A synthesis of evidence for policy from behavioural science during COVID-19.

Scientific evidence regularly guides policy decisions1, with behavioural science increasingly part of this process2. In April 2020, an influential paper3 proposed 19 policy recommendations ('claims') detailing how evidence from behavioural science could contribute to efforts to reduce impacts and end the COVID-19 pandemic. Here we assess 747 pandemic-related research articles that empirically investigated those claims. We report the scale of evidence and whether evidence supports them to indicate applicability for policymaking. Two independent teams, involving 72 reviewers, found evidence for 18 of 19 claims, with both teams finding evidence supporting 16 (89%) of those 18 claims. The strongest evidence supported claims that anticipated culture, polarization and misinformation would be associated with policy effectiveness. Claims suggesting trusted leaders and positive social norms increased adherence to behavioural interventions also had strong empirical support, as did appealing to social consensus or bipartisan agreement. Targeted language in messaging yielded mixed effects and there were no effects for highlighting individual benefits or protecting others. No available evidence existed to assess any distinct differences in effects between using the terms 'physical distancing' and 'social distancing'. Analysis of 463 papers containing data showed generally large samples; 418 involved human participants with a mean of 16,848 (median of 1,699). That statistical power underscored improved suitability of behavioural science research for informing policy decisions. Furthermore, by implementing a standardized approach to evidence selection and synthesis, we amplify broader implications for advancing scientific evidence in policy formulation and prioritization.

Global pain levels before and during the COVID-19 pandemic.

Physical pain has trended upward globally over the last decade. Here, we explore whether the COVID-19 pandemic modified this alarming trend. We used data from 146 countries worldwide (510,247 respondents) to examine whether pain levels changed during the COVID-19 pandemic. Adjusted regressions across countries revealed that 33.3% of people were in pain in 2019, 32.8% in 2020, 32.5% in 2021, and 34.1% in 2022. The change in pain from 2019 to each of the pandemic years was not statistically significant. This suggests that, on average, there was no significant change in pain during the pandemic. However, from 2019 to 2020 there was a significant decline in pain among individuals over 55 years of age, those who were widowed, and those without children in the household. On a global scale, the COVID-19 pandemic was not associated with a significant change in pain levels. The concerning pre-pandemic elevation in global pain continued during this challenging period.

Income is more protective against pain in more equal countries.

It is empirically well-established that the rich suffer less pain on average than the poor. However, much less is known about the factors that moderate the size of the income gradient of pain. Using data from over 1 million adults from 127 countries worldwide, this article conducts a systematic test on whether income inequality moderates the pain gap between the rich and the poor. While pain is negatively associated with income in all but one country, there is strong evidence to suggest that an increase in income is much more protective against pain in countries where the income distribution is relatively more equal. The results are robust to using different measures of income inequality, removing outliers, and accounting for country and year fixed effects. We explain our results through the lens of income rank effects on health outcomes. Overall, our findings suggest that pain-reducing policies through income redistribution may need to take income inequality into consideration when evaluating their effectiveness.

The effect of adverse employment circumstances on physical pain: Evidence from Australian panel data.

Physical pain is a common health problem with great public health implications. Yet evidence on whether adverse employment circumstances shape physical pain is limited. Using longitudinal data from 20 waves (2001-2020) from the Household, Income and Labour Dynamics of Australia Survey (HILDA; N = 23,748), a lagged design, Ordinary Least Squares (OLS) regressions as well as multilevel mixed effect linear regressions, we investigated the association between past accumulated unemployment and recent employment circumstances with physical pain. We found that adults who spent more years unemployed and looking for work subsequently reported greater physical pain (b = 0.034, 95% CI = 0.023, 0.044) and pain interference (b = 0.031, 95% CI = 0.022, 0.038) than those who spent fewer years unemployed. We also found that those experiencing overemployment (working full-time while wanting to work fewer hours) and underemployment (working part-time while wanting to work more hours) reported greater subsequent physical pain (overemployment: b = 0.024, 95% CI = 0.009, 0.039; underemployment: b = 0.036, 95% CI = 0.014, 0.057) and pain interference (overemployment: b = 0.017, 95% CI = 0.005, 0.028; underemployment: b = 0.026, 95% CI = 0.009, 0.043) than those content with their working hours. These results held after controlling for socio-demographic characteristics, occupation, and other health-related factors. These findings are consistent with recent work that suggested that psychological distress can influence physical pain. Understanding how adverse employment circumstances impact physical pain is crucial to the design of health promotion policies.

Understanding Despair: The Role of Physical Pain.

In the United States, mortality due to alcohol, opioid overdose, and suicide has increased dramatically in the last decades. These deaths of despair have been the focus of recent and fast-growing literature. Yet little is known about the factors that are involved in despair. This article moves this area of research forward by highlighting the role that physical pain plays in the deaths of despair. This piece critically analyses the link between physical pain, the psychological states that precede pain, and the premature mortality that follows physical pain as well as the bidirectional relationships among these aspects.

Prosocial behaviour helps to ease physical pain: Longitudinal evidence from Britain.

OBJECTIVE: Prior studies suggest that prosocial behaviour can lead to better mental and physical health. Yet little is known about whether engaging in prosocial behaviour contributes to reducing physical pain. The objective of this study is to investigate longitudinal associations of two prosocial behaviours, donating money to charity and/or volunteering time to an organisation, with pain. METHODS: Data are from the United Kingdom Household Longitudinal Survey (UKHLS, approximate N = 48,000 individuals). Both prosocial behaviours were assessed in 2011 and pain was assessed annually through 2020, according to the extent to which it interfered with respondents' ability to do work. Using a prospective longitudinal study design, linear mixed models examined associations of each prosocial behaviour separately and both combined on pain interference across 10 years of follow-up adjusting for a broad range of covariates including demographics, initial health status, and depression. RESULTS: People who did versus did not donate or volunteer reported lower pain interference over 10 years of follow-up (donating b = -0.059, p < 0.001; volunteering b = -0.086, p < 0.001). Individuals who donated more versus less money reported lower pain interference although volunteering more hours was not associated with lower pain interference. Finally, findings suggested that engaging in both donating and volunteering versus neither was associated with lower pain interference over follow-up. CONCLUSION: There is a longitudinal association between donating money to charity and/or volunteering time to an organisation with pain interference with work. Understanding factors that help to reduce pain is relevant for the design of public health policies.

Global trends in emotional distress.

In this study, we examined emotional distress using annual representative survey data from 1.53 million individuals surveyed in 113 countries from 2009 to 2021. Participants reported whether they had experienced worry, sadness, stress, or anger during a lot of the previous day. Within-country estimates showed that the prevalence of feelings of emotional distress increased from 25 to 31% between 2009 and 2021, with those with low levels of education and income experiencing the largest increases in distress. On a global level, the pandemic period was characterized by an initial increase in distress in 2020 followed by recovery in 2021.

Pain trends and pain growth disparities, 2009-2021.

Physical pain is a major public health concern. Yet evidence on trends in physical pain around the world barely exists. Using nationally representative data from 146 countries (N = 1.6 million respondents), this paper finds that, all over the world, the percentage of people in pain increased from 26.3 in 2009 to 32.1 in 2021. This rising trend was present in both higher- and lower-income countries. This article also documents pain disparities: In the worldwide population, pain grew faster among women, the less educated, and the poor. Although the aggregate level of pain was greater among the elderly (> 60 years old), the growth in pain was faster among the younger (< 35 years old). These findings hold after controlling for sociodemographic factors. Disparities of pain growth in higher- and lower-income nations and potential explanatory factors are also discussed. Understanding how the level of pain varies over time and across demographic groups is crucial to evaluate and shape public health policies.

Physical pain, gender, and the state of the economy in 146 nations.

RATIONALE: Physical pain is one of the most severe of human experiences. It is thus one of the most important to understand. OBJECTIVE: This paper reports the first cross-country study of the links between physical pain and the state of the economy. A key issue examined is how the level of pain in a society is influenced by the unemployment rate. METHODS: The study uses pooled cross-sectional Gallup data from 146 countries (total N > 1.3 million). It estimates fixed-effects regression equations that control for personal characteristics. RESULTS: More than a quarter of the world's citizens are in physical pain. Physical pain is lower in an economic boom and greater in an economic downturn. Estimated effect sizes are substantial. Remarkably, increases in pain are borne almost exclusively by women and found principally in rich nations. These findings have paradoxical aspects. The counter-cyclicality of physical pain is not what would be predicted by conventional economic analysis: during an expansion, people typically work harder and longer, and accidents and injuries increase. Nor are the study results due to unemployed citizens experiencing more pain (although they do). Instead, the study's findings are consistent with an important hypothesis proposed recently, using different kinds of evidence, by brain and behavioural-science researchers (e.g., Wiech and Tracey, 2009; Chou et al.; 2016). The hypothesis is that economic worry can create physical pain. CONCLUSIONS: This study provides the first cross-country evidence that the level of physical pain in a nation depends on the state of the economy. Pain is high when the unemployment rate is high. That is not because of greater pain among people who lose their jobs - it extends far beyond that into wider society. The increase in physical pain in a downturn is experienced disproportionately by women.

Buying Happiness in an Unequal World: Rank of Income More Strongly Predicts Well-Being in More Unequal Countries.

Does income rank matter more for well-being in more unequal countries? Using more than 160,000 observations from 24 countries worldwide, we replicate previous studies and show that the ranked position of an individual's income strongly predicts life evaluation and positive daily emotional experiences, whereas absolute and reference income generally have weak or no effects. Furthermore, we find the association between income rank and an individual's well-being to be significantly larger in countries where income inequality, represented by the share of taxable income held by the top 1% of income earners, is high. These results are robust to using an alternative measure of income inequality and different reference group specifications. Our findings suggest that people in more unequal societies place greater weight on the pursuit of higher income ranks, which may contribute to enduring income inequality in places where greater well-being can be bought from moving up the income ladder.

Mesangiogenic progenitor cells are forced toward the angiogenic fate, in multiple myeloma.

Multiple myeloma (MM) progresses mainly in the bone marrow where the involvement of a specific microenvironment plays a critical role in maintaining plasma cell growth, spread, and survival. In active disease, the switch from a pre-vascular/non-active phase to a vascular phase is coupled with the impairment of bone turnover. Previously, we have isolated Mesangiogenic Progenitor Cells (MPCs), a bone marrow population that showed mesengenic and angiogenic potential, both in vitro and in vivo. MPC differentiation into musculoskeletal tissue and their ability of sprouting angiogenesis are mutually exclusive, suggesting a role in the imbalancing of the microenvironment in multiple myeloma. MPCs from 32 bone marrow samples of multiple myeloma and 23 non-hematological patients were compared in terms of frequency, phenotype, mesengenic/angiogenic potential, and gene expression profile. Defective osteogenesis was recorded for MM-derived MPCs that showed longer angiogenic sprouting distances respect to non-hematological MPCs, retaining this capability after mesengenic induction. This altered MPCs differentiation potential was not detected in asymptomatic myelomatous disease. These in vitro experiments are suggestive of a forced angiogenic fate in MPCs isolated from MM patients, which also showed increased sprouting activity. Taking together our results suggest a possible role of these cells in the "angiogenic switch" in the MM micro-environment.

Valuing time over money predicts happiness after a major life transition: A preregistered longitudinal study of graduating students.

How does prioritizing time or money shape major life decisions and subsequent well-being? In a preregistered longitudinal study of approximately 1000 graduating university students, respondents who valued time over money chose more intrinsically rewarding activities and were happier 1 year after graduation. These results remained significant controlling for baseline happiness and potential confounds, such as materialism and socioeconomic status, and when using alternative model specifications. These findings extend previous research by showing that the tendency to value time over money is predictive not only of daily consumer choices but also of major life decisions. In addition, this research uncovers a previously unidentified mechanism-the pursuit of intrinsically motivated activities-that underlies the previously observed association between valuing time and happiness. This work sheds new light on whether, when, and how valuing time shapes happiness.

The Combination of Rituximab and Bendamustine as First-Line Treatment Is Highly Effective in the Eradicating Minimal Residual Disease in Follicular Lymphoma: An Italian Retrospective Study.

R-Bendamustine is an effective treatment for follicular lymphoma (FL). Previous large trials demonstrated the prognostic role of the molecular minimal residual disease (MRD) during the most frequently adopted chemotherapeutic regimens, but there are not yet conclusive data about the effect of combination of rituximab (R) and bendamustine in terms of MRD clearance. Thus, the aim of this retrospective study was to assess if and in what extent the combination of rituximab and bendamustine would exert a significant reduction of the molecular disease in 48 previously untreated FL patients. The molecular marker at baseline was found in the 62.5% of cases; no significant differences were observed between patients with or without the molecular marker in respect of the main clinical features. Moreover, the quantization of the baseline molecular tumor burden showed a great variability: the median value was 1.4 × 10-2 copies, ranging from 3 × 10-5 to 4 × 104. The initial molecular tumor burden did not correlate with clinical features and did not impact on the subsequent quality of response. After treatment, 93% of cases became MRD-negative; the median reduction of the BCL2/JH load was 4 logs. The 2-years PFS was 85%; it was significantly longer for patients in complete than for those in partial response (91 vs. 57%; p = 0.002), and for cases with lower FLIPI-2 score (88 vs. 60%; p = 0.004). On the contrary, PFS did not differ between patients with or without the molecular marker at baseline; a molecular tumor burden 15 times higher was observed in the relapsed subgroup in comparison to the relapse-free one, but this difference did not change the PFS length. The 2-years OS was 93.6%; the only variable that significantly impacted on it was the FLIPI-2 score; the presence of the molecular marker at baseline or its behavior after treatment did not impact on survival. This study, even if retrospective and conducted on a small series of patients, would represent a proof of concept that R-bendamustine is able to so efficaciously eradicate MRD that it could be able to by-pass the prognostic significance of MRD already demonstrated for other chemotherapeutic regimens in FL.