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Pandemic-related uncertainties and intolerance of uncertainty (IU) could negatively affect physicians’ well-being and functioning, being associated with experiences of distress and problematic decision-making processes. To summarize the available quantitative and qualitative evidence of physicians’ IU and decisional uncertainty during COVID-19 and problems associated with it, a systematic search was conducted to identify all relevant articles describing physician uncertainty with regard to medical decision making and well-being in COVID-19 pandemic conditions. Medical, psychological, and preprint databases were searched. Ten articles met all eligibility criteria, with eight describing quantitative and two describing qualitative research outcomes, assessed primarily in European regions and via online surveys. Associations between IU and symptoms of poor mental health and mental health risk factors were widespread, but inconsistencies emerged. Qualitative studies emphasized decisional uncertainty as a stressor for physicians, and quantitative studies suggest it may have fostered more unproven treatment choices. While the prevalence and impact of physician uncertainty under COVID-19 conditions requires further investigation, sighting available literature indicates that IU coincided with experiences of poor mental health and, at least towards the beginning of the pandemic, with willingness to endorse unproven treatments. Efforts to reduce uncertainty-related problems for physicians seem warranted, for example, through normalizing experiences of uncertainty or reducing avoidable uncertainty through maintaining open and timely communication channels.

Formal thought disorder (FTD) is a clinical key factor in schizophrenia, but the neurobiological underpinnings remain unclear. In particular, the relationship between FTD symptom dimensions and patterns of regional brain volume loss in schizophrenia remains to be established in large cohorts. Even less is known about the cellular basis of FTD. Our study addresses these major obstacles by enrolling a large multi-site cohort acquired by the ENIGMA Schizophrenia Working Group (752 schizophrenia patients and 1256 controls), to unravel the neuroanatomy of FTD in schizophrenia and using virtual histology tools on implicated brain regions to investigate the cellular basis. Based on the findings of previous clinical and neuroimaging studies, we decided to separately explore positive, negative and total formal thought disorder. We used virtual histology tools to relate brain structural changes associated with FTD to cellular distributions in cortical regions. We identified distinct neural networks positive and negative FTD. Both networks encompassed fronto-occipito-amygdalar brain regions, but positive and negative FTD demonstrated a dissociation: negative FTD showed a relative sparing of orbitofrontal cortical thickness, while positive FTD also affected lateral temporal cortices. Virtual histology identified distinct transcriptomic fingerprints associated for both symptom dimensions. Negative FTD was linked to neuronal and astrocyte fingerprints, while positive FTD also showed associations with microglial cell types. These results provide an important step towards linking FTD to brain structural changes and their cellular underpinnings, providing an avenue for a better mechanistic understanding of this syndrome.

Infancy is a critical period that shapes an individual's emotional and developmental trajectory. Indeed, negative early life experiences have been suggested to form the foundation for later-life mental health function with many anxiety disorders having their onset during childhood or adolescence. Despite this, there are still many unanswered questions regarding how these early life experiences are retained. This is surprising given that, unlike adult animals, infants exhibit an impaired ability to form long-term memories. More recently, several studies have demonstrated that exposure to a novel environment may stabilize the persistence of weak memories, a phenomenon often attributed to a process referred to as behavioral tagging. While behavioral tagging processes have been repeatedly demonstrated in adult animals, few studies have examined whether it occurs in the developing animal, which is somewhat puzzling given the typically weak memory in the young. In this chapter, we explore whether behavioral tagging processes may also underlie the formation of long-term memories in infant animals. We also examine whether the processes underlying behavioral tagging in the adult animal may be similar in the developing animal.

The present research aimed to better understand individual differences in attitudes towards emotions with a focus on anger. We report findings of four studies conducted with American and Polish individuals. Results showed that individuals who have more positive attitudes toward anger are higher in trait anger (Studies 1–4), are more likely to think about getting revenge (Study 1), and expect that getting revenge will make them feel good (Studies 1–2). In addition, these individuals are lower in agreeableness and lower in the tendency to engage in avoidance when angered (Studies 1–4). They score lower in humility (Studies 3–4), lower in secure romantic attachment but higher in anxious and avoidance attachment (Study 3). Finally, they are more likely to believe a wide range of conspiracies (Studies 2–4). Discussion focuses on the implications of these results.

Background: Women from migrant and refugee backgrounds living in high-income countries have increased risk of adverse perinatal outcomes and report lower satisfaction with perinatal healthcare. In Sydney, Australia, a new service known as the Cross Cultural Workers (CCWs) in Maternity and Child and Family Health Service (the CCW Service) was implemented to support such women and families from pregnancy to the early parenting period. This study aimed to ascertain the experiences of women and their partners engaging with the CCW Service. Methods: A survey study was undertaken. Women accessing the CCW Service were recruited during pregnancy and were asked to complete surveys at three time points: in the third trimester of pregnancy, at 6 and 12 months postpartum. Their partners were invited to complete a survey at 6 months postpartum. Survey data were analysed to compare satisfaction, usefulness, number of CCW interactions, cultural sensitivity, and service improvement recommendations across all three survey timepoints. Results: A total of 231 surveys were received: 113 during pregnancy, 50 at 6-months postpartum, 44 at 12-months postpartum, and 24 partner surveys. Participants in all surveys reported the CCW Service to be useful (84–94%), stating that it increased their understanding of pregnancy, birth and parenting (95–100%), and that they would recommend the CCW Service (92–98%). Participants experienced a high level of satisfaction (88–95%) irrespective of the number of CCW interactions (p = 0.42). Thoughts on becoming a mother or parent were more positive after meeting the CCW than before for both women (p = 0.01) and partners (p = 0.12). Suggestions for CCW Service improvement were to 1) increase the provision of information, specifically financial entitlements, postnatal depression, and support services, 2) increase involvement of partners in care, 3) increase the CCW workforce/or number of CCWs. Conclusion: The CCW Service was associated with positive experien

The growing demand for aged care services has become a pressing challenge worldwide. However, the future changes in demand for aged care services and the corresponding socioeconomic consequences in rapidly aging societies are not yet adequately understood. To achieve a better understanding of the future demand for aged care services, this study provides a set of comprehensive projections of the scale of demand for aged care services and the associated economic burdens between 2010 and 2050 in the context of China. Using a research framework based on the life cycle approach and a modified Personal Social Services Research Unit model, the study projects that the size of Chinese elderly population (i.e., aged ≥ 60) demanding aged care services will grow considerably, reaching 127.4 million in 2050 and costing 2.6 trillion yuan (or 1.01% of Chinese gross domestic product). Home-/community-based care services will be the form of aged care most in demand by the 70.21 million Chinese elderly people in 2050, and the most needed types of aged care services will be feeding assistance. The results of the sensitivity analysis indicate that demand for and costs of aged care services are sensitive to the assumptions about patterns of elderly disability and the prices of aged care services. The projected growth in the future demand and costs of aged care services warrants more heightened attention from Chinese policymakers and providers of aged care services. The implications for other rapidly aging societies are also discussed.

Although APOE ɛ4 has been identified as the strongest genetic risk factor for Alzheimer’s Disease, there are some APOE ɛ4 carriers who do not go on to develop Alzheimer’s disease or cognitive impairment. This study aims to investigate factors contributing to this “resilience” separately by gender. Data were drawn from APOE ɛ4 positive participants who were aged 60 + at baseline in the Personality and Total Health Through Life (PATH) Study (N = 341, Women = 46.3%). Participants were categorised into “resilient” and “non-resilient” groups using Latent Class Analysis based on their cognitive impairment status and cognitive trajectory across 12 years. Logistic regression was used to identify the risk and protective factors that contributed to resilience stratified by gender. For APOE ɛ4 carriers who have not had a stroke, predictors of resilience were increased frequency of mild physical activity and being employed at baseline for men, and increased number of mental activities engaged in at baseline for women. The results provide insights into a novel way of classifying resilience among APOE ɛ4 carriers and risk and protective factors contributing to resilience separately for men and women.

BACKGROUND: Telehealth and telecare are particularly important and beneficial to long-term care facilities due to care demands, workforce, and the unique environment. Stemming from the recent findings on telehealth utilisation in residential aged-care facilities in Australia, this commentary seeks to identify lessons and perspectives learned during the Covid-19 pandemic from multiple users, including patients, physicians, nurses, and healthcare workers in long-term care (LTC) settings. MAIN BODY: From patients' perspectives, older adults residing in LTC settings often opt not to use virtual care, with the majority preferring in-person visits. This is despite residents expressing their willingness to use telehealth, and virtual care has advantages in LTC settings or in remote areas. Additionally, hearing, vision, or cognitive impairment can limit residents' ability to use information technology to access care, so their preferences for phone or video consultations depend on the health conditions or care requirement. From physicians' perspectives, most healthcare practitioners have a positive attitude toward using telehealth. However, telephone consultations tended to be the dominant mode during the early period of the Covid-19 pandemic. Physicians also raised several major concerns, including technical and equipment-related issues, expanded roles, or additional workloads of LTC staff that could negatively affect clinical decision-making and unequal access in rural, older, and cognitively impaired patients. Most nurses and healthcare workers perceived telehealth positively as a way to enhance patients' care access. However, the majority had concerns about acquiring appropriate knowledge of using the technology for themselves and their patients. In remote areas, nurses expressed higher efficiency and higher care quality when utilising telehealth in caring for older patients than in the regular in-person care mode. CONCLUSION: Since the beginning of the Covid-19 pandemic

Background: Growing evidence suggests that there is an association between poor oral health and cognitive function in late adulthood. However, most studies to date have relied on cross-sectional research methods that do not permit inferences about the temporality of any association. Moreover, the few longitudinal studies that do exist have typically relied on small samples and quite limited cognitive or oral health assessments. The aim of the present study was therefore designed to provide the first direct evaluation of whether cognitive function is predictive of poor oral health in older adults. Methods: This longitudinal research included data from 339 participants aged 70 years or older from The Sydney Memory and Ageing Study (MAS), a large cohort of healthy community-dwelling older adults. Cognitive function was assessed using a battery of tests at baseline (Wave 1) in 2005 and six years later (Wave 4) in 2011. In 2015 (Wave 6), participants were assessed for oral health using the Oral Health Assessment Tool (OHAT), number of functional occluding pairs of natural teeth and sublingual resting saliva pH (SRSpH). Ordinal least squares regression analysis was used to model the effect of cognitive function on total OHAT score, and binomial logistic regression used for SRSpH and occluding pairs of functional teeth. Results: Two models were tested. In the partially adjusted model, age, gender and years of education were included. The fully adjusted model additionally included medical conditions, general health, depression, smoking, alcohol consumption, functionality, and dental care utilization. The key finding to emerge was that a six-year change in memory (from Wave 1 to Wave 4) was associated with lower sublingual resting saliva pH at Wave 6 in partially (Odds Ratio (OR) = 0.65) and fully adjusted model (OR = 0.63). Conclusions: This longitudinal study provides further evidence that a relationship between cognitive function and oral health exists, and also points to

Grey matter volume (GMV) may be associated with polygenic risk for schizophrenia (PRS-SZ) and severe cognitive deficits in people with schizophrenia, schizoaffective disorder (collectively SSD), and bipolar disorder (BD). This study examined the interactive effects of PRS-SZ and cognitive subtypes of SSD and BD in relation to GMV. Two-step cluster analysis was performed on 146 clinical cases (69 SSD and 77 BD) assessed on eight cognitive domains (verbal and visual memory, executive function, processing speed, visual processing, language ability, working memory, and planning). Among them, 55 BD, 51 SSD, and 58 healthy controls (HC), contributed to focal analyses of the relationships between cognitive subtypes, PRS-SZ and their interaction on GMV. Two distinct cognitive subtypes were evident among the combined sample of cases: a ‘cognitive deficit’ group (CD; N = 31, 20SSD/11BD) showed severe impairment across all cognitive indices, and a ‘cognitively spared’ (CS; N = 75; 31SSD/44BD) group showed intermediate cognitive performance that was significantly worse than the HC group but better than the CD subgroup. A cognitive subgroup-by-PRS-SZ interaction was significantly associated with GMV in the left precentral gyrus. Moderation analyses revealed a significant negative relationship between PRS-SZ and GMV in the CD group only. At low and average (but not high) PRS-SZ, larger precentral GMV was evident in the CD group compared to both CS and HC groups, and in the CS group compared to HCs. This study provides evidence for a relationship between regional GMV changes and PRS-SZ in psychosis spectrum cases with cognitive deficits, but not in cases cognitively spared.

Obstacle crossing requires visuospatial working memory to guide the trailing leg trajectory when vision in unavailable. Visuospatial working memory, as assessed with neuropsychological tests, declines with age, however, this remains to be investigated functionally in obstacle crossing. There is also evidence that visuospatial encoding during a secondary task interferes with balance control during stepping and walking in older people. Here, we studied the interaction effects of age by delay (study 1) and age by secondary visuospatial task (study 2) conditions on obstacle clearance in a visuospatial working memory -guided obstacle crossing task. Healthy young adults aged 19 to 36 years (n = 20 in study 1 and n = 17 in study 2) and healthy older adults aged 66 to 83 years (n = 29 in study 1 and n = 21 in study 2) were instructed to step over an obstacle with their leading leg and straddle it for a delay period before completing the crossing with their trailing leg. In study 1, two obstacle height conditions (12 cm, 18 cm) and two delay durations (20 s, 60 s) were presented in random order. In study 2, participants were required to attend to either no secondary task (control), a visuospatial secondary (star movement) task, or a nonspatial secondary (arithmetic) task, while straddling the obstacle for a delay duration of 20 s, at obstacle heights of 12 cm and 18 cm, randomly presented. Trailing leg kinematics (mean and variability of maximum toe clearance over the obstacle) were determined via motion capture. There were no statistically significant age by delay or age by secondary task interactions. In study 1, toe clearance variability was significantly greater in young adults and increased with increasing delay duration in both groups. In study 2, compared with the control condition, toe clearance variability was significantly greater in the non-spatial secondary task condition but not in the visuospatial condition. Contrary to our hypotheses, these findings suggest th

Doublecortin (DCX) has long been implicated in, and employed as a marker for, neurogenesis, yet little is known about its function in non-neurogenic brain regions, including the amygdala. This study sought first to explore, in rodents, whether fear learning and extinction modulate amygdala DCX expression and, second, to assess the utility of peripheral DCX correlates as predictive biomarkers of trauma response in rodents and humans. Pavlovian conditioning was found to alter DCX protein levels in mice 24 h later, resulting in higher DCX expression associated with enhanced learning in paradigms examining both the acquisition and extinction of fear (p < 0.001). This, in turn, is associated with differences in freezing on subsequent fear expression tests, and the same relationship between DCX and fear extinction was replicated in rats (p < 0.001), with higher amygdala DCX levels associated with more rapid extinction of fear. RNAseq of amygdala and blood from mice identified 388 amygdala genes that correlated with DCX (q < 0.001) and which gene ontology analyses revealed were significantly over-represented for neurodevelopmental processes. In blood, DCX-correlated genes included the Wnt signaling molecule Cdk14 which was found to predict freezing during both fear acquisition (p < 0.05) and brief extinction protocols (p < 0.001). High Cdk14 measured in blood immediately after testing was also associated with less freezing during fear expression testing (p < 0.01). Finally, in humans, Cdk14 expression in blood taken shortly after trauma was found to predict resilience in males for up to a year post-trauma (p < 0.0001). These data implicate amygdala DCX in fear learning and suggest that Cdk14 may serve as a predictive biomarker of trauma response.

Purpose: Parents are important facilitators of physical activity for children, yet little is known about the perceptions of parents of childhood cancer survivors. We investigated parent perceptions of their own and their child’s physical activity levels after cancer treatment and examined associations with clinical, demographic, and psychosocial factors. Methods: We conducted a cross-sectional survey among 125 parents and 125 survivors. Parents reported on the perceived importance of their child being physically active and concerns regarding exercising after cancer treatment. Results: Parents and survivors self-reported median (range) of 127.5 (0–1260) and 220 (0–1470) min/week of moderate-to-vigorous physical activity. Most parents (n = 109, 98%) believed that physical activity was highly important for their child. Some parents (n = 19, 17%) reported concerns, most commonly regarding exercise safety (n = 7, 22%). Parents were more likely to perceive that their child should increase physical activity if their child was an adolescent and had high body fat percentage. Conclusions: Physical activity levels varied widely among survivors, reflecting factors including parents’ lifestyles, limited understanding of exercise benefits and perceptions of risk. Given survivors’ insufficient physical activity levels and sedentary behaviour among families, embedding physical activity promotion into health systems and follow-up support could benefit the entire family unit.

Background: Unemployment is known to involve various psychosocial challenges that can negatively impact mental health. However, the intricacies of how individuals experience these challenges and strive to cope within the context of varied sociocultural and individuating factors, remain comparatively understudied. The present qualitative study used an interpretative phenomenological approach to explore the lived experiences of mental health and coping during unemployment. Methods: Fifteen Australian adults who had recently experienced unemployment (for ≥3 months in the last 2 years), despite being available for and able to work, participated in semi-structured interviews from August to September 2021. Maximum variation sampling ensured participants represented diverse sociodemographic backgrounds. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis within NVivo12 software. Results: Four major themes were identified: 1) disrupted identity and direction in life; 2) navigating conflicting views of contribution and progress; 3) knowing how to cope is not enough; and 4) unemployment as a catalyst for new understandings. Unemployment disrupted participants’ sense of purpose, identity and visions for the future. It signified a perceived failure to meet societal standards of value based upon the economic functions of work, which participants struggled to reconcile with their own priorities for work that satisfied psychosocial needs. Participants were aware of effective coping strategies, although these had mixed positive and negative effects on mental health, or were difficult to mobilise during unemployment. The COVID-19 pandemic, while normalising unemployment to some degree, exacerbated future uncertainty and prevented engagement with known coping strategies (e.g., social interaction). However, unemployment could also instigate growth through re-defining markers of achievement, re-aligning goals with one’s core values, and d

Resting state low-frequency brain activity may aid in our understanding of the mechanisms of aging-related cognitive decline. Our purpose was to explore the characteristics of the amplitude of low-frequency fluctuations (ALFF) in different frequency bands of fMRI to better understand cognitive aging. Thirty-seven cognitively normal older individuals underwent a battery of neuropsychological tests and MRI scans at baseline and four years later. ALFF from five different frequency bands (typical band, slow-5, slow-4, slow-3, and slow-2) were calculated and analyzed. A two-way ANOVA was used to explore the interaction effects in voxel-wise whole brain ALFF of the time and frequency bands. Paired-sample t-test was used to explore within-group changes over four years. Partial correlation analysis was performed to assess associations between the altered ALFF and cognitive function. Significant interaction effects of time × frequency were distributed over inferior frontal gyrus, superior frontal gyrus, right rolandic operculum, left thalamus, and right putamen. Significant ALFF reductions in all five frequency bands were mainly found in the right hemisphere and the posterior cerebellum; whereas localization of the significantly increased ALFF were mainly found in the cerebellum at typical band, slow-5 and slow-4 bands, and left hemisphere and the cerebellum at slow-3, slow-2 bands. In addition, ALFF changes showed frequency-specific correlations with changes in cognition. These results suggest that changes of local brain activity in cognitively normal aging should be investigated in multiple frequency bands. The association between ALFF changes and cognitive function can potentially aid better understanding of the mechanisms underlying normal cognitive aging.

Resilience is a process of adaptive recovery crucial in maintaining mental wellbeing after stress exposure. A psychological factor known to buffer stress and promote positive wellbeing outcomes is the ability to regulate emotions. However, the neural networks underlying resilience, and the possible mediating role of emotion regulation, remain largely unknown. Here, we examined the association between resilience and grey matter covariation (GMC) in healthy adults with and without early life stress (ELS) exposure, and whether emotion regulation mediated this brain-resilience association. Source-based morphometry was used to identify spatial patterns of common GMC in 242 healthy participants. Wellbeing was measured using the COMPAS-W Wellbeing Scale. Linear mixed models were run to establish associations between GMC and wellbeing scores. Moderated mediation models were used to examine a conditional mediating effect of emotion regulation on the brain-wellbeing relationship, moderated by ELS exposure. Distinct ELS-related morphometric patterns were found in association with resilience. In participants without ELS exposure, decreased GMC in the temporo-parietal regions was associated with wellbeing. In participants with ELS exposure, we observed increased patterns of covariation in regions related to the salience and executive control networks, and decreased GMC in temporo-parietal areas, which were associated with resilience. Cognitive reappraisal mediated the brain-wellbeing relationship in ELS-exposed participants only. Patterns of stronger GMC in regions associated with emotional and cognitive functioning in ELS-exposed participants with high levels of wellbeing may indicate possible neural signatures of resilience. This may be further heightened by utilising an adaptive form of emotion regulation.

This paper compares the monetary and living standards approaches to poverty using Australian data for the period 2006–2017. The aim is to highlight the conceptual and empirical strengths and weaknesses of the two approaches and identify the similarities and differences that emerge when both are applied to examine what happened over the period and to a limited degree, why. The acknowledged limitations of estimating poverty rates by comparing household income with a poverty line have to a degree been addressed by developments in deprivation research that have generated estimates that are more directly related to living standards, more democratic and more credible. But this approach also has limitations, so its growing popularity need not signify the end of poverty line studies. This paper compares the two approaches, with specific attention paid to ensuring that the estimates are internally consistent over time and comparable at a point in time. Both show a consistent pattern of modest improvement in social disadvantage over the period examined, but they reveal different aspects of change. The monetary approach highlights the role of housing costs in driving changes in poverty, while the more nuanced explanation generated by estimates of deprivation provides detailed insights. The results suggest that each has a positive role to play in better understanding the nature of poverty and identifying the factors driving change over time.

The Chinese government has launched a series of health reforms to establish universal health insurance coverage, particularly for vulnerable groups, including middle-aged and older adults. However, the current public health insurance system is highly fragmented, consisting of different programs with different levels of premiums and benefits. We analyse whether the universal health insurance system increases the life satisfaction of middle-aged and older Chinese people and to what extent the type of health insurance affects the life satisfaction of this group. Our study is based on data from the China Health and Retirement Longitudinal Study, a nationally representative longitudinal survey of Chinese aged 45 and above, in 2011, 2013, and 2015. We find that the life satisfaction of middle-aged and older adults does not depend on having any health insurance coverage but varies with the type of health insurance coverage, controlling for potential confounding variables such as health status, occupation, hukou status, and other demographic variables. Individuals covered by the most generous program, the Government Medical Insurance, reported a higher life satisfaction. In comparison, individuals covered by the Urban Employee Medical Insurance, the Urban Resident Medical Insurance, and the New Rural Cooperative Scheme reported a lower life satisfaction by 0.155, 0.106, and 0.112 standard deviations, respectively. Our results suggest that establishing a more equitable health insurance system should be the next step in health reforms in China.

Visual comparison—comparing visual stimuli (e.g., fingerprints) side by side and determining whether they originate from the same or different source (i.e., “match”)—is a complex discrimination task involving many cognitive and perceptual processes. Despite the real-world consequences of this task, which is often conducted by forensic scientists, little is understood about the psychological processes underpinning this ability. There are substantial individual differences in visual comparison accuracy amongst both professionals and novices. The source of this variation is unknown, but may reflect a domain-general and naturally varying perceptual ability. Here, we investigate this by comparing individual differences (N = 248 across two studies) in four visual comparison domains: faces, fingerprints, firearms, and artificial prints. Accuracy on all comparison tasks was significantly correlated and accounted for a substantial portion of variance (e.g., 42% in Exp. 1) in performance across all tasks. Importantly, this relationship cannot be attributed to participants’ intrinsic motivation or skill in other visual-perceptual tasks (visual search and visual statistical learning). This paper provides novel evidence of a reliable, domain-general visual comparison ability.

Background: Medical practitioners can experience considerable stress and poor mental health during their careers, with doctors in training known to be particularly vulnerable. Previous research has documented work-related factors that may play a role in the mental health status of junior doctors. However, these and additional factors, need to be explored further by considering theory-driven, social, structural and contextual issues. This qualitative study aimed to explore the experiences of junior doctors working in Australian hospitals to identify factors that impact their mental health during medical training. Method: Semi-structured interviews were conducted with 12 junior medical officers (JMOs) employed across six hospitals in Australia. Transcribed de-identified interviews were analysed thematically using a data-driven inductive approach. Results: Four interrelated main themes were identified: i) professional hierarchies; ii) occupational stress; iii) emotional labour, and iv) taking distress home; which detail the complex affective, relational and professional experiences of JMOs. The accounts demonstrate how the social, professional and organisational dimensions of these experiences impact upon trainee’s well-being and mental health, both positively and negatively. Together, the findings document the dynamic, nuanced aspects of junior doctors’ experiences of medical training and practice and highlights the importance of relational connections and the workplace environment in shaping JMOs’ social and emotional well-being. Conclusion: The current study adds to the understanding of how junior doctors navigate medical training in Australian hospitals and highlights the complexities of this experience, particularly the ways in which mental health and well-being are shaped by different elements. These findings have important implications to inform new strategies to improve JMO mental health and to leverage work and non-work contexts to better support JMOs during m

Background: While there is a growing body of empirical studies focusing on the social and behavioral predictors of psychological health, the mechanisms that may underlie the reported associations have not been adequately explored. This study aimed to examine the association of social and lifestyle factors with psychological distress, and the potential mediating role of the lifestyle factors in the estimated associations between social circumstances and psychological distress. Methods: A total of 742 tertiary level students (53% females) from a range of socio-economic backgrounds and multiple educational institutions participated in this cross-sectional study. The 12-items General Health Questionnaire (GHQ-12) was utilized for measuring psychological distress. Data related to students’ socio-demographic characteristics, family social circumstances, and lifestyle factors were also collected. Modified Poisson regression analysis was used to estimate the risk ratios (RR) and their 95% confidence intervals (CI). Results: The multivariable regression analysis suggests heightened risks of psychological distress associated with low parental Socio-Economic Position (SEP) (RR: 1.36; 95% CI: 1.07, 1.76), childhood poverty (RR: 1.31; 95% CI: 1.11, 1.55), and living away from the family (RR: 1.28; 95% CI: 1.07, 1.54). Among the lifestyle factors, past smoking, physical inactivity, inadequate fruit intake, and poor sleep quality were strongly associated with psychological distress and these associations persisted when the family social circumstances and lifestyle factors were mutually adjusted for. The lifestyle factors did not considerably mediate the estimated associations between family social circumstances and psychological distress. Conclusion: The social and lifestyle factors operated independently to increase students’ risk of psychological distress. Accordingly, while promoting students’ healthy lifestyles may reduce the overall burden of psychological distress, any equit

Background: Women are disadvantaged by ageing: older women are more likely than older men to suffer from ill-health, have less access to health care and suffer discrimination within the health care system. Globally, there is a dearth of health research on gender and ageing with substantial knowledge gaps in low and middle-income country contexts. Part of a wider investigation on health and ageing in Fiji, our objective was to identify and describe gendered differences in healthy ageing in this Pacific Island context. We believe this to be the first such study in the Pacific region. Methods: Applying a health systems lens, we used a mixed-methods approach, encompassing analysis of cause of death data; focus group discussion to gather community and family attitudes to health services; and policy analysis, and then used data triangulation techniques to draw out key themes and insights. Results: We found that gender affects health outcomes among older persons, attitudes towards and experience of healthy ageing, and an older person’s access to and use of health services. We also found that while Fiji’s policy response to ageing has recognised the importance of gender, to-date there has been limited action to address gender differences. Gender (as oppose to sex differences) has direct and indirect implications for the health of older Fijians, while gendered inequalities and patriarchal norms appear to affect both men and women’s experience of ageing and the health system response. Further, gender and age discrimination may be intersecting, intensifying their separate effects. Conclusion: This study demonstrates the feasibility and importance of applying a gender lens to the study of healthy ageing. Our findings from Fiji may be relevant to other island nations in the south Pacific which share similar challenges of population ageing, a constrained health budget and geographically-dispersed populations. The data triangulation methodology may be considered an efficient and i

Unintended pregnancy is among the major challenges of public health and a major reproductive health issue, due to its implications on the health, economic and social life of a woman and her family mainly in low and middle-income countries, particularly sub-Saharan Africa. The study aimed to assess unintended pregnancy and associated factors among pregnant women in Ethiopia using multilevel analysis from the EDHS 2016. We used the data from the 2016 Ethiopian Demographic and Health Survey, comprised of 1122 pregnant women. The prevalence of unintended pregnancy was determined through descriptive statistics and multilevel logistic regression was performed to identify factors associated with unintended pregnancy. Variables with a p-value < 0.05 in the selected model were considered as significantly associated and an adjusted odds ratio was used to determine the strength and direction of the association. The prevalence of unintended pregnancy was 29.7% (CI 27.0%, 32.4%), of which 20.4% were mistimed and 9.3% unwanted. Being multi-para and fertility preference to have no more child were associated with a higher risk of unintended pregnancy whereas husbands' polygamy relation, having no women autonomy, and living in Afar and Somali regions showed a less likely risk of experiencing an unintended pregnancy. This study showed that the proportion of women who experienced unintended pregnancy is considerably high. Parity, fertility preference, polygamy relation, women autonomy, and region were identified factors associated with unintended pregnancy. Therefore, policymakers at all levels, reproductive health experts, and concerned organizations should emphasize minimizing unintended pregnancy targeting the regional variation at large. Researchers have to explore the regional variations through a qualitative study.

Physical or perceived (i.e. loneliness) social isolation is increasing in Western cultures. Unfortunately, social isolation is associated with a range of negative physical and mental health outcomes, including increased incidence of obesity and smoking. Here we monitored the impact of social isolation on a range of physical measures, and then tested whether social isolation in adult rats changes how reward-related stimuli motivate sucrose- or nicotine-seeking. Socially isolated rats showed elevated baseline CORT, gained significantly less weight across the study, were more active in response to a novel or familiar environment. Isolated rats also acquired nose-poking for a food pellet more rapidly, and showed increased susceptibility to cue-, but not reward-induced reinstatement. Notably, these effects are partially mitigated by a return to group housing, suggesting that they are not necessarily permanent, and that a return to a social setting can quickly reverse any deficits or changes associated with social isolation. This study advances our understanding of altered reward-processing in socially isolated individuals and reiterates the importance of socialisation in the treatment of disorders such as overeating and addiction.

Despite evidence of premature, accentuated and accelerated aging for some age-related conditions such as cardiovascular diseases in people living with HIV (PLHIV), the evidence for these abnormal patterns of aging on neurocognition remains unclear. Further, no systematic review has been dedicated to this issue. Using PRISMA guidelines, we searched standard databases (PubMed, EMBASE, CINAHL and PsycINFO). Articles were included if they analyzed and reported the effect of age on neurocognition among PLHIV as one of their major findings, if they were conducted in the combination anti-retroviral therapy era (after 1996) and published in a peer-reviewed journal in English. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) appraisal tools. To systematically target the abnormal patterns of neurocognitive aging, we define premature cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive test performance covering both the normal and abnormal performance range; accentuated cognitive aging as significant interaction effect of HIV status and age on cross-sectional neurocognitive impairment (NCI) rate, thus covering the abnormal performance range only; accelerated cognitive aging as significant interaction effect of HIV status and age on longitudinal neurocognitive test performance or incidence of NCI. Because these definitions require an age-comparable HIV-negative (HIV−) control group, when no controls were included, we determined the range of the age effect on neurocognitive test performance or NCI among PLHIV. A total of 37 studies originating from the US (26), UK (2), Italy (2), Poland (2), China (2), Japan (1), Australia (1), and Brazil (1) were included. Six studies were longitudinal and 14 included HIV- controls. The quality appraisal showed that 12/37 studies neither used an age-matched HIV- controls nor used demographically corrected cognitive scores. A meta-analysis was not possible because study

While the English literacy outcomes of Aboriginal children are constantly measured and debated, attention falls away once they leave school, leading to limited data on English literacy rates among Australia’s Aboriginal adults. This paper reports on an investigation into the prevalence of low literacy in adults in eight Aboriginal communities in NSW, Australia, drawing on both self-report data from household surveys and objective professional assessments using the Australian Core Skills Framework (ACSF). The research was conducted in partnership with a national Aboriginal organisation as part of a longitudinal study of the impact of improved adult literacy on the social determinants of health and social wellbeing. Of the participants who were measured to have low or very low English-language literacy level using ACSF, 51% had completed Year 10 or higher. This casts serious doubt on the value of school completion data which is used, for example, in Close the Gap reporting, as an accurate predictor of adult literacy rates. Results further show that while self-reported low literacy was prevalent in the population studied, there was also a significant overestimation, with adults who have completed years 10–11 nearly 30 times more likely to overestimate compared to people who only complete primary school. Given the well-known associations between adult literacy and a range of other outcomes including income, employment and health, national adult literacy surveys such as the Program for International Assessment of Adult Competencies should aim to produce more comprehensive national, regional and local data on Aboriginal adult English literacy.

The COVID-19 pandemic and the policy measures to control its spread—lockdowns, physical distancing, and social isolation—have coincided with the deterioration of people’s mental well-being. We use data from the UK Household Longitudinal Study (UKHLS) to document how this phenomenon is related to the situation of working parents who now have to manage competing time demands across the two life domains of work and home. We show that the deterioration of mental health is worse for working parents, and that it is strongly related to increased financial insecurity and time spent on childcare and home schooling. This burden is not shared equally between men and women, and between richer and poorer households. These inequalities ought to be taken into account when crafting policy responses.

Challenging parenting behavior (CPB) encompasses parental encouragement of children to push their own limits and take safe risks. Increased CPB has been associated with reduced anxiety scores in young children. This study sought to develop and evaluate a measure of CPB relevant to emerging adults (CPBQ-EA), and examine the relationship between anxiety and parenting behaviors, including; CPB, overprotection, rejection, and warmth. A sample of 442 18–25 year-olds completed self-report measures of anxiety and parenting. Exploratory factor analysis revealed three CPB domains; social, novelty, and competition. Greater social CPB was associated with lower social anxiety scores in emerging adults, but only when exhibited by fathers. Greater rejection exhibited by both parents was associated with higher emerging adult general anxiety and stress scores. These findings highlight the connection between paternal CPB and offspring social anxiety symptoms, the salience of parental rejection in emerging adult anxiety, and the importance of including fathers in parenting studies.

The kynurenine pathway (KP) of tryptophan (TRP) catabolism links immune system activation with neurotransmitter signaling. The KP metabolite kynurenic acid (KYNA) is increased in the brains of people with schizophrenia. We tested the extent to which: (1) brain KP enzyme mRNAs, (2) brain KP metabolites, and (3) plasma KP metabolites differed on the basis of elevated cytokines in schizophrenia vs. control groups and the extent to which plasma KP metabolites were associated with cognition and brain volume in patients displaying elevated peripheral cytokines. KP enzyme mRNAs and metabolites were assayed in two independent postmortem brain samples from a total of 71 patients with schizophrenia and 72 controls. Plasma KP metabolites, cognition, and brain volumes were measured in an independent cohort of 96 patients with schizophrenia and 81 healthy controls. Groups were stratified based on elevated vs. normal proinflammatory cytokine mRNA levels. In the prefrontal cortex (PFC), kynurenine (KYN)/TRP ratio, KYNA levels, and mRNA for enzymes, tryptophan dioxygenase (TDO) and kynurenine aminotransferases (KATI/II), were significantly increased in the high cytokine schizophrenia subgroup. KAT mRNAs significantly correlated with mRNA for glial fibrillary acidic protein in patients. In plasma, the high cytokine schizophrenia subgroup displayed an elevated KYN/TRP ratio, which correlated inversely with attention and dorsolateral prefrontal cortex (DLPFC) volume. This study provides further evidence for the role of inflammation in a subgroup of patients with schizophrenia and suggests a molecular mechanism through which inflammation could lead to schizophrenia. Proinflammatory cytokines may elicit conversion of TRP to KYN in the periphery and increase the N-methyl-d-aspartate receptor antagonist KYNA via increased KAT mRNA and possibly more enzyme synthesis activity in brain astrocytes, leading to DLPFC volume loss, and attention impairment in schizophrenia.

Background: The misuse of tramadol has become a major aspect of the wider substance use challenge in recent years and is evolving into a health crisis at an alarming rate. However, literature on motivations for non-medical purpose tramadol use among commercial vehicle operators remains inadequate. The aim of this study was to document the motivations for non-medical purposes tramadol use in Kumasi. Such an understanding could inform policy direction to regulate non-medical purposes tramadol use in Ghana. Methods: We conducted this exploratory qualitative study with 23 purposively selected commercial vehicle drivers (15) and assistants (8) in Kumasi, Ghana. Data for the study were collected through in-depth face-to-face interviews between June 2018 and March 2019. Using a thematic analytical approach, the interviews were coded and analysed. Results: Multiple motivations for non-medical purposes tramadol use were found including those related to: (1) sexual; (2) psychological; (3) physical; and (4) economic factors. Participants also reported three main inter-linking categories of perceived tramadol adverse effects: (1) physical; (2) psychological; and (3) social effects. Although participants indicated no plans for stopping their non-medical use of tramadol any time soon, strong willingness was voiced for supporting officials in finding and dealing with non-medical purpose tramadol sellers. Conclusion: Non-medical purposes tramadol use was associated with a confluence of factors, ranging from enhanced sexual performance to economic reasons. Based on the findings of the study and the dependence and addictive potentials of tramadol, there is the need for psychoeducational programmes for persons who misuse tramadol and enhancement of operational capacities of regulatory agencies.

This longitudinal study examined a multitude of early childhood predictors of anxiety symptoms and disorders over an 8-year period. The purpose of the study was to identify early life predictors of anxiety across childhood and early adolescence in a sample of at-risk children. The sample included 202 preschool children initially identified as behaviorally inhibited or uninhibited between the ages of 3 years 2 months and 4 years 5 months. Temperament and familial environment variables were assessed using observation and parent report at baseline. Anxiety symptoms and disorders were assessed using questionnaires and diagnostic interviews at baseline (age 4), and at age 6, 9 and 12 years. In line with our hypotheses, the findings showed that preschool children were more likely to experience anxiety symptoms and disorders over time i) when the child was inhibited, ii) when there was a history of maternal anxiety disorders or iii) when mothers displayed high levels of overinvolvement. Further, the study identified a significant interaction effect between temperament and maternal overvinvolvement such that behaviorally inhibited preschoolers had higher anxiety symptoms at age 12, only in the presence of maternal overinvolvement at age 4. The increased risk of anxiety in inhibited children was mitigated when mothers demonstrated low levels of overinvolvement at age 4. This study provides evidence of both additive and interactive effects of temperament and family environment on the development of anxiety and provides important information for the identification of families who will most likely benefit from targeted early intervention.

Previous research on psychological stress in the construction industry tends to focus on professionals working in construction organizations. The psychological stress problem among engineering design professionals (architect, structural designer, etc.) has been overlooked in the existing stress literature, despite their significant contributions to construction projects and the construction industry. Hence, the aim of this study is to: (1) identify the job stressors of engineering design professionals; (2) measure the stress level of engineering design professionals; and (3) explore the stress coping behavior of engineering design professionals. In order to achieve these research objectives, a questionnaire was distributed to engineering design professionals in Suzhou, China, in which 57 valid questionnaires were obtained. The statistical analysis results showed that the most significant job stressors of engineering design professionals are meeting project quality requirements, salary expectation, client's requirement, and fast delivery of design work. The majority of engineering design professionals in Suzhou experience a high level of stress, with over 14% of them suffering from a very high level of stress. The most popular approaches adopted by engineering design professionals to cope with stress are traveling/vacationing, exercising, and communicating with family/friends. The research findings are valuable to assess the current stress situation of engineering design professionals in China.

Background: Children from refugee backgrounds are less likely to access appropriate health and social care than non-refugee children. Our aim was to identify refugee children's health/wellbeing strengths and needs, and the barriers and enablers to accessing services while preparing for primary and secondary school, in a low socio-economic multicultural community in Australia. Method: Ten focus groups were facilitated with Arabic-speaking refugee parents of children aged 2-5 years (n = 11) or in first year secondary school (n = 22); refugee adolescents starting high school (n = 16); and key service providers to refugee families (n = 27). Vignettes about a healthy child and a child with difficulties guided the discussions. Data was thematically analysed and feedback sought from the community via the World Café method. Results: Personal resilience and strong family systems were identified as strengths. Mental health was identified as a complex primary need; and whilst refugees were aware of available services, there were issues in knowing how to access them. Opportunities for play/socialisation were recognised as unmet adolescent needs. Adults spoke of a need to support integration of "old" and "new" cultural values. Parents identified community as facilitating health knowledge transfer for new arrivals; whilst stakeholders saw this as a barrier when systems change. Most parents had not heard of early childhood services, and reported difficulty accessing child healthcare. Preschooler parents identified the family "GP" as the main source of health support; whilst parents of adolescents valued their child's school. Health communication in written (not spoken) English was a significant roadblock. Differences in refugee family and service provider perceptions were also evident. Conclusions: Refugee families face challenges to accessing services, but also have strengths that enable them to optimise their children's wellbeing. Culturally-tailored models of care embedded with

Mass migration is increasing urban populations globally. One country where urban migration is significantly increasing is Bangladesh, where systematic research will explore the reasons for urban migration in order to devise policies in this area, including maintaining the balance of urban–rural developments. This study used the Urban Health Survey (UHS) 2013 to ascertain the reasons for urban migration in large divisional cities in Bangladesh. The 2013 survey examined the differences between male and female migration, alongside any significant sociodemographic factors that might contribute to their motivation for moving to the city. The survey revealed that a majority of women (64.8%) migrated for family purposes, for example, joining husbands or in-laws, or parents/children. However, in recent years, female migrants have been involved in income-generating activities mostly due to a recent garment-making boom in Dhaka and its suburbs. A higher proportion of men (85.3%) moved to urban areas for work-related reasons: searching for new jobs, better income, or transfer in services. Among the sample in this study, 77% of the respondents (79.3% female and 73.5% male) migrated from villages. This migration mostly centered on Dhaka, the capital city of Bangladesh, where 68.1% of the total study sample migrated followed by 15.7% who went to Chittagong. The results indicate that the contemporary urban-centered economic policy in Bangladesh might require revision to accommodate the increased migrants from rural areas.

Disrupted serotonin neurotransmission has been implicated in the etiology of psychopathic traits. Empirical research has found that people with high levels of psychopathic traits have a deficit in reinforcement learning that is thought to be linked with amygdala dysfunction. Altered serotonin neurotransmission provides a plausible explanation for amygdala dysfunction in psychopathic traits and recent research suggests that this may be associated with serotonin 1B (5-HT 1B ) receptor function. This research used an animal model to test the hypothesis that 5-HT 1B receptors are involved in the encoding of the specific features of reinforcing outcomes. An outcome devaluation task was used to test the effect of the systemic administration of a selective 5-HT 1B receptor agonist administered before encoding of “action-outcome” associations. Results showed that while administration of a 5-HT 1B receptor agonist allowed rats to acquire instrumental responding for food, when the content of that learning was further probed using an outcome devaluation task, performance differed from controls. 5-HT 1B agonism impaired learning about the specific sensory qualities of food rewards associated with distinct instrumental responses, required to direct choice performance when the value of one outcome changed. These findings suggest a role for 5-HT 1B receptor function in the encoding of the specific features of reinforcing outcomes.

Psychosocial and behavioral outcomes of genetic testing in oncology are well known, however, it is unclear how these findings will generalize to more complex genomic testing. The aim of this systematic review was to assess the psychosocial and behavioral outcomes of cancer genomic testing. Studies were selected for inclusion if they were published from January 2003 to January 2017 and addressed psychological and behavioral outcomes of cancer genomic testing in adults. A review of four databases identified 9620 abstracts, with 22 publications meeting the inclusion criteria. Of the included articles, 11 studies reported on outcomes of germline testing, with three articles assessing panel testing and eight SNP testing. No studies assessed the outcomes of WGS or WES. Eleven articles assessed the outcomes of somatic testing, including testing for cancer prognosis and for personalized therapies. Studies were biased toward breast cancer and Caucasian women with high education and socioeconomic status. While studies demonstrated limited adverse psychological outcomes associated with genomic testing, a lack of consistency in psychosocial measures precluded any meta-analysis. Changes in health behavior following positive results were limited, and in some cases risk perception was not altered following genomic testing. There is limited evidence of adverse psychosocial outcomes and changes in health behavior following genomic testing to assess cancer risk. Findings from this review highlight the need for longitudinal research with superior methodological and theoretical design.

Adults with severe traumatic brain injury (TBI) often suffer poor social cognition. Social cognition is complex, requiring verbal, non-verbal, auditory, visual and affective input and integration. While damage to focal temporal and frontal areas has been implicated in disorders of social cognition after TBI, the role of white matter pathology has not been examined. In this study 17 adults with chronic, severe TBI and 17 control participants underwent structural MRI scans and Diffusion Tensor Imaging. The Awareness of Social Inference Test (TASIT) was used to assess their ability to understand emotional states, thoughts, intentions and conversational meaning in everyday exchanges. Track-based spatial statistics were used to perform voxelwise analysis of Fractional Anisotropy (FA) and Mean Diffusivity (MD) of white matter tracts associated with poor social cognitive performance. FA suggested a wide range of tracts were implicated in poor TASIT performance including tracts known to mediate, auditory localisation (planum temporale) communication between nonverbal and verbal processes in general (corpus callosum) and in memory in particular (fornix) as well as tracts and structures associated with semantics and verbal recall (left temporal lobe and hippocampus), multimodal processing and integration (thalamus, external capsule, cerebellum) and with social cognition (orbitofrontal cortex, frontopolar cortex, right temporal lobe). Even when controlling for non-social cognition, the corpus callosum, fornix, bilateral thalamus, right external capsule and right temporal lobe remained significant contributors to social cognitive performance. This study highlights the importance of loss of white matter connectivity in producing complex social information processing deficits after TBI.

This research examined the relationship between recalled challenging parenting behavior (CPB) and adult anxiety and aimed to determine the underlying latent factors involved in CPB. CPB is a novel parenting construct that involves the encouragement of children to go beyond their own limits and engage with concepts they may find scary or that destabilises them, in a playful and fun way. Participants in the current study were 386 undergraduate psychology students (M age = 19.89 years, SD = 4.6; range 17–56). Questionnaire measures of CPB, anxiety, and social anxiety were delivered to participants via an online survey. An exploratory factor analysis was conducted using Principle Axis Factoring with Oblimin rotation. This identified three latent constructs underlying adults recall of CPB during childhood; parental encouragement of social assertion (‘Social’), parental encouragement to engage in novel or new situations (‘Novelty’), and intentional teasing (‘Teasing’) CPB. Both mother and father Social and Novelty CPB was associated with lower report of adult anxiety. However, only fathers Teasing was able to predict adult anxiety.

We investigated the role of self-reports and behavioral measures of interpretation biases and their content-specificity in children with varying levels of spider fear and/or social anxiety. In total, 141 selected children from a community sample completed an interpretation bias task with scenarios that were related to either spider threat or social threat. Specific interpretation biases were found; only spider-related interpretation bias and self-reported spider fear predicted unique variance in avoidance behavior on the Behavior Avoidance Task for spiders. Likewise, only social-threat related interpretation bias and self-reported social anxiety predicted anxiety during the Social Speech Task. These findings support the hypothesis that fearful children display cognitive biases that are specific to particular fear-relevant stimuli. Clinically, this insight might be used to improve treatments for anxious children by targeting content-specific interpretation biases related to individual disorders.

Background: One of the purposes of undergraduate medical education is to assist students to consider their future career paths in medicine, alongside the needs of the societies in which they will serve. Amongst the most medically underserved groups of society are people in prison and those with a history of incarceration. In this study we examined the experiences of medical students undertaking General Practice placements in a prison health service. We used the theoretical framework of the Social Cognitive Career Theory (SCCT) to explore the potential of these placements to influence the career choices of medical students. Methods: Questionnaire and interview data were collected from final year students, comprising pre and post placement questionnaire free text responses and post placement semi-structured interviews. Data were analysed using inductive thematic analysis, with reference to concepts from the SCCT Interest Model to further develop the findings. Results: Clinical education delivered in a prison setting can provide learning that includes exposure to a wide variety of physical and mental health conditions and also has the potential to stimulate career interest in an under-served area. While students identified many challenges in the work of a prison doctor, increased confidence (SCCT- Self-Efficacy) occurred through performance success within challenging consultations and growth in a professional approach to prisoners and people with a history of incarceration. Positive expectations (SCCT- Outcome Expectations) of fulfilling personal values and social justice aims and of achieving public health outcomes, and a greater awareness of work as a prison doctor, including stereotype rejection, promoted student interest in working with people in contact with the criminal justice system. Conclusion: Placements in prison health services can stimulate student interest in working with prisoners and ex-prisoners by either consolidating pre-existing interest or expandin

Objectives: While obesity has been linked with lower quality of life in the general adult population, the prospective effects of present obesity on future quality of life amongst the elderly is unclear. This article investigates the cross-sectional and longitudinal relationships between obesity and aspects of quality of life in community-dwelling older Australians. Method: A 2-year longitudinal sample of community dwellers aged 70–90 years at baseline, derived from the Sydney Memory and Ageing Study (MAS), was chosen for the study. Of the 1037 participants in the original MAS sample, a baseline (Wave 1) sample of 926 and a 2-year follow-up (Wave 2) sample of 751 subjects were retained for these analyses. Adiposity was measured using body mass index (BMI) and waist circumference (WC). Quality of life was measured using the Assessment of Quality of Life (6 dimensions) questionnaire (AQoL-6D) as well as the Satisfaction with Life Scale (SWLS). Linear regression and analysis of covariance (ANCOVA) were used to examine linear and non-linear relationships between BMI and WC and measures of health-related quality of life (HRQoL) and satisfaction with life, adjusting for age, sex, education, asthma, osteoporosis, depression, hearing and visual impairment, mild cognitive impairment, physical activity, and general health. Where a non-linear relationship was found, established BMI or WC categories were used in ANCOVA. Results: Greater adiposity was associated with lower HRQoL but not life satisfaction. Regression modelling in cross-sectional analyses showed that higher BMI and greater WC were associated with lower scores for independent living, relationships, and pain (i.e. worse pain) on the AQoL-6D. In planned contrasts within a series of univariate analyses, obese participants scored lower in independent living and relationships, compared to normal weight and overweight participants. Longitudinal analyses found that higher baseline BMI and WC were associated with lower inde

General cognitive function is a prominent and relatively stable human trait that is associated with many important life outcomes. We combine cognitive and genetic data from the CHARGE and COGENT consortia, and UK Biobank (total N = 300,486; age 16-102) and find 148 genome-wide significant independent loci (P < 5 × 10-8) associated with general cognitive function. Within the novel genetic loci are variants associated with neurodegenerative and neurodevelopmental disorders, physical and psychiatric illnesses, and brain structure. Gene-based analyses find 709 genes associated with general cognitive function. Expression levels across the cortex are associated with general cognitive function. Using polygenic scores, up to 4.3% of variance in general cognitive function is predicted in independent samples. We detect significant genetic overlap between general cognitive function, reaction time, and many health variables including eyesight, hypertension, and longevity. In conclusion we identify novel genetic loci and pathways contributing to the heritability of general cognitive function.

Learning the causal relation between actions and their outcomes (AO learning) is critical for goal-directed behavior when actions are guided by desire for the outcome. This can be contrasted with habits that are acquired by reinforcement and primed by prevailing stimuli, in which causal learning plays no part. Recently, we demonstrated that goal-directed actions are impaired in schizophrenia; however, whether this deficit exists alongside impairments in habit or reinforcement learning is unknown. The present study distinguished deficits in causal learning from reinforcement learning in schizophrenia. We tested people with schizophrenia (SZ, n = 25) and healthy adults (HA, n = 25) in a vending machine task. Participants learned two action-outcome contingencies (e.g., push left to get a chocolate M&M, push right to get a cracker), and they also learned one contingency was degraded by delivery of noncontingent outcomes (e.g., free M&Ms), as well as changes in value by outcome devaluation. Both groups learned the best action to obtain rewards; however, SZ did not distinguish the more causal action when one AO contingency was degraded. Moreover, action selection in SZ was insensitive to changes in outcome value unless feedback was provided, and this was related to the deficit in AO learning. The failure to encode the causal relation between action and outcome in schizophrenia occurred without any apparent deficit in reinforcement learning. This implies that poor goal-directed behavior in schizophrenia cannot be explained by a more primary deficit in reward learning such as insensitivity to reward value or reward prediction errors.

Globalization has led to an increasing geospatial separation of production and consumption, and, as a consequence, to an unprecedented displacement of environmental and social impacts through international trade. A large proportion of total global impacts can be associated with trade, and the trend is rising. Advances in global multi-region input-output models have allowed researchers to draw detailed, international supply-chain connections between harmful production in social and environmental hotspots and affluent consumption in global centres of wealth. The general direction of impact displacement is from developed to developing countries - an increase of health impacts in China from air pollution linked to export production for the United States being one prominent example. The relocation of production across countries counteracts national mitigation policies and may negate ostensible achievements in decoupling impacts from economic growth. A comprehensive implementation of the United Nations Sustainable Development Goals therefore requires the inclusion of footprint indicators to avoid loopholes in national sustainability assessments.

The comparative effects on both working memory and recognition memory of the same A-weighted noise levels of background noise, typically of that present in many transportation work areas, were investigated (55 and 65 dBA). One noise was a babble, multi-talker incomprehensible speech and representative of the many work areas dealing with administrative tasks. The other noise was broadband and similar to services and machinery noise. Forty participants, half non-native English speakers, were asked to complete three different working memory tests (linguistics, grammatical reasoning and mathematics) and one recognition memory test (cued recall) in the presence of the two types of noise at the two different levels. Broadband noise at 65 dBA was found to adversely affect recall by as much as 15%. The native language advantage was only evident with the linguistic working memory task. The findings highlight the interplay between type of noise, level of noise, demand of task, and language background of the person completing the task, and also the limitations of the use of dBA alone for assessment of acceptability of a workspace.