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Alberto Cella,1 Nicola Veronese,2 Carlo Custodero,3 Alberto Castagna,4 Lisa A Cammalleri,1 Walter M Capitano,2 Luisa Solimando,2 Luca Carruba,2 Carlo Sabbà,3 Giovanni Ruotolo,4 Mario Barbagallo,2 Alberto Pilotto1,3 1Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy; 2Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy; 3Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy; 4Geriatrics Unit, “Pugliese Ciaccio” Hospital, Catanzaro, ItalyCorrespondence: Alberto Pilotto, Via delle Mura Capuccine, 14, Genova, 16128, Italy, Tel +39 010 5634400, Fax +39 010 5634400, Email alberto.pilotto@galliera.itPurpose: To screen multidimensional frailty in older people, using a comprehensive geriatric assessment (CGA) tool such as the multidimensional prognostic index (MPI), is a public health priority. Unfortunately, the screening tools available are not able to capture multidimensional frailty. In this work, we aimed to evaluate in a population of hospitalized and ambulatory older patients, the agreement between an abbreviated form of the MPI (ie, BRIEF-MPI) and the standard/full version.Participants and Methods: All participants included in the study completed both versions of the MPI, brief and full, which share the following domains: 1) basic and 2) instrumental activities of daily living, 3) mobility/risk of pressure sores, 4) cognition, 5) nutrition, 6) comorbidity, 7) social and 8) number of medications. The agreement between the two instruments was reported using either the mean comparisons with a t-test matched sample, a simple correlation analysis and the Bland–Altman methodology.Results: The study sample included 110 participants (mean age=83.2 years, 51.8% women). The mean difference was statistically and clinically irrelevant (mean difference=0.01± 0.10; p=0.27). The correlation between brief and full MPI versions was optimal (R=0.82, p< 0.0001). Using the Bland–Altman methodology, we observed that only three participants over 110 (=2.73%) were outside the limits of agreement. The accuracy of BRIEF-MPI in predicting multidimensional frailty, as full MPI> 0.66, was optimal (area under the curve=0.92, p< 0.0001). A BRIEF-MPI value of 0.59 yielded the highest sensitivity and specificity in predicting multidimensional frailty.Conclusion: BRIEF-MPI had a good agreement with the full/standard version of the MPI, making this tool as ideal for the screening of multidimensional frailty in older people.Keywords: multidimensional prognostic index, screening, frailty, agreement

Jingyuan Lin,1,* Tianyou Guo,2,* Benjamin Becker,3 Qian Yu,2 Si-Tong Chen,4 Stubbs Brendon,5 Md Mahbub Hossain,6 Paolo M Cunha,7 Fernanda Cunha Soares,8 Nicola Veronese,9 Jane Jie Yu,10 Igor Grabovac,11 Lee Smith,12 Albert Yeung,13 Liye Zou,2 Hong Li1 1Research Centre of Brain Function and Psychological Science; Center for Language and Brain, Shenzhen Institute of Neuroscience; Shenzhen Key Laboratory of Affective and Social Cognitive Science, School of Psychology, Shenzhen University, Shenzhen, 518060, People’s Republic of China; 2Exercise and Mental Health Laboratory, School of Psychology, Shenzhen University, Shenzhen 518060, People’s Republic of China; 3The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, People’s Republic of China; 4Institute for Health and Sport, Victoria University, Melbourne, VIC, 8001, Australia; 5Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK; 6Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX 77843, USA; 7Metabolism, Nutrition, and Exercise Laboratory, Londrina State University, Londrina, Paraná 86010-580, Brazil; 8Superior School of Physical Education, University of Pernambuco, Recife, PE, Brazil; 9Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo 90100, Italy; 10Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Shatin, New Territories 999077, Hong Kong; 11Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, 1090 Wien, Austria; 12The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK; 13Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA*These authors contributed equally to this workCorrespondence: Hong LiResearch Centre of Brain Function and Psychological Science; Center for Language and Brain, Shenzhen Institute of Neuroscience; Shenzhen Key Laboratory of Affective and Social Cognitive Science, School of Psychology, Shenzhen University, Shenzhen 518060, People’s Republic of ChinaEmail lihongwrm@vip.sina.comPurpose: The novel coronavirus disease (COVID-19) pandemic and associated restrictive measures have implications for depressive symptoms (henceforth depression) of young people and risk may be associated with their reduced physical activity (PA) level. Therefore, we aimed to examine the association between depressive symptoms and PA among college students with different gender and gender role (masculinity traits and femininity traits) during the COVID-19 pandemic.Participants and Methods: Cross-sectional study included 628 healthy college students from nineteen different locations. The Center for Epidemiological Studies Depression Scales (CES-D), the International Physical Activity Questionnaire - Short Form (IPAQ-SF), and the 50-item Chinese Sex-Role Inventory (CSRI-50) were used to measure depressive symptoms, PA continuous (weekly metabolic equivalent minutes, MET-minutes/week) and categorical indicators (activity level category) and gender role, respectively. The statistical analyses were used in partial correlation analysis, t-test, one-way ANOVA, moderation model tests, and linear regression model tests.Results: Total of 34.72% participants had clinically relevant depression (16, CES-D scale). Total of 58.6% participants were classified as a “low” activity level for spending less time on PA. Depression significantly negatively correlated with MET-minutes/week in moderate-intensity PA but not vigorous and walking scores. Of note, the depression-PA association was only moderated by the “low” activity level group in terms of categorical scores across gender groups. Participants with higher masculinity traits were less likely to have depression among all participants. Moreover, more recovered cases and fewer deaths could also predict the lower depression risk in the “high” activity level group.Conclusion: Moderate-intensity PA is beneficial for reducing depression risk among college students at a low activity level. College students with fewer masculinity traits (regardless of gender) are highly vulnerable to depression during the outbreak of COVID-19. Effective control of the COVID-19 pandemic seems critical to alleviating the burden of mental disorders of the public including depression.Keywords: depression, physical activity, gender, masculinity, femininity, COVID-19

Chunping Lu,1,* Xinli Chi,2,* Kaixin Liang,2 Si-Tong Chen,3 Liuyue Huang,2 Tianyou Guo,2 Can Jiao,2 Qian Yu,4 Nicola Veronese,5 Fernanda Cunha Soares,6 Igor Grabovac,7 Albert Yeung,8 Liye Zou4 1The Greater Bay Area Institute of Educational Research, Shenzhen University, Shenzhen 518060, People’s Republic of China; 2Center for Lifestyle and Mental Health, Shenzhen University, Shenzhen 518060, People’s Republic of China; 3Institute for Health and Sport, Victoria University, Melbourne 8001, Australia; 4Exercise and Mental Health Laboratory, Shenzhen University, Shenzhen 518060, People’s Republic of China; 5Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy; 6School of Physical Education, University of Pernambuco, Recife, PE, Brazil; 7Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Wien 1090, Austria; 8Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA*These authors contributed equally to this workCorrespondence: Liye ZouExercise and Mental Health Laboratory, Shenzhen University, Shenzhen 518060, People’s Republic of ChinaTel +86 188-2343-7684Email liyezou123@gmail.comPurpose: This study aimed to investigate associations of physical activity time (PAT) and sitting time (ST) independently and jointly with insomnia, depressive and anxiety symptoms among Chinese adolescents in the context of COVID-19.Methods: A cross-sectional study including 965 adolescents (mean age = 15.26, SD = 0.46) was conducted in May 2020. PAT, ST and the symptoms of insomnia, depression and anxiety were assessed with the International Physical Activity Questionnaire Short Form, the Youth Self-Rating Insomnia Scales, the 9-item Patient Health Questionnaire and the Generalized Anxiety Disorder scale via an online survey platform. Logistic regression was used to analyze the association between COVID-19-related fear, PAT, ST and combinations of PAT and ST with insomnia, depressive and anxiety symptoms.Results: COVID-19-related fear was associated with higher odds of insomnia, depressive and anxiety symptoms. PAT was associated with lower odds of insomnia and depressive symptoms, while ST was associated with higher odds of these three symptoms. After combining PAT and ST, the group with both low PAT and high ST was set as the referent. For insomnia, groups with low ST reported significantly lower odds of symptoms. For depression, groups with high PAT and/or low ST reported lower odds of symptoms. Regarding anxiety, only the group with both high PAT and low ST reported lower odds of symptoms. Generally, group with both high PAT and low ST reported lower odds of the three symptoms than the referent.Conclusion: COVID-19-related fear was a risk factor for developing insomnia, depressive and anxiety symptoms among Chinese adolescents. Fortunately, moving more and sitting less were good for sleep and mental health in Chinese adolescents during the pandemic. Educators should help adolescents to be more physically active in their daily life in the primary prevention of adolescent insomnia, depression and anxiety.Keywords: exercise, physical activity, sedentary behavior, sleep, mental health

Alberto Cella,1 Alberto Ferrari,2 Giuseppe Rengo,3 Vincenzo Solfrizzi,4 Nicola Veronese,5 Matteo Puntoni,6 Sabrina Zora,1 Alberto Pilotto,1,4 Filippo Fimognari7 On behalf of the SELFY-MPI SIGOT Investigators1Geriatric Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy; 2Geriatric Unit, Arcispedale S. Maria Nuova, AUSL Reggio Emilia, Reggio Emilia, Italy; 3Department of Translational Medical Sciences, Division of Geriatrics, Federico II University, Napoli, Italy; 4Department of Interdisciplinary Medicine, University of Bari, Bari, Italy; 5Primary Care Department, Azienda ULSS 3 Serenissima, Venice, Italy; 6Scientific Coordination Unit, EO Galliera Hospital, Genova, Italy; 7Geriatric Unit, Department of Internal Medicine, Azienda Ospedaliera di Cosenza, Cosenza, ItalyCorrespondence: Sabrina ZoraGeriatric Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, ItalyEmail sabrina.zora@galliera.itBackground: The Multidimensional Prognostic Index (MPI) is a comprehensive geriatric assessment (CGA)-based tool that has shown excellent accuracy in predicting negative health outcomes in older people. Recently, the self-administered version of MPI (SELFY-MPI) has been validated in a community-dwelling sample, revealing excellent agreement with the original MPI. In the SELFY-MPI, Gijon’s social-familial evaluation scale (SFES) was used to assess socio-relational and economic aspects. Completion of the SELFY-MPI, however, requires a significant amount of time in people aged over 60 years, particularly to fill in the SFES scale. The aim of this study was to validate, in a sample of community-dwelling older people, a short-form version of the SELFY-MPI (SELFY-MPI-SF), in which the SFES scale was replaced by the “co-habitation status” domain, as in the original version of the MPI.Methods: All participants included in the study completed both versions of the self-administered MPI, which share the following seven domains: 1) basic and 2) instrumental activities of daily living, 3) mobility, 4) cognition, 5) nutrition, 6) comorbidity, and 7) number of medications. Moreover, in the SELFY-MPI-SF, the 8th domain “co-habitation status” (ie living alone, with family or in a residential facility) replaced the SFES scale. The Bland–Altman methodology was applied in order to measure the agreement between the two instruments. Finally, the time to complete the SFES scale and the question on co-habitation was measured.Results: The final study sample was composed of 129 participants (mean age=76.8 years, range=65– 93 years, 64.3% women) were enrolled. The mean SELFY-MPI and SELFY-MPI-SF values were 0.221± 0.196 and 0.246± 0.188, respectively. The mean difference was clinically irrelevant (− 0.025± 0.058). None of the 129 observations showed values outside the established 5% limits of agreement. The agreement between SELFY-MPI and SELFY-MPI-SF was excellent (k=0.762; rho=0.924, p< 0.0001 for both). Stratified analyses of agreement among subgroups of participants of different ages did not show any significant differences between the two versions. Completion of the SFES required about 7 mins, on average, while the question on habitation status required about 10 s.Conclusion: The SELFY-MPI-SF showed strong agreement and precision when compared with the standard SELFY-MPI in people aged 65 and older and can therefore be successfully used as a quicker self-administered frailty instrument in community-dwelling older people.Keywords: comprehensive geriatric assessment, multidimensional prognostic index, frailty, self assessment

Pinar Soysal,1 Nicola Veronese,2,3 Ferhat Arik,4 Ugur Kalan,4 Lee Smith,5 Ahmet Turan Isik6 1Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey; 2National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy; 3Department of Geriatric Care, Ortho Geriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genova, Italy; 4Department of Internal Medicine, Geriatric Center, Kayseri Education and Research Hospital, Kayseri, Turkey; 5The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK; 6Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey Aim: Mini Nutritional Assessment-Short Form (MNA-SF) is used to assess nutritional status in older adults, but it is not known whether it can be used to define frailty. This study was aimed to investigate whether or not MNA-SF can identify frailty status as defined by Fried’s criteria. Methods: A total of 1,003 outpatients (aged 65 years or older) were included in the study. All patients underwent comprehensive geriatric assessment. Frailty status was evaluated by Fried’s criteria: unintentional weight loss, exhaustion, low levels of activity, weakness, and slowness. One point is assigned for each criterion, and frailty status is identified based on the number of points scored: 0 points, not frail; 1–2 points, pre-frail; ≥3 points, frail. A total score of MNA-SF 11 indicates malnutrition, risk of malnutrition, and no malnutrition, respectively. Results: Of the 1,003 outpatients (mean age 74.2±8.5 years), 313 participants (31.2%) were considered frail and 382 (38.1%) pre-frail. Among frail and pre-frail patients, 49.2% and 25.1% were at risk of malnutrition and 22.0% and 1.6% were malnourished, respectively. MNA-SF with a cut-off point of 11.0 had a sensitivity of 71.2% and a specificity of 92.8% for the detection of frail participants, and with a cut-off point of 13 had a sensitivity of 45.7% and a specificity of 78.3% for the detection of pre-frailty. The area under the curve for MNA-SF was estimated to be 0.906 and 0.687 for frailty and pre-frailty, respectively. Conclusion: MNA-SF can be useful for frailty screening in older adults. Keywords: malnutrition, frailty, nutritional status, pre-frailty

Marco Solmi,1,2 Andrea Murru,3 Isabella Pacchiarotti,3 Juan Undurraga,4,5 Nicola Veronese,2,6 Michele Fornaro,7,8 Brendon Stubbs,2,9–11 Francesco Monaco,2 Eduard Vieta,3 Mary V Seeman,12 Christoph U Correll,13,14 André F Carvalho2,15 1Neuroscience Department, University of Padua, 2Institute for Clinical Research and Education in Medicine, Padua, Italy; 3Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; 4Department of Psychiatry, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, 5Early Intervention Program, J. Horwitz Psychiatric Institute, Santiago, Chile; 6National Research Council, Ageing Section, Padua, 7Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, School of Medicine, University “Federico II”, Naples, Italy; 8New York State Psychiatric Institute, Columbia University, New York, NY, USA; 9Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 10Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, 11Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK; 12Institute of Medical Science, Toronto, ON, Canada; 13Department of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, 14Department of Psychiatry and Molecular Medicine Hempstead, Hofstra Northwell School of Medicine, Hempstead, NY, USA; 15Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil Abstract: Since the discovery of chlorpromazine (CPZ) in 1952, first-generation antipsychotics (FGAs) have revolutionized psychiatric care in terms of facilitating discharge from hospital and enabling large numbers of patients with severe mental illness (SMI) to be treated in the community. Second-generation antipsychotics (SGAs) ushered in a progressive shift from the paternalistic management of SMI symptoms to a patient-centered approach, which emphasized targets important to patients – psychosocial functioning, quality of life, and recovery. These drugs are no longer limited to specific Diagnostic and Statistical Manual of Mental Disorders (DSM) categories. Evidence indicates that SGAs show an improved safety and tolerability profile compared with FGAs. The incidence of treatment-emergent extrapyramidal side effects is lower, and there is less impairment of cognitive function and treatment-related negative symptoms. However, treatment with SGAs has been associated with a wide range of untoward effects, among which treatment-emergent weight gain and metabolic abnormalities are of notable concern. The present clinical review aims to summarize the safety and tolerability profile of selected FGAs and SGAs and to link treatment-related adverse effects to the pharmacodynamic profile of each drug. Evidence, predominantly derived from systematic reviews, meta-analyses, and clinical trials of the drugs amisulpride, aripiprazole, asenapine, brexpiprazole, cariprazine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, sertindole, ziprasidone, CPZ, haloperidol, loxapine, and perphenazine, is summarized. In addition, the safety and tolerability profiles of antipsychotics are discussed in the context of the “behavioral toxicity” conceptual framework, which considers the longitudinal course and the clinical and therapeutic consequences of treatment-emergent side effects. In SMI, SGAs with safer metabolic profiles should ideally be prescribed first. However, alongside with safety, efficacy should also be considered on a patient-tailored basis. Keywords: antipsychotics, side effects, tolerability, safety, psychosis, psychiatry

Purpose As studies examining the association between bone mineral density (BMD) and airflow limitation (AL) have produced conflicting results, the current one set out to analyze if and to what degree there are any correlations between these variables in a population of fit elderly women. Methods One hundred and twenty-one non-smoking, fit and healthy women (age [greater than or equal to] 65 years) underwent anthropometric assessment, laboratory testing (serum 25-hydroxy vitamin D, parathormone, and cytokine levels), pulmonary function testing (PFT), and dual-energy X-ray absorptiometry to evaluate BMD values of the lumbar and femoral regions. Results A significant positive association was found between FEV.sub.1/FVC ratio (Tiffeneau index), a sensitive index of AL, and lumbar and femoral BMD; a 10 % increase in the FEV.sub.1/FVC ratio resulted in a significant increase of 0.025 g/cm.sup.2 in the total hip (p = 0.05), 0.027 g/cm.sup.2 in the femoral neck (p = 0.02), 0.028 g/cm.sup.2 in the femoral trochanter (p = 0.01), and 0.047 g/cm.sup.2 in the lumbar (p = 0.03) BMDs. Binary logistic analyses demonstrated more than a threefold higher risk of low BMD values for the lowest FEV.sub.1/FVC quartile in the lumbar (OR 4.62, 95 % CI 1.48-14.40, p = 0.008), total hip (OR 4.09, 95 % CI 1.28-13.05, p = 0.02 for the second quartile), and femoral trochanter regions (OR 3.90, 95 % CI 1.25-12.20, p = 0.02 for the third quartile). Conclusions AL was associated with a higher risk of reduced BMD in healthy, fit elderly women., Author(s): Caterina Trevisan[sup.1] , A. Vianello[sup.2] , N. Veronese[sup.1] , S. Carraro[sup.1] , S. Pizzato[sup.1] , P. Lucato[sup.1] , G. Girotti[sup.1] , C. Rinaldo[sup.2] , A. Coin[sup.1] , E. Manzato[sup.1] [...]