Lack of physical activity is one of the main cause of obesity. Currently, scientists proposed that teenagers and women are overweight or obese than men in Bangladesh. Furthermore, non-communicable diseases (NCDs) are becoming more prevalent in Bangladesh. By 2050, the illness burden of non-communicable diseases will have a significant impact on the health budget. To reduce non-communicable diseases, physical activity is one of the options. However, the lack of public facilities for physical (...) activities in each community is a concern. According to the Department of Military Estate Administration, Central Circle, DOHS (Defense Officers' Housing Scheme) has a total of 2966 plots and 396.6327 acres of area (640 acres =1 square mile) including 5 DOSH in Bangladesh. However, each DOHS has all the public facilities including structures streets, parks, walking paths, squares, gyms, cultural and sports grounds, walkways, waterfronts, lakes, mosques, cafeterias, public toilets, sitting areas for elderly or passersby, etc for physical activities specially for women, children, and the disabled people. Gulshan, Baridhara, Banani, and Dhanmondi areas are other good examples from Bangladesh where dwellers specially, women and children have facilities for physical activities. Sangmoo Kim, urban specialist said, “it is not over-ambitious thinking to have public facilities; it is a basic need for each city dweller for a healthy life”. This report aims to explore what are the policy drawbacks of the Government of Bangladesh not providing public facilities to perform physical activities in each area. (shrink)

An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and (...) exercise scientists recently sent a well-publicised letter to the General Medical Council and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula. The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health amongst doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020. Whilst we agree with the need to address this apparent lack of understanding, we argue that the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonably harming patients. This duty requires that doctors refrain from (i) preventing patients from undergoing beneficial treatment without good reason, (ii) exposing patients to unreasonable risks and (iii) reducing the therapeutic effect of an effective medical intervention. This requires an understanding of the physical impact of exercise. (shrink)

On 11 March 2020, the World Health Organization declared a pandemic of the COVID-19 coronavirus disease that was first recognized in China in late 2019. Among the primary effects caused by the pandemic, there was the dissemination of health preventive measures such as physical distancing, travel restrictions, self-isolation, quarantines, and facility closures. This includes the global disruption of socio-economic systems including the postponement or cancellation of various public events (e.g., sporting, cultural, or religious), supply shortages and fears of the (...) same, schools and universities closure, evacuation of foreign citizens, a rise of unemployment, changes in the international aid schemes, misinformation, and incidents of discrimination toward people affected by or suspected of having the COVID-19 disease. The pandemic has brought to the fore unpreparedness in critical areas that require attention, amid prospects and challenges. Moreover, considerable reorganization efforts are required with implications for assets, resources, norms, and value systems. COVID-19 is challenging the concept of globalization and stimulating responses at the levels of local and regional socio-economic systems that lead to the mobilization of assets that have been unrecognized earlier on, such as various forms of economic capital, social capital, cultural capital, human capital, and creative capital. For example, through digital channels, local groups are forming to create schemes of support for physical and mental wellbeing. These emerging exchanges lead to various social and technological innovations by building on skills and assets that are less important in the free-market economy, such as empathy, skills for crafts, making and fixing; locally grown microgreens; and micromanufacturing. Isolation and local living are also making it much harder to ignore the civic responsibilities towards communities, meant as individuals, vulnerable groups, and local businesses. Whilst the pandemic is limiting physical participation, this challenging time is uncovering alternative ways of mutual support, which may create long-term benefits for socio-economic systems, including environmental and biodiversity protection, reduction of the air pollution, and climate action. The pandemic’s threat to public health will hopefully be overcome with implications for disruption for an extended period that we are unable to forecast at this stage. It is key to focus on studies recognizing the activities and interventions leading to the recovery of socio-economic systems after the pandemic. Reflecting and planning on how societies and economies will go back to “business as usual” requires new forms of communication and cooperation, imaginative design thinking, new styles of management, as well as new tools and forms of participation in various public policies. Many questions related to the care of the vulnerable, economic restart, and the risk of future pandemics, to mention but a few, are already occupying the academic, scientific, experts, and activist communities, who have started to imagine the “new normal.”. (shrink)

Obesity has been described as pandemic and a public health crisis. It has been argued that concerted research efforts are needed to enhance our understanding and develop effective interventions for the complex and multiple dimensions of the health challenges posed by obesity. This would provide a secure evidence base in order to justify clinical interventions and public policy. This paper critically examines these claims through the examination of models of public health and public health ethics. I argue that the concept (...) of an effective public health intervention is unclear and underdeveloped and, as a consequence, normative frameworks reliant on meeting the effectiveness criterion may miss morally salient dimensions of the problems. I conclude by arguing for the need to consider both an ecological model of public health and inclusion of a critical public health ethics perspective for an adequate account of the public health challenges posed by obesity. (shrink)

ObjectivesThe aims of this research were to compare the levels of physical activity of eHealth users and non-users, to determine the effects of these technologies on motivations, and to establish the relationship that could exist between psychological constructs and physical activity behaviors.MethodsThis cross-sectional study involved 569 adults who responded to an online questionnaire during confinement in France. The questions assessed demographics, usage of eHealth for exercise and physical activity, and behavioral levels. The questionnaire also measured the constructs (...) of Social Cognitive Theory, the Theory of Planned Behavior, and automaticity facets toward eHealth for exercise and physical activity.ResultsParticipants who were users of eHealth for exercise and physical activity presented significantly higher levels of vigorous physical activity and total physical activity per week than non-users. The chi-square test showed significant interactions between psychological constructs toward eHealth and physical activity levels. Self-efficacy was significantly and negatively correlated with walking time per week. Concerning the automaticity facets, efficiency was positive and significantly correlated with vigorous physical activity levels per week. Then, regressions analyses showed that self-efficacy and automaticity efficiency explained 5% of the variance of walking minutes per week and vigorous physical activity per week, respectively.ConclusionThis study has shown that people during confinement looked for ways to stay active through eHealth. However, we must put any technological solution into perspective. The eHealth offers possibilities to stay active, however its benefits and the psychological mechanisms affected by it remains to be demonstrated: eHealth could be adapted to each person and context. (shrink)

A major concern of public health authorities is to also encourage adults to be exposed to enriched environments during the pandemic lockdown, as was recently the case worldwide during the COVID-19 outbreak. Games for adults that require physical activity, known as exergames, offer opportunities here. In particular, the output of the gaming industry nowadays offers computer games with extended reality which combines real and virtual environments and refers to human-machine interactions generated by computers and wearable technologies. For example, playing (...) the game in front of a computer screen while standing or walking on a force plate or treadmill allows the user to react to certain infrastructural changes and obstacles within the virtual environment. Recent developments, optimization, and minimizations in wearable technology have produced wireless headsets and sensors that allow for unrestricted whole-body movement. This makes the virtual experience more immersive and provides the opportunity for greater engagement than traditional exercise. Currently, XR serves as an umbrella term for current immersive technologies as well as future realities that enhance the experience with features that produce new controllable environments. Overall, these technology-enhanced exergames challenge the adult user and modify the experience by increasing sensory stimulation and creating an environment where virtual and real elements interact. As a therapy, exergames can potentially create new environments and visualizations that may be more ecologically valid and thus simulate real activities of daily living that can be trained. Furthermore, by adding telemedicine features to the exergame, progress over time can be closely monitored and feedback provided, offering future opportunities for cognitive-motor assessment. To more optimally serve and challenge adults both physically and cognitively over time in future lockdowns, there is a need to provide long-term remote training and feedback. Particularly related to activities of daily living that create opportunities for effective and lasting rehabilitation for elderly and sufferers from chronic non-communicable diseases. The aim of the current review is to envision the remote training and monitoring of physical and cognitive aspects for adults with limited mobility, through the implementation of concurrent telehealth and exergame features using XR and wireless sensor technologies. (shrink)

Non-communicable diseases disproportionately affect low and middle-income countries where nearly three quarters of NCD deaths occur. Bangladesh is also in NCD burden. This cross-sectional study was done on 50 health facilities centres at Gazipur district in Bangladesh from July 2015 to December 2015 to introduce SARA for better monitoring and evaluation of non-communicable diseases health service delivery. The General Service readiness index score was 61.52% refers to the fact that about 62% of all the facilities were (...) ready to provide general services like basic amenities, basic equipment, standard precautions for infection prevention, and diagnostic capacity and essential medicines to the patients. But in case of non-communicable diseases, among all the health facilities 40% had chronic respiratory disease and cardiovascular diseases diagnosis/ management and only 32% had availability of diabetes diagnosis/management. Overall readiness score was 52% in chronic respiratory disease, 73% in cardiovascular disease and 70% in diabetes. Therefore, service availability and readiness of the health facilities to provide NCD related health services were not up to the mark for facing future targets. A full-scale census survey of all the facilities of the study area would give a better understanding of the availability and service readiness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:On Concepts and Theories of AddictionLennart Nordenfelt (bio)Keywordsaddiction, disease, will power, autonomy, holistic view of healthThe article "A Liberal Account of Addiction" is a good piece of analytic philosophy applied to psychiatry. It is well-informed both with regard to empirical matters and philosophical conceptualization. The arguments are often—but, as I will show, not always—quite convincing. The conclusions of the paper also have crucial consequences for practice, for the treatment (...) of patients, and for social policy.The authors argue that current scientific understandings of the problem of addiction are fundamentally flawed. They distinguish between two main positions in science: The Disease View and the Willpower View. According to the Disease View, drug-seeking behavior is the direct result of some physiological change in the drug seeker's brain. According to the Willpower View, the addict is no longer rational; he or she uses drugs as a result of a fundamentally non-voluntary process.The authors dismiss the Disease View in the following way. They first note that drug addicts are in many ways rational planners. The addicts may have to think a lot to find the best ways to find the heroin, cigarettes, or alcohol, and they normally act according to this planning. They are not in any simple sense "caused" to act in a particular way. Moreover, referring to recent neurological literature, the authors note that the changes caused by drug addiction—which have to do with activating reward pathways in the brain—are identical with the outcomes of many other human activities that we do not call addiction. "In fact, any pleasurable experience causes dopamine to be released within the brain, activating these reward pathways" (Foddy and Savulescu 2010, 4). These experiences can be the result of coffee drinking, sexual activity, and physical exercise. Thus, the physical changes in the brain are not effects peculiar to the pharmacology of the drugs; they are instead the effects of the pleasure that the subject has experienced.The argument against the Willpower View is lengthy and more involved. The proponent of the Willpower View must argue that there is some flaw in the subject's autonomy. The drug addict is in some sense unable to avoid taking the drug. The authors of the present article scrutinize this idea on the basis of distinguishing between different senses of autonomy: Substantive autonomy and procedural autonomy. They state that we must here be talking about procedural autonomy, namely, autonomy regarded as dependent only on our capacity to process information and make choices in accordance with our preferences. We cannot, as in the case of substantive autonomy, require that the preferences themselves be reasonable. [End Page 27] In such a case, many of our ordinary actions would be judged non-autonomous.The most reasonable Willpower accounts rely on the idea that addicted people in some sense lack self-control. The authors cite different interpretations of the concept of lacking self- control and they conclude that "none of these … theories can say that addicts are necessarily lacking in self-control unless they also make unreasonable normative or false factual claims about the nature of drug- or pleasure-oriented choices" (Foddy and Savulescu 2010, 10). For instance, according to one interpretation the subject does not endorse his own desire for drugs, but takes the drug anyway. According to another interpretation, the addict regrets taking the drug after having done so. Against such claims the authors claim that many addicts indeed endorse their desires for drugs and many addicts do not regret their addictive behavior.So what is the positive account proposed by the authors? They put forward what they call a Liberal View. It contains three claims about addiction: First, we do not know whether an addict values anything more than the satisfaction of his addictive desires; second, we do not know whether an addict behaves autonomously when he uses drugs; and third, addictive desires are just strong regular desires.According to the Liberal View, one has to accept that the addicts may have drug taking as their highest priority and that they do not have any reduced procedural autonomy. The authors say: "Once we abandon normative bias, we must accept... (shrink)

In spite of laws in many states regulating the nutritional content of foods and the availability of “junk food” and soda, a 2001 Surgeon General’s Report indicated that 15% to 20% of the nation’s children are overweight or obese. In areas that are predominately Hispanic and African American, the numbers rise to between 40% and 50%. Although there are continuing efforts to educate the adult population, many school systems and public health jurisdictions have had little impact on the rising numbers (...) of overweight and obese children. This session described the process of initiating a student-based, student driven approach to obesity, junk food, and diabetes and disease prevention.A need existed for a grassroots approach at the student level to raise awareness of increasing obesity rates and diabetes and other related diseases in the adolescent population. (shrink)

The Infectious Diseases Act entered into force officially on 14 November 2018 in Bangladesh. The Act is designed to raise awareness of, prevent, control, and eradicate infectious or communicable diseases to address public health emergencies and reduce health risks. A novel coronavirus disease was first identified in Bangladesh on 8 March 2020, and the Ministry of Health and Family Welfare issued a gazette on 23 March, listing COVID-19 as an infectious disease and addressing COVID-19 as a public (...) health emergency. The gazette empowers the government to monitor the spread of infection. Despite there being an infrastructure of research ethics committees in almost all hospitals in Bangladesh, a lack of such committees in the clinical setting often forces healthcare professionals to allocate scarce healthcare resources to the task. These personnel are often either influenced by materialistic matters or guided by the emergency policies, without reaching a consensus on how to allocate scarce resources in times of need, especially in the time of the COVID-19 pandemic. Ethical dilemmas often arise when a number of patients with COVID-19, especially in poor and middle-class areas, are denied care while elites are prioritized to receive such scarce resources. Resource allocation in healthcare during the COVID-19 pandemic in Bangladesh appears to be unethical and in direct conflict with the biomedical principles of non-maleficence and procedural justice. The findings of this study suggest that the Act needs substantive changes in the stipulation of policy directing hospitals in the provision of resource allocation framework. Furthermore, parliament should produce guidance outlining how to successfully implement the law with the aim of protecting public health in times of emergency, especially the COVID-19 pandemic. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Calling Obesity a Disease Is A Terrible DecisionMoose FinklesteinFactsThe medical world struggles to see the difference between health and body weight. It is still mostly combined with the strong belief that there is no way a fat person can be fit and healthy. Despite repeated studies and work to show differently, this prejudice remains. This has become part of what I call “Everyone Knows” pseudoscience, where data that have (...) no scientific basis become “fact” due to constant repetition.Obesity is already the cause of great stigma in our society. Fat people are considered “ugly,” fat jokes are acceptable in everyday life, and being called ‘fat’ is, to many, as big an insult as a racial slur. Fat prejudice can approach the levels of racial prejudice (Puhl, Andreyevea & Brownell, 2008). Fat children are bullied, sometimes to the point of suicide. Some studies have found children as young as five trying to diet for being fat, no matter their actual weight. Fat people are more likely to be unemployed or underemployed, and there are prejudicial beliefs that fat workers are more problematic, despite research saying otherwise (Roehling, Roehling, & Odland, 2008).Obesity is seen by the masses as something people choose. However, science disagrees. There has long been a link between depression and obesity. Mental health is tightly tied to obesity, where those who experience weight discrimination are more likely to gain weight, although unhealthy behaviours such as binge eating and exercise avoidance are sometimes seen as a coping mechanism (Sutin & Teracciano, 2013).It has been reported in a number of journals that 90–95% of the people who lose weight regain the weight within 10 years (Mann et al., 2007; Miller, 1999). “Everyone Knows” claims that this is because people go back to bad habits. Science, however, says that there are complex ways the body wants to regain the weight (Sumithran & Proietto, 2013; Sumithran et al., 2011). Worse, dieting may contribute to obesity. Adolescent girls who diet are at 324% greater risk for obesity than those who do not diet (Stice, Cameron, R. P., Killen, J. D., Hayward, C. & Taylor, C. B. 1999). Weight loss dieting may cause other health problems as well, such as immune system problems (Shade ED, et al. 2004).In the medical world, doctors are encouraged to talk to patients about their weight. Every fat person has heard, “What are we going to do about your weight?” The “we” is supposed encourage the patient to feel that the doctor is on the patient’s side in their battle. Yet what many patients hear is, “I don’t see you as a patient, I see you as fat.” Science says that the higher a patient’s BMI the less respect a doctor has for the patient (Huzinga, Cooper, Bleich, Clark, & Beach, 2009).Horror stories about fat people trying to get decent health care are everywhere. For a good example, see Bruce Taylor Seeman’s piece, “The Perils of Obesity May Include the Doctor” (2006). [End Page E1] There are many blogs and stories on the internet about the way patients are not just shamed for their weight, but actively bullied by medical professionals. One blog, The Well Rounded Mama (wellroundedmama.blogspot.com), discusses the bias of doctors against pregnant fat women, who are told things like, “You cannot have a healthy baby when you are this fat” and encouraged to abort. Tales from people told that their weight is the cause for everything and anything can be found on sites like First Do No Harm (fathealth.wordpress.com). Reading blogs by medical professionals can show the disdain they have for fat people. In one, an emergency room nurse declared that all fat diabetics have poor control, based solely on perceptions from her job. Comments were mostly other nurses agreeing with how “disgusting” fat people are to have to deal with. However, Yale University’s Rudd Center for Food Policy & Obesity not only recognizes the problem but aims to help medical professionals eliminate the bias.If obesity becomes a disease, weight loss surgery (WLS) becomes a bigger gold mine. Medical insurance will be more likely to cover weight loss surgery. WLS is an ever-changing target: there... (shrink)

Introduction: Physical distancing under the coronavirus disease 2019 pandemic had a significant impact on lifestyles, including exercise routines. In this study, we examined the relationship between mental health and addictive behaviors, such as excessive exercise and the use of image and performance enhancing drugs across 12 sport disciplines.Materials and methods: A large cross-sectional sample of the adult population was surveyed. The mean age was 33.09. The number of male participants was 668. The use of IPEDs was assessed in conjunction (...) with psychometric measures such as the Exercise Addiction Inventory and the Appearance Anxiety Inventory. The participants were grouped into activity group and non-activity group according to the presence or absence of their exercise habits. The results were compared between these groups, as well as across sport disciplines, while taking into account the relationship between different psychological measures and IPEDs consumption.Results: The frequency of IPEDs use was higher among AG than NAG, although AG participants reported less history of addictions than NAG. The logistic regression analysis revealed that scores equal to or above cutoff points, in both the EAI and AAI, predicted the IPEDs use. Regarding the differences across the various sport disciplines, those who were involved in practicing Weight Lifting and Cross Fit were found to be more at risk of excessive exercising and more inclined to use a wide range of IPEDs.Conclusions: Although exercise could help to increase well-being and prevent addictions during the COVID-19 pandemic, our results show that those in the AG are particularly vulnerable to excessive IPEDs use. Sport disciplines associated with higher EAI and AAI scores have also shown a higher tendency to excessive IPEDs use. Furthermore, the factor of having above the cutoff scores in EAI or AAI in each sport could indicate larger IPEDs consumption regardless of the discipline. In light of the current findings, it is necessary to better define the “non-excessive” levels of exercise in various sport disciplines and an adequate intake of IPEDs to ensure the safety and well-being of people during a pandemic. (shrink)

The novel pandemic called “Coronavirus Disease 2019”, as a global public health emergency and global threat, has affected many countries in unpredictable ways and impacted on physical activity behaviors to various extents. Specific populations including refugees, asylum seekers, and prisoners, are vulnerable groups with multiple complex health needs and worse health outcomes with respect to the general population worldwide and at high risk of death from the “Severe Acute Respiratory Syndrome-related Coronavirus type 2”. Governments around the world have been (...) implementing preventive healthcare policies, including physical and social distancing, isolation, and confinement, to mitigate against the burden imposed by the COVID-19 outbreak. This pandemic period is characterized by reduced or lack of movement. During this period of lockdown, PA can represent an immunotherapy and a preventative approach to avoid the harmful effects of inactivity due to the pandemic. Moreover, PA could be prescribed to improve the immune system of specific populations, which particularly experience the condition of being confined. The present narrative review discusses the potential impacts of COVID-19 pandemic on these specific populations’ health status and the importance of performing PA/exercise to reduce the deleterious effects of COVID-19 pandemic. In addition, we aim to provide useful recommendations on PA/exercise for these specific populations to maintain their level of independence, physical, and mental health as well as their wellbeing. (shrink)

The potential of physical activity to improve our health has been the subject of extensive research [38]. The relationship between physical activity and well-being has prompted substantial interest from exercise psychologists in particular [3], and it seems, is generating increasing interest outside the academic community in healthcare policy and practice inter alia through GP referrals for exercise. Researchers in the field have benefited from a rich tradition within psychology that investigates subjective well-being and its antecedents [7]. We argue (...) that the exercise and health psychology research suffers from this intellectual ancestry specifically in the form of two significant conceptual limitations. First, short-term pleasure and enjoyment which are associated with exercise induced well-being may mask activities that are doing us no good or even harm us [18]. Second, focusing on pleasure entails unacceptable methodological reductionism which undermines the validity of such research by excluding other ways in which our well-being may be enhanced in non-hedonistic terms. (shrink)

Data analysis from diverse medical fields suggests that we have reached a tipping point in the digitalization dynamic through the ongoing COVID-19 crisis, leading to an escalation of physical inactivity and related diseases. The lack of prioritization of physical activity designed to intervene against obesity, diabetes, loneliness, depression, anxiety disorders and suicide risk could destabilize our current global health system beyond rehabilitation. To counteract this, the author outlines the basis for a sustainable solution to best integrate physical (...) activity into work, daily life and education. In addition, he highlights the potential benefits of combining exercise training with microdosing of psilocybin or of active ingredient essences of psilocybin-containing mushrooms. The article also shows that the integration of mindfulness-based practice and neuroplastic movement practice is a necessity and a competitive advantage for the future. (shrink)

Since the outbreak of the COVID-19 pandemic, the physical and mental health of older adults has been threatened. Promoting physical and mental health through physical activity has therefore become a strategy for healthy aging. In order to better understand the impact of the participation of older adults in physical activity, this paper selects different types of physical activity, and examines the relationship between them and subjective well-being through the analysis of the mediation effect of outdoor (...) exercise environment and the regulating effect of exercise form. In this cross-sectional study, a questionnaire survey was conducted in mainland China. The main data come from 903 older adults in five urban areas in Chengdu, Sichuan Province. The surveys were carried out using the Physical Activity Rating Scale, Newfoundland Subjective Well-Being Scale, Exercise Environment Scale, and Exercise Form Scale. SPSS was used for statistical analysis, linear regression analysis was adopted for processing data, and AMOS was used to establish a mediation model. The mediating variable is the outdoor exercise environment, and the moderating variable is exercise form; gender, age, education level, and monthly income were used as control variables. The study results showed that different physical activities were significantly, positively correlated with the subjective well-being of older adults ; among the activities, tai chi had the strongest effect on the subjective well-being of older adults. Outdoor exercise environment played a mediating role between different physical activity types and subjective well-being of older adults [tai chi: β = 0.030, 95% CI ; health qigong: β = 0.018, 95% CI ; walking and jogging: β = 0.034, 95% CI ]. Exercise form moderated the subjective well-being of older adults in different physical activities. The results of this study demonstrate that the outdoor exercise environment plays a mediating role between different physical activities and the subjective well-being of older adults, and the form of exercise can also moderate the impact of different physical activities on the subjective well-being of older adults. This study has enlightening significance for psychological intervention with older adults facing stress, anxiety and depression. (shrink)

Introduction Adolescents’ physical activity (PA) behavior can be driven by several psychosocial determinants at the same time. Most analyses use a variable-based approach that examines relations between PA-related determinants and PA behavior on the between-person level. Using this approach, possible coexistences of different psychosocial determinants within one person cannot be examined. Therefore, by applying a person-oriented approach, this study examined a) which profiles regarding PA-related psychosocial variables typically occur in female sixth-graders, b) if these profiles deliver a self-consistent picture (...) according to theoretical assumptions, and c) if the profiles contribute to the explanation of PA. Materials and Methods The sample comprised 475 female sixth-graders. Seventeen PA-related variables were assessed: support for autonomy, competence and relatedness in PE as well as their satisfaction in PE and leisure-time; behavioral regulation of exercise (five subscales); self-efficacy and social support from friends and family (two subscales). Moderate-to-vigorous PA was measured using accelerometers. Data were analyzed using the self-organizing maps (SOM) analysis, a cluster analysis including an unsupervised algorithm for non-linear models. Results According to the respective level of psychosocial resources, a positive, a medium and a negative cluster were identified. This superordinate cluster solution represented a self-consistent picture that was in line with theoretical assumptions. The three-cluster solution contributed to the explanation of PA behavior, with the positive cluster accumulating an average of six minutes more moderate-to-vigorous PA per day than the medium cluster and ten minutes more than the negative cluster. Additionally, SOM detected a subgroup within the positive cluster that benefited from a specific combination of intrinsic and external regulations with regard to PA. Discussion The results underline the relevance of the assessed psychosocial determinants of PA behavior in female sixth-graders. The results further indicate that the different psychosocial resources within a given person do not develop independently of one another, which supports the use of a person-oriented approach. In addition, the SOM analysis identified subgroups with specific characteristics, which would have remained undetected using variable-based approaches. Thus, this approach offers the possibility to reduce data complexity without overlooking subgroups with special demands that go beyond the superordinate cluster solution. (shrink)

The purpose of the present two studies was to investigate whether in framing messages that target salient beliefs of youth, the type of goal framed matter to promote physical activity participation among low-active adolescents. More specifically, the main trial compared the effect of intrinsic and extrinsic-goal framing messages alongside planning to a control condition on low-active adolescents’ physical activity, intention, attitude, and exercise goals, and examined the potential meditational effect of these variables between condition and PA. Low-active students (...) from fifteen classes were assigned to one of these three conditions. PA was assessed using an accelerometer, and the socio-cognitive mediators were measured at baseline and post-test, and the intention was measured again at follow-up. Results showed that compared to adolescents in the CC group, those in the experimental conditions did not do more moderate PA, but carried out more light PA, and yielded an increase in attitude and intention. Mediational analysis revealed no significant effect of the potential mediators. (shrink)

Joaquin Segura. Untitled (fig. 40) . 2007 continent. 1.2 (2011): 117-124. The interview that follows is a dialogue between artist and gallerist with the intent of unearthing the artist’s working strategies for a general public. Joaquin Segura is at once an anomaly in Mexico’s contemporary art scene at the same time as he is one of the most emblematic representatives of a larger shift toward a post-national identity among its youngest generation of artists. If Mexico looks increasingly like a foreclosed (...) home burning to the ground, Segura could likely be the one walking away, charred matchstick between thumb and forefinger and shit-eating grin on his face. His corrosive attacks on institutions, ideologies, and power reflect a deep general distrust of authority, increasingly evident within the work of younger Mexican artists. It is perhaps most directly the result of President Calderon’s deeply unpopular war against the cartels but no doubt equally the product of decades upon decades of rampant corruption and errant policy within Mexico. Brett W Schultz (BWS): A recurring—if not dominant—theme within your current work and investigation explores ideological extremism in reaction to some perceived political and economic disenfranchisement, especially that espoused and practiced by right-wing groups in United States. That's exactly why I thought of you when I was approached to contribute a piece to an issue on the subject of the moraine—taken metaphorically here to signify a certain set of beliefs that have resurfaced within mainstream American culture in the wake of a probably over-exaggerated political sea-change, marked by Obama's election. You're a Mexican artist who now lives and works in Guadalajara, far from the border cities where such concerns would seem more likely to be relevant to a contemporary artist; of course, you're even farther from the culture that birthed this nature of extremism. What interests you so intensely about this movement, if we can call it that? Joaquin Segura (JS): I think there are several seminal points that you touch on in this particular question. There's a very specific set of interests that make me address the socio-political issues I've been dissecting through my practice in the last few years. First of all, I don't really consider myself a 'mexican' artist. As I've made clear in the past, I don't really believe in the notion of 'identity' or the idea of 'nation', which I find totally laughable and heartwarmingly passé. I'm convinced that these are totally outdated models of understanding our differences and similarities, expanding our already immense and irreconcilable cultural abysses instead of bringing them together, thus resulting in their total dispersion among the complex and extremely arbitrary weaving of contemporary social nucleii. Pretty much a frankly bad joke, if I may say so. The fact that I live and work in Mexico is a completely random geographical and temporal factor, which of course affects what I think and what I do, but I've chosen not to be limited by this specific circumstance. In the past, while working abroad, I've taken advantage of this preconception of Mexico—to be more exact, pretty much all of Latin America—as one of the last barbaric bastions of western civilization. Totally amusing, if you ask me about it. I consider my practice to be, among other things, a gonzo strategy of deceit: there are quite a few roles you can adopt in this approach that may actually reveal themselves to be a privileged vantage point. In my experience, the gentle savage is one of the most effective ones to establish my standing position. Thus, I'm a mexican artist if I need it to prove my point. If it's not necessary in a specific circumstance, I'm not. Quite simple, I think. Said in other words, it's just an ace I can play to win a particular match. It has worked so far, at least for me. L: Hey, America… , 2009. R: The Inaugural Address , 2009. I am interested in the nature of power and the rise and fall of totalitarian ideological and political apparatuses nowadays. But I guess, going even further, I'm essentially fascinated by the fissures and contradictions that have made these structures spectacularly crumble to the ground. I do believe extreme ideologies have played a crucial role in the globalization of socio-political crisis. In the end, our world is nothing more than a fading monument to all things gone wrong—the inspiring triumph of failure, in every sense. I see this as an exciting parable. And of course, it is an undeniable fact that the US, through their influence in world economy, international policies and general attitude towards the rest of the planet is the largest structure waiting to collapse. I think we are all secretly awaiting that moment of splendor, even americans. It'll be disastrous and as nasty as it can get, but it will also be liberating and incredibly inspirational. Not just because it’s the US but because it'll prove that absolutely everything is susceptible to fall. And not only that, most importantly, it would confirm that radical change may actually be possible and not just one more of the unfulfilled promises modernity has left us to struggle with on our own. BWS: I want to talk first about two of your works in particular: Hey, America... and The Inaugural Address . I feel like your more recent work has a subtle —or even hidden—sinisterness, but these two works are perfect examples of how brutally confrontational your earlier work has been. When we showed Hey, America... at Mexico City's Zona Maco art fair in 2010, there were at least a couple visitors to our stand who were absolutely ready to punch me in my gringo face for having done so. Certainly the shock value of these works is crucial to their central ideas, but can you tell me more about your intentions and how these works relate to your general oeuvre? JS: So funny. Perhaps we do deserve to be punched in the face. I think that's what I'm sometimes looking for, but I hardly ever get it. I do think of such works as some sort of logical trap, a somewhat perverse ambush waiting for someone to walk into head-on. I think what I tried to do with those two specific works, as well as some other past projects, is just emphasize issues or themes that do disturb or make me uneasy and restless. I consider my essential intention a need to make clear that we do not have to look the other way, ignore or forget. We must address, understand and solve these manifestations of senseless violence and absurdity because if we don't confront them this way, they'll end up consuming us. In other words, I do consider these works as a personal need of coming to terms with the nonsense of the world we all are living in. I don't particularly consider myself to be someone with a clear set of beliefs. Perhaps my only certainty would be that everything is there to be denied, demolished and obliterated—even my supposed unquestionability of that particular 'dogma.' My practice is a reflection of that paradox, and I do think that's how these two pieces relate to a wider body of work. Every democratic system and so-called developed contemporary society is deeply flawed on the inside, and that is because each has swept things under the rug. Of course, there's tolerance, good will and eagerness to make a difference but there's also hatred, pain and fear lingering all around. We must learn to relate to both sides of the spectrum. In a way, I approach the themes behind these particular works in what I think to be a non-biased, somewhat 'neutral' way. I do think there's an encryption process going on in the way I work, some sort of formal refinement of this somewhat outrageous content. A digest of infamy, if we can refer to it that way. It is up to the individual experiencing the work to decide which way these pieces lean. They can easily be seen from both positions and I'm ok with that. If you look closely at these works, there's nothing that establishes an unrelenting position—neither support nor rejection. I don't want my personal political views to directly set an agenda for the spectator as that’s essentially propaganda, which is one of the things I absolutely despise. To sum it up, I strive for the spectator to complete the piece in that sense. The work then becomes a reflection of his or her own contradictions, a playground of the mind. I'm interested in achieving a deadpan and deadlock state in the observer. So, in a way, those visitors threatening to beat the shit out of you unconsciously became that particular issue the work is alluding to. Just blind and senseless reaction to god knows what people feel must be defended, the overwhelming virtue of ambiguity. Beautiful. Perhaps you can also think of my practice as a uber-sophisticated and snobbish version of Punk'd. And you wouldn't be far from what I'm trying to convey. Untitled (Disturbance Scenarios #2) . 2010. BWS: To me, an important transitional marker in the overall trajectory of your work is the series, Disturbance Scenarios , which evokes a similar generalized state of panic, paranoia, and impending doom through its incorporation of sensationalist newspaper headlines, yet also suggests this slyly mysterious meta-narrative via the context in which the newspaper itself is placed. How did you arrive at this series and why did you choose photorealistic painting as the medium for it? JS: I consider this series to be a by-product of the process I follow when making work. I spend an important part of my time just doing research, going through documentation and accumulating visual or historical references for the themes or episodes I'm interested in, in that particular moment. These are, of course, valuable assets that connect among themselves in a mysterious and almost undetectable manner, sometimes a few years between one and the other. I've employed similar production strategies in the past, in ongoing series like Random Moments of Urban Decay , in which I document what I consider to be physical traces of ethnic, religious or ideological violence in the form of text graffiti, invisibly scattered in different cities of the world, mostly in the US. Disturbance Scenarios was started in early 2010, following a particularly intense period of traveling here and there that lasted for most of the year. I've always felt compelled by text, as I find quite intriguing the idea of how words can create equally intense evocations of what I call a mental panorama of uneasiness than those produced by aesthetically-charged imagery; of course, if handled right. I have a close relationship to print media—due both to my academic background and to my attraction to its ubiquity and almost unlimited influence, which in the end, is nothing else but power—so I found myself with a growing archive of newspaper headlines snapshots from cities like Melbourne, Auckland, London, and LA. Going through them, I noticed that they had in common a very specific thematic slant: they were all about some sort of conflict: energy crisis, political unrest, local episodes of domestic violence, you name it. So as you very well put it, I felt they all connected through this feeling of anxiety and anguish and I decided to start thinking of them as a body of work. Basically, I felt an interest in creating what I think of as my personal fragmented prefigurements of the end of civilization. There were few elements on the shots that could give away its actual location, geographically speaking, and I liked that. I find this sensation of vagueness and uncertainty quite alluring. The more subtle, the more perverse. The formal resolution of the series—as photo-realistic painting—is linked to my intention of creating distance between me as the artist and the themes I work with. I rarely execute my own work, and that is more a personal choice as I'm more interested in the ideas I mingle with than in the actual outcome of that process, understood as an "art-object" with certain market value. I did some tests with light-jet prints of those snapshots and I found them devoid of that nightmarish, disturbing indistinctness that I felt was so important for them to be able to project the turmoil I experienced upon encountering them and in conceiving of them as a series. So I thought that photorealistic painting would be an interesting resource to play with, as I hardly had worked with that medium before because of my lenient animosity toward painters and their craft. So they were executed like that and I think it turned out to be just right. Homemade (Napalm #2) . 2010. BWS: Though Disturbance Scenarios remains ongoing, it's an interesting contrast to another series of yours, Homemade, which are these beautifully banal photographs of the ingredients used to make improvised explosives. Whereas Disturbance Scenarios still confronts the viewer aggressively with its visual emphasis on loaded texts, in Homemade , you've dropped the surface-level bravado entirely. They're pieces that require explanation to someone not already versed in the fine art of amateur explosive-making. You weren't known for subtlety in your past work; why this change in direction? JS: I'm personally convinced that these are just two angles of the same conceptual preoccupation. I mentioned before my obsession with the idea of encryption. I'm quite enticed by how these processes of translation can politically and semantically alter and deviate purportedly subversive materials such as the ones these works allude to. I do think subversion is futile. I was really troubled by that thought for some time, but I think now I understand that it's not really that important. What is really significant is to elaborate on these alternate views, to envision and refine possible escape routes. It doesn't really matter if they go nowhere, but that is because nothing really matters. A "mute" artwork is a notion that captivates me. When you look at the works you mention, you know there's something off, but it's not fully clear how and why that is. I rely on that insecurity—on that moment of hesitation. And that can also be achieved through an approach like the one I'm now interested in. Let's just call it a smoke screen, a surrogate ruse to get to the same point: to talk about impotence and defeat in contemporary life. The notion that readily accessible information is actually a weapon is a double-edged fallacy: sure, you can make use of whatever resources you can lay your hands on, but that doesn't set you free because freedom is impossible. Still, that doesn't mean you can't blow up stuff during the process, metaphorically or not. I didn't understand the nature of subtlety before. I used to think that you needed to be loud and manifest anger and unconformity in the most aggressive manner possible. Then I finally realized that you can actually permeate and rarify a battleground—because after all, this is low-intensity war—if you actually aim at silently building up the contradictions and making the symbolic value of ideas and acts clash within themselves. Or perhaps it is that I am just getting old. I guess I used to be an angry kid until recently. Now I think of myself as a disenchanted post-teenager, and of course that reflects in my work and my approach to art-making. Kind of a rite of passage and I laugh at it because, overall, it has been overwhelmingly fun. And that doesn't mean that I'm not ready to stick it in someone or something's face again if I feel like it. BWS: You're now taking the subtlety of the Homemade series even further with your newest series, Definitive Reader For a Botched Revolution , in which you photograph a series of politically-charged books side-on, negating their content entirely—essentially reducing them to purely aesthetic objects in which the subject matter is only revealed in the title of the work. Can you talk about the ideas behind this series? Furthermore, is your recent interest in this idea of the "botched revolution" an indication of a general attitudinal or philosophical shift you've since adopted? JS: This new series of works is the logical outcome of a brief period I went through. Probably the last couple years, in which due to a number of circumstances that don't really have to do with my art-making, I was forced to renegotiate my ideas, my beliefs and practically everything that surrounds me. It was quite distressful and turbulent, but in the end, I think it was also almost epiphanic. I came to terms with myself and now I'm calm and serene. That is, of course, my personal take on it but I mention it because I do think it's important to address this shift you mention. The idea of an artwork as a container for latent revelations enthralls me quite a bit. That's how I see these particular works: art as an incendiary agent. It's up to the artist and the spectator to do whatever they please with it. I think the detachment and almost surgical cleanliness from the Definitive Reader series is also my take at poking fun of the way some art is totally innocuous and uncompromising. These images may be pleasing to the eye, but there's something twisted and rotten within them, well hidden beneath. You'll either see it or not, but without a doubt, it will not cancel its presence. This series is intrinsically linked to Homemade . I'm pretty much horsing around with similar ideas and statements here. And well, yes, I do think any revolution is a botched one. There's nothing too heavy about their own downfall. Decay and breakdown are here and will not go away. Perhaps we must learn to embrace them in one way or another, for our own sake. L: Untitled (T.A.Z.). R: Untitled (United States Marine Guidebook of Essential Subjects) . 2011. BWS: Finally, let's discuss the near future. You've got an upcoming solo show at the Sala de Arte Público Siqueiros [SAPS] in Mexico City this summer. What can we expect from that? What else do you have planned? JS: I'll go and get seafood as soon as I'm done with this interview. It's pretty good here in Guadalajara. That's my top priority at this very moment. About my solo project at SAPS, it's due to open in late July. I'm quite looking forward to it. I'm still closely working with the curator on the general feel for the show but I can say that it'll be more of a revision of past works that have not been shown in Mexico City except for a couple pieces. It definitely won't be a showcase for new projects, although we may include one or two previously unseen works. What you can expect is a rereading of what I've been working on during the past few years. In a way, that's exciting to me because for some reason I don't really care about, I'm not that active in Mexico City even though that's where I lived and work for years. I've hardly shown there after my solo project at Yautepec in February of 2010. It'll be nice to see how it all comes together and I'm more thrilled about it because I totally love the space and I think they're doing an excellent job with their programming and its direction. And in a certain way it feels like going back home. About everything else, I need a period to reflect and fully understand what I've been thinking and working on. I've got a few group shows here and there: New York, San Francisco, and Melbourne are the ones happening soon. I will present my censored project Untitled ( Gringo Loco ) as part of the programming of the Museo de Arte de Zapopan in Guadalajara, two years after being escorted at gunpoint from the installation site by police sent by the extreme right-wing mayor of the city, which I found pretty amusing for an otherwise typical Saturday afternoon. I'm also involved in a couple "curatorial" projects. In my case, "curatorial" means that I help put together stuff I like and I'm interested in. One of them will open in late September of 2011 at Arena Mexico Arte Contemporaneo, and I will work with three of whom I consider to be some of the best artists in a lively and active scene such as the one here in Guadalajara. But most importantly, I've been doing heavy research so there are also a number of projects that I've yet to finalize. That'll be my main focus during the rest of the year, even though I really enjoy procrastination. There'll be time for that later. Or maybe not. We'll see. About Joaquin Segura The action, installation, intervention and photographic work of Joaquin Segura (b. Mexico City, 1980) has been shown in solo and group exhibitions in Mexico, the United States, Europe, and Asia. Some spaces that have featured his work include La Panaderia, Museo de Arte Carrillo Gil, Centro de la Imagen and Ex-Teresa Arte Actual in Mexico City; El Museo del Barrio and apexart, New York, NY; Museo Nacional Centro de Arte Reina Sofia in Madrid, Spain; National Center for Contemporary Art, Moscow, Russia; and Palace Adria in Prague, Czech Republic. In 2008 and 2009, Segura was an artist-in-residence at the International Studio and Curatorial Program, New York, NY and at the 18th Street Arts Center, Santa Monica, CA. He is represented YAUTEPEC in Mexico City and by Arena Mexico Arte Contemporáneo in Guadalajara. Further Reading Joaquin Segura’s website YAUTEPEC artist page for Joaquin Segura Capps, Kriston. “ID-ENTITY: Washington, DC.” ART PAPERS . 2009. (shrink)

Human behavior is an underlying cause for many of the ecological crises faced in the 21st century, and there is no escaping from the fact that widespread behavior change is necessary for socio-ecological systems to take a sustainable turn. Whilst making people and communities behave sustainably is a fundamental objective for environmental policy, behavior change interventions and policies are often implemented from a very limited non-systemic perspective. Environmental policy-makers and psychologists alike often reduce cognition ‘to the brain,’ focusing only to (...) a minor extent on how everyday environments systemically afford pro-environmental behavior. Symptomatic of this are the widely prevalent attitude–action, value–action or knowledge–action gaps, understood in this paper as the gulfs lying between sustainable thinking and behavior due to lack of affordances. I suggest that by adopting a theory of affordances as a guiding heuristic, environmental policy-makers are better equipped to promote policies that translate sustainable thinking into sustainable behavior, often self-reinforcingly, and have better conceptual tools to nudge our socio–ecological system toward a sustainable turn. Affordance theory, which studies the relations between abilities to perceive and act and environmental features, is shown to provide a systemic framework for analyzing environmental policies and the ecology of human behavior. This facilitates the location and activation of leverage points for systemic policy interventions, which can help socio–ecological systems to learn to adapt to more sustainable habits. Affordance theory is presented to be applicable and pertinent to technically all nested levels of socio–ecological systems from the studies of sustainable objects and households to sustainable urban environments, making it an immensely versatile conceptual policy tool. Finally, affordance theory is also discussed from a participatory perspective. Increasing the fit between local thinking and external behavior possibilities entails a deep understanding of tacit and explicit attitudes, values, knowledge as well as physical and social environments, best gained via inclusive and polycentric policy approaches. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Road to Understanding and Acceptance of the Late Effects of Pediatric Brain Tumors and TreatmentJeanne CarlsonWe had little warning or time to adjust to our daughter’s diagnosis. A call from her third grade teacher reporting that Sarah seemed to be having vision problems rapidly led to eye exams, an MRI, and the discovery of a Germinoma brain tumor in the suprastellar region of Sarah’s brain. We were terrified (...) but began treatment feeling optimistic about the outlook for Sarah’s recovery. Luckily, Sarah’s treatment was relatively non–invasive and quick, chemotherapy and radiation, five months start to finish. We were thrilled to have Sarah’s treatment behind us.As any parent of a child with a life–threatening illness knows, family life is seriously disrupted by the countless doctor, lab, and hospital visits, the worry, and the financial strain that are suddenly added to the demands of everyday life. We did our best to balance our focus on both of our children as Sarah is a twin and we didn’t want her brother Will to suffer as a result of his sister’s illness. It wasn’t easy but we found a way to schedule Will’s usual play dates, baseball practice, and family time. We were all happy and relieved when Sarah’s treatment was completed, yet we would later learn that we had been incredibly naïve in two ways; we thought that our brain tumor journey was over after Sarah’s treatment was completed and we thought that we’d brought Will through the process without effect. We had a lot to learn.At the time of diagnosis we knew that Sarah’s memory and ability to express emotion had already been impacted by the tumor but we didn’t yet know what that would mean to her quality of life. We were virtually unaware however that at age nine the chemotherapy and radiation treatments that Sarah received would result in profound late effects. Following treatment Sarah successfully completed 3rd grade and even received excellent STAR test scores (California state standardized tests). In 4th grade however, Sarah’s performance began to diverge from that of her peers and she found herself struggling in school and unable to make friends. We began looking for ways to help our daughter.What followed was a five year long journey through testing, evaluations, individualized education plans (IEPs), and therapies, which, in the end, left our family needing to accept the fact that although Sarah remains intelligent and artistically talented, she suffers from a constellation of late effects that will always affect her ability to function in the world. As a result of Sarah’s tumor and treatment she struggles with Auditory Processing Disorder, word finding problems, poor executive function, inability to recognize how she feels, significant difficulty making decisions, inability to read social cues, poor memory, slow processing, an emotional age of about nine, and lots of anxiety. She is also panhypopituitary, meaning that she has no remaining pituitary function and must take replacement medications by pill and injection, has hypothalamic obesity (HO), which is primarily controlled by more medication, and Raynaud’s Disease. The HO is an ongoing challenge because if Sarah does gain weight she can’t lose it again and exercise is not an easy solution because, like many pediatric brain tumor survivors, Sarah is easily fatigued. Finally, although Sarah’s vision improved after treatment her vision loss is significant enough to prevent her from driving. We pieced together this understanding of Sarah’s challenges and disabilities slowly so it wasn’t until the end of our children’s middle school years that we finally accepted the magnitude of the damage caused by the tumor and treatment. Thereafter we changed our focus from what Sarah might achieve in life to how to support [End Page 21] her in the activities at which she still excels and how to keep her active, interested in life, and feeling good about herself.It would have been a huge gift if we had been provided with information about the possible late effects that can result from treating the brain of a 9–year–old... (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

Neglected diseases are severe conditions that mainly affect the world's poorest people. Those suffering from neglected diseases are mostly suffering from tropical infections that have failed to receive priority in pharmaceutical research and development programs, as well as in public health policies aimed at improving availability and access to preventive, diagnostic and curative medicine. The World Health Organization has issued a number of documents directing attention to the plight affecting one third of the world's population, assisted by active support from (...) private organizations, notably the Bill and Melissa Gates Foundation, but the overall situation remains dismal. In the wake of major socioeconomic processes including globalization, steadily growing economic disparity, healthcare inequality, the instability created by rogue states and terrorism, as well as massive migration, and epidemic outbreaks, the features of neglected diseases have been changing. Neglected populations affected by tropical diseases are suffering increasingly from non-infectious degenerative conditions and disabilities due to untreated chronic maladies. Pockets of poverty and neglect can also be detected in high-income countries, contributing to the emergence of new diseases and the reemergence of infections believed to be disappearing such as tuberculosis and the measles. Included in the issues of neglect are rare diseases, mostly of genetic origin, affecting a small number of patients that suffer from multiple life-shortening functional impairment and organ defects. Effective medicines are extremely expensive, allegedly because research and development of appropriate drugs is resources and time consuming, requiring exorbitant prices to recoup investment from a small number of consumers. Bioethics has been tardy in addressing the suffering and destitution of neglected and rare diseases. Convinced that permanently repeated denunciations blunt the sensitivity towards suffering, whereas statistics are bloodless and unable to elicit commitment, this book attempts to explore a different strategy. In an upstream approach, bioethics needs to engage in ethnographic fieldwork that confronts and shares the context in which people suffer, vividly presenting what epidemiological research has blunted into statistical data. Additionally, a downstream approach is suggested, requiring bioethics to vigorously and openly denounce unethical biomedical and pharmaceutical research, misdeeds in registration and marketing of drugs, and misalignment of policies with the unmet healthcare needs of the destitute. More than being critical observers, bioethicists ought to shed lurking conflicts of interests and seek active participation in planning research and public healthcare practices aimed at improving the lives of medically neglected populations. (shrink)

This study investigates the Proteus effect from the first-person perspective and during avatar embodiment in actual exercise. In addition to the immediate measurements of the Proteus effect, prolonged effects such as next-day perception and exercise-related outcomes are also explored. We theorized the Proteus effect as altered perceived self-concept and explored the association between virtual reality avatar manipulation and self-concept in the exercise context. While existing studies have mainly investigated the Proteus effect in a non-VR environment or after VR embodiment, we (...) aim to contribute to the literature by addressing this concern to explore how the Proteus effect works in actual VR exercise. Through a 2 × 2 between-subject experiment, the results partially support the Proteus effect. Regarding actual physical activity, embodying an avatar with a six pack during exercise creates fewer body movements. No significant effect was found for perceived exertion. We also explored the role of sex as a potential moderator in the association of the Proteus effect on exercise outcomes. The Proteus effect was supported by immediate and next-day self-efficacy for core-muscle exercise only among female participants. The between-subject design allowed us to probe how avatar manipulation of muscular body shape with a six pack as opposed to normal body shape influences participants’ self-concept and exercise outcomes, as limited VR studies have employed within-subject comparisons. This also contributes to the literature by providing an upward comparison as opposed to the previous downward comparison regarding body fitness. The overall results supported the Proteus effect in the context of core-muscle exercise when comparing normal and ideal body shape avatars. However, the Proteus effect as an altered self-concept and its effects on self-efficacy for exercise were supported among females but not males. Whereas the female participants who embodied avatars with a six pack associated themselves more with the muscular concept than other people, the male participants who embodied avatars with a six pack perceived themselves as more normal than others. Theoretical and practical implications are discussed. (shrink)

Context and AimsAlthough some exercise-based interventions have been associated with lower levels of pain and performance-related musculoskeletal disorders among musicians, the evidence is still mixed. Furthermore, little is known about musicians’ general engagement in physical activity, their knowledge of PA guidelines, or the relevant training they receive on pain prevention and the sources of such training. Similarly, little is known about the relationship between PA and PRMDs and other risk factors for PRMDs.MethodsFollowing a cross-sectional correlational study design, both standardized (...) andad hocmeasurements were used to investigate self-reported PA [International Physical Activity Questionnaire – Short Form ], knowledge of PA guidelines, and barriers to engaging in PA [Centers for Disease Control ; Determinants of Physical Activity Questionnaire ]; sedentary behavior [Sedentary Behavior Questionnaire ]; pain [36-Item Short Form Survey Instrument ] and PRMDs ; reported physical exertion ; anxiety [Hospital Anxiety and Depression Scale ]; practice behaviors ; and relevant training among conservatoire students in the United Kingdom. The entire set of questionnaires was administered both online and via hard copies between June 2017 and April 2018.ResultsDemographic information was obtained from 111 respondents, mostly undergraduate students from seven conservatoires. They reported high levels of engagement in PA, despite poor knowledge of PA guidelines. Teachers were the most frequently mentioned source of pain prevention information, and 62% agreed that they had received advice on why they should engage in cardio PA. Sedentary behavior was comparable to normative data. Levels of bodily pain and PRMDs were low, but 43% showed “abnormal” clinical anxiety and found playing their instruments “somewhat hard” on average. Bodily pain interfering with practice and performance was positively correlated with frequency and severity of PRMDs, anxiety, and RPE. Frequency and severity of PRMDs were also associated with sedentary behavior at the weekend. Anxiety was associated with RPE. No association was found between PA and PRMDs.ConclusionThe relationship between PA and PRMDs and pain remains unclear and needs further investigation. While health education needs to be improved, other pathways may need to be taken. Given the high levels of anxiety, the ideology of Western classical music itself may need to be challenged. (shrink)

The global burden of obesity has risen due to various factors, including sociocultural aspects. Social representations (SRs) of obesity could help to understand the problem. Nowadays, social networks activate new social interaction processes and enable the construction of SRs. Tweets can identify mind-sets as cultural reflections of the times. This study aimed to identify widely shared obesity topics on Twitter-Argentina using Natural Language Processing. First, 134,766 Spanish tweets about obesity were collected from August 2021 to July 2022. Next, a geolocation (...) filter removed non-Argentinian messages, leaving 48,149 tweets. The body text was cleaned and prepared for analysis. K-means clustering model was applied and 21 clusters were identified after reaching theoretical saturation. Then, 10 tweets from each cluster were randomly selected to analyse word usage and identify cluster themes. Thus, the main themes were “Gender-related”, “Obesity and family”, “Hate speech and fatphobia”, “Body image, perceptions and feelings”, “Public health actions” and “Obesity as a health-disease process”. These aggregations allowed us to understand obesity as a sociocultural phenomenon, the Argentinian culture-specific discourses surrounding it, and their connections to health. We firmly believe that this valuable information will enlighten the planning of future social-political actions to address this health-disease process. (shrink)

“Exercise starts and ends in the brain”: this was the title of a review article authored by Dr. Bengt Kayser back in 2003. In this piece of work, the author highlights that pioneer studies have primarily focused on the cardiorespiratory-muscle axis to set the human limits to whole-body exercise tolerance. In some circumstances, however, exercise cessation may not be solely attributable to these players: the central nervous system is thought to hold a relevant role as the ultimate site of exercise (...) termination. In fact, there has been a growing interest relative to the “brain” response to exercise in chronic cardiorespiratory diseases, and its potential implication in limiting the tolerance to physical exertion in patients. To reach these overarching goals, non-invasive techniques, such as near-infrared spectroscopy and transcranial magnetic stimulation, have been successfully applied to get insights into the underlying mechanisms of exercise limitation in clinical populations. This review provides an up-to-date outline of the rationale for the “brain” as the organ limiting the tolerance to physical exertion in patients with cardiorespiratory diseases. We first outline some key methodological aspects of neuromuscular function and cerebral hemodynamics assessment in response to different exercise paradigms. We then review the most prominent studies, which explored the influence of major cardiorespiratory diseases on these outcomes. After a balanced summary of existing evidence, we finalize by detailing the rationale for investigating the “brain” contribution to exercise limitation in hitherto unexplored cardiorespiratory diseases, an endeavor that might lead to innovative lines of applied physiological research. (shrink)

Despite the important role of physical activity in population health and well-being, it has received less focus in public health ethics as compared to other modifiable lifestyle factors such as smoking and diet. However, when considering the current and potential role of physical activity within public health—including interventions and policies to encourage physical activity in schools and workplaces, changes to the built environment and the equity issues associated with access to physical activity—it is a ripe territory (...) for ethical analysis. This paper makes a case for a more sustained focus on physical activity within public health ethics by reviewing two ethical issues within physical activity and public health: physical activity inequity as a structural injustice issue, and stigma in physical activity promotion. While the benefits of physical activity for every age group and demographic are numerous, ethics oversight is encouraged to ensure that these efforts do not impose unnecessary risks or stigmatize marginalized populations. (shrink)

This study investigated the association between Big Five Personality Traits and nutrition-related variables. We used secondary data from the Indonesia Family Life Survey wave 5 involving a total of 14,473 men and 16,467 women aged 15−101 years in Indonesia that was selected by stratified random sampling conducted in the period 2014 to 2015. Data were collected through interviews with the Big Five Index 15 and a questionnaire similar to the Global Physical Activity Questionnaire which was translated into the Indonesian (...) language, and based on measurements of height and weight. Analyses used binary logistic regression test controlled by socio-demographic factors to determine the association between Big Five Personality Traits and eating habits, physical activity, and obesity. Results showed that openness and extraversion were positively associated with recommended and non-recommended foods, conscientiousness was positively associated with only recommended foods, agreeableness was positively associated with recommended foods, and negatively associated with only one non-recommended food. Whereas, neuroticism was positively associated with non-recommended foods and negatively associated with recommended foods. Openness and conscientiousness were associated with physical activity. Conscientiousness, extraversion, and neuroticism were associated with obesity. Although some results were different from previous studies, these associations can be used as strategies of behavioral change due to the adaptation of personality characteristics, which can be modified even though the personality tends to be persistent. Further studies are needed to understand other mechanisms that might underlie this association. (shrink)

BackgroundAdolescents’ engagement in daily physical activity brings multiple benefits, including reduction in obesity, improvement of mental health, and enhancement of cognitive function. While prior studies have examined the link between physical activity and cognitive function, little is known regarding the extent to which this relationship is shaped by health and wellbeing factors. This study examines how subjective wellbeing and general health mediate the relationship between adolescents’ physical activity and cognitive function.MethodsThis study estimates a parallel structural equation model (...) using the Program for International Student Assessment 2018 dataset. Specifically, a total of 63,228 15-year-old subjects in nine countries/economies satisfied the study inclusion criteria, including in Bulgaria, Georgia, Hong Kong, Ireland, Mexico, Panama, Serbia, Spain, and United Arab Emirates. Frequency of moderate physical activity was reported weekly; SWB and GH were assessed using an internationally validated multi-item standardized questionnaire. SWB was measured by students’ self-evaluated satisfaction with their health, life, and schooling. GH was measured by students’ physical health and mental health status. Cognitive function was modeled as a latent function consisting of plausible values derived using item response theory on reading, mathematics, and science achievement tests.ResultsFindings indicated that increase in weekly MPA was positively associated with higher levels of SWB, GH, and CF among the study subjects. Parallel mediation analyses revealed that more frequent weekly MPA had relatively large direct effects on CF, and indirect effects channeling through improvements in SWB and GH were non-trivial. Heterogeneity results showed that boosts to CF, associated with MPA, were larger for mathematics and science than for reading.ConclusionThis study used a large-scale international dataset to show that the positive relationship observed between MPA and CF among adolescents was robust, and that SWB and GH were two critical mediators through which physical activity positively bolster CF. (shrink)

Most of the discussion in bioethics and health policy concerning social responsibility for health has focused on society’s obligation to provide access to healthcare. While ensuring access to healthcare is an important social responsibility, societies can promote health in many other ways, such as through sanitation, pollution control, food and drug safety, health education, disease surveillance, urban planning and occupational health. Greater attention should be paid to strategies for health promotion other than access to healthcare, such as environmental and (...) public health and health research.Lifestyle plays a major role in most of the illnesses in industrialised nations.1 Six of the 10 leading factors contributing to the global burden of disease are lifestyle related: unsafe sex, high blood pressure, tobacco use, alcohol use, high cholesterol and obesity.2 Lifestyle-related illnesses also contribute to the rising costs of healthcare. Spending on healthcare accounts for about 16% of the gross domestic product in the USA, or US$1.9 trillion.3 Although smoking has declined steadily there since the 1960s, smoking-related medical expenses are still about US$75.5 billion per year.4 Obesity, which has been climbing in the past two decades, accounts for about US$75 billion in healthcare costs there each year.5 Alcoholism and drug addiction in the USA account for annual healthcare costs of about US$22.5 billion and US$12 billion, respectively.6,7 Federal government spending on healthcare relating to HIV/AIDS is over US$13 billion per year.8Given the well-documented relationship between lifestyle, disease burden and healthcare costs, it makes economic and medical sense to hold individuals morally responsible for their health-related choices. While this view has a great deal of intuitive appeal, it also faces numerous objections.9–12 First, holding individuals entirely responsible for their own health conflicts with medicine’s obligation to treat the sick and society’s obligation …. (shrink)

Major depressive disorder (MDD) is a severe mental illness that affects 5 to 20% of the general population. Current antidepressant drugs exerts only a partial clinical efficacy because approximately 30% of depressed patients failed to respond to these drugs and antidepressants produce remission only in 30% of patients. This can be explained by the fact that the complex pathophysiology of depression has not been completely elucidated, and treatments have been mainly developed following the “monoaminergic hypothesis” of depression without considering the (...) key role of other factors involved in the pathogenesis of MDD, such as the role of chronic stress and neuroinflammation. Chronic stress acts as a risk factor for the development of MDD through the impairment of neurotrophins signaling such as brain-derived neurotrophic factor (BDNF) and transforming-growth-factor-β1 (TGF-β1). Stress-induced depressive pathology contributes to altered BDNF level and function in MDD patients and, thereby, an impairment of neuroplasticity at the regional and circuit level. Recent studies demonstrate that aerobic exercise strongly increases BDNF production and it may contribute as a non-pharmacological strategy to improve the treatment of cognitive and affective symptoms in MDD. Here we will provide a general overview on the possible synergism between physical activity and antidepressants in MDD. Physical activity can synergize with antidepressant treatment by rescuing neurotrophin signaling in MDD patients, promoting neuronal health and recovery of function in MDD-related circuits, finally enhancing pharmacotherapeutic response. This synergism might be particularly relevant in elderly patients with late-life depression, a clinical subgroup with an increased risk to develop dementia. (shrink)

BackgroundPhysical activity has a significant health impact worldwide and has been linked to a lower risk of the common cold.ObjectiveThe aim of this study was to estimate the form of PA among Chinese adults and the correlation between PA and number of the common cold in China's eastern, central, and western areas.DesignA cross-sectional study.SettingChina's eastern, central, and western regions from 30 November 2020 to 30 March 2021.PatientsA total of 1,920 healthy participants, who aged over 18 years old, with Internet access, (...) were enrolled, and then self-reported PA behaviors and number of the common cold were collected.MeasurementsThe authors calculated preference, intensity, frequency, and duration of PA in Chinese based on gender, age, and broad occupational categories and explored the potential effect between these factors and the common cold.ResultsApproximately 20.4% of participants reported not participating in sports regularly. Except for gender, there were significant differences in PA preference and intensity among the remaining individuals. However, intensity shows a U-shaped dose-response relationship with colds, whereas the frequency and duration have an inverse dose-response relationship. High intensity combined with high frequency increased colds the most. Nevertheless, non-exercise groups always have the most colds in each comparison.LimitationsThe result may be vulnerable to recall bias.ConclusionIntensity showed that U-shape, frequency, and duration showed inverse response to the number of colds last year, but age, sex, and occupation had no significant effects. High intensity and high frequency mixed increased colds the most, regardless of duration. (shrink)

Type 2 diabetes mellitus (T2DM) is a multifaceted chronic condition characterized by insulin resistance and hyperglycemia. This review synthesizes evidence on the influence of lifestyle factors such as diet, physical activity, and stress on the development and progression of T2DM. It highlights the intricate relationship between obesity, insulin resistance, and β-cell dysfunction, with a particular focus on the role of psychological stress in exacerbating disease outcomes. Through the analysis of recent studies, the review explores how lifestyle interventions, including dietary (...) changes, exercise, and stress management, can improve glycemic control and reduce complications. This comprehensive review underscores the need for integrated, personalized management strategies in T2DM care, emphasizing the importance of addressing both physiological and psychological factors to optimize outcomes and prevent complications. (shrink)

Objectives: The present study aimed to systematically analyze the effects of physical activity on executive function, working memory, cognitive flexibility, and activities of daily living in Alzheimer's disease patients and to provide a scientific evidence-based exercise prescription.Methods: Both Chinese and English databases were used as sources of data to search for randomized controlled trials published between January 1980 and December 2019 relating to the effects of physical activity on executive function, working memory, cognitive flexibility, and ADL issues in (...) AD patients. Sixteen eligible RCTs were ultimately included in the meta-analysis.Results: Physical activity had significant benefits on executive function [standard mean difference = 0.42, 95% confidence interval 0.22–0.62, p < 0.05], working memory, cognitive flexibility, and ADLs among AD patients. Subgroup analysis indicated that, for executive function issues, more than 60 min per session for 16 weeks of moderate-to-high-intensity dual-task exercises or multimodal exercise had a greater effect on AD patients. For working memory and cognitive flexibility issues, 60–90 min of moderate-intensity dual-task exercises 1–4 times/week was more effective. For ADL issues, 30–90 min of multimodal exercise at 60–79% of maximal heart rate 3–4 times/week had a greater effect on AD patients.Conclusions: Physical activity was found to lead to significant improvements in executive function, working memory, cognitive flexibility, and ADLs in AD patients and can be used as an effective method for clinical exercise intervention in these patients. However, more objective, scientific, and effective RCTs are needed to confirm this conclusion. (shrink)

That there is a heritable or familial component of susceptibility to chronic non‐communicable diseases such as type 2 diabetes, obesity and cardiovascular disease is well established, but there is increasing evidence that some elements of such heritability are transmitted non‐genomically and that the processes whereby environmental influences act during early development to shape disease risk in later life can have effects beyond a single generation. Such heritability may operate through epigenetic mechanisms involving regulation of either imprinted or non‐imprinted genes (...) but also through broader mechanisms related to parental physiology or behaviour. We review evidence and potential mechanisms for non‐genomic transgenerational inheritance of ‘lifestyle’ disease and propose that the ‘developmental origins of disease’ phenomenon is a maladaptive consequence of an ancestral mechanism of developmental plasticity that may have had adaptive value in the evolution of generalist species such as Homo sapiens. BioEssays 29: 145–154, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

Due to the COVID-19 pandemic, cities and states adopted social distancing, social isolation, or quarantine measurements to slow the transmission of the disease. Negative mental health outcomes including depression and anxiety have been associated with social distancing or social isolation. The purpose of the present study was to examine changes in psychological health and physical activity over an 8 week period under social distancing policies during the COVID-19 pandemic.Methods: Ninety individuals participated in this study. Qualifying participants answered questions using (...) an online survey regarding their loneliness, depressive symptoms, anxiety symptoms, mood state, and physical activity over four time points each lasting two weeks.Results: Symptoms of depression and state anxiety were increased in the population when compared to nationwide statistics from before the COVID-19 pandemic. Time point 2, ~1 month into social isolation, showed the most significant effects on mental health. During this time point, 100% of the participants showed symptoms of depression. There were no significant changes in physical activity over the 8 weeks. Loneliness, depressive symptoms, fatigue, and mood state were negatively associated with participation in physical activity. Vigor and state anxiety were associated with participation in physical activity.Conclusion: Social isolation and social distancing practices have had a negative effect on depression, anxiety, and mood over time. It appeared that depressive symptoms and total mood disturbance was elevated during time point two. Depressive symptoms were much higher than average compared to previous epidemiological data. Physical activity amount did not change over time but was associated with poor mental health. (shrink)

Objective: To cope with the Coronavirus Disease 2019 pandemic health authorities released social restrictions. Such social restrictions impacted on the people's possibilities to move deliberately in a public space and to gather with other people. In the present study, we investigated the impact of COVID-19-related restrictions on physical activity patterns before and during the confinement among team sports participants. Such PA patterns were further related to current mood states, and possible sex differences were also explored.Methods: A total of 476 (...) adults exercising team sport completed a series of self-rating questionnaires covering sociodemographic information, former and current PA patterns, and current mood states.Results: Compared with the period before the confinement, PA intensity decreased, but PA frequency increased during the confinement. Past, current, and changes in physical activity patterns were unrelated to participants' mood states. Sex differences in mood were spurious. Sex differences in physical activity patterns were modest, with male participants reporting a higher physical activity intensity during the confinement.Conclusions: The present pattern of results suggests that the COVID-19-related confinement did not impact in a uniform fashion on PA patterns of adults attending team sports. Furthermore, mood states were unrelated to current physical activity patterns. Given the complex psychosocial situation of COVID-19-related confinement, it appeared very unlikely that sole physical activity patterns could counterbalance possible impaired states of mood and behavior. (shrink)

The practice of physical activity (PA) contributes to the prevention of chronic diseases such as obesity, metabolic syndrome or cardiovascular diseases, being also directly related to the individual’s physical fitness. Therefore, it is necessary to measure and monitoring the levels of PA in childhood and adolescence, since it may be useful to describe their current health status and the association with physical fitness, as well as to reveal putative consequences in the future. Within the educational field, it (...) has been shown that physical education (PE) classes are a favorable context for the creation of healthy physical-sports habits and self-determined motivation could be a key for explaining the level of PA practice. For this reason, the purpose of this research was to study the mediating role of integrated regulation (IR) on the relationship between PA and physical fitness in children and adolescents. A total of 325 students between 11 and 14 years old participated in the study. The level of PA was estimated through the specific Physical Activity Questionnaire for Children (PAQ-C), while motivation and IR were measured by using the Perceived Locus of Causality scale (PLOC-2). In addition, physical fitness was measured through the Eurofit fitness battery of tests, composed of three body composition measures and seven tests of different physical capacities. The physical fitness score showed no differences when genders were compared. After regression analysis, the resulti... (shrink)

Tri Hita Karana is a traditional Balinese philosophy that emphasizes the importance of balance in the relationships between humans and God, humans and others, and humans and the natural environment. Although this principle underpins many aspects of life, its application in architectural and urban planning often faces various challenges. This research identifies the gap between traditional principles and the demands of modern development. A qualitative case study approach was used in Kedonganan Traditional Village, Kuta, Bali, employing in-depth interviews and (...) direct observation methods. The results of the study show that the people of Kedonganan Traditional Village still uphold customs and cultural traditions, which are implemented in various aspects of daily life, including religious activities, mutual cooperation, and environmental management. Collaboration between the government and traditional communities has proven effective in maintaining ecological, social, and spiritual balance. Additionally, the findings indicate that cultural, architectural and landscape elements remain relevant and functional in community life. The implications of this research highlight the importance of integrating Tri Hita Karana values into development policies to achieve sustainable balance. (shrink)

Public health agencies undertake a broad range of health promotion and injury and disease prevention activities in collaboration with an array of actors, such as the community, businesses, and non-profit organizations. These activities are “multisectoral” in nature and centered on public health agencies that oversee and engage with the other actors. Public health agencies can influence the hazardous activities in the private sector in a variety of ways, “ranging from prohibition and regulation to volunteerism, and from cooperation to cooption.” Hence, (...) a public health agency that possesses the necessary administrative resources and authority is vital to the effective implementation of health policies and regulations.In the developing world, however, many state health agencies lack these basic capacities in dealing with critical health threats, including their ability to avert epidemics of communicable diseases arising from poor sanitary conditions. A serious constraint is the shortage of public health funding for health agencies in the developing world for typical agency functions. This is often aggravated by the transaction-intensive demands entailed in enforcing regulations among an array of private and public sector actors including individuals, businesses, and local bodies responsible for providing civic services. (shrink)

The purpose of the present study was to evaluate the effectiveness of a physical activity intervention program designed to enhance levels of engagement in PA. Despite robust evidence supporting the beneficial effects of PA on overall health, only about 22% of individuals engage in the recommended minimum amount of PA. Recent surveys suggested that most individuals express intentions to be physically active, though the psychological state of amotivation dismissed these struggles. In the current study, we pilot-tested a new intervention (...) program, aimed at enhancing engagement in PA among sedentary individuals. The intervention was based on two behavioral change and motivational psychological frameworks: Self-Determination Theory and Acceptance and Commitment Therapy. During a 14-week intervention program, 94 sedentary Israeli college students were randomly assigned into one of three groups: SDT and ACT-based intervention, traditional intervention, and a non-treatment group. Prior to and following the intervention, participants completed the Behavioral Regulation in Exercise Questionnaire-3 to examine motivation to exercise and the International Physical Activity Measurement IPAQ to evaluate their training frequency. Results showed that the SDT and ACT-based intervention group exhibited a significant increase in motivation to exercise between time 1 and time 2, while the other two groups showed insignificant differences in motivation to exercise. Furthermore, neither of the groups showed significant differences in their training frequency per week. However, those in the SDT and ACT-based groups reported an increase in activity intensity from time 1 to time 2 compared to the two other groups. Further, exercise psychology consultants and scholars can use the intervention protocol and utilize these findings to improve PA behaviors and promote health in the general population. Limitations, future directions, and implications are discussed in detail. (shrink)

We tested the plausibility of a persuasion model to understand the effects of messages framed in terms of gain, non-loss, loss, and non-gain, and related to the physical, mental and social consequences of doing physical activity at home during the lockdown restrictions. 272 Italian participants responded to a questionnaire on their attitude and intention at Time 1, frequency of past behavior, and self-efficacy related to exercising at home. Then, participants were randomly assigned to four different message conditions: gain (...) messages focused on the positive outcomes associated with doing physical activity at home; non-loss messages focused on the avoided negative outcomes associated with doing physical activity at home; loss messages focused on the negative outcomes associated with not doing physical activity at home; non-gain messages focused on the missed positive outcomes associated with not doing physical activity at home. After reading the messages, participants answered a series of questions regarding their perception of threat and fear, their evaluation of the messages, and their attitude and intention toward exercising at home at Time 2. Using multigroup structural equation modeling, we compared message conditions, and tested whether the effects of the messages on attitude and intention at Time 2 were mediated by message-induced threat, message-induced fear, and message evaluation. Results showed that the perception of the messages as not threatening was the key point to activate a positive evaluation of the recommendation. The highest persuasive effect was observed in the case of the non-loss frame, which did not threaten the receivers, triggered a moderated fear and, in turn, activated a positive evaluation of the recommendation, as well as higher attitude and intention to do home-based physical activity at Time 2. Overall, these results advance our comprehension of the effects of message framing on receivers' attitudes and intentions toward home-based physical activity. (shrink)

The article examines the impact of the virtual public sphere on how urban spaces are experienced and conceived in our data-driven society. It places particular emphasis on urban scale digital twins, which are virtual replicas of cities that are used to simulate environments and develop scenarios in response to policy problems. The article also investigates the shift from the technical to the socio-technical perspective within the field of smart cities. Despite the aspirations of urban scale digital twins (...) to enhance the participation of citizens in the decision-making processes relayed to urban planning strategies, the fact that they are based on a limited set of variables and processes makes them problematic. The article aims to shed light on the tension between the real and the ideal at stake during this process of abstracting sets of variables and processes in the case of urban scale digital twins. (shrink)

Although the study of the affective components involved in predicting physical activity is spreading faster and faster, there is a lack of studies testing their role when promoting physical activity through message interventions. In the present study, we considered these components by focusing on how anticipated affective reactions and emotional processing of the messages influence receivers’ affective attitude toward physical activity, concurrent behavior, and future intention. A sample of 250 participants was involved in an intervention relying on (...) prefactual messages promoting physical activity. All messages were sent through a research app and were focused on the expected consequences of exercising. Four experimental conditions involving messages differing as to their outcome sensitivity framing were compared to a control condition. Results showed that reading gain and non-gain messages enhanced the positive affective attitude toward physical activity, compared to control. Enhanced affective attitude after the intervention increased, in turn, self-reported physical activity and future intention. Interestingly, gain messages were even more persuasive for people with a low level of positive anticipated affective reactions. Furthermore, their effectiveness was especially attributable to the elicitation of hope in receivers. Discussion focuses on the advantages of considering affective components and their implications when promoting physical activity. (shrink)

AimThe aim of our study was to analyze physical activity levels, sitting time, physical fitness, and their relationship with depressive symptoms after home confinement in previously active older adults.MethodsThis cross-sectional study sample comprised 68 older adults from a community-based exercise program conducted in Porto, Portugal. After home confinement, participants were assessed in person for lower-body strength, cardiorespiratory fitness, agility/dynamic balance, handgrip strength, and anthropometry. Telephone interviews were performed to evaluate depressive symptoms with the Geriatric Depression Scale – 15 (...) items and physical activity levels through the International Physical Activity Questionnaire. Individuals were also asked to self-report changes in their physical activity levels and time spent sitting.ResultsNinety percent of older adults self-reported a decrease in overall physical activity levels, and nearly 65% increased daily sitting time during the home confinement. However, previously active older adults still presented high levels of physical fitness after 11 weeks of home confinement. Overall, 52.9% of participants scored 5 or more points on GDS-15, which is suggestive of depression. Higher levels of moderate-to-vigorous physical activity and cardiorespiratory fitness were found in the non-depressed group compared with the depressed group. Finally, results from multiple regression analysis revealed that MVPA was negatively associated with depression. This model explained 16.4% of the variability seen in depression score, controlled for age, gender, and education.ConclusionEven reporting a decline in physical activity, older adults who previously participated in a formal exercise program, still presented high levels of physical fitness after 11 weeks of home confinement. However, MVPA, but not physical fitness, seems to be an associated depression score in previously active older adults. These results reinforce the importance of older adults to remain physically active, since higher levels of MVPA may have a protective effect on depressive symptoms and, therefore, mitigate the negative impact of home confinement on mental health. Future longitudinal research studies are needed to ascertain these results. (shrink)

BackgroundIndividuals with early phase cognitive impairment are frequently affected by existential distress, social avoidance and associated health issues. The demand for efficient psychological support is crucial from both an individual and a societal perspective. We have developed a novel psychological intervention manual for providing a non-medical path to enhanced psychological health in the cognitively impaired population. The current article provides specific information on the randomized controlled trial -design and methods. The main hypothesis is that participants receiving PIPCI will increase their (...) psychological flexibility compared to participants in the active control group and the waiting list control group. The secondary hypotheses are that participants receiving PIPCI will improve psychological health compared to participants in the active control group and the waiting list control group.Materials and MethodsThis three-arm RCT will recruit participants from the cognitive centers at Karolinska University Hospital in Stockholm and randomize approximately 120 individuals in the early phase of cognitive impairment to either an experimental group, an active control group or a waiting list control group. Intervention outcome will be evaluated with self-report questionnaires on physical and psychological aspects of health, cognitive assessment, biological markers and health care costs. Assessments will be performed at pre- and post-intervention, as well as at a 6-month follow-up.DiscussionThe development of a potentially feasible and effective psychological intervention tailored for early phase cognitive impairment has the potential to advance the non-pharmacological intervention field. This is especially important given the extensive burden for many affected individuals and their families and the current lack of effective treatments. If the psychological intervention discussed here shows feasibility and efficacy, there is potential for far-reaching healthcare implications for patients with early cognitive impairment at risk of developing dementia.Clinical Trial RegistrationClinicalTrials.gov: NCT04356924. Date of registration: April 22, 2020. URL: https://clinicaltrials.gov/ct2/show/NCT04356924. (shrink)