A Novel Dual-Language Touch-Screen Intervention to Slow Down Cognitive Decline in Older Adults: A Randomized Controlled Trial.

Background and Objectives: Bilingualism has been suggested to protect older adults from cognitive aging and delay the onset of dementia. However, no studies have systematically explored bilingual usage as a tool to mitigate age-related cognitive decline. We developed the Dual-Language Intervention in Semantic memory-Computerized (DISC), a novel cognitive training program with three training tasks (object categorization, verbal fluency, and utility of things) designed specifically for older adults that featured two modes: single-language (SL) exposure mode and dual-language (DL) exposure mode. Research Design and Methods: The final sample included 50 cognitively healthy (CH; 33 female, M age = 72.93 years, range = 53.08-87.43 years) and 48 cognitively impaired (CI; 35 female, M age = 80.93 years, range = 62.31-96.67 years) older adults, randomly assigned them into one of three groups: SL group, DL group, and control group (no training). Participants in SL and DL groups used DISC in either SL mode (i.e., training instructions were spoken in only one language throughout the entire training) or DL mode (i.e., training instructions alternated between two languages), respectively, for 24 sessions. Participants in the control group were asked to continue with their normal daily activities (e.g., playing bingo and reading newspapers). Results: For CH older adults, we found significant improvements in the Rey Auditory Verbal Learning Test (RAVLT) Trial 5 score and the Clock Drawing Test score in the DL group but not in the SL and control groups posttraining compared with pretraining. For CI older adults, there was a delayed improvement in the RAVLT Trial 1, six months later. Discussion and Implications: Our findings provided novel evidence that implementing DL cognitive training benefits CH older adult's late verbal learning and visuospatial construction skills, and a delayed improvement in CI older adults' early verbal learning abilities.

Unity Assumption in Audiovisual Emotion Perception.

We experience various sensory stimuli every day. How does this integration occur? What are the inherent mechanisms in this integration? The "unity assumption" proposes a perceiver's belief of unity in individual unisensory information to modulate the degree of multisensory integration. However, this has yet to be verified or quantified in the context of semantic emotion integration. In the present study, we investigate the ability of subjects to judge the intensities and degrees of similarity in faces and voices of two emotions (angry and happy). We found more similar stimulus intensities to be associated with stronger likelihoods of the face and voice being integrated. More interestingly, multisensory integration in emotion perception was observed to follow a Gaussian distribution as a function of the emotion intensity difference between the face and voice-the optimal cut-off at about 2.50 points difference on a 7-point Likert scale. This provides a quantitative estimation of the multisensory integration function in audio-visual semantic emotion perception with regards to stimulus intensity. Moreover, to investigate the variation of multisensory integration across the population, we examined the effects of personality and autistic traits of participants. Here, we found no correlation of autistic traits with unisensory processing in a nonclinical population. Our findings shed light on the current understanding of multisensory integration mechanisms.

Factors influencing protective behaviours during haze episodes in Singapore: A population-based study.

INTRODUCTION: Haze is a recurrent problem in Southeast Asia. Exposure to haze is linked to ophthalmic, respiratory and cardiovascular diseases, and mortality. In this study, we investigated the role of demographic factors, knowledge and perceived risk in influencing protective behaviours during the 2013 haze in Singapore. METHODS: We evaluated 696 adults in a cross-sectional study. Participants were sampled via a 2-stage simple random sampling without replacement from a large residential district in Singapore in 2015. The questionnaire measured the participant's knowledge, perceived risk and behaviours during the Southeast Asian haze crisis in 2013. Reliability and validity of the questionnaire were assessed using comparative fit index (≥0.96) and root mean square error of approximation (≤0.05). We performed structural equation modelling to examine the relationship between the hypothesised factors and protective behaviours. RESULTS: More than 95% of the individuals engaged in at least 1 form of protective behaviour. Knowledge was strongly associated with protective behaviours via direct effect (ß=0.45, 95% CI 0.19-0.69, P<0.001) and indirect effect through perceived risk (ß=0.18, 95% CI 0.07-0.31, P=0.002). Perceived risk was associated with protective behaviours (ß=0.28, 95% CI:0.11-0.44, P=0.002). A lower household income and ethnic minority were associated with protective behaviours. A lower education level and smokers were associated with lower knowledge of haze. A higher education and ethnic minority were associated with a lower perceived risk. Wearing of N95 masks was associated with other haze-related protective behaviours (ß=0.24, 95% CI 0.08-0.37, P=0.001). CONCLUSION: Knowledge was associated with protective behaviours, suggesting the importance of public education. Efforts should target those of lower education level and smokers. The wearing of N95 masks correlates with uptake of other protective behaviours.

Brief facial emotion aftereffect occurs earlier for angry than happy adaptation.

Prolonged exposure to an emotional face biases our judgement of subsequent face stimulus toward the opposite emotion. This emotion aftereffect has been suggested to occur as early as 35 ms exposure duration in cartoon faces. In the current study, we are interested in investigating the time-course of brief emotional face adaptation, and the relationship between brief emotional face adaptation and prolonged emotional face adaptation. We adapted the subjects from 17 ms to 1000 ms with a happy or angry adapting face. We found that a facial emotion adaptation aftereffect started from 17 ms adapting duration for angry face adaptation, and from 50 ms for happy face adaptation. Factor analysis on the adaptation effects highlighted three different components: brief angry adaptation (17 ms, 34 ms, and 50 ms), prolonged angry adaptation (100 ms and 1000 ms), and happy face adaptation (from 17 ms to 1000 ms). We found that the brief angry face adaptation was negatively associated with the awareness of the adapting face, and the prolonged angry face adaptation was stronger in subjects who perceived the angry adapting face as more negative in valence. Together, these findings suggest that (1) facial emotion adaptation can be induced by brief (17 ms) adapting face presentation; (2) brief angry face adaptation may be related to early visual processing, whereas prolonged angry face adaptation may be related to adaptation at later and higher-level visual emotional processing; and (3) brief and prolonged adaptations may adapt different neural populations. Our findings thus shed light on the current understanding of the neural mechanisms of emotional face adaptation.

Exploring the association between depression and shenjing shuairuo in a population representative epidemiological study of Chinese adults in Guangzhou, China.

Traditional mental illness concepts remain prevalent in China. Shenjing shuairuo (i.e., neurasthenia), a depressive-like syndrome less favored in Western psychiatric nosology, has a long tradition of acceptance among Chinese lay people. The concept may be more easily accepted in China due to the culturally informed view of the importance of harmony between mind and body and is consistent with Traditional Chinese Medicine. The goals of this study were to estimate the prevalence of shenjing shuairuo, the overlap between shenjing shuairuo and depression, and whether these two disorders share correlates. Data was obtained from 751 Chinese adults using stratified random sampling. Spatial epidemiological methods were utilized with face-to-face interviews conducted in Guangzhou, China. The Patient Health Questionnaire (PHQ-9) and the neurasthenia criteria from ICD-10 measured depression and shenjing shuairuo. The prevalence of depression and shenjing shuairuo were 5.3% and 15.4%, respectively. Participants with depression were nearly six times more likely to have shenjing shuairuo. Women were more likely than men to have comorbid depression and shenjing shuairuo. Poorer health was reported across disorders. Those with shenjing shuairuo were more likely to report medical diagnoses. Longer sleep latency was reported for those with shenjing shuairuo and those with depression reported fewer hours of sleep and lower sleep quality. Those with depression alone reported the poorest sleep. Significant diagnostic overlap and few distinct correlates were observed. Nevertheless, the difference in prevalence and acceptance among non-professionals suggests that shenjing shuairuo is a useful category of distress among Chinese adults in Southern China.

Enhancing Public Health HIV Interventions: A Qualitative Meta-Synthesis and Systematic Review of Studies to Improve Linkage to Care, Adherence, and Retention.

Although HIV services are expanding, few have reached the scale necessary to support universal viral suppression of individuals living with HIV. The purpose of this systematic review was to summarize the qualitative evidence evaluating public health HIV interventions to enhance linkage to care, antiretroviral drug (ARV) adherence, and retention in care. We searched 19 databases without language restrictions. The review collated data from three separate qualitative evidence reviews addressing each of the three outcomes along the care continuum. 21,738 citations were identified and 24 studies were included in the evidence review. Among low and middle-income countries in Africa, men living with HIV had decreased engagement in interventions compared to women and this lack of engagement among men also influenced the willingness of their partners to engage in services. Four structural issues (poverty, unstable housing, food insecurity, lack of transportation) mediated the feasibility and acceptability of public health HIV interventions. Individuals living with HIV identified unmet mental health needs that interfered with their ability to access HIV services. Persistent social and cultural factors contribute to disparities in HIV outcomes across the continuum of care, shaping the context of service delivery among important subpopulations.

Barriers and Facilitators to Interventions Improving Retention in HIV Care: A Qualitative Evidence Meta-Synthesis.

Retention in HIV care is vital to the HIV care continuum. The current review aimed to synthesize qualitative research to identify facilitators and barriers to HIV retention in care interventions. A qualitative evidence meta-synthesis utilizing thematic analysis. Prospective review registration was made in PROSPERO and review procedures adhered to PRISMA guidelines. Nineteen databases were searched to identify qualitative research conducted with individuals living with HIV and their caregivers. Quality assessment was conducted using CASP and the certainty of the evidence was evaluated using CERQual. A total of 4419 citations were evaluated and 11 were included in the final meta-synthesis. Two studies were from high-income countries, 3 from middle-income countries, and 6 from low-income countries. A total of eight themes were identified as facilitators or barriers for retention in HIV care intervention: (1) Stigma and discrimination, (2) Fear of HIV status disclosure, (3) task shifting to lay health workers, (4) Human resource and institutional challenges, (5) Mobile Health (mHealth), (6) Family and friend support, (7) Intensive case management, and, (8) Relationships with caregivers. The current review suggests that task shifting interventions with lay health workers were feasible and acceptable. mHealth interventions and stigma reduction interventions appear to be promising interventions aimed at improving retention in HIV care. Future studies should focus on improving the evidence base for these interventions. Additional research is needed among women and adolescents who were under-represented in retention interventions.