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The awardees for the second round of the University of Oxford’s Enriching Engagement funding scheme have now been announced, including six projects from across the Medical Sciences Division.
Understanding the associations between information sources, sociodemographics, and views on public health measures: evidence from the COVID-19 pandemic in Austria
Abstract Background Throughout the COVID-19 pandemic, it was a key priority for governments globally to ensure agreement with, and subsequently adherence to, imposed public health measures, specifically non-pharmaceutical interventions (NPIs). Prior research in this regard highlighted the role of COVID-19 information sources as well as sociodemographic and other personal characteristics, however, there is only limited evidence including both. To bridge this gap, this study investigated the associations of COVID-19 information sources such as social media and participant characteristics with agreement with and adherence to NPIs during the first lockdown in Austria. Methods An online survey was conducted in May 2020 among adult Austrian residents asking about their experiences during the first lockdown. Collected data included sociodemographic characteristics, main COVID-19-related information sources, agreement with/adherence to three NPIs (no physical contact to family members not living in the same household, leisurely walks restricted to members of the same household, mandatory face masks) and information about perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS), anxiety/depression levels using the Hospital Anxiety and Depression Scale (HADS), whether participants felt well advised by the government, and whether participants perceived the pandemic to threaten their income. Ordered and multinomial logistic regression models were employed to achieve the research aims. Results The cross-sectional sample consisted of 559 Austrian residents. Using social media as main COVID-19 information source was consistently associated with lower agreement with NPIs. A positive association with agreement with measures was found for higher educational backgrounds and higher anxiety levels. By contrast, higher levels of depression, not feeling well advised by the government, and perceiving the pandemic as an economic threat were negatively associated with agreement with measures. Moreover, the use of social media as main COVID-19 information source and not feeling well advised by the government were associated with lower adherence to NPIs. By contrast, higher levels of education were associated with higher adherence. Conclusions This comprehensive analysis emphasizes the associations of COVID-19 information sources as well as sociodemographic and other participant characteristics with agreement with and adherence to NPIs, bearing important implications for future public health crisis communication strategies.
A Guide for Self-Help Guides: Best practice implementation
Guided self-help is an evidence-based intervention used globally. Internet and other forms of self-help are fundamental parts of the stepped care model of mental health services that enables the efficient use of limited resources. Despite its importance, there is no easily available, published information defining the role of the guide and the key competences required. In this context, the guide is defined as the person who facilitates and supports the use self-help materials. It is important to make the role of the guide explicit since many guides are relatively inexperienced. This article sets out the role of the guide in guided self-help. It considers practical issues such as the importance of engagement to motivate clients for early change, personalising the intervention, structuring sessions, how best to use routine outcome monitoring and supervision requirements. Key competences are proposed, including generic competences to build the relationship as well as specific competences such as being able to clearly convey the role of the guide to clients. Guides should be prepared for ‘self-help drift’, a concept akin to therapist drift in more traditional therapies. Knowing how to identify mental health problems, use supervision and manage risk and comorbidity are all key requirements for guides. The paper concludes by calling for increased recognition and value of the role of the guide within mental health services. Keywords: Low intensity, guided self-help, evidence-based, cognitive behaviour therapy, stepped care, therapist drift.
Cognitive demand modulates connectivity patterns of rostral inferior parietal cortex in cognitive control of language.
The inferior parietal cortex (IPC) is involved in different cognitive functions including language. In line with the correlated transmitter receptor-based organization of the IPC, this part of the brain is parcellated into the rostral, the middle and the caudal clusters; however, the tripartite organization of the IPC has not been addressed in studies with a focus on cognitive control of language. Using multiband EPI, in this study we investigated how the rostral IPC contributes to this executive function in bilinguals. In doing so, we focused on the functional connectivity patterns of this part of the cortex with other brain areas in a context characterized with language engagement and disengagement that recruits the neural mechanisms of cognitive control. We found that in switching to L2, which was cognitively less demanding, the right rostral IPC had positive functional connectivity with the anterior division of the cingulate gyrus and the precentral gyrus. However, in switching to L1, which was cognitively more demanding, the right IPC rostral cluster had negative functional coupling with the postcentral gyrus and the precuneus cortex and positive connectivity with the posterior lobe of the cerebellum. In this condition, the left IPC rostral cluster had negative functional coupling with the superior frontal gyrus and the precuneus cortex. Thus, the connectivity patterns of the rostral IPC was influenced by the cognitive demand in an asymmetrical and lateral manner during cognitive control of language.
Connectivity Profile of Middle Inferior Parietal Cortex Confirms the Hypothesis About Modulating Cortical Areas.
According to the correlated transmitter-receptor based structure of the inferior parietal cortex (IPC), this brain area is divided into three clusters, namely, the caudal, the middle and the rostral. Nevertheless, in associating different cognitive functions to the IPC, previous studies considered this part of the cortex as a whole and thus inconsistent results have been reported. Using multiband echo planar imaging (EPI), we investigated the connectivity profile of the middle IPC while forty-five participants performed a task requiring cognitive control. The middle IPC demonstrated functional associations which do not have similarities to a contributing part in the frontoparietal network, in processing cognitive control. At the same time, this cortical area showed negative functional connectivity with both the precuneus cortex, which is resting- state related, and brain areas related to general cognitive functions. That is, the functions of the middle IPC are not accommodated by the traditional categorization of different brain areas i.e. resting state-related or task-related networks and this advanced our hypothesis about modulating cortical areas. Such brain areas are characterized by their negative functional connectivity with parts of the cortex involved in task performance, proportional to the difficulty of the task; yet, their functional associations are inconsistent with the resting state-related cortical areas.
Dual Function of Primary Somatosensory Cortex in Cognitive Control of Language: Evidence from Resting State fMRI.
Resting state functional connectivity can be leveraged to investigate bilingual individual differences in cognitive control of language; however, thus far no report is provided on how the connectivity profiles of brain functional networks at rest point to different language control behavior in bilinguals. In order to address this gap in state-of-the-art research we did a functional connectivity analysis on the resting state data acquired via multiband EPI to investigate three resting state networks of interest namely, the frontoparietal network (FPN), the salience network (SN), and the default mode network (DMN), which are related to cognitive control, between two groups of Dutch-English bilinguals based on how they performed in a language switching task. Results demonstrated that there is the increased coupling of the left primary somatosensory cortex with the dorsolateral prefrontal cortex in the group with better performance in cognitive control of language and the increased coupling of the right primary somatosensory cortex with the inferior parietal cortex in the group with poorer performance in this executive function. As regards these results, we claim that the primary somatosensory cortex has a dual function in coupling with the dorsolateral prefrontal cortex and the inferior parietal cortex in the FPN, and in fact, in what characterizes bilingual individual differences in cognitive control of language in healthy participants. The results of this study provide a model for future research in cognitive control of language and may serve as a reference in clinical neuroscience when bilinguals are diagnosed with dysfunction in cognitive control.
Mapping caudal inferior parietal cortex supports the hypothesis about a modulating cortical area.
The cytoarchitectonically tripartite organization of the inferior parietal cortex (IPC) into the rostral, the middle and the caudal clusters has been generally ignored when associating different functions to this part of the cortex, resulting in inconsistencies about how IPC is understood. In this study, we investigated the patterns of functional connectivity of the caudal IPC in a task requiring cognitive control, using multiband EPI. This part of the cortex demonstrated functional connectivity patterns dissimilar to a cognitive control area and at the same time the caudal IPC showed negative functional associations with both task-related brain areas and the precuneus cortex, which is active during resting state. We found evidence suggesting that the traditional categorization of different brain areas into either task-related or resting state-related networks cannot accommodate the functions of the caudal IPC. This underlies the hypothesis about a new brain functional category as a modulating cortical area proposing that its involvement in task performance, in a modulating manner, is marked by deactivation in the patterns of functional associations with parts of the brain that are recognized to be involved in doing a task, proportionate to task difficulty; however, its patterns of functional connectivity in some other respects do not correspond to the resting state-related parts of the cortex.
Ethico-legal considerations in the assessment of capacity
The right of an autonomous person to make decisions about their care is central to the practice of medicine. However, we are often faced with situations where someone is unable to make those decisions because of their medical status, mental health or intellectual ability. Here we consider the legal framework for the treatment of individuals who lack the capacity to decide for themselves, and some of the ethical issues that inform how such decisions are made.
Safety outcomes following COVID-19 vaccination and infection in 5.1 million children in England.
The risk-benefit profile of COVID-19 vaccination in children remains uncertain. A self-controlled case-series study was conducted using linked data of 5.1 million children in England to compare risks of hospitalisation from vaccine safety outcomes after COVID-19 vaccination and infection. In 5-11-year-olds, we found no increased risks of adverse events 1-42 days following vaccination with BNT162b2, mRNA-1273 or ChAdOX1. In 12-17-year-olds, we estimated 3 (95%CI 0-5) and 5 (95%CI 3-6) additional cases of myocarditis per million following a first and second dose with BNT162b2, respectively. An additional 12 (95%CI 0-23) hospitalisations with epilepsy and 4 (95%CI 0-6) with demyelinating disease (in females only, mainly optic neuritis) were estimated per million following a second dose with BNT162b2. SARS-CoV-2 infection was associated with increased risks of hospitalisation from seven outcomes including multisystem inflammatory syndrome and myocarditis, but these risks were largely absent in those vaccinated prior to infection. We report a favourable safety profile of COVID-19 vaccination in under-18s.
Post-traumatic stress disorder symptoms following exposure to acute psychological trauma in children aged 8-16 years in South Africa: protocol for the Sinethemba longitudinal study
Abstract Introduction Children exposed to trauma are vulnerable to developing posttraumatic stress disorder (PTSD) and other adverse mental health outcomes. In low-and-middle-income countries (LMICs), children are at increased risk of exposure to severe trauma and co-occurring adversities. However, relative to high income countries, there is limited evidence of the factors that predict good versus poor psychological recovery following trauma exposure in LMIC children, and the role of caregiver support in these high-adversity communities. Methods and analysis We will conduct a longitudinal, observational study of 250 children aged 8-16 years and their caregivers in South Africa, following child exposure to acute trauma. Dyads will be recruited from community hospitals following a potentially traumatic event, such as a motor vehicle accident or assault. Potential participants will be identified during their hospital visit, and if they agree, will subsequently be contacted by study researchers. Assessments will take place within 4 weeks of the traumatic event, with 3-month and 6-month follow-up assessments. Participants will provide a narrative description of the traumatic event and complete questionnaires designed to give information about social and psychological risk factors. Child PTSD symptoms will be the primary outcome, and wider trauma-related mental health (depression, anxiety, behavioral problems) will be secondary outcomes. Regression-based methods will be used to examine the association of psychosocial factors in the acute phase following trauma, including caregiver support and responding, with child PTSD and wider mental health outcomes. Ethics and dissemination Ethical approvals have been granted by Stellenbosch University and the University of Bath, with additional to recruit via hospitals and healthcare clinics being granted by the University of Cape Town, the Department of Health, and the City of Cape Town. Study findings will be disseminated via publication in journals, workshops for practitioners and policymakers, and public engagement events. Strengths and Limitations • Longitudinal methods were piloted in settlement communities of Cape Town, enabling strong links to be established with proposed recruitment sites. • Focus groups have been conducted with members of the community to ensure proposed study methods and materials are culturally sensitive. • Pilot work has demonstrated excellent retention rates, however some missing data will be expected due to study participant attrition. This will be managed using multiple imputation methods during analysis. • A limited set of biological samples will be collected, including heart rate data and dried blood spot samples. This will allow a robust examination of the biological predictors of childhood PTSD whilst maximizing study acceptability.
Longitudinal alcohol-related brain changes in older adults: The Sydney Memory and Ageing Study.
Increases in harmful drinking among older adults indicate the need for a more thorough understanding of the relationship between later-life alcohol use and brain health. The current study investigated the relationships between alcohol use and progressive grey and white matter changes in older adults using longitudinal data. A total of 530 participants (aged 70 to 90 years; 46.0% male) were included. Brain outcomes assessed over 6 years included total grey and white matter volume, as well as volume of the hippocampus, thalamus, amygdala, corpus callosum, orbitofrontal cortex and insula. White matter integrity was also investigated. Average alcohol use across the study period was the main exposure of interest. Past-year binge drinking and reduction in drinking from pre-baseline were additional exposures of interest. Within the context of low-level average drinking (averaging 11.7 g per day), higher average amount of alcohol consumed was associated with less atrophy in the left (B = 7.50, pFDR = 0.010) and right (B = 5.98, pFDR = 0.004) thalamus. Past-year binge-drinking was associated with poorer white matter integrity (B = -0.013, pFDR = 0.024). Consuming alcohol more heavily in the past was associated with greater atrophy in anterior (B = -12.73, pFDR = 0.048) and posterior (B = -17.88, pFDR = 0.004) callosal volumes over time. Across alcohol exposures and neuroimaging markers, no other relationships were statistically significant. Within the context of low-level drinking, very few relationships between alcohol use and brain macrostructure were identified. Meanwhile, heavier drinking was negatively associated with white matter integrity.
A cross-sectional investigation into the role of intersectionality as a moderator of the relation between youth adversity and adolescent depression/anxiety symptoms in the community.
BACKGROUND: Adolescents exposed to adversity show higher levels of depression and anxiety, with the strongest links seen in socially/societally disadvantaged individuals (e.g., females, low socioeconomic status [SES]), as well as neurodivergent individuals. The intersection of these characteristics may be important for the differential distribution of adversity and mental health problems, though limited findings pertain to the extent to which intersectional effects moderate this association. METHODS: Combined depression/anxiety symptoms were measured using the emotional problems subscale of the Strengths and Difficulties Questionnaire in 13-14-year-olds in Cornwall, United Kingdom in 2017-2019. In a cross-sectional design (N = 11,707), multiple group structural equation modeling was used to estimate the effects of youth adversity on depression/anxiety symptoms across eight intersectionality profiles (based on gender [female/male], SES [lower/higher], and traits of hyperactivity/inattention [high/low]). Moderation effects of these characteristics and their intersections were estimated. RESULTS: Youth adversity was associated with higher levels of depression/anxiety (compared to an absence of youth adversity), across intersectional profiles. This effect was moderated by gender (stronger in males; β = 0.22 [0.11, 0.36]), and SES (stronger in higher SES; β = 0.26 [0.14,0.40]); with indications of moderation attributable to the intersection between gender and hyperactivity/inattention (β = 0.21 [-0.02,0.44]). CONCLUSIONS: Youth adversity is associated with heightened depression/anxiety across intersectional profiles in 13-14-year-olds. The stronger effects observed for males, and for higher SES, may be interpreted in terms of structural privilege. Preliminary findings suggest that vulnerability and resilience to the effects of youth adversity may partially depend on specific intersectional effects. Importantly, the current results invite further investigation in this emerging line of inquiry.
Hierarchical syntax model of music predicts theta power during music listening.
Linguistic research showed that the depth of syntactic embedding is reflected in brain theta power. Here, we test whether this also extends to non-linguistic stimuli, specifically music. We used a hierarchical model of musical syntax to continuously quantify two types of expert-annotated harmonic dependencies throughout a piece of Western classical music: prolongation and preparation. Prolongations can roughly be understood as a musical analogue to linguistic coordination between constituents that share the same function (e.g., 'pizza' and 'pasta' in 'I ate pizza and pasta'). Preparation refers to the dependency between two harmonies whereby the first implies a resolution towards the second (e.g., dominant towards tonic; similar to how the adjective implies the presence of a noun in 'I like spicy … '). Source reconstructed MEG data of sixty-five participants listening to the musical piece was then analysed. We used Bayesian Mixed Effects models to predict theta envelope in the brain, using the number of open prolongation and preparation dependencies as predictors whilst controlling for audio envelope. We observed that prolongation and preparation both carry independent and distinguishable predictive value for theta band fluctuation in key linguistic areas such as the Angular, Superior Temporal, and Heschl's Gyri, or their right-lateralised homologues, with preparation showing additional predictive value for areas associated with the reward system and prediction. Musical expertise further mediated these effects in language-related brain areas. Results show that predictions of precisely formalised music-theoretical models are reflected in the brain activity of listeners which furthers our understanding of the perception and cognition of musical structure.
Development and evaluation of neuroscience lesson content to improve Key Stage 3 (11–14 year old) students' understanding of the early years in England
The Oxford SEEN (Secondary Education around Early Neurodevelopment) project developed Key Stage 3 (11–14 year olds) science lesson content about the importance of the early years for lifelong health and evaluated its impact on students' knowledge of the neuroscience and practical application to a real-world scenario. A mixed methods approach was used collecting quantitative and qualitative data from students and staff using pre- and post-lesson surveys and focus groups. Data were analysed from 2767 students from 20 schools in England. The new curriculum successfully increased both student's scientific understanding and practical application of knowledge about neurodevelopment and the role of the caregiver. students’ mean multiple choice question scores (assessing knowledge) were higher post-lesson compared to pre-lesson; this increase was consistent across gender and year group. The post-lesson and 6–8-week follow-up scores were similar, indicating a retention in students' knowledge. Students were also asked how they would care for a 2-year-old child to promote brain development; before the lessons 89% of students provided no or a basic level answer, but after the lessons 50% of students provided detailed or advanced comments. The lessons were feasible and acceptable; both teachers and students stated the curriculum should be taught to other students. Qualitative analyses indicated that the lessons inspired the curiosity of both teachers and students and were perceived to impact on students' interaction with children in their current lives and their future career choices. The Oxford SEEN curriculum could serve as a foundation to build community-wide knowledge about the importance of the early years, with the aim of enhancing mental and physical health outcomes for future generations.
Restless legs symptoms increased during COVID-19 pandemic. International ICOSS-survey.
BACKGROUND AND OBJECTIVES: Restless legs syndrome (RLS) has been associated with anxiety, depression, insomnia, lifestyle factors and infections. We aimed to study the prevalence of symptoms of RLS during the COVID-19 pandemic versus pre-pandemic. We hypothesized that pre-existing RLS symptoms worsened and pandemic-related factors may have triggered new symptoms of RLS. METHODS: Adults (≥18 years) from fifteen countries across four continents participated in an online survey between May and August 2020. The harmonized questionnaire included a validated single question on RLS with response alternatives from 1 to 5 on a scale from never to every/almost every evening or night. Other measures were the Insomnia Severity Index (ISI), measures of symptoms of anxiety (GAD-2) and depression (PHQ-2), and questions on different pandemic-related factors. RESULTS: Altogether, 17 846 subjects (63.8 % women) were included in the final analyses. The mean age was 41.4 years (SD 16.1). During the pandemic, symptoms of RLS (≥3 evenings/nights per week) were more common 9.1 % (95 % CI 8.7-10.1) compared to 5.4 % (95 % CI 4.9-6.0) before the pandemic (P