whether this influenced subsequent driving behaviour. The results of the present study show that aspects of the playing experience, in particular "flow" and "competence", appear to be important in the regulation of risk appetite. It can be assumed that, rather than the mere playing of VRGs, the type of game experience during play is determinant for subsequent risk propensity while driving.

Lifestyle factors in the prevention of COVID-19.

Confinement to the home and psychological distress due to the coronavirus disease 2019 (COVID-19) pandemic may lead to harmful health behaviors, such as overeating, sedentary behavior with reduced physical activity, elevated alcohol and tobacco use and increased screen time causing impaired sleep. All of these behaviors are associated with non-communicable diseases and can interfere with immunity. While no foods, single nutrients or dietary supplements are capable of preventing infection with COVID-19, a balanced diet containing sufficient amounts of macronutrients and diverse micronutrients is a prerequisite of an optimally functioning immune system. High-energy "Western" diets and obesity are major risk factors for a more severe course of COVID-19. Alcohol use and tobacco also have detrimental effects on the immune system. Therefore, population-wide body weight control, reduction of smoking rates and limitation of alcohol consumption are important preventive measures. Furthermore, sufficient restorative sleep is needed for adequate immune functioning. Appropriate lifestyle changes in regard to nutrition, exercise, sleep, smoking and alcohol intake may help shift the population distribution of infection risk and aid in preventing severe COVID-19 disease. Large-scale surveys should explore the effects of lifestyle changes, and the provision of reliable lifestyle information and effective interventions to individuals and communities during the pandemic is a pressing need.

Simulated car driving and its association with cognitive abilities in patients with schizophrenia.

OBJECTIVES: Patients with schizophrenia commonly suffer from impairments in various aspects of cognition. These deficits were shown to have detrimental effects on daily life functioning and might also impair car driving. This study is the first to examine driving behaviour of patients with schizophrenia using an advanced driving simulator, and to explore the role of cognitive abilities of people with schizophrenia for driving. METHODS: Non-acute patients with schizophrenia (n = 31) and healthy comparison participants (n = 31) performed a comprehensive neuropsychological assessment and driving simulator rides. Neuropsychological and driving performances were compared between groups. Moreover, associations were explored between cognitive functions and driving behaviour in the entire group. RESULTS: Patients with schizophrenia revealed impairments in multiple aspects of cognition. In the driving simulator, patients with schizophrenia showed no indication of deviant driving in terms of number of collisions or reacting to critical situations, and even showed better lane control compared to healthy individuals. However, patients with schizophrenia drove significantly slower than healthy individuals, and caused more hindrance to the car behind while merging on the motorway. Slower driving was associated with lower test scores on attention and processing speed. Hindering the car behind was associated with test performance on planning and inhibition. CONCLUSIONS: It is concluded that driving of patients with schizophrenia is characterized by a relatively slow speed, and can also be impaired in certain aspects, i.e. hindering a car behind while merging. Cognitive functions are crucial for driving, and should be target of treatment.

Resveratrol, pterostilbene, and dementia.

Resveratrol is a natural phytoestrogen with neuroprotective properties. Polyphenolic compounds including resveratrol exert in vitro antioxidant, anti-inflammatory, and antiamyloid effects. Resveratrol and its derivative pterostilbene are able to cross the blood-brain barrier and to influence brain activity. The present short review summarizes the available evidence regarding the effects of these polyphenols on pathology and cognition in animal models and human subjects with dementia. Numerous investigations in cellular and mammalian models have associated resveratrol and pterostilbene with protection against dementia syndromes such as Alzheimer's disease (AD) and vascular dementia. The neuroprotective activity of resveratrol and pterostilbene demonstrated in in vitro and in vivo studies suggests a promising role for these compounds in the prevention and treatment of dementia. In comparison to resveratrol, pterostilbene appears to be more effective in combatting brain changes associated with aging. This may be attributed to the more lipophilic nature of pterostilbene with its two methoxyl groups compared with the two hydroxyl groups of resveratrol. The findings of available intervention trials of resveratrol in individuals with mild cognitive impairment or AD do not provide evidence of neuroprotective or therapeutic effects. Future clinical trials should be conducted with long-term exposure to preparations of resveratrol and pterostilbene with high bioavailability. © 2017 BioFactors, 44(1):83-90, 2018.

Noncredible cognitive performance at clinical evaluation of adult ADHD: An embedded validity indicator in a visuospatial working memory test.

The assessment of performance validity is an essential part of the neuropsychological evaluation of adults with attention-deficit/hyperactivity disorder (ADHD). Most available tools, however, are inaccurate regarding the identification of noncredible performance. This study describes the development of a visuospatial working memory test, including a validity indicator for noncredible cognitive performance of adults with ADHD. Visuospatial working memory of adults with ADHD (n = 48) was first compared to the test performance of healthy individuals (n = 48). Furthermore, a simulation design was performed including 252 individuals who were randomly assigned to either a control group (n = 48) or to 1 of 3 simulation groups who were requested to feign ADHD (n = 204). Additional samples of 27 adults with ADHD and 69 instructed simulators were included to cross-validate findings from the first samples. Adults with ADHD showed impaired visuospatial working memory performance of medium size as compared to healthy individuals. Simulation groups committed significantly more errors and had shorter response times as compared to patients with ADHD. Moreover, binary logistic regression analysis was carried out to derive a validity index that optimally differentiates between true and feigned ADHD. ROC analysis demonstrated high classification rates of the validity index, as shown in excellent specificity (95.8%) and adequate sensitivity (60.3%). The visuospatial working memory test as presented in this study therefore appears sensitive in indicating cognitive impairment of adults with ADHD. Furthermore, the embedded validity index revealed promising results concerning the detection of noncredible cognitive performance of adults with ADHD. (PsycINFO Database Record

Patients' experience of breast reconstruction after mastectomy and its influence on postoperative satisfaction.

PURPOSE: Breast cancer patients have the option to choose a breast reconstruction after mastectomy. A range of studies have postulated that patients' individually appraised significance of their breast is an important factor in the decision for or against breast reconstruction. This study explored the individually perceived significance of the breast among patients with and without breast reconstruction and its correlation with postoperative satisfaction. METHODS: Ten patients without breast reconstruction, and ten patients with immediate breast reconstruction after mastectomy participated in the study. The perceived importance of the breast and the pre-and postoperative esthetic satisfaction of the patients were obtained using an 11-point Likert scale. Qualitative interviews explored patients' views on the meaning of their breast and their experience after surgery. RESULTS: Patients who had decided for breast reconstruction rated the importance of their breast for femininity (p = 0.004) and attractiveness (p = 0.037) significantly higher than patients without reconstruction. The qualitative data provide evidence that the breast of a woman fulfills a variety of intrapsychic and interactional functions. Difficulties in integrating the reconstructed breast into the body image were reported. A high importance of the breast correlated significantly with a decrease in satisfaction with the breast after reconstruction (rs = -0.652, p = 0.041). CONCLUSIONS: Patients who found their breast to be highly important were more likely to decide for a reconstruction. Mastectomy has an impact on various psychosocial variables but impairments may also occur after breast reconstruction. Patients reporting a high significance of their breast showed the greatest decrease in satisfaction with their breast after reconstruction.

Dietary factors in the etiology and therapy of attention deficit/hyperactivity disorder.

PURPOSE OF REVIEW: The purpose of this study is to discuss the role of dietary factors in the etiology and therapy of attention deficit/hyperactivity disorder (ADHD). Relevant literature published from January 2016 to January 2017 was included in this review. RECENT FINDINGS: Unhealthy prenatal diet may be associated with ADHD in the offspring through an increase in epigenetic changes. The few-foods diet may have some efficacy, but requires further investigation before firm conclusions can be drawn. The efficacy of the supplementation of polyunsaturated fatty acids in the therapy of ADHD is probably small and may be confined to patient subgroups. It is unclear whether vitamin deficiency plays a role in the etiology of ADHD. SUMMARY: There is no clear evidence supporting a role of food or nutrient-based intervention strategies in the etiology and therapy of ADHD. The investigation of the inter-relationship between diet and other lifestyle interventions may be a promising approach.