Neurological symptoms occur in more than 90% of patients with SARS-CoV2 infection; women more frequently present subjective neurological symptoms than men

Subjective neurological symptoms frequently occur in patients with SARS-CoV2 infection. Claudio Liguori et al. Brain, Behavior, and Immunity, May 19 2020. https://doi.org/10.1016/j.bbi.2020.05.037

Highlights
• COVID-19 is a novel pathology due to SARS-CoV2 infection.
• Nervous system manifestations of SARS-CoV2 infection has been reported.
• Neurological symptoms occur in more than 90% of patients with SARS-CoV2 infection.
• Women more frequently present subjective neurological symptoms than men.

Abstract
Objective: Coronavirus disease 2019 (COVID-19) represents a novel pneumonia leading to severe acute respiratory syndrome (SARS). Recent studies documented that SARS-Coronavirus2 (SARS-CoV2), responsible for COVID-19, can affect the nervous system. The aim of the present observational study was to prospectively assess subjective neurological symptoms (sNS) in patients with SARS-CoV2 infection.

Methods: We included patients hospitalized at the University Hospital of Rome Tor Vergata, medical center dedicated to the treatment of patients with COVID-19 diagnosis, who underwent an anamnestic interview about sNS consisting of 13 items, each related to a specific symptom, requiring a dichotomized answer.

Results: We included 103 patients with SARS-CoV2 infection. Ninety-four patients (91.3%) reported at least one sNS. Sleep impairment was the most frequent symptom, followed by dysgeusia, headache, hyposmia, and depression. Women more frequently complained hyposmia, dysgeusia, dizziness, numbeness/paresthesias, daytime sleepiness, and muscle ache. Moreover, muscle ache and daytime sleepiness were more frequent in the first 2 days after admission. Conversely, sleep impairment was more frequent in patients with more than 7 days of hospitalization. In these patients we also documented higher white blood cells and lower C-reactive protein levels. These laboratory findings correlated with the occurrence of hyposmia, dysgeusia, headache, daytime sleepiness, and depression.

Conclusions: Patients with SARS-CoV2 infection frequently present with sNS. These symptoms were present from the early phases of the disease. The possibly intrinsic neurotropic properties of SARS-CoV2 may justify the very high frequency of sNS. Further studies targeted at investigating the consequences of SARS-CoV2 infection on the CNS should be planned.

Keywords: SARS-CoV2 infectionCOVID-19neurological symptomscentral nervous systemsex

7. Discussion

This observational study, carried out in 103 patients affected by SARS-CoV2 infection, documented the high prevalence of sNS during the course of the disease, even immediately after admission to the Hospital.

Although the involvement of nervous system during SARS-CoV2 infection has been extensively proposed, [10], [11], [12] few studies focused the investigation on neurological symptoms in patients with COVID-19. [4], [7] The largest study examining the neurological manifestations of hospitalized patients with COVID-19 was a retrospective analysis achieved by reviewing patients’ clinical charts.4 The authors documented a neurological manifestation in 36.4% of cases, reporting that patients with severe COVID-19 showed more nervous system symptoms than patients with the non-severe form of the infection. [4] Moreover, other reports, not centered on the neurological manifestations of COVID-19, reported the presence of few neurological symptoms in patients with SARS-CoV2 infection. [5], [6], [13], [14] However, since all these studies have a retrospective design and data were achieved by the extraction from electronic medical records, detection of slight neurological manifestations, such as sleep and wake impairment, headache, dysgeusia, hyposmia, and dizziness, could be limited HYPERLINK "SPS:refid::bib15" [15]

In the present study, we performed a prospective observation in patients with non-severe respiratory form of SARS-CoV2 by using an anamnestic interview designed to better determinate the occurrence and type of sNS over the course of the disease. Based on the prospective design of this examination, we documented a very high number of patients complaining sNS. Consistently, only 9 out of 103 patients (less than 10%) did not report sNS and more than 65% of the whole sample described three or more sNS at the interview. Namely, in the total group of patients, sleep impairment, dysgeusia, headache and hyposmia were the most frequent complained sNS. Notably, the frequency of sNS was elevated from the early phases of the disease, immediately after the admission to the hospital, remaining high also after a prolonged hospitalization. Considering the different timing of administration of the anamnestic interview in the patients included, we documented that muscle ache and daytime sleepiness were more frequent in the first two days after admission, whereas sleep impairment appeared more frequently after the 7th day of hospitalization.

Taking all the findings of this study into account, it appeared evident that patients with SARS-CoV2 frequently experienced sNS. Accordingly, during the infection, sNS seem to be present from the very early stages of the disease and in some cases prior to the hospitalization, as previously reported. [7], [16] We documented that patients may complain more than one sNS during the prolonged hospitalization and sleep impairment was the main complain in patients interviewed after the 7th day from admission. It has been already explained that hospitalization may significantly disrupt sleep, thus clinically producing insomnia symptoms[17] HYPERLINK "SPS:refid::bib17"

The mechanisms at the basis of the high frequency of neurologic complaints in patients with SARS-CoV2 infection are not completely understood and thus they are still hypothetical. [8], [18], [19] The autoptic studies performed in patients with COVID-19 documented hyperemia, oedema, and neuronal degeneration reflecting nervous system damage. [3] Therefore, the intrinsic properties of this novel coronavirus may represent possible mechanisms for affecting the nervous system. SARS-CoV2 may enter the nervous system through hematogenous or non-hematogenous routes. No study demonstrated the ability of the novel coronavirus to pass the BBB, but only singular case reports documented encephalitis due to SARS-CoV2 possibly passing the BBB by increasing its permeability through the production of cytokines or by the action of concomitant bacteria destroying it. Therefore, the non-hematogenous route of infection has been mostly hypothesized. [8], [20], [21], [22] Considering this latter route of infection, neuronal pathway represents the most suitable mechanism of infection, since it is considered an important vehicle for neurotropic viruses to enter the CNS. In the hypothetical model of CNS invasion, virus can migrate by infecting nerve endings and achieving retrograde or anterograde neuronal transport through the motor proteins, dynein and kinesins. [23] The main gate of CNS infection by neurotropic viruses is the olfactory pathway. [24] As a consequence, SARS-CoV2, as the other coronaviruses affecting the nasal mucosa, can enter the brain through the olfactory tract from the early stages of infection. [8], [25], [26] Moreover, coronaviruses can migrate from the olfactory bulb to cortex, basal ganglia, and midbrain, which are affected during their spreading. [27] This hypothesis has been confirmed in animal models by the removal of the olfactory bulb, which resulted in a restricted invasion of coronaviruses into CNS. [28] Taken together, the potential neuroinvasive propensity of SARS-CoV2 may justify the sNS complained by patients. Further possible mechanism explaining the involvement of nervous system during COVID-19 is related to ACE2 that represents the functional receptor of SARS-CoV2 and is widely expressed in multiple tissues, including the nervous system. [29], [30] Finally, the nervous system can by indirectly affected by SARS-CoV2 due to the mediated effects generated by the immune system. [31] Accordingly, this neurotropic virus can trigger the development of a systemic inflammatory response syndrome (SIRS). SIRS can be localized also in the nervous system and is mediated by activated glial cells inducing a pro-inflammatory state during the SARS-CoV2 infection. [32] As a consequence, activated glial cells release several inflammatory factors, such as interleukin (IL)-6, which is an important member of the cytokine storm. [28], [33] This inflammatory response may be responsible for sNS in patients with COVID-19. Consistently, IL-6, IL-1, and tumor necrosis factor (TNF)-α have been reported to induce symptoms such as impaired mood, anxiety, cognitive disturbances, fatigue, hyperalgesia. [34], [35], [36] We also included in the analysis the main laboratory findings used for quantifying the immune and inflammatory response, such as WBC and CRP, in order to investigate the relationship between these immune parameters and the occurrence of sNS. Significantly, the increment of CRP was evident in the first days after admission, while WBC count was higher in patients evaluated after a prolonged hospitalization. This finding may reflect the initial inflammatory response and possibly subsequent bacterial co-infection in patients with SARS-CoV2 infection. [37] In patients with more than 3 sNS the CRP tended to be higher, but the distribution of patients in the three groups cannot allow achieving the statistical significance. This point needs to be further analyzed in studies focused on the relationship between the inflammatory response and the occurrence of sNS in patients with SARS-CoV2 infection. [15]

The sex-based distribution of patients demonstrated that female patients [17] reported more frequently sNS than men. In particular, hyposmia, dysgeusia, headache, dizziness, numbness/paresthesia, daytime sleepiness, and muscle ache were more frequent in women than men. This sex-based difference can be attributed to the humoral and innate immune responses to viral infections more marked in women than men. [38], [39], [40] However, we documented higher CRP, WBC, and neutrophil cell count in men than women, which can reflect an higher immune response in men possibly driven by the occurrence of a concomitant bacterial infection leading to a more severe infection[37], [37], [41]

In this study we documented the high frequency of neurological symptoms in patients with SARS-CoV2 infection. In particular, sNS were present in patients not admitted to intensive care units and without severe pneumonia. Hence, it is conceivable that the infection per se, more than the severity of pneumonia, prolonged hospitalization, or adverse effects of the anti-COVID treatments, may affect the CNS and thus cause the neurological symptoms in patients with COVID-19. [42] To check this hypothesis, we documented the relationship between the occurrence of sNS and the alteration of the main laboratory findings reflecting the immune and inflammatory responses (CRP and WBC); however, this very [41]preliminary impression needs to be further investigated in larger studies evaluating different infection-related biomarkers, inflammatory cytokines, and WBC subsets.

8. Limitations

We are aware that this study presents some limitations. We included patients admitted to a single hospital recognized by the Government for treating patients with SARS-CoV2 infection; more information about patients confined to home isolation can be useful to mitigate the possibly negative effects of hospitalization. We performed an observational, but cross-sectional analysis, in patients at different time points during their hospitalization and a longitudinal evaluation of patients during the course of the disease can give more information about the progression of the sNS. However, the strength of this study is the homogeneous sample of patients prospectively evaluated by using an anamnestic interview centered on sNS, which were categorized for better analyzing their prevalence.

Even for severe cases of childhood maltreatment identified through court records, risk of psychopathology linked to objective measures was minimal in the absence of subjective reports

Objective and subjective experiences of child maltreatment and their relationships with psychopathology. Andrea Danese & Cathy Spatz Widom. Nature Human Behaviour, May 18 2020. https://www.nature.com/articles/s41562-020-0880-3

Abstract: Does psychopathology develop as a function of the objective or subjective experience of childhood maltreatment? To address this question, we studied a unique cohort of 1,196 children with both objective, court-documented evidence of maltreatment and subjective reports of their childhood maltreatment histories made once they reached adulthood, along with extensive psychiatric assessment. We found that, even for severe cases of childhood maltreatment identified through court records, risk of psychopathology linked to objective measures was minimal in the absence of subjective reports. In contrast, risk of psychopathology linked to subjective reports of childhood maltreatment was high, whether or not the reports were consistent with objective measures. These findings have important implications for how we study the mechanisms through which child maltreatment affects mental health and how we prevent or treat maltreatment-related psychopathology. Interventions for psychopathology associated with childhood maltreatment can benefit from deeper understanding of the subjective experience.

Like the previous study, magpies showed both social and self-directed behavior more frequently in front of the mirror versus a control cardboard stimulus; but we failed to replicate mirror self-recognition

Soler, M., Colmenero, J. M., Pérez-Contreras, T., & Peralta-Sánchez, J. M. (2020). Replication of the mirror mark test experiment in the magpie (Pica pica) does not provide evidence of self-recognition. Journal of Comparative Psychology. Advance, May 2020. https://doi.org/10.1037/com0000223

Abstract: Self-recognition in animals is demonstrated when individuals pass the mark test. Formerly, it was thought that self-recognition was restricted to humans, great apes, and certain mammals with large brains and highly evolved social cognition. However, 1 study showed that 2 out of 5 magpies (Pica pica) passed the mark test, suggesting that magpies have a similar level of cognitive abilities to great apes. The scientific advancement depends on confidence in published science, and this confidence can be reached only after rigorous replication of published studies. Here, we present a close replication of the magpie study but using a larger sample size while following a very similar experimental protocol. Like the previous study, in our experiment, magpies showed both social and self-directed behavior more frequently in front of the mirror versus a control cardboard stimulus. However, during the mark test, self-directed behavior proved more frequent in front of the cardboard than in the mirror. Thus, our replication failed to confirm the previous results. Close replications, while not disproving an earlier study, identify results that should be considered with caution. Therefore, more replication studies and additional experimental work is needed to unambiguously demonstrate that magpies are consistently able to pass the mark test. The existence of compelling evidence of self-recognition in other corvid species is discussed in depth.

HEXACO: National‐level sex differences in Emotionality are larger in wealthy and gender‐egalitarian countries, replicating previous counter‐intuitive findings

Sex Differences in HEXACO Personality Characteristics Across Countries and Ethnicities. Kibeom Lee  Michael C. Ashton. Journal of Personality, May 12 2020. https://doi.org/10.1111/jopy.12551

Abstract
Objective: We examined sex differences in the HEXACO Personality Inventory—Revised (HEXACO‐PI‐R) factor‐ and facet‐level scales and the associations of national sex differences in those scales with national characteristics such as wealth and gender equality.

Method: HEXACO‐PI‐R self‐reports were collected online from persons in 48 countries (N=347,192).

Results: (1) Women averaged substantially higher than men in Emotionality and in Honesty‐Humility, with (sample‐unweighted) mean differences across countries of d = 0.84 and d = 0.37, respectively; (2) the HEXACO‐PI‐R factor scales showed a rather large multivariate sex difference (D > 1 in most countries), about 16% larger than found in similar samples with the Big Five personality factors, (3) some facet scales belonging to the same factor showed widely varying sex differences, (4) national‐level sex differences in Emotionality are larger in wealthy and gender‐egalitarian countries, replicating previous counter‐intuitive findings, but such a tendency was not clearly observed for Honesty‐Humility, and (5) within several English‐speaking countries, sex differences in Emotionality show little ethnic variation, supporting the suggestion that societal characteristics may influence the size of sex differences in Emotionality.

Conclusion: The HEXACO model of personality structure provides some new insights in understanding sex differences in personality at the individual and national levels.

The Dark Triad traits are positively related to the deadly sins; results are similar between self- and other-report

Personality underpinnings of dark personalities: An example of Dark Triad and deadly sins. Piotr Paweł at al. Personality and Individual Differences, Volume 163, 1 September 2020, 110085. https://doi.org/10.1016/j.paid.2020.110085

Highlights
• The Dark Triad traits are positively related to the deadly sins.
• The Dark Triad and the seven deadly sins are located near Alpha-Minus.
• Results are similar between self- and other-report.

Abstract: The Dark Triad of personality is most commonly studied model of dark personality traits. The current study attempts to empirically compare the Dark Triad to other catalog of dark personality traits, namely the seven deadly sins, and locate them within the broader model of personality – the Circumplex of Personality Metatraits model. We examined this problem from two perspectives: self- (N = 280) and other-report (N = 412) using the Short Dark Triad, Vices and Virtues Scales, and the Circumplex of Personality Metatraits Questionnaire. The Dark Triad and the seven deadly sins were substantially interrelated. Moreover, both analyzed models of dark personality traits were strongly associated with Alpha-Minus (both, in self- and other-report), providing evidence about their dark character. The expected locations within the Circumplex of Personality Metatraits were generally supported, nevertheless there were some discrepancies between self- and other report. Results of our study reveals that the Dark Triad of personality does not fully exhaust the possible catalog of the dark personality and future research is needed to fill this gap.

Keywords: Dark personalityDeadly sinsDark TriadCircumplex of Personality Metatraits

Why Has the US Economy Recovered So Consistently from Every Recession in the Past 70 Years?

Why Has the US Economy Recovered So Consistently from Every Recession in the Past 70 Years? Robert E Hall and Marianna Kudlyak, April 2020. https://sites.google.com/site/mariannakudlyak/home/recovery

Abstract: It is a remarkable fact about the historical US business cycle that, after unemployment reached its peak in a recession, and a recovery began, the annual reduction in the unemployment rate was stable at around 0.55 percentage points per year. The economy seems to have had an irresistible force toward restoring full employment. There was high variation in monetary and fiscal policy, and in productivity and labor-force growth, but little variation in the rate of decline of unemployment. We explore models of the labor market's self-recovery that imply gradual working off of unemployment following a recession shock. These models explain why the recovery of market-wide unemployment is so much slower than the rate at which individual unemployed workers find new jobs. The reasons include the fact that the path that individual job-losers follow back to stable employment often includes several brief interim jobs, sometimes separated by time out of the labor force. We show that the evolution of the labor market involves more than the direct effect of persistent unemployment of job-losers from the recession shock---unemployment during the recovery is elevated for people who did not lose jobs during the recession.

Mentoring Millennials

Mentoring Millennials. Jennifer F. Waljee, Vineet Chopra, Sanjay Saint. JAMA. 2020;323(17):1716-1717, May 5, 2020, doi:10.1001/jama.2020.3085

The surgical case was straightforward: a young man had experienced a radial nerve injury from a broken humerus, now without neurological recovery. Tendon transfers to restore wrist and finger extension were planned. The surgeon, resident, and medical student approached the scrub sink together to review major teaching points, potential pitfalls, and contingency plans in case of complications. As the surgeon reached for a scrub brush, the medical student lingered back, his thumbs incessantly and rhythmically tapping on the screen of his phone. The surgeon peered at him with frustration, annoyed that again his student appeared more interested in his smartphone than the pathology. In an effort to engage him back to the case, the surgeon asked: “Can you tell me what tendons lie in each of the extensor compartments in the hand?” The student’s head snapped up, and he quickly rattled off the answer with ease. Smiling momentarily, he then asked, “Could I get your thoughts on this new video describing nerve transfers rather than tendon transfers for radial nerve injuries that was just uploaded to our educational portal? See, I have it pulled up right here, it was just presented last week at the plenary session…”

Generational diversity describes the shared perspectives and experiences among individuals born within boundaries of time, such as the silent generation (1925-1945), the baby boomers (1946-1964), and Generation X (1965-1980).1 Individuals entering medicine today were born between 1980 and 2000, termed millennials. Millennials comprise about 25% of today’s workforce and will account for 40% and 75% of the workforce in 2020 and 2025, respectively. We recognize that these assertions do not apply to every member of a particular generation. Nevertheless, the values, expectations, and ethos that define millennials are perceived as substantially different from their predecessors and have caught the attention, and concern, of older generations. This is particularly true in medicine where training, advancement, and mentorship are steeped in tradition and where change often comes slowly.

Millennials have been shaped by a profound expansion of information technology, enhanced social networking, and a connected global culture. Although sometimes labeled as impatient, distracted, overly socialized, and entitled, millennials could also be characterized as deeply empowered, collaborative, and innovative. These generalizations, however, can lead to conflict and misunderstanding, particularly in environments such as hospitals where apprenticeship and hierarchy are the norm.

Mentorship is the cornerstone of academic medicine. A mentor is defined as an advisor characterized by altruism, expertise, patience, and experience. In many ways, graduate medical education has adapted to millennials through the expansion of online and video-based learning resources, disease-based educational curricula, abbreviated work hours, and team-based care models.2 However, mentorship strategies for millennial faculty members, residents, and medical students are not well understood. Indeed, we have personally witnessed generational differences leading to frustration, miscommunication, and attrition in these mentor-mentee dyads. Consider 3 common scenarios.

Example 1. Susan is a junior faculty member drafting her career development award with her division chief, Mary, as primary mentor. Their offices are in close proximity; Susan often drops in throughout the day between Mary’s meetings to ask questions on the wording. Mary finds this irritating, as it circumvents the usual scheduling channels. Susan is annoyed that Mary seems to have little time for her.

Theme 1. As Needed vs Scheduled Engagement. Millennials have grown up with virtually instant communication and information dissemination. Such engagement facilitates quick decision making and expands collaboration networks. Millennials expect accessibility, fast responses, rapid turnaround, and frequent short meetings to ensure clear direction. Senior mentors often balance administrative, clinical, and academic demands with greater structure and less ad hoc availability. Combined, this leads to frustration and stress for both parties.

Example 2. John is a third-year medical student conducting a summer project examining the effects of mindfulness-based stress reduction techniques on cardiovascular risk in patients following myocardial infarction. He has a question about the survey data collection and sends a group email to Sam, a junior faculty member directly supervising the project, and to Mark, the chairman of the department who will serve as a senior author on the project. Mark is annoyed that Sam isn’t taking care of the question; Sam is embarrassed that John emailed the chair directly, and John is frustrated that no one appears to be answering his question.

Theme 2. Flat vs Pyramidal Infrastructure. Millennials embrace collaboration and cognitive diversity more readily than prior generations.3 In some aspects of academic medicine, these attributes will serve them well. For example, team science, multidisciplinary care, and collective leadership are welcomed by millennials who embrace groupthink, in contrast to their senior counterparts. However, flattening social and hierarchical gaps may also lead to conflict. Millennials do not necessarily embrace the siloed communication typical of traditional academic departments. Removing these barriers can cause frustration among older physicians accustomed to hierarchical communication channels and younger physicians who desire broad access to all stakeholders.

Example 3. Scott, a junior attending, has developed an intervention to improve the safety of common percutaneous cardiac procedures with Shawn, a professor in biomedical engineering. He begins to implement his intervention in practice with promising results but is counseled by his mentor, Julie, to wait and develop a clinical trial to generate a high-impact scientific paper. Scott is uninterested because he wants to move toward developing intellectual property and associated rights for the invention. Shawn and Julie are frustrated that Scott may be undermining his research potential; Scott, with the inertia of scientific investigation.

Theme 3. Purpose vs Process. For millennials, purpose is paramount. Millennials may derive greater satisfaction from results and implementation over the traditional, well-worn metrics of academic success. Such goals often include strategies that include developing intellectual property, commercialization of products, or launching a health care start-up.

These examples illustrate potential conflicts between different generations engaging in the workplace. However, these are also opportunities for greater understanding of a new generation. A keen awareness of generational mindsets and motivations can allow for more productive and rewarding mentoring relationships, and several strategies can improve intergenerational working relations. First, physicians and mentors must be cognizant of common generational misperceptions (Table). As illustrated in the examples, millennials generally desire frequent interaction, are quick to multitask, and relish the ability to connect rapidly across the globe. These connections are often brief and need not occur within a backdrop of lengthy face-to-face connections. As a result, millennials differ in skills critical to building professional relationships and may be perceived as impatient and needy, rather than efficient and engaged. Some suggestions for how best to engage millennials include:

Table.  Mentoring Millennials: Myths, Truths, and Best Practices

Micromentoring. In contrast to traditional apprenticeship mentoring models (in which relationships are built over years and encompass numerous aspects of professional life), micromentoring—similar to coaching—offers an efficient alternative.4 Early-career faculty members may seek counsel from senior mentors for defined needs over abbreviated time intervals, allowing for flexibility and cognitive diversity in mentorship. Micromentoring entails more frequent, but more rapid, meetings that often provide thumbs up or down, yes or no answers on narrow topics. For Susan and Mary (example 1), brief meetings may provide quick answers to potential roadblocks that will help Susan speed her progress. Open communication regarding scheduling limits and accessibility can also ease Mary’s frustration by reframing the interruptions as mentoring sessions.

Reverse Mentoring. To create the flat leadership structure that millennials embrace, mentorship paradigms may be upended to allow younger individuals to impart perspective, skills, and guidance to older colleagues. Reverse mentoring can fuel a sense of leadership and broader collaboration, empowering mentees in their relationships. For example, social media platforms such as Twitter or LinkedIn are powerful mechanisms for disseminating research findings and connecting with faculty and are often more easily navigated by millennials than older generations. For John, Mark, and Sam (example 2), breaking down the hierarchical communication structures that are common in academic medicine can allow for more efficient teamwork, as well as provide an opportunity for all perspectives to be shared.

Mentorship Teams. Collaborative mentorship provides a diverse perspective and helps mitigate against the isolation and competition that often permeate academia. Such teams can capitalize on the individual strengths of a variety of mentors as well as the power of cognitive diversity.5 For Scott, Julie, and Shawn (example 3), a mentorship team may provide balance in weighing the senior faculty’s interest in traditional metrics in academics against innovation. Including members from industry, policy, engineering, and quality, for example, could allow Scott to have more clinical impact in his work as well as recognition and promotion for his efforts.

Generational differences must be recognized and embraced to achieve productive mentoring relationships. Given the value of a vibrant and diverse faculty, it is essential to understand the factors that motivate or deter the next generation.6 Physicians seek purpose, collaboration, and advancement in their professional lives; millennials are no different than prior generations in this respect.7 Moreover, millennials are willing to look for opportunities elsewhere if they are not fulfilled in their position, leading to faculty attrition and high-opportunity costs in academic medicine. We hope that some of the modest changes suggested may help engage the next generation of physicians. Keeping an open mind on the use of smartphones at the scrub sink may be but one example of this approach.

Never smoking, moderate-to-high physical act'y, moderate-to-h. Mediterranean diet, healthy BMI, alcohol moderation, no binge drinking, low TV exposure, short nap, time with friends, & working ≥40 hours/w

Lifestyle-Related Factors and Total Mortality in a Mediterranean Prospective Cohort. Liz Ruiz-Estigarribia et al. American Journal of Preventive Medicine, May 16 2020. https://doi.org/10.1016/j.amepre.2020.01.032

Introduction: Lifestyle-related habits have a strong influence on morbidity and mortality worldwide. This study investigates the association between a multidimensional healthy lifestyle score and all-cause mortality risk, including in the score some less-studied lifestyle-related factors.

Methods: Participants (n=20,094) of the Seguimiento Universidad de Navarra cohort were followed up from 1999 to 2018. The analysis was conducted in 2019. A 10-point healthy lifestyle score previously associated with a lower risk of major cardiovascular events was applied, assigning 1 point to each of the following items: never smoking, moderate-to-high physical activity, moderate-to-high Mediterranean diet adherence, healthy BMI, moderate alcohol consumption, avoidance of binge drinking, low TV exposure, short afternoon nap, time spent with friends, and working ≥40 hours per week.

Results: During a median follow-up of 10.8 years, 407 deaths were documented. In the multivariable adjusted analysis, the highest category of adherence to the score (7–10 points) showed a 60% lower risk of all-cause mortality than the lowest category (0–3 points) (hazard ratio=0.40, 95% CI=0.27, 0.60, p<0.001 for trend). In analyses of the healthy lifestyle score as a continuous variable, for each additional point in the score, a 18% relatively lower risk of all-cause mortality was observed (adjusted hazard ratio=0.82, 95% CI=0.76, 0.88).

Conclusions: Adherence to a healthy lifestyle score, including some less-studied lifestyle-related factors, was longitudinally associated with a substantially lower mortality rate in a Mediterranean cohort. Comprehensive health promotion should be a public health priority.

No strong evidence for a beauty premium is found for either men or women; attractiveness positively associates with the number of fringe benefits of both men and women

Beauty Perks: Physical Appearance, Earnings, and Fringe Benefits. Maryam Dilmaghani. Economics & Human Biology, May 17 2020, 100889. https://doi.org/10.1016/j.ehb.2020.100889

Highlights
• This paper examines how attractiveness associates with earnings and fringe benefits.
• No strong evidence for a beauty premium is found for either men or women.
• Attractiveness positively associates with the number of fringe benefits of both men and women.

Abstract: While the existence of a beauty premium is documented for many labour markets, there has been no study on the association of attractiveness with fringe benefits. This is a significant limitation of the extant literature, since fringe benefits are increasingly acknowledged as an integral part of the employees’ compensation, and a main indicator of job quality. Using the Canadian General Social Survey of 2016, the present paper examines how a self-rated measure of attractiveness associates with both labour earnings and fringe benefits. Employing a rich set of controls, no evidence for a beauty premium is found for men, while there is some evidence for a beauty penalty for women. However, attractiveness is found to positively predict the number of fringe benefits of both men and women. Therefore, at equal level of earnings, more attractive individuals appear able to secure higher quality jobs, as measured by the number of fringe benefits. The results, hence, suggest that the effects of attractiveness on labour market outcomes cannot be fully captured by a separate examination of earnings and the hiring process.

Keywords: Physical AppearanceBeauty PremiumEarningsFringe Benefits

Aesthetics & morality judgments share cortical neuroarchitecture: Neural commonalities (sentimentalism & a valuation framework) are more pronounced than predominant philosophical views predict

Aesthetics and morality judgments share cortical neuroarchitecture. Nora C. Heinzelmann, Susanna C. Weber, Philippe N. Tobler. Cortex, May 15 2020. https://doi.org/10.1016/j.cortex.2020.04.018

Abstract: Philosophers have predominantly regarded morality and aesthetics judgments as fundamentally different. However, whether this claim is empirically founded has remained unclear. In a novel task, we measured brain activity of participants judging the aesthetic beauty of artwork or the moral goodness of actions depicted. To control for the content of judgments, participants assessed the age of the artworks and the speed of depicted actions. Univariate analyses revealed whole-brain corrected, content-controlled common activation for aesthetics and morality judgments in frontopolar, dorsomedial and ventrolateral prefrontal cortex. Temporoparietal cortex showed activation specific for morality judgments, occipital cortex for aesthetics judgments. Multivariate analyses revealed both common and distinct whole-brain corrected representations for morality and aesthetics judgments in temporoparietal and prefrontal regions. Overall, neural commonalities are more pronounced than predominant philosophical views would predict. They are compatible with minority accounts that stress commonalities between aesthetics and morality judgments, such as sentimentalism and a valuation framework.

Keywords: valuesmoralityaestheticsdecision-makingMVPA

Moderate amounts of media multitasking are associated with optimal task performance and minimal mind wandering

Moderate amounts of media multitasking are associated with optimal task performance and minimal mind wandering. Myoungju Shin, Astrid Linke, Eva Kemps. Computers in Human. Behavior, Volume 111, October 2020, 106422. https://doi.org/10.1016/j.chb.2020.106422

Highlights
• Media multitasking is an ever-increasing phenomenon in our daily lives.
• A moderate amount of media multitasking is associated with optimal task performance.• Moderate media multitasking is also associated with minimal mind wandering.
• These relationships are more prominent during difficult than easy tasks.

Abstract: The simultaneous engagement in more than one form of media, known as media multitasking, is an ever-increasing phenomenon in our daily lives. Previous studies have associated media multitasking with lower self-control, greater sensation seeking and inattention, which could have detrimental effects on task performance. The current study examined task performance and mind wandering of heavy, intermediate and light media multitaskers as a function of task difficulty in an n-back task. The results showed that intermediate media multitaskers performed better than heavy media multitaskers at the more difficult than easier levels of the task. The performance of heavy and light media multitaskers did not significantly differ across difficulty levels. Intermediate media multitaskers also mind wandered less than heavy media multitaskers; however, their mind wandering did not differ from that of light media multitaskers. Thus, the results indicate an inverted U-shape relationship between media multitasking, task performance and mind wandering. The findings further suggest that the association between frequent media multitasking and greater mind wandering may be due to executive function failures as a result of insufficient cognitive control and distraction.

Keywords: Media multitaskingMind wanderingN-back taskSelf-controlBoredom

Despite significant partisan splits on most issues, Democrats and Republicans converge on widespread reluctance to use smartphone contact tracing apps

Zhang, Baobao, Sarah E. Kreps, and Nina McMurry. 2020. “Americans' Perceptions of Privacy and Surveillance in the COVID-19 Pandemic.” OSF Preprints. May 13. doi:10.31219/osf.io/9wz3y

Abstract: As COVID-19 continues to spread, public health authorities have implemented or plan to implement smartphone apps to supplement traditional contact tracing. Experts suggest that at least 60% of the public would need to use these apps for them to be effective at limiting the spread of COVID-19. Yet fears that these apps would violate users' privacy by expanding governments' and tech companies' surveillance capacity may limit adoption. We study Americans' attitudes toward smartphone contact tracing apps and public health surveillance policies using a large, nationally representative survey of U.S. adults (N=2,612). We find widespread reluctance among the public: support for contact tracing apps is lower than for expanding traditional contact tracing or introducing new measures like temperature checks and centralized quarantine. Using a conjoint analysis experiment embedded in the survey, we find that privacy-preserving features, including non-location tracking and decentralized data storage, increases the public's acceptance of contact tracing apps. Within the population, those with pre-existing health conditions or who know someone who had been COVID-19 positive were more likely to support the tool, suggesting that support will grow as cases increase. Despite significant partisan splits on most issues, Democrats and Republicans converge on levels of support for contact tracing apps, suggesting that bipartisan elite cues could work to augment support. Overall, we found sizable amounts of concern about privacy and misunderstanding about the technology used. Public education campaigns are much needed before states deploy contact tracing apps.

Pressure testing your research: On the need of having a red team

Pandemic researchers — recruit your own best critics. Daniël Lakens. Nature, May 11 2020. https://www.nature.com/articles/d41586-020-01392-8
To guard against rushed and sloppy science, build pressure testing into your research.


As researchers rush to find the best ways to quell the COVID-19 crisis, they want to get results out ultra-fast. Preprints — public but unvetted studies — are getting lots of attention. But even their advocates are seeing a problem. To keep up the speed of research and reduce sloppiness, scientists must find ways to build criticism into the process.

Finding ways to prove ourselves wrong is a scientific ideal, but it is rarely scientific practice. Openness to critiques is nowhere near as widespread as researchers like to think. Scientists rarely implement procedures to receive and incorporate pushback. Most formal mechanisms are tied to the peer-review and publishing system. With preprints, the boldest peers will still criticize the work, but only after mistakes are made and, often, widely disseminated.

An initial version of a recent preprint by researchers at Stanford University in California estimated that COVID-19’s fatality rate was 0.12–0.2% (E. Bendavid et al. Preprint at medrXiv http://doi.org/dskd; 2020). This low estimate was removed from a subsequent version, but it had already received widespread attention and news coverage. Many immediately pointed out flaws in how the sample was obtained and the statistics were calculated. Everyone would have benefited if the team had received this criticism before the data were collected and the results were shared.

It is time to adopt a ‘red team’ approach in science that integrates criticism into each step of the research process. A red team is a designated ‘devil’s advocate’ charged to find holes and errors in ongoing work and to challenge dominant assumptions, with the goal of improving project quality. The team has a role similar to that of ‘white-hat hackers’ hired in the software industry to identify security flaws before they can be discovered and exploited by malefactors. Similarly, teams of scientists should engage with red teams at each phase of a research project and incorporate their criticism. The logic is similar to the Registered Report publication system — in which protocols are reviewed before the results are known — except that criticism is not organized by journals. Ideally, there is a larger amount of speedier communication between researchers and their red team than peer review allows, resulting in higher-quality preprints and submissions for publication.

Even scientists who invite criticism from a red team acknowledge that it is difficult not to become defensive. The best time for scrutiny is before you have fallen in love with your results. And the more important the claims, the more scrutiny they deserve. The scientific process needs to incorporate methods to include ‘severe’ tests that will prove us wrong when we really are wrong.

An example of a large-scale collaboration that applies a red-team approach is the Psychological Science Accelerator (PSA), a global network of more than 500 psychology laboratories. The PSA has solicited research projects on questions related to the COVID-19 pandemic and has offered to assist with data collection. Projects range from effective risk communication to cognitive-reappraisal interventions. After researchers develop protocols, the PSA assembles a red team of experts in research ethics, measurement, data analysis and the project’s field to offer criticism and to allow researchers to revise their protocols.

I reviewed one of these protocols after it had been submitted to a journal. I later saw the PSA reviews and learnt that I had repeated many criticisms, such as the generalizability of the stimulus and flexibility of the data analysis, that the red team had made — and that the researchers had opted to ignore.

This shows that assembling a red team isn’t enough: research teams need to commit to addressing criticism from the outset. Sometimes, this is straightforward — items on checklists are absent from a proposal, or an independent statistical analysis yields different results, for example. Usually, it will be less clear whether criticism merits changing a protocol or including a caveat. The key is that, when results are presented, the team transparently communicates the criticism that the red team raised. (Perhaps incorporated criticism could be listed in the methods section of a paper, and unincorporated criticism in the limitations.) This will show how severely a claim has been tested.

Pushback on each step of a research project should be recognized as valuable quality control and adherence to scientific values. Ideally, a research team could recruit their own red team from group members not immediately involved in the project.

Incentives for red teams in science deserve special consideration. A red team might identify major flaws that mean a study should not proceed, so including a team member as a co-author on a future publication by the group would be a conflict of interest. In the computer-security industry, a red team is often paid if it uncovers serious errors. Computer scientist Donald Knuth famously gave out ‘bug bounties’ to people who uncovered technical errors in his published work. (Recipients often kept the small cheques as souvenirs, suggesting that social credit works as an incentive.) To investigate incentivized criticism, my group is now recruiting red-team members and offering financial rewards (https://go.nature.com/3frPBJq).

With research moving faster than ever, scientists should invest in reducing their own bias and allowing others to transparently evaluate how much pushback their ideas have been subjected to. A scientific claim is as reliable as only the most severe criticism it has been able to withstand.

This paper examines the impact of the U.S. fracking boom on local STI transmission rates and prostitution activity as measured by online prostitution review counts

Fracking and Risky Sexual Activity. Scott Cunningham, Gregory DeAngelo, Brock Smith. Journal of Health Economics, May 15 2020, 102322. https://doi.org/10.1016/j.jhealeco.2020.102322

Abstract: This paper examines the impact of the U.S. fracking boom on local STI transmission rates and prostitution activity as measured by online prostitution review counts. We first document significant and robust positive effects on gonorrhea rates in fracking counties at the national level. But we find no evidence that fracking increases prostitution when using our national data, suggesting sex work may not be the principal mechanism linking fracking to gonorrhea growth. To explore mechanisms, we then focus on remote, high-fracking production areas that experienced large increases in sex ratios due to male in-migration. For this restricted sample we find enhanced gonorrhea transmission effects and moderate evidence of extensive margin effects on prostitution markets. This study highlights public health concerns relating to economic shocks and occupational conditions that alter the local demographic composition.

JEL classification: I12 I15 Q33 Q35

Sleepers Selectively Suppress Informative Inputs during REM: Informative speech is selectively processed over meaningless speech, & selectively suppressed during eye movements in REM

Koroma et al., Sleepers Selectively Suppress Informative Inputs during Rapid Eye Movements, Current Biology (2020), https://doi.org/10.1016/j.cub.2020.04.047

Highlights
* A neural decoder tracks speech processing in a cocktail party paradigm during sleep
* Speech is encoded in cortical activity during rapid eye movement (REM) sleep
* Informative speech is selectively processed over meaningless speech during REM sleep
* Informative speech is on the contrary selectively suppressed during eye movements within REM

SUMMARY: Sleep leads to a disconnection from the external world. Even when sleepers regain consciousness during rapid eye movement (REM) sleep, little, if any, external information is incorporated into dream content [1–3]. While gating mechanisms might be at play to avoid interference on dreaming activity [4], a total disconnection from an ever-changing environment may prevent the sleeper from promptly responding to informative events (e.g., threat signals). In fact, a whole range of neural responses to external events turns out to be preserved during REM sleep [5–9]. Thus, it remains unclear whether external inputs are either processed or, conversely, gated during REM sleep. One way to resolve this issue is to consider the specific impact of eye movements (EMs) characterizing REM sleep. EMs are a reliable predictor of reporting a dream upon awakening [10, 11], and their absence is associated with a lower arousal threshold to external stimuli [12]. We thus hypothesized that the presence of EMs would selectively prevent the processing of informative stimuli, whereas periods of REM sleep devoid of EMs would be associated with the monitoring of external signals. By reconstructing speech in a multi-talker environment from electrophysiological responses, we show that informative speech is amplified over meaningless speech during REM sleep. Yet, at the precise timing of EMs, informative speech is, on the contrary, selectively suppressed. These results demonstrate the flexible amplification and suppression of sensory information during REM sleep and reveal the impact of EMs on the selective gating of informative stimuli during sleep.

Metaanalysis: Moderate effect of prosocial modeling in eliciting subsequent helping behavior; effect was larger after witnessing the model's generosity & in studies with higher percentage of females

Jung, H., Seo, E., Han, E., Henderson, M. D., & Patall, E. A. (2020). Prosocial modeling: A meta-analytic review and synthesis. Psychological Bulletin, May 2020. https://doi.org/10.1037/bul0000235

Abstract: Exposure to prosocial models is commonly used to foster prosocial behavior in various domains of society. The aim of the current article is to apply meta-analytic techniques to synthesize several decades of research on prosocial modeling, and to examine the extent to which prosocial modeling elicits helping behavior. We also identify the theoretical and methodological variables that moderate the prosocial modeling effect. Eighty-eight studies with 25,354 participants found a moderate effect (g = 0.45) of prosocial modeling in eliciting subsequent helping behavior. The prosocial modeling effect generalized across different types of helping behaviors, different targets in need of help, and was robust to experimenter bias. Nevertheless, there was cross-societal variation in the magnitude of the modeling effect, and the magnitude of the prosocial modeling effect was larger when participants were presented with an opportunity to help the model (vs. a third-party) after witnessing the model’s generosity. The prosocial modeling effect was also larger for studies with higher percentage of female in the sample, when other people (vs. participants) benefitted from the model’s prosocial behavior, and when the model was rewarded for helping (vs. was not). We discuss the publication bias in the prosocial modeling literature, limitations of our analyses and identify avenues for future research. We end with a discussion of the theoretical and practical implications of our findings.

The meaning of meat: (Un)sustainable eating practices at home and out of home

The meaning of meat: (Un)sustainable eating practices at home and out of home. Gesa Biermann, Henrike Rau. Appetite, May 15 2020, 104730. https://doi.org/10.1016/j.appet.2020.104730

Highlights
• Our findings suggest that few people eat sustainably in all settings.
• Eating practices at home and out of home differ in their environmental impact.
• The normative and emotive expectations of eating out and eating at home diverge.
• Meat and eating out are both associated with ‘special’ and ‘treating oneself’.
• Social setting matters: cooking for others at home coincides with increased use of meat.

Abstract: Many sociological accounts of life in the 21st century include reflections on the dissolution of distinctions between the public and private sphere, aided by social media and information technology. In this paper, we argue that everyday practices around the consumption of food continue to display strong home/out-of-home divisions, especially regarding the consumption of meat and its deeply rooted social meanings. Using data from a German online survey on food preparation and consumption practices, we report and critically examine empirical evidence of significant differences between public and private food consumption. In addition to divergent meanings, we pay particular attention to environmental impacts related to the resource implications of eating in or out. For many, eating out in a restaurant means to treat oneself to something special. Cultural links between eating meat and the celebration of special occasions, the role of meat as a signifier of hospitality, and meat consumption as an expression of high social status leads to considerable resource implications for the practice of eating out and hosting guests. This, in turn, throws up interesting questions regarding the (in)effectiveness of sustainable food campaigns, many of which have hitherto ignored the distinction between public and private consumption. We conclude by arguing for strategies that connect the consumption of plant-based dishes to already established social practices such as hosting guests, barbecuing or celebrating special occasions.

Keywords: Food consumptionMeatSustainable dietSocial meaning of foodPractice theoryBehavior change

Partners’ ability to track mothers’ negative mood dropped during infancy & remained low in toddlerhood; moms' ability to track partners' positive mood dropped in infancy & recovered in toddlerhood

Understanding in transition: The influence of becoming parents on empathic accuracy. Jerica X. Bornstein, Eshkol Rafaeli, Marci E.J. Gleason. Journal of Social and Personal Relationships. May 14, 2020. https://doi.org/10.1177/0265407520924124

Abstract: Empathic accuracy (EA), the ability to understand a close other’s thoughts and feelings, is linked to relationship satisfaction. Yet, it is unclear whether stress interferes with relationship partners’ ability to be empathically accurate. The present study investigates whether a major life stressor, the transition to parenthood (TTP), interferes with EA between partners. In a daily diary study of 78 couples expecting their first child, couples reported on their own and their partners’ daily mood for 3 weeks during three separate time periods across the TTP: pregnancy, infancy, and toddlerhood. Both mothers and their partners demonstrated EA across the TTP. However, there was evidence that the transition interfered with EA: Partners’ ability to track mothers’ negative mood dropped significantly during infancy and remained low in toddlerhood, whereas mothers’ ability to track their partners’ positive mood dropped significantly in infancy and recovered in toddlerhood. This suggests that one way in which a major life stressor, in this case, the TTP, may interfere with relationship functioning is by decreasing couples’ understanding of each other’s mood states.

Keywords: Close relationships, empathic accuracy, mood states, stress, transition to parenthood

In Search of the Appeal of the “DILF”: Why women find DILFs more attractive than otherwise equally attractive men without children

In Search of the Appeal of the “DILF”. Flora Oswald, Shelby Hughes, Amanda Champion & Cory L. Pedersen. Psychology & Sexuality, May 13 2020. https://doi.org/10.1080/19419899.2020.1769164

Abstract: Contemporary culture has afforded a new sexualized identity to fatherhood. Fathers are often labeled as nurturing, dominant, and domesticated; attributes demonstrably appealing to females. Colloquially, the sexy dad has come to be referred to as “DILF” (i.e., Dad I’d Like to Fuck), a concept popularized in the media since its debut online in 2011. DILFs are increasingly searched for by women on pornography websites, evidence of an increasing sexual interest in or awareness of the DILF phenomenon. Although sometimes conceptualized as a passing colloquialism, the DILF is reflective of shifts in popular culture pertaining to media, gendered parenting, notions of masculinity, and women’s sexual expression. This unique cultural intersection merits empirically driven investigation. This study explored whether women find DILFs more attractive than otherwise equally attractive men without children. Female participants were randomly assigned to one of two possible male profile conditions of the same attractive man (with children versus without children). Overall, results revealed that women rated the male target with children as possessing more positive attributes relative to the male target without children. Follow-up analyses revealed more positive emotional attributes ascribed to the DILF target condition, whereas more positive social attributes were ascribed to the non-DILF target condition. Results are discussed in reference to the changing landscape of masculinity and fatherhood.

Keywords: fatherhood, parenting, DILF, mate choice, evolutionary psychology, Freudian theory mate selection, masculinity

Research says perceivers can accurately diagnose infection using e.g., sight, smell, but these authors find people overperceive pathogen threat in subjectively disgusting sounds

Michalak, Nicholas M., Oliver Sng, Iris Wang, and Joshua Ackerman. 2020. “Sounds of Sickness: Can People Identify Infectious Disease Using Sounds of Coughs and Sneezes?.” PsyArXiv. May 14. doi:10.1098/rspb

Abstract: Cough, cough. Is that person sick, or do they just have a throat tickle? A growing body of research suggests pathogen threats shape key aspects of human sociality. However, less research has investigated specific processes involved in pathogen threat detection. Here, we examine whether perceivers can accurately detect pathogen threats using an understudied sensory modality—sound. Participants in four studies judged whether cough and sneeze sounds were produced by people infected with a communicable disease or not. We found no evidence that participants could accurately identify the origins of these sounds. Instead, the more disgusting they perceived a sound to be, the more likely they were to judge that it came from an infected person (regardless of whether it did). Thus, unlike research indicating perceivers can accurately diagnose infection using other sensory modalities (e.g., sight, smell), we find people overperceive pathogen threat in subjectively disgusting sounds.

Heritability of affectionate communication: A twins study

Heritability of affectionate communication: A twins study. Kory Floyd, Chance York & Colter D. Ray. Communication Monographs, May 13 2020. https://doi.org/10.1080/03637751.2020.1760327

ABSTRACT: Using a twin study design, we explored the extent to which affectionate communication is a heritable behavioral trait. Participants (N = 928) were 464 adult twin pairs (229 monozygotic, 235 dizygotic) who provided data on their affectionate communication behaviors. Through ACE modeling, we determined that approximately 45% of the variance in trait expressed affectionate communication is heritable, whereas 21% of the variance in trait received affection was heritable. A bivariate Cholesky decomposition model also revealed that almost 26% of the covariation in expressed and received affection is attributable to additive genetic factors. These estimates were driven primarily by females and those 50 years of age and older. The results suggest the utility of giving greater attention to genetic and biological influences on communicative behaviors by expanding the scope of communication theory beyond consideration of only environmental influences.

KEYWORDS: Affectionate communication, genetics, twin study, ACE model, heritability, affection exchange theory

COVID-19 social distancing and sexual activity in a sample of the British Public

COVID-19 social distancing and sexual activity in a sample of the British Public. Louis Jacob et al. The Journal of Sexual Medicine, May 14 2020. https://doi.org/10.1016/j.jsxm.2020.05.001

ABSTRACT
Background: On 23rd March 2020 the UK government released self-isolation guidance to reduce the risk of transmission of SARS-Cov-2. The influence such guidance has on sexual activity is not known.

Aim: To investigate levels and correlates of sexual activity during COVID-19 self-isolation in a sample of the UK public.

Methods: This paper presents pre-planned interim analyses of data from a cross-sectional epidemiological study, administered through an online survey.

Outcomes: Sexual activity was measured using the following question: “On average after self-isolating how many times have you engaged in sexual activity weekly?” Demographic and clinical data was collected, including sex, age, marital status, employment, annual household income, region, current smoking status, current alcohol consumption, number of chronic physical conditions, number of chronic psychiatric conditions, any physical symptom experienced during self-isolation, and number of days of self-isolation. The association between several factors (independent variables) and sexual activity (dependent variable) was studied using a multivariable logistic regression model.

Results: 868 individuals were included in this study. There were 63.1% of women, and 21.8% of adults who were aged between 25 and 34 years. During self-isolation, 39.9% of the population reported engaging in sexual activity at least once per week. Variables significantly associated with sexual activity (dependent variable) were being male, a younger age, being married or in a domestic partnership, consuming alcohol, and a higher number of days of self-isolation/social distancing.

Clinical Implications: In this sample of 868 UK adults self-isolating owing to the COVID-19 pandemic the prevalence of sexual activity was lower than 40%. Those reporting particularly low levels of sexual activity included females, older adults, those not married, and those who abstain from alcohol consumption.

Strength and Limitations: This is the first study to investigate sexual activity during the UK COVID-19 self-isolation/social distancing. Participants were asked to self-report their sexual activity potentially introducing self-reporting bias into the findings. Second, analyses were cross-sectional and thus it is not possible to determine trajectories of sexual activity during the current pandemic.

Conclusion: Interventions to promote health and wellbeing during the COVID-19 pandemic should consider positive sexual health messages in mitigating the detrimental health consequences in relation to self-isolation and should target those with the lowest levels of sexual activity.

Key words: Sexual activityCOVID-19SARS-Cov-2Self-isolationUK

Discussion

In the present study in a sample of 868 individuals residing in the UK during COVID-19 self-isolation/social distancing 39.9% of the sample reported engaging in sexual activity at least once per week. Being male, a younger age, married, consuming alcohol, and a higher number of days in self-isolation/social distancing were all associated with greater sexual activity in comparison to their counter parts.

Findings from the present study for the first-time sheds light on sexual activity during COVID-19 self-isolation/social distancing among the UK public. Importantly, 60.1% of the sample studied reported to not be sexually active during self-isolation/social distancing. The promotion of consensual sexual activity among the UK adult population during self-isolation/social distancing may mitigate some of the detrimental consequences that self-isolation/social distancing may impose, particularly in relation to mental health. However, in order to do this correlates of sexual activity during self-isolation/social distancing need to be identified. The present study sheds light on this.

Indeed, the present study found that being male, a younger age, married, and consuming alcohol were all associated with greater sexual activity in comparison to their counter parts during COVID-19 self-isolation/social distancing. These findings correspond to the existing literature during non-pandemic times. [11,[19], [20], [21]] These findings suggest that interventions to promote good mental and physical health during the COVID-19 self-isolation/social distancing period should take into account positive sexual health as part of any messaging. Interventions might particularly focus on females, older adults, those not married, and those who abstain from alcohol consumption. A detailed discussion on potential strategies is beyond the scope of this paper. However, would likely include the promotion of respected websites such as [22], as well as platforms to provide advice and support in relation to sexual activity among older adult populations.

Interestingly, the present paper also found that number of days in self-isolation/social distancing was also associated with sexual activity. This may be explained by the simple fact that each day of self-isolation/social distancing would increase ones chances of engaging in sexual activity if they are sexually active or potentially sexual activity is being used for a means to ease stress and anxiety or overcome boredom which is likely to increase with increasing days of isolation. Moreover, in modern times people lead busy lives and may have little discretionary time to spend with their intimate partner. COVID-19 self-isolation may have disrupted daily activities that take time from one’s day, such as commuting to work, this time may be being spent with one’s partner allowing them to reconnect with increasing days of isolation and consequently engage in sexual activity. However, there is no literature to support these hypothesizes and future work of a qualitative nature is required.

This is the first study to investigate sexual activity during the UK COVID-19 self-isolation/social distancing. However, the study findings must be interpreted in light of its limitations. First, participants were asked to self-report their sexual activity and thus potentially introducing self-reporting bias into the findings. Second, analyses were cross-sectional and thus it is not possible to determine trajectories of sexual activity during the current pandemic.

In conclusion, in this sample of 868 UK adults self-isolating/social distancing owing to the COVID-19 pandemic those at particular risk of lower levels of sexual activity included females, older adults, those not married, and those who abstain from alcohol consumption. Interventions to promote sexual activity during the COVID-19 pandemic may mitigate some of the detrimental health consequences in relation to self-isolation and should target those with the lowest levels of sexual activity.

Toward a Multidimensional Perspective on Wisdom and Health—An Analogy With Depression Intervention and Neurobiological Research

Toward a Multidimensional Perspective on Wisdom and Health—An Analogy With Depression Intervention and Neurobiological Research. Charles F. Reynolds III, Dan G. Blazer. JAMA Psychiatry, May 13, 2020. doi:10.1001/jamapsychiatry.2020.0642

The article by Lee and colleagues1 in this issue of JAMA Psychiatry explores 3 domains or components of wisdom: prosocial relations, emotional regulation, and spirituality. The authors’ basic hypothesis is that interventions may enhance these domains of wisdom (although they found no eligible studies that addressed wisdom as an inclusive or unitary construct). Interventions ranged widely, from mindfulness to emotional intelligence training. The literature contains many approaches to measuring wisdom as reviewed by the authors.1 One helpful distinction is between theoretical wisdom (understanding the deep nature of reality and humans’ place in it) and practical wisdom (also known as phronesis: making good decisions or doing the right thing, at the right time, for the right reasons), as delineated by Jeste and colleagues in a previous article.2 Both can be measured, yet practical wisdom is perhaps more easily captured via a questionnaire than theoretical wisdom. In the current study, the authors1 combine domains characterized as practical (prosocial behavior and emotional regulation) and theoretical (spirituality). They do not include other domains, such as decisiveness and the tolerance of and ability to deal with uncertainty, because of a dearth of intervention studies in these domains.3 Therefore, the reader should focus on the 3 domains examined as components of a much larger and more complex construct of wisdom, a construct that may be beyond the boundaries of empirical exploration or at least pose considerable challenges thereto.

Regardless, the 3 components measured have been studied frequently in the extant literature, and scales have been developed that provide a foundation for intervention trials. In other words, the data from these intervention trials are fair game for this meta-analysis. However, the serious reader must take advantage of the Supplement to gain a clear understanding of the range of studies included, the scales for measuring outcome, and the approaches to intervention.1 In this spirit, we offer the following perspective and address the importance of defining wisdom as a unitary construct.

In their meta-analysis of 57 published studies, the authors1 found that interventions can enhance prosocial behaviors, emotional regulation, and spirituality. Effect sizes did not vary by component, but for prosocial behaviors and spirituality, larger effect sizes were associated with older mean ages of participants. Estimates of benefits for prosocial behavior and spirituality survived correction for publication bias, but emotional regulation did not. Forty-seven percent of studies reported a significant improvement in one component or another, while the remaining studies did not. Only 40% of studies included an active control group, while many used a waiting list or another inactive control group. The authors suggest that the modern behavioral epidemics of social isolation, loneliness, suicide, and opioid abuse point to a growing need for wisdom-enhancing interventions that promote individual and societal well-being—a behavioral vaccine, as it were.

Part of the heuristic value of the study1 is that it raises important questions. Some pertain to the construct and predictive validity of the wisdom domains analyzed, others to concurrent validity, and still others to scalability and population outcomes. Regarding construct and predictive validity, the authors acknowledge a need to assess well-being and other health-associated measures by objective means (in addition to but not in place of self-reports), such as reports by close associates and hence to determine if enhancements in components of wisdom generalize to everyday life, over longer follow-up periods, to promote individual and population well-being. With respect to concurrent validity, neurobiological assessments with appropriate comparator conditions could examine if there is specific neurocircuitry activation for specific components of wisdom. Using interventional platforms, one could investigate whether there are brain-based mechanisms that mediate improvement in wisdom and/or in its specific components. If so, one could further investigate whether targeted neurostimulation techniques selectively activate neurocircuits associated with components of wisdom, facilitating adaptation as a result of specific, learning-based interventions. This approach bears analogy to emerging research testing the ability of behavioral and neurocognitive interventions to activate specific neurocircuits that in turn relieve depressive symptoms.4 Ultimately, one would like to know if interventions can be simplified, sustained, and scaled up—by analogy with depression, for example, through the use of lay counselors or digital platforms. As with depression, it may be that different interventions better fit the needs and values of individuals depending on sociodemographic, developmental, cultural, and clinical characteristics.

Now to revisit the basic question as to whether wisdom is a unitary construct with multiple components or dimensions: Lee and colleagues1 believe this to be the case and analogize wisdom to a syndrome, that is, a condition characterized by several medical signs and symptoms that more or less consistently occur together and are associated with a common entity (ie, a latent construct). The authors’ San Diego Wisdom Scale (SD-WISE) scale measures individual components, such as prosocial behaviors (empathy and compassion), emotional regulation, and self-reflection.3 In different samples, they have found that subscales of SD-WISE measuring these components correlate with the total composite SD-WISE score, and the total score correlates in cross-sectional studies with measures of overall well-being.1 In their search for the neurobiological correlates of individual components of wisdom (or their opposite, such as with antisocial personality or impulsivity, as in the case of Phineas Gage, or in cases of frontotemporal dementia), the authors have found evidence implicating prefrontal cortex and limbic striatum.5 This is certainly plausible, if relatively nonspecific.

The study1 thus prompts us to ask also which components of wisdom are most important for health and well-being. It is plausible that a combination of wisdom components is more likely to be associated with measures of health and well-being than any individual component. Which specific components should be considered in mechanistic studies to optimize the development of interventions? Our view is that adopting a multidimensional approach to ascertain associations between wisdom and health or well-being may provide greater, more nuanced information about risk for health than the considerations of individual components alone. We suggest another analogy with depression intervention research, where a combination of interventions is often needed to achieve and sustain optimal outcomes.6 Again, it may be that, as with depression treatment or prevention, one size does not fit all. Different interventions or combinations of interventions may better fit the needs of a person depending on sociodemographic, cultural, developmental, and clinical characteristics. By this logic, no single construct (such as prosocial behavior) should automatically be conflated with wisdom as a whole. Higher levels of spirituality, for example, may rate lower in interventions to promote practical wisdom. To be effective against the current epidemics of loneliness, social isolation, opiate addiction, and suicide, a multicomponent, so-called behavioral vaccine, as well as changes in the health care delivery system (to be more collaborative and integrated) may been needed.7

We concur with the authors1 that wisdom is a complex human characteristic with a number of specific components, such as those they have delineated using Delphi methods, resulting in a mixture of pragmatic and theoretical components. More than 1 component may be needed to optimize health effects and elucidate mechanisms of action and underlying neurobiology.

As the authors1 in their wisdom readily acknowledge, the science of wisdom is still at an early stage. Like them, we anticipate that more precise answers will emerge as empirical research, grounded in theory, deepens and widens.

How do people behave when disasters strike? Popular media accounts depict panic and cruelty, but in fact, individuals often cooperate with and care for one another during crises

Catastrophe Compassion: Understanding and Extending Prosociality Under Crisis. Jamil Zaki. Trends in Cognitive Sciences, May 14 2020. https://doi.org/10.1016/j.tics.2020.05.006

ABSTRACT: How do people behave when disasters strike? Popular media accounts depict panic and cruelty, but in fact, individuals often cooperate with and care for one another during crises. I summarize evidence for such “catastrophe compassion,” discuss its roots, and consider how it might be cultivated in more mundane times.


Roots of Catastrophe Compassion

Psychologists have pinpointed a number of mechanisms that might underlie catastrophe compassion. One pertains to the powerful nature of social identity. Each of us identifies with multiple groups, for instance based on our generation, ideology, and profession , and commonly expresses loyalty, care, and prosociality towards members of our own groups .

Social identity is also malleable. You might be an Ohioan and a tuba player, but those identities will vary in salience depending on whether you’re at band practice or a Buckeyes game. Even new identities created in a lab can take on importance, and shift one’s tendency to act prosocially towards people in novel groups. Identities also tend to matter most when they contain certain characteristics, including shared goals and shared outcome s .

When disasters strike, victims might suddenly be linked in the most important de novo groups to which they’ve ever belonged. Strangers on a bus that is bombed might experience a visceral, existential sense of shared fate, and might thus quickly not be strangers any longer—but rather collaborators in a fight for their lives. As described by Drury [8], an elevated sense of shared identity is indeed common to disaster survivors, and a potent source of cooperative behavior .

A second source of catastrophe compassion is emotional connection. Empathy—sharing, understanding, and caring for others’ emotional experiences —predicts prosocial behavior across a range of settings. Consistent with this connection, a recent study found that individuals’ empathy for those affected by the COVID -19 pandemic tracked their willingness to engage in physical distancing and related protective behaviors, and that inducing empathy for vulnerable people increased intention to socially distance [9].

Emotional connection can also comprise mutual sharing of affect across people. After disclosing emotional experiences with each other, individuals tend to feel more strongly affiliated to one another. Such disclosures are also a powerful way to recruit supportive behavior in during difficult times and thus buffer individuals against stress [10]. However, individuals often avoid disclosing negative experiences —for instance because they imagine others will judge or stigmatize them—and thus miss out on the benefits of affect sharing [11].

Disasters thrust people into a situation where their suffering is obviously shared with others. This could in turn lower psychological barriers to disclosure, thus creating opportunities for deeper connection, mutual help, and community. Consistent with this idea, in the wake of the 1989 Loma Prieta earthquake, individuals frequently talked about the disaster and its effects on them for about two weeks [12]. A similar elevation in emotional conversations was found among Spaniards following a 2004 terrorist bombing in Madrid [5]. Researchers further found that that sharing one week after the attacks predicted increases in solidarity, social support, as well as decreases in loneliness, seven weeks later.


Extending Catastrophe Compassion

As Solnit [2] observes, although few people would want a disaster to befall them, many survivors look back on disasters with a surprising amount of nostalgia. Floods, bombings, and earthquakes are horrific, but in their aftermath individuals glimpse levels of community, interdependence, and altruism that are difficult to find during normal times. Then, normal times return, and often so do the boundaries that typically separate people. Might catastrophe compassion outlast catastrophes themselves, and if so, how?

Some suggestive evidence emerges from the study of individuals who endure personal forms of disaster—adverse events such as severe illness, family loss, and victimization by crime. Such adversity often generates increases in prosocial behavior, which Staub and Vollhardt [13] have termed “altruism born of suffering .” Positive effects of adversity appear to extend in time. For instance, individuals’ experience of lifetime adversity reportedly tracks their willingness to help strangers and their ability to avoid “compassion collapse ,” by maintaining empathy even in the face of numerous victims [14].