Using Smartphones and Wearable Devices to Monitor Behavioral Changes During COVID-19.

BACKGROUND: In the absence of a vaccine or effective treatment for COVID-19, countries have adopted nonpharmaceutical interventions (NPIs) such as social distancing and full lockdown. An objective and quantitative means of passively monitoring the impact and response of these interventions at a local level is needed. OBJECTIVE: We aim to explore the utility of the recently developed open-source mobile health platform Remote Assessment of Disease and Relapse (RADAR)-base as a toolbox to rapidly test the effect and response to NPIs intended to limit the spread of COVID-19. METHODS: We analyzed data extracted from smartphone and wearable devices, and managed by the RADAR-base from 1062 participants recruited in Italy, Spain, Denmark, the United Kingdom, and the Netherlands. We derived nine features on a daily basis including time spent at home, maximum distance travelled from home, the maximum number of Bluetooth-enabled nearby devices (as a proxy for physical distancing), step count, average heart rate, sleep duration, bedtime, phone unlock duration, and social app use duration. We performed Kruskal-Wallis tests followed by post hoc Dunn tests to assess differences in these features among baseline, prelockdown, and during lockdown periods. We also studied behavioral differences by age, gender, BMI, and educational background. RESULTS: We were able to quantify expected changes in time spent at home, distance travelled, and the number of nearby Bluetooth-enabled devices between prelockdown and during lockdown periods (P<.001 for all five countries). We saw reduced sociality as measured through mobility features and increased virtual sociality through phone use. People were more active on their phones (P<.001 for Italy, Spain, and the United Kingdom), spending more time using social media apps (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), particularly around major news events. Furthermore, participants had a lower heart rate (P<.001 for Italy and Spain; P=.02 for Denmark), went to bed later (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), and slept more (P<.001 for Italy, Spain, and the United Kingdom). We also found that young people had longer homestay than older people during the lockdown and fewer daily steps. Although there was no significant difference between the high and low BMI groups in time spent at home, the low BMI group walked more. CONCLUSIONS: RADAR-base, a freely deployable data collection platform leveraging data from wearables and mobile technologies, can be used to rapidly quantify and provide a holistic view of behavioral changes in response to public health interventions as a result of infectious outbreaks such as COVID-19. RADAR-base may be a viable approach to implementing an early warning system for passively assessing the local compliance to interventions in epidemics and pandemics, and could help countries ease out of lockdown.

Mediterranean diet and depression among older individuals: The multinational MEDIS study.

BACKGROUND: Depression has been linked to a large and growing economic and societal burden worldwide. In Europe, depression is one of the most frequent mental disorders across all age groups, but particularly in people aged 65 years and over, and higher depressive symptoms have been reported among individuals with chronic diseases (e.g., diabetes and heart disease). AIM: To evaluate the role of adherence to the Mediterranean diet (MedDiet) in depression in a sample of older people living in the Mediterranean basin. METHODS: Standard procedures were used to determine socio-demographic, lifestyle, and clinical characteristics of the participants, as well as their dietary habits, and depressive symptoms were evaluated using the Geriatric Depression Scale (GDS). Multi-adjusted logistic and linear regression analyses were carried out to evaluate the associations between participants' characteristics and depression. RESULTS: Participants classified as having mild or severe depression were less educated and physically active, and more diabetic, and they reported less adherence to the MedDiet. Adherence to the MedDiet was associated with the absence of depression [(OR, 95% CI): 0.65, 0.50-0.85]. In addition, daily tea drinking was also related to the absence of depression [(OR, 95% CI): 0.51, 0.40-0.65]. CONCLUSIONS: Greater adherence to the MedDiet and daily tea drinking seem to have a beneficial effect on depressive symptoms in older adults.

A pilot study of the efficacy of a mindfulness program for children newly diagnosed with Attention-Deficit Hyperactivity Disorder: Impact on core symptoms and executive functions

Mindfulness has emerged as a new approach for treating mental disorders. The aim of this study is to investigate preliminary efficacy of group-based mindfulness meditation training for children on core symptoms, executive functioning and comorbidity symptoms in a children naïve Attention-Deficit Hyperactivity Disorder (ADHD) sample. Five children aged 7-12 years newly diagnosed with ADHD received an eight-week group-based mindfulness treatment. The program consisted of once-per-week sessions lasting 75 minutes and daily homework assignments. The study assessments included pre-and posttest measure of psychiatric symptoms and cognitive functioning. Data were analyzed using Wilcoxon signed-rank test. Pre-post improvements in ADHD symptoms and test performance on tasks measuring executive functioning were noted. Significant results were observed in total ADHD symptoms (p= .042), anxiety symptoms (p= .042), cognitive inhibition (p= .042) and processing speed (p= .043). In summary, although the sample size was small, our pilot study suggests that mindfulness training for children is a feasible intervention in at least a subset of ADHD children and may improve behavioral and neurocognitive impairments (AU)

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n-3 Fatty acids, Mediterranean diet and cognitive function in normal aging: A systematic review.

BACKGROUND: Intake of n-3 fatty acids and adherence to the Mediterranean diet (MedDiet) have been shown to slow the progression of age-related cognitive decline, but the results are mixed. We summarized and evaluated the effect of n-3 fatty acids and MedDiet on cognitive outcomes in a cognitively healthy aged population. METHODS: Relevant published studies from January 2000 to May 2015 were identified by searching three electronic databases: Pubmed, Web of Science/MEDLINE, and CINHAL. Observational studies and randomized controlled trials (RCTs) were considered. RESULTS: Twenty-four studies were included for the systematic review. n-3 fatty acids were associated with better global cognition and some specific cognitive domains though some results were conflicting. Adherence to the MedDiet was also significantly associated with better cognitive performance and less cognitive decline. Finally, better cognitive performance was observed in men compared to women and mixed results were also found for the influence of APOE4 genotype on the association between n-3 fatty acids or MedDiet and cognition. CONCLUSIONS: Studies suggest that n-3 fatty acids in the diet and adherence to the MedDiet are beneficial in slowing age-related cognitive decline. However, more high-quality RCTs would be useful to clarify the effect of n-3 fatty acid supplements on cognition.

Seeking help for mental health problems outside the conventional health care system: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD).

OBJECTIVE: In certain countries, it is not uncommon to turn to professionals outside the conventional health care system for psychological problems. As this situation is not well documented in Europe, we assessed use of nonconventional care for mental health in 6 European countries. METHOD: A cross-sectional survey was conducted in representative samples of noninstitutionalized adults in 6 European countries. Participants (n = 8796) completed a survey, which included, among other items, the Composite International Diagnostic Interview 3.0 and in-depth questions about lifetime consultations for mental health problems. RESULTS: Among the respondents (n = 2928) who reported having already sought help in their lifetime for psychological problems (20.0%), 8.6% turned to complementary and alternative medicine (CAM) providers, such as chiropractors and herbalists, and a similar proportion (8.4%) to religious advisers such as ministers, priests, or rabbis. Only a small proportion (2.9%) consulted only these professionals for their problems. CAM providers were more frequently used in the Netherlands (13.5%) and Germany (9.4%), while religious advisers were more often consulted in Italy (12.6%) and Germany (11.6%). Multivariate analyses confirmed differences between countries and revealed that people turning to religious advisers tended to be older, foreign born, and with alcohol problems, whereas those consulting CAM providers were younger, wealthier, and more frequently depressed. CONCLUSIONS: In Europe, patients who turn to CAM therapists and those who seek help from religious advisers for psychological problems are not exactly the same. In addition, these professionals are not consulted frequently in most countries, and are almost always associated with more traditional follow-up when used.