Inter-brain synchronization occurs without physical co-presence during cooperative online gaming.

Inter-brain synchronization during social interaction has been linked with several positive phenomena, including closeness, cooperation, prosociality, and team performance. However, the temporal dynamics of inter-brain synchronization during collaboration are not yet fully understood. Furthermore, with collaboration increasingly happening online, the dependence of inter-brain phase synchronization of oscillatory activity on physical presence is an important but understudied question. In this study, physically isolated participants performed a collaborative coordination task in the form of a cooperative multiplayer game. We measured EEG from 42 subjects working together as pairs in the task. During the measurement, the only interaction between the participants happened through on-screen movement of a racing car, controlled by button presses of both participants working with distinct roles, either controlling the speed or the direction of the car. Pairs working together in the task were found to have elevated neural coupling in the alpha, beta, and gamma frequency bands, compared to performance matched false pairs. Higher gamma synchrony was associated with better momentary performance within dyads and higher alpha synchrony was associated with better mean performance across dyads. These results are in line with previous findings of increased inter-brain synchrony during interaction, and show that phase synchronization of oscillatory activity occurs during online real-time joint coordination without any physical co-presence or video and audio connection. Synchrony decreased during a playing session, but was found to be higher during the second session compared to the first. The novel paradigm, developed for the measurement of real-time collaborative performance, demonstrates that changes in inter-brain EEG phase synchrony can be observed continuously during interaction.

Perceptions of Doctors' Empathy and Patients' Subjective Health Status at an Online Clinic: Development of an Empathic Anamnesis Questionnaire.

OBJECTIVE: Medical doctors' empathy is known to support patients' health status after face-to-face clinical visits. However, the role of doctors' empathy in chat-based encounters is not yet well understood. This study investigates whether patients' evaluations of doctors' empathy are associated with their health perceptions after a meeting at an online clinic and whether experiences of empathy could be enhanced by augmenting an automated anamnesis questionnaire completed before the visit. METHODS: A total of 209 adult patients agreed to participate in the study. First 103 patients filled out the regular version of the questionnaire (June-August 2019) and then 106 filled out the augmented version of the online anamnesis questionnaire (August-November 2019). Patients' perceptions of doctors' empathy were measured with the Consultation and Relational Empathy questionnaire. Patients' self-perceived health status, potential confounders, and demographic background information were measured via questionnaires. RESULTS: Patients' perceptions of doctors' empathy during a chat-based encounter were associated with patients being less concerned about their symptoms (estimated odds ratios varied between 0.45 and 0.55 depending on the model, p values < .003) and considering their symptoms as less severe (estimated odds ratios = 0.54-0.61, p values < .007), as well as a higher probability of alleviation of symptoms as rated by the patients (estimated odds ratios = 2.16-2.24, p values < .001). Augmenting the anamnesis questionnaire did not affect patient reports on doctors' overall empathy, but it did have positive effects on specific areas of doctors' empathy covered by the questionnaire. CONCLUSIONS: These results show that patients' experience of doctors' empathy not only is important during face-to-face encounters but also supports patients' perceptions of health when the interaction is text based. The results also encourage further development of means to support patients' experiences of empathy during online interaction with medical doctors.

Collaborative block design task for assessing pair performance in virtual reality and reality.

Collaborative problem solving is more important than ever as the problems we try to solve become increasingly complex. Meanwhile, personal and professional communication has moved from face-to-face to computer-mediated environments, but there is little understanding on how the characteristics of these environments affect the quality of interaction and joint problem solving. To develop this understanding, methods are needed for measuring success of collaboration. For this purpose, we created a collaborative block design task intended to evaluate and quantify pair performance. In this task, participants need to share information to complete visuospatial puzzles. Two versions of the task are described: a physical version and one that can be completed in virtual reality. A preliminary study was conducted with the physical version (N = 18 pairs) and the results were used to develop the task for a second study in virtual reality (N = 31 pairs). Performance measures were developed for the task, and we found that pair performance was normally distributed and positively associated with visuospatial skills, but not with other participant-specific background factors. The task specifications are released for the research community to apply and adapt in the study of computer-mediated social interaction.

Maternal Licorice Consumption During Pregnancy and Pubertal, Cognitive, and Psychiatric Outcomes in Children.

Earlier puberty, especially in girls, is associated with physical and mental disorders. Prenatal glucocorticoid exposure influences the timing of puberty in animal models, but the human relevance of those findings is unknown. We studied whether voluntary consumption of licorice, which contains glycyrrhizin (a potent inhibitor of placental 11ß-hydroxysteroid dehydrogenase type 2, the "barrier" to maternal glucocorticoids), by pregnant women was associated with pubertal maturation (height, weight, body mass index for age, difference between current and expected adult height, Tanner staging, score on the Pubertal Development Scale), neuroendocrine function (diurnal salivary cortisol, dexamethasone suppression), cognition (neuropsychological tests), and psychiatric problems (as measured by the Child Behavior Checklist) in their offspring. The children were born in 1998 in Helsinki, Finland, and examined during 2009-2011 (mean age = 12.5 (standard deviation (SD), 0.4) years; n = 378). Girls exposed to high maternal glycyrrhizin consumption (≥500 mg/week) were taller (mean difference (MD) = 0.4 SD, 95% confidence interval (CI): 0.1, 0.8), were heavier (MD = 0.6 SD, 95% CI: 0.2, 1.9), and had higher body mass index for age (MD = 0.6 SD, 95% CI: 0.2, 0.9). They were also 0.5 standard deviations (95% CI: 0.2, 0.8) closer to adult height and reported more advanced pubertal development (P < 0.04). Girls and boys exposed to high maternal glycyrrhizin consumption scored 7 (95% CI: 3.1, 11.2) points lower on tests of intelligence quotient, had poorer memory (P < 0.04), and had 3.3-fold (95% CI: 1.4, 7.7) higher odds of attention deficit/hyperactivity disorder problems compared with children whose mothers consumed little to no glycyrrhizin (≤249 mg/week). No differences in cortisol levels were found. Licorice consumption during pregnancy may be associated with harm for the developing offspring.

Increased Melatonin Signaling Is a Risk Factor for Type 2 Diabetes.

Type 2 diabetes (T2D) is a global pandemic. Genome-wide association studies (GWASs) have identified >100 genetic variants associated with the disease, including a common variant in the melatonin receptor 1 b gene (MTNR1B). Here, we demonstrate increased MTNR1B expression in human islets from risk G-allele carriers, which likely leads to a reduction in insulin release, increasing T2D risk. Accordingly, in insulin-secreting cells, melatonin reduced cAMP levels, and MTNR1B overexpression exaggerated the inhibition of insulin release exerted by melatonin. Conversely, mice with a disruption of the receptor secreted more insulin. Melatonin treatment in a human recall-by-genotype study reduced insulin secretion and raised glucose levels more extensively in risk G-allele carriers. Thus, our data support a model where enhanced melatonin signaling in islets reduces insulin secretion, leading to hyperglycemia and greater future risk of T2D. The findings also imply that melatonin physiologically serves to inhibit nocturnal insulin release.

Poor sleep and neurocognitive function in early adolescence.

BACKGROUND: Evidence regarding the associations between sleep duration and quality, and neurocognitive function in adolescents remains scanty. This study examined the associations in early adolescence between: sleep duration; efficiency; fragmentation; wake-after-sleep-onset (WASO); catch-up sleep; intelligence; memory; and executive function, including attention. METHODS: This study included 354 girls and boys with a mean age 12.3 years (SD = 0.5) from a birth cohort born in 1998. Sleep was measured with accelerometers for an average of eight nights. Cognitive function was evaluated with subtests from the Wechsler Intelligence Scale for Children-III (WISC-III), the Developmental Neuropsychological Assessment 2 (NEPSY-2), the Wisconsin Card Sorting Task (WCST), Conners' Continuous Performance Task (CPT), and the Trail Making Test (TMT). RESULTS: In girls, a higher WASO and fragmentation index were associated with poorer executive functioning (higher number of perseverative errors in the WCST), and longer catch-up sleep was associated with longer reaction times and better performance in one verbal intelligence test (Similarities subtest of the WISC-III). In boys, shorter sleep duration, lower efficiency, higher WASO, higher sleep fragmentation and shorter catch-up sleep were associated with lower executive functioning (more commission errors, shorter reaction times, and had lower D Prime scores in CPT). CONCLUSIONS: In adolescent girls, poorer sleep quality was only weakly associated with poorer executive functioning, while in boys, poorer sleep quantity and quality were associated with an inattentive pattern of executive functioning. The amount of catch-up sleep during weekends showed mixed patterns in relation to neurocognitive function.

Ambulatory blood pressure and its variability in adults born preterm.

Adults born preterm have higher blood pressure (BP) than those born at term. Most studies have focused on preterm birth, and few have assessed BP variability, an independent risk factor of cardiovascular disease. We studied the association of preterm birth with 24-hour ambulatory BP, measured by an oscillometric device, in 42 young adults born early preterm (<34 weeks), 72 born late preterm (34-36 weeks), and 103 controls (≥37 weeks). Sleep was confirmed with accelerometry in 72.4% of subjects. The 24-hour systolic BP of adults born early preterm was 5.5 mm Hg higher (95% confidence interval, 1.9-9.3), awake systolic BP was 6.4 mm Hg higher (95% confidence interval, 2.8-10.1), and sleeping systolic BP was 2.9 mm Hg higher (95% confidence interval 0.3-7.5) when adjusted for age, sex, and use of accelerometry. The differences remained similar when adjusted for height, body mass index, physical activity, smoking, parental education, maternal body mass index, smoking during pregnancy, and gestational diabetes mellitus and attenuated slightly when adjusted for maternal hypertensive pregnancy disorders. Adults born early preterm also had higher BP variability as indicated by higher individual standard deviations of systolic BP and diastolic BP. Although our results were consistent with a dose-response relationship between shorter gestation and higher BP, the difference between the late preterm and term groups was not statistically significant. Our results suggest that the higher BP in adults born early preterm is present during both waking and sleeping hours, may be more pronounced during waking hours, and is accompanied by higher individual BP variability.

Objectively measured physical activity in young adults born preterm at very low birth weight.

Unimpaired adults born preterm at very low birth weight (<1500 g) consistently have lower conditioning physical activity than those born at term. We used wrist-worn accelerometers to measure objectively physical activity in 57 very low birth weight and 47 control subjects aged 25 years. We found no difference in any physical activity measures.

The associations between adolescent sleep, diurnal cortisol patterns and cortisol reactivity to dexamethasone suppression test.

Information on the associations between objectively measured sleep and hypothalamic-pituitary-adrenal axis function in early adolescence is scarce. We examined associations between average sleep duration and quality (sleep efficiency and wake after sleep onset) over 8 days with actigraphs and (1) diurnal cortisol patterns and (2) cortisol reactivity to a low-dose (3 µg/kg) overnight dexamethasone suppression test (DST) in a birth cohort born in 1998 (N=265 participants, mean age 12.3 years, SD=0.5). We also explored (3) if sleep duration and quality were affected the nights after the DST exposure. Cortisol was measured during 2 days, and participants were exposed to dexamethasone in the evening of first day. In boys, short sleep duration was associated with higher cortisol upon awakening and lower cortisol awakening response (CAR; P<0.05 and P<0.01). Long sleep duration in boys associated with higher CAR (P<0.02). Lower sleep quality in boys associated with lower CAR, but fell slightly short of significance (P<0.06). In girls, no significant associations were detected. Sleep quantity and quality were not associated with responses to the DST. There were no effects of DST on sleep (P>0.15 in between-subject analyses). The average sleep patterns showed associations with diurnal cortisol patterns during early adolescence, but only in boys. Sleep was not associated with cortisol reactivity to DST and the exogenous corticosteroid exposure did not affect sleep significantly.

Physical activity and hypothalamic-pituitary-adrenocortical axis function in adolescents.

Little is known about the associations between physical activity (PA) and hypothalamic-pituitary-adrenocortical axis (HPAA) activity in adolescents. This knowledge could offer insight into the links between PA and well-being in youth. We studied whether objectively-measured PA is associated with diurnal salivary cortisol responses and morning salivary cortisol responses after a low-dose overnight dexamethasone suppression test (DST) in adolescent girls and boys. We conducted a cross-sectional birth cohort study in Helsinki, Finland. At a mean age of 12.4 (SD=0.5) years, 150 girls and 133 boys wore wrist-worn accelerometers over at least 4 days to measure PA. Their salivary cortisol was measured across 1 day and upon awakening after a low-dose overnight DST (3 µg/kg of weight). Girls with higher overall PA and vigorous PA (VPA), and less sedentary time had lower salivary cortisol upon awakening and/or after (decreases between |0.17| and |0.25| SDs per SD increase in overall PA, VPA and decrease in sedentary time; P-values<0.039). Boys with higher overall PA, and less sedentary time had greater suppression of salivary cortisol following overnight DST (suppression between |0.24| and |0.27| SDs per SD increase in overall PA and decrease in sedentary time; P-values<0.012). Overall PA, VPA and sedentary time did not associate with DST suppression in girls or with diurnal salivary cortisol in boys. These results show that PA is associated with altered HPAA function in early adolescents, and that the associations are sex specific.

Continuity and change in poor sleep from childhood to early adolescence.

STUDY OBJECTIVES: We examined associations between pubertal maturation and sleep in early adolescence, at age 12 y, and continuity and change in actigraphy-based sleep and parent-reported sleep disorders from age 8 to 12 y. We also explored longitudinal associations between actigraph estimates of sleep and sleep disorders. DESIGN: A cohort study of children born in 1998 and tested at ages 8 y (standard deviation [SD] = 0.3) and 12 y (SD = 0.5). PARTICIPANTS: A total of 348 children participated in cross-sectional analyses. We had longitudinal actigraphy data for 188 children and repeated parent reports of sleep disorders for 229 children. MEASUREMENTS AND RESULTS: At age 8 y, participants wore actigraphs for 7.1 nights (SD = 1.2, range 3-14) on average and at age 12 y for 8.4 nights (SD = 1.7, range 3-11). Sleep disorders were parent-rated based on the Sleep Disturbance Scale for Children. Pubertal maturity was self-reported at age 12 y using the continuous Pubertal Development Scale and the picture-assisted categorical Tanner scales. RESULTS: Significant mean-level changes toward shorter but higher quality sleep occurred over time. Sleep variables had low to high rank-order stability over time. Sleep disorders were highly stable from age 8 to 12 y. Actigraphy-based sleep and parent-rated sleep disorders showed no association either in cross-section or longitudinally. Pubertal maturation was not associated with worse sleep. CONCLUSIONS: Sleep in early adolescence can be anticipated from childhood sleep patterns and disorders, but is not associated with pubertal maturity. Although sleep duration becomes shorter, sleep quality may improve during early adolescence. Parent-rated sleep disorders are distinct from actigraph estimates of sleep.

Sleep problems and cardiovascular function in children.

OBJECTIVE: To assess the associations of sleep problems with 24-hour ambulatory blood pressure and cardiovascular reactivity in children. METHODS: Sleep problems in 285 term-born, healthy 8-year-olds (mean [standard deviation] = 8.1 [0.3] years) were measured with a parent-rated Sleep Disturbance Scale for Children. Ambulatory blood pressure (n = 241) was measured for 24 hours (41% nonschool days) with an oscillometric device. The children (n = 274) underwent the Trier Social Stress Test for Children during which blood pressure, electrocardiography, and thoracic impedance were recorded and processed offline to give measures of cardiovascular and autonomic function. RESULTS: No associations were found between sleep problems and 24-hour ambulatory blood pressure. Children with sleep breathing disorders (n = 5) had higher baseline sympathetic vascular activity (p = .014) and higher heart rate (p = .044) and sympathetic cardiac activity (p = .031) in reaction to stress. Children with disorders of excessive somnolence (n = 55) had higher baseline parasympathetic activity (p = .016). None of the associations remained significant after controlling for multiple testing. CONCLUSIONS: Our results suggest that in a healthy community sample of prepubertal children, sleep problems are not associated with an unhealthy cardiovascular phenotype at this age. However, associations may be underestimated because of the low prevalence of sleep breathing disorders in this sample and may not generalize to older populations.

Higher levels of physical activity are associated with lower hypothalamic-pituitary-adrenocortical axis reactivity to psychosocial stress in children.

CONTEXT: Children who undertake more physical activity (PA) not only have more optimal physical health but also enjoy better mental health. However, the pathways by which PA affects well-being remain unclear. OBJECTIVE: To address this question, we examined whether objectively measured daytime PA was associated with diurnal hypothalamic-pituitary-adrenocortical axis (HPAA) activity and HPAA responses to psychosocial stress. DESIGN AND SETTING: We conducted a cross-sectional study in a birth cohort in Helsinki, Finland. PARTICIPANTS: We studied 258 8-year-old children. MAIN OUTCOME MEASURES: PA was assessed with wrist-worn accelerometers. Overall PA and percentage of time spent in vigorous PA (VPA) were categorized by sex into thirds. Salivary cortisol was measured diurnally and in response to the Trier Social Stress Test for Children. RESULTS: The children in different PA groups did not show differences in diurnal salivary cortisol (P > .10 for overall PA and VPA). Children with the highest levels of overall PA or VPA showed no, or only small, increases over time in salivary cortisol after stress (P = .10 and P =.03 for time in analyses of PA and VPA, respectively), whereas children belonging to the lowest and intermediate thirds showed significant increases over time in salivary cortisol after stress (P ≤ .002 for time in the analyses of overall PA and VPA). CONCLUSIONS: These results suggest that children with lower levels of daytime PA have higher HPAA activity in response to stress. These findings may offer insight into the pathways of PA on physical and mental well-being.

Physical activity and psychiatric problems in children.

We studied whether physical activity, measured by wrist-worn accelerometers, is associated with mother- and teacher-rated psychiatric problems in 8-year-old children (n = 199). Higher overall physical activity and more time spent in more intense physical activity were associated with lower odds for psychiatric problems in emotional, social, and behavioral domains.

Temporal associations between daytime physical activity and sleep in children.

OBJECTIVES: We examined temporal associations between objectively-measured physical activity (PA) during the day and in the evening, and sleep quantity and quality. STUDY DESIGN: PA and sleep were measured by actigraphs for an average of one week in an epidemiological cohort study of 275 eight-year-old children. RESULTS: For each one standard deviation (SD) unit of increased PA during the day, sleep duration was decreased by 0.30, sleep efficiency by 0.16, and sleep fragmentation increased by 0.08 SD units that night. For each one SD unit increase in sleep duration and efficiency the preceding night, PA the following day decreased by 0.09 and 0.16 SD units, respectively. When we contrasted days with a high amount of moderate to vigorous activity during the day or in the evening to days with a more sedentary profile, the results were essentially similar. However, moderate to vigorous PA in the evening shortened sleep latency. CONCLUSIONS: The relationship between a higher level of PA and poorer sleep is bidirectional. These within-person findings challenge epidemiological findings showing that more active people report better sleep. Since only a few studies using objective measurements of both PA and sleep have been conducted in children, further studies are needed to confirm/refute these results.

Poor sleep and cardiovascular function in children.

We investigated whether sleep quantity and quality were related to 24-hour ambulatory blood pressure and cardiovascular reactivity in children. We studied term-born, healthy 8.0-year olds (SD: 1.4 years) without sleep-disordered breathing (231 and 265 children provided valid data for analyses of ambulatory blood pressure and cardiovascular reactivity, respectively). Sleep was registered with an actigraph for 6 nights on average (SD: 1.2; range: 3 to 13 nights). Ambulatory blood pressure was measured for 24-hours (41% nonschool days) with an oscillometric device. The children underwent the Trier Social Stress Test for Children, during which blood pressure, electrocardiography, and thoracic impedance were recorded and processed offline to give measures of cardiovascular and autonomic function. Neither quantity nor quality of sleep was related to 24-hour ambulatory blood pressure or cardiovascular reactivity after accounting for major covariates (sex, age, height, body mass index, and parental education). Although lower sympathetic nervous system activation and higher cardiac activation under stress were found in the group of children who slept for short duration when they were compared with the average sleep duration group, these associations were not significant after correction for multiple testing and were not seen in linear regression models of the effects of sleep duration. These findings do not support the mainstream of epidemiological findings, derived from samples more heterogeneous in age, sociodemographic characteristics, and health, suggesting that poor sleep is associated with an unhealthy cardiovascular phenotype.