‘Super Kids’: Regulating the Use of Cognitive and Psychological Enhancement in Children

With headlines such as ‘Get Smart Drugs Out of the Closet, Scientists Urge’ and ‘Smart Drugs for Straight As’,1 discussions about individuals taking psychopharmaceutical drugs to enhance their cognitive performance2 are increasingly in the public domain. In the US, drugs such as Modafinil are being used by university students because they provide a more targeted, powerful mental ‘sharpening’ than traditional stimulants such as caffeine in its various forms.3 Such drugs are readily available over the internet,4 and the US experience is reflected in the UK.5 There have been calls from a former governmental Chief Scientific Officer to make ‘smart’ pills available for all.6 His report noted scientists’ calls for the removal of restrictions on cognitive enhancers that have been dubbed ‘cosmetic neurology’ and ‘nip and tuck’ for the mind.7 It is perhaps unsurprising that many of these drugs are already being used ‘off-label’, whereby an approved drug may be used in ways not specifically sanctioned, although it is likely to be supported by scientific evidence.8 The prospect of older individuals avoiding debilitating conditions such as Alzheimer’s disease is exciting, and the popular perception is that there are no obvious short-term harmful effects.9 However, these psychopharmacological drugs do have sideeffects and have the potential to become addictive.10 In addition, they target molecular events underlying cognition and emotion,11 and there is a concern that there may be long-term consequences such as cognitive decline, even when taken by the young.12 Enhancement of psychological traits, such as personality or cognitive ability, has particular ethical, legal and social implications when applied to children

Bidirectional association between mental health and physical activity in older adults: Whitehall II prospective cohort study.

To investigate longitudinal and bidirectional associations between mental health and physical activity from midlife into old age

Reciprocal associations between smoking cessation and depression in older smokers: findings from the English Longitudinal Study of Ageing (ELSA)

Background: Depression is a particular problem in older people and it is important to know how it affects and is affected by smoking cessation. Aims: To identify reciprocal, longitudinal relationships between smoking cessation and depression among older smokers. Methods: Across four waves, covering six years (2002–2008), changes in smoking status and depression, measured using the 8–item Centre for Epidemiologic Studies Depression Scale, were assessed among recent ex-smokers and smokers (N=2,375) in the English Longitudinal Study of Ageing. Results: In latent growth curve analysis, smoking at baseline predicted depression caseness longitudinally and vice versa. When both processes were modelled concurrently, depression predicted continued smoking longitudinally (B(β)=0.21 (0.27); 95%CI 0.08,0.35) but not the other way around. This was the case irrespective of mental health history and adjusting for a range of covariates. Conclusions: In older smokers, depression appears to act as an important barrier to quitting while quitting has no long-term impact on depression

Reaction Time and Mortality from the Major Causes of Death:The NHANES-III Study

Studies examining the relation of information processing speed, as measured by reaction time, with mortality are scarce. We explored these associations in a representative sample of the US population

Gender differences and individual, household, and workplace characteristics: Regional geographies of extended working lives

Increasing labour market participation among older workers is embedded in government policy in the United Kingdom and many other industrialised countries with rises in the state pension age in response to increasing life expectancy. Despite this, many workers stop working before state pension age with around a 20% reduction in the proportion of adults in work between ages 50 and 60 in 2011 in England and Wales. This paper considers the risk of remaining in work by region and gender between 2001 and 2011 for adults aged 40–49 in 2001. Men had significantly higher risk of extended working in the East Midlands (1.4×) East of England (1.5×), South East (1.6×), and South West (1.6×) compared with the North East. Women in all regions apart from London and Wales had significantly higher risk of extended working compared with the North East: ranging from 1.15 times in the North West and West Midlands to 1.6 times in the South West. Adjustment for nonemployment-related socio-economic status, housing tenure, qualifications, and car ownership, and employment status in 2001 attenuated all significant regional differences in extended working in men and in women in most regions. Workplace characteristics attenuated most of the remaining regional differences in women: women working in larger employers in 2001 or working at distances of 200 km or more, abroad or from home, had lower risk of remaining in work, whereas access to a car and higher working hours increased risk. Policies to increase qualifications and skills among older adults are recommended

Pre-pandemic cognitive function and COVID-19 mortality:Prospective cohort study

Poorer performance on standard tests of pre-morbid cognitive function is related to an elevated risk of death from lower respiratory tract infections but the link with coronavirus (COVID‑19) mortality is untested. Participants in UK Biobank, aged 40 to 69 years at study induction (2006–10), were administered a reaction time test, an indicator of information processing speed, and also had their verbal-numeric reasoning assessed. Between April 1st and September 23rd 2020 there were 388 registry-confirmed deaths (138 women) ascribed to COVID-19 in 494,932 individuals (269,602 women) with a reaction time test result, and 125 such deaths (38 women) in the subgroup of 180,198 people (97,794 women) with data on verbal-numeric reasoning. In analyses adjusted for age, sex, and ethnicity, a one standard deviation slower reaction time was related to a higher rate of death from COVID-19 (hazard ratio; 95% confidence interval: 1.18; 1.09, 1.28), as was a one standard deviation disadvantage on the verbal-numeric reasoning test (1.32; 1.09, 1.59). While there was some attenuation in these relationships after adjustment for additional covariates which included socio-economic status and lifestyle factors, the two pre-pandemic indicators of cognitive function continued to be related to COVID-19 mortality

Cigarette smoking and alcohol drinking in a representative sample of English school pupils: cross-sectional and longitudinal associations.

Objective: The aim of our study was to examine cross-sectional and longitudinal associations between cigarette smoking and alcohol drinking, in a representative sample of English pupils. Method: Data from 13,635 school pupils in the Longitudinal Study of Young People in England (LSYPE) on usage of cigarettes from 2004 (typical age 14) to 2006 (age 16) and alcohol from 2004 to 2007 (age 17), analyzed with latent growth curve models. Results: The weighted percentage of pupils drinking alcohol increased from 26% at age 14 to 71% by age 17, smoking from 12% to 27% by age 16. Pupils with lower socio-economic status were more likely to smoke but less likely to drink alcohol regularly. Both behaviors were positively correlated at age 14, adjusted for several confounding factors. The rate of increase over time was also positively correlated. Conclusion: Cigarette smoking and alcohol drinking are already correlated by age 14, are socio-economically patterned, and ‘move together’ during adolescence. Future studies and interventions should be targeted at a younger age range, to identify early smoking and potentially hazardous alcohol drinking patterns

Sexual orientation and symptoms of common mental disorder or low wellbeing: combined meta-analysis of 12 UK population health surveys

Background Previous studies have indicated increased risk of mental disorder symptoms, suicide and substance misuse in lesbian, gay and bisexual (LGB) adults, compared to heterosexual adults. Our aims were to determine an estimate of the association between sexual orientation identity and poor mental health and wellbeing among adults from 12 population surveys in the UK, and to consider whether effects differed for specific subgroups of the population. Methods Individual data were pooled from the British Cohort Study 2012, Health Survey for England 2011, 2012 and 2013, Scottish Health Survey 2008 to 2013, Longitudinal Study of Young People in England 2009/10 and Understanding Society 2011/12. Individual participant meta-analysis was used to pool estimates from each study, allowing for between-study variation. Results Of 94,818 participants, 1.1 % identified as lesbian/gay, 0.9 % as bisexual, 0.8 % as ‘other’ and 97.2 % as heterosexual. Adjusting for a range of covariates, adults who identified as lesbian/gay had higher prevalence of common mental disorder when compared to heterosexuals, but the association was different in different age groups: apparent for those under 35 (OR = 1.78, 95 % CI 1.40, 2.26), weaker at age 35–54.9 (OR = 1.42, 95 % CI 1.10, 1.84), but strongest at age 55+ (OR = 2.06, 95 % CI 1.29, 3.31). These effects were stronger for bisexual adults, similar for those identifying as ‘other’, and similar for 'low wellbeing'. Conclusions In the UK, LGB adults have higher prevalence of poor mental health and low wellbeing when compared to heterosexuals, particularly younger and older LGB adults. Sexual orientation identity should be measured routinely in all health studies and in administrative data in the UK in order to influence national and local policy development and service delivery. These results reiterate the need for local government, NHS providers and public health policy makers to consider how to address inequalities in mental health among these minority groups

Peer support to improve diabetes care: An implementation evaluation of the Australasian Peers for Progress Diabetes Program

Background: Several studies have now demonstrated the benefits of peer support in promoting diabetes control. The aim of this study is to evaluate the implementation of a cluster randomised controlled trial of a group-based, peer support program to improve diabetes self-management and thereby, diabetes control in people with Type 2 Diabetes in Victoria, Australia. Methods: The intervention program was designed to address four key peer support functions i.e. 1) assistance in daily management, 2) social and emotional support, 3) regular linkage to clinical care, and 4) ongoing and sustained support to assist with the lifelong needs of diabetes self-care management. The intervention participants attended monthly group meetings facilitated by a trained peer leader for 12 months. Data was collected on the intervention's reach, participation, implementation fidelity, groups' effectiveness and participants' perceived support and satisfaction with the intervention. The RE-AIM and PIPE frameworks were used to guide this evaluation. Results: The trial reached a high proportion (79%) of its target population through mailed invitations. Out of a total of 441 eligible individuals, 273 (61.9%) were willing to participate. The intervention fidelity was high (92.7%). The proportion of successful participants who demonstrated a reduction in 5 years cardiovascular disease risk score was 65.1 and 44.8% in the intervention and control arm respectively. Ninety-four percent (94%) of the intervention participants stated that the program helped them manage their diabetes on a day to day basis. Overall, attending monthly group meetings provided 'a lot of support' to 57% and 'moderate' support to 34% of the participants. Conclusion: Peer support programs are feasible, acceptable and can be used to supplement treatment for patients motivated to improve behaviours related to diabetes. However, program planners need to focus on the participation component in designing future programs. The use of two evaluation frameworks allowed a comprehensive evaluation of the trial from the provider-, participant- and public health perspective. The learnings gained from this evaluation will guide and improve future implementation by improving program feasibility for adoption and acceptability among participants, and will ultimately increase the likelihood of program effectiveness for the participants. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12609000469213. Registered 16 June 2009