Multi-level metacognition for adaptive behavior

Purpose: Many veterans face difficulties related to physical and mental health issues, but little is known about how these are related within veterans in the general population. The purpose of this study was to examine the association between current mental health, health problems, and activity limitations in population-based samples of veterans aged 25 years and older. Methods: This cross sectional analysis used 2015 data from the Behavioral Risk Factor Surveillance System (BRFSS) for veterans aged 25 and older from Oklahoma, Virginia, and Washington. Multiple logistic regression analysis was used to assess the relationship between current mental health, health conditions, and activity limitations after controlling alcohol use and demographic variables. Results: Across states, most veterans aged 25 and older reported good current mental health (77-81%), about half reported 3 or more health conditions (40-54%), and about one-fourth reported activity limitations (17-28%). After controlling for alcohol use and demographic factors, good current mental health was inversely related to health conditions and activity limitations in all three states with moderate to high effect sizes. Conclusion: The results of this study indicated that current mental health among veterans aged 25 years and older in general populations is significantly related to health conditions, activity limitations, and gender. Because of moderate to high relations, primary care practitioners should screen for mental health, health conditions, and activity limitations if a veteran, especially a female veteran, presents with any of these, and then educate, treat, and provide referral services as comorbid conditions versus separate issues.

Childhood violence has been linked to a variety of health outcomes in adulthood; however, little research has focused on the impact of childhood violence on behavior and health during pregnancy. We aimed to explore the role of experiencing childhood physical and sexual violence in health status and high-risk behaviors among young, urban pregnant women. Pregnant women seeking care in an urban emergency department were recruited. Information on demographics, prior and current violence, depressive symptoms, stress, substance use, and health conditions was collected, and multivariate analyses were used. Twenty-nine percent of women reported at least one episode of childhood physical violence before the age of 16, and 14% reported at least one episode of rape during childhood. Women reporting any type of childhood violence were > twice as likely to be experiencing current violence (odds ratio [OR] 2.45, 95% confidence interval [95% CI] 1.83-2.74). Pregnant women who reported childhood physical violence without current violence had a higher odds of prior sexually transmitted diseases (STDs), confirmed cigarette use (OR 1.98, 95% CI 1.44-2.74), and depressive symptoms, adjusting for age, race, and education. The group of pregnant women reporting childhood sexual violence/rape without current violence reported significantly higher levels of depressive symptoms, stress, problem drinking, and cigarette use during pregnancy (OR 4.11, 95% CI 2.24-7.55). Women who experienced any type of childhood violence and reported current violence were > five times more likely to report depressive symptoms and have confirmed, recent cocaine use compared with women without a history of prior or current violence. These findings underscore the importance of understanding the full impact of early childhood violence on behaviors during pregnancy and provide direction for substance use and depression prevention strategies among pregnant women.

In dynamic (social) environments, an affective state of “stress” can be adaptive and promote agent wellbeing, but maladaptive if not appropriately regulated. The presence of (and interactions with) affect-based social support has been hypothesised to provide mechanisms to regulate stress (the “social buffering” hypothesis), though the precise, underlying mechanisms are still unclear. However, the hormone oxytocin has been implicated in mediating these effects in at least two ways: by improving social appraisals and reducing the short-term release of stress hormones (i.e., cortisol), and adapting an agent’s long-term stress tolerance. These effects likely facilitate an agent’s long-term adaptive ability by grounding their physiological and behavioural adaptation in the (affective) social environment, though these effects also appear to be context-dependent. In this paper, we investigate whether two of the hypothesised hormonal mechanisms that underpin the “social buffering” phenomenon affect the long-term wellbeing of (artificial) social agents who share affective social bonds, across numerous social and physical environmental contexts. Building on previous findings, we hypothesise that “social buffering” effects can improve the long-term wellbeing of agents who share affective social bonds in dynamic environments, through regular prosocial interactions with social bond partners. We model some of the effects associated with oxytocin and cortisol that underpin these hypothesised mechanisms in our biologically-inspired, socially-adaptive agent model, and conduct our investigation in a small society of artificial agents whose goal is to survive in challenging environments. Our results find that, while stress can be adaptive and regulated through affective social support, long-term behavioural and physiological adaptation is determined by the contextual perception of affective social bonds, which is influenced by early-stage interactions between affective social bond partners as well as the degree of the physical and social challenges. We also show how these low-level effects associated with oxytocin and cortisol can be used as “biomarkers” of social support and environmental stress. For socially-situated artificial agents, we suggest that these “social buffering” mechanisms can adapt the (adaptive) stress mechanisms, but that the long-term efficacy of this adaptation is related to the temporal dynamics of social interactions and the contextual perception of the affective social and physical environments.

This study was conducted to describe the relationship of past trauma and current stress on the mental health of North Korean (NK) defectors living in South Korea 7 years after a baseline assessment. Of the 200 who participated in the initial study, 106 participated in follow-up. Previous data regarding past traumatic events experienced in North Korea and during defection, past posttraumatic stress disorder (PTSD), and their current stress levels were correlated with the participants' current mental health status including depression, anxiety, and PTSD. The rate of PTSD in the sample and the scores on the PTSD symptom scale decreased significantly from the baseline. The participants' current mental health was negatively related to previous traumatic experiences in North Korea and past symptoms of PTSD, but unrelated to previous trauma experienced during defection. In addition, although current mental health was negatively related to only current culture-related stress, it was unrelated to the level of current ordinary life stress. The results of this study suggest that PTSD symptoms decreased during the 7 years between assessments, and that current culture-related stress is the most important variable related to the mental health of NK defectors living in South Korea.

Although systemic inequities, broadly defined, are associated with health disparities in adults, there is a dearth of research linking contextual measures of exclusionary policies or prejudicial attitudes to health impairments in children, particularly among Latino populations. In this study, we examined a composite measure of systemic inequities in relation to the cooccurrence of multiple health problems in Latino children in the United States. Participants included 17 855 Latino children aged 3 to 17 years from the National Survey of Children's Health (2016-2020). We measured state-level systemic inequities using a factor score that combined an index of exclusionary state policies toward immigrants and aggregated survey data on prejudicial attitudes toward immigrants and Latino individuals. Caregivers reported on 3categories of child health problems: common health difficulties in the past year, current chronic physical health conditions, and current mental health conditions. For each category, we constructed a variable reflecting 0, 1, or 2 or more conditions. In models adjusted for sociodemographic covariates, interpersonal discrimination, and state-level income inequality, systemic inequities were associated with 1.13 times the odds of a chronic physical health condition (95% confidence interval: 1.02-1.25) and 1.24 times the odds of 2 or more mental health conditions (95% confidence interval: 1.06-1.45). Latino children residing in states with higher levels of systemic inequity are more likely to experience mental health or chronic physical health conditions relative to those in states with lower levels of systemic inequity.

Introduction: An aging population will bring a pressing challenge for the healthcare system. Insights into promoting healthy longevity can be gained by quantifying the biological aging process and understanding the roles of modifiable lifestyle and environmental factors, and chronic disease conditions. Methods: We developed a biological age (BioAge) index by applying multiple state-of-art machine learning models based on easily accessible blood test data from the Canadian Longitudinal Study of Aging (CLSA). The BioAge gap, which is the difference between BioAge index and chronological age, was used to quantify the differential aging, i.e., the difference between biological and chronological age, of the CLSA participants. We further investigated the associations between the BioAge gap and lifestyle, environmental factors, and current and future health conditions. Results: BioAge gap had strong associations with existing adverse health conditions (e.g., cancers, cardiovascular diseases, diabetes, and kidney diseases) and future disease onset (e.g., Parkinson’s disease, diabetes, and kidney diseases). We identified that frequent consumption of processed meat, pork, beef, and chicken, poor outcomes in nutritional risk screening, cigarette smoking, exposure to passive smoking are associated with positive BioAge gap (“older” BioAge than expected). We also identified several modifiable factors, including eating fruits, legumes, vegetables, related to negative BioAge gap (“younger” BioAge than expected). Conclusions: Our study shows that a BioAge index based on easily accessible blood tests has the potential to quantify the differential biological aging process that can be associated with current and future adverse health events. The identified risk and protective factors for differential aging indicated by BioAge gap are informative for future research and guidelines to promote healthy longevity.

Objective: This study aimed to determine the current work environment and health conditions for delivery workers in Ulsan Metropolitan City.Methods: Data from 64 delivery workers were collected, including their sociodemographic and employment information, and their opinions on labor environment, health status, health check-ups, and national health services. Quantitative data were analyzed through frequency analysis to explore the results. Qualitative data, such as descriptive responses, were examined through a process of categorization and multi-frequency responses.Results: The primary risk exposure of delivery workers in workplace was vibration from machines, high temperatures enough to sweat even when not working, smoke, gas, dust, etc. (each at 50.0%). Physical threats during work included postures that caused fatigue or pain (76.6%) and direct interaction with people (76.6%). Challenges in welfare and support within the work environment included the lack of rest time or difficulty in utilizing it (60.9%), no regular mealtime (65.6%), and no provision of protective equipment by the company (57.8%). A total of 48.8% of delivery workers responded that there were health and safety risks in their work environment, and overall job satisfaction was low (59.4% expressed dissatisfaction). While the general health condition was good, there were numerous complaints of pain (79.7%). Specific health issues included upper limb muscle pain (70.3%), lower limb muscle pain (62.5%), and the most diagnosed disease was hyperlipidemia (23.4%). Over the past two years, 10.9% of the participants had not had health check-ups. 71.9% expressed their willingness to participate in health promotion services, followed by improvement in working conditions and the management of harmful substances, musculoskeletal disorders, and cardiovascular diseases.Conclusion: This study, by examining the health status of delivery workers in Ulsan Metropolitan City, provides valuable foundational data for improving their work environment and preventing occupational diseases among them.

With the recent increase in the interest of individuals in health, lifecare, and disease, hospital medical services have been shifting from a treatment focus to prevention and health management. The medical industry is creating additional services for health- and life-promotion programs. This change represents a medical-service paradigm shift due to the prolonged life expectancy, aging, lifestyle changes, and income increases, and consequently, the concept of the smart health service has emerged as a major issue. Due to smart health, the existing health-promotion medical services that typically have been operated by large hospitals have been developing into remote medical-treatment services where personal health records are used in small hospitals; moreover, a further expansion has been occurring in the direction of u-Healthcare in which health conditions are continuously monitored in the everyday lives of the users. However, as the amount of data is increasing and the medical-data complexity is intensifying, the limitations of the previous approaches are increasingly problematic; furthermore, since even the same disease can show different symptoms depending on the personal health conditions, lifestyle, and genome information, universal healthcare is not effective for some patients, and it can even generate severe side effects. Thus, research on the AI-based healthcare that is in the form of mining-based smart health, which is a convergence technology of the 4IR, is actively being carried out. Particularly, the introduction of various smart medical equipment for which healthcare big data and a running machine have been combined and the expansion of the distribution of smartphone wearable devices have led to innovations such as personalized diagnostic and treatment services and chronic-disease management and prevention services. In addition, various already launched applications allow users to check their own health conditions and receive the corresponding feedback in real time. Based on these innovations, the preparation of a way to determine a user’s current health conditions, and to respond properly through contextual feedback in the case of unsound health conditions, is underway. However, since the previously made healthcare-related applications need to be linked to a wearable device, and they provide medical feedback to users based solely on specific biometric data, inaccurate information can be provided. In addition, the user interfaces of some healthcare applications are very complicated, causing user inconvenience regarding the attainment of desired information. Therefore, we propose a chatbot-based healthcare service with a knowledge base for cloud computing. The proposed method is a mobile health service in the form of a chatbot for the provision of fast treatment in response to accidents that may occur in everyday life, and also in response to changes of the conditions of patients with chronic diseases. A chatbot is an intelligent conversation platform that interacts with users via a chatting interface, and since its use can be facilitated by linkages with the major social network service messengers, general users can easily access and receive various health services. The proposed framework enables a smooth human–robot interaction that supports the efficient implementation of the chatbot healthcare service. The design of the framework comprises the following four levels: data level, information level, knowledge level, and service level.

Small studies suggest that head trauma in men may be associated with low testosterone levels and sexual dysfunction through mechanisms that likely include hypopituitarism secondary to ischemic injury and pituitary axonal tract damage. Athletes in contact sports may be at risk for pituitary insufficiencies or erectile dysfunction (ED) because of the high number of head traumas experienced during their careers. Whether multiple symptomatic concussive events are associated with later indicators of low testosterone levels and ED is unknown. To explore the associations between concussion symptom history and participant-reported indicators of low testosterone levels and ED. This cross-sectional study of former professional US-style football players was conducted in Boston, Massachusetts, from January 2015 to March 2017. Surveys on past football exposures, demographic factors, and current health conditions were sent via electronic and postal mail to participants within and outside of the United States. Analyses were conducted in Boston, Massachusetts; the data analysis began in March 2018 and additional analyses were performed through June 2019. Of the 13 720 male former players eligible to enroll who were contacted, 3506 (25.6%) responded. Concussion symptom score was calculated by summing the frequency with which participants reported 10 symptoms, such as loss of consciousness, disorientation, nausea, memory problems, and dizziness, at the time of football-related head injury. Self-reported recommendations or prescriptions for low testosterone or ED medication served as indicators for testosterone insufficiency and ED. In 3409 former players (mean [SD] age, 52.5 [14.1] years), the prevalence of indicators of low testosterone levels and ED was 18.3% and 22.7%, respectively. The odds of reporting low testosterone levels or ED indicators were elevated for previously established risk factors (eg, diabetes, sleep apnea, and mood disorders). Models adjusted for demographic characteristics, football exposures, and current health factors showed a significant monotonically increasing association of concussion symptom score with the odds of reporting the low testosterone indicator (highest vs lowest quartile, odds ratio, 2.39; 95% CI, 1.79-3.19; P < .001). The ED indicator showed a similar association (highest quartile vs lowest, odds ratio, 1.72; 95% CI, 1.30-2.27; P < .001). Concussion symptoms at the time of injury among former football players were associated with current participant-reported low testosterone levels and ED indicators. These findings suggest that men with a history of head injury may benefit from discussions with their health care clinicians regarding testosterone deficiency and sexual dysfunction.

This study examined gender differences in depression by examining differential exposure and vulnerability to socioeconomic factors during the life course. The data used for the analyses originated from a cross-national survey of older adults living in seven large Latin American cities. We examined associations between depressive symptomatology and socioeconomic conditions and health indicators in childhood, adulthood, and old age. We used the Geriatric Depression Scale to classify respondents with high levels of depressive symptoms. The prevalence of depression in the urban population of Latin America was relatively low, ranging across cities from 0.4 to 5.2% in men and from 0.3 to 9.5% in women. Women were more exposed to social and material disadvantages during their life course than men but were not more vulnerable to them than men. Current socioeconomic conditions and health status as well as functional disabilities mainly accounted for gender differences in the prevalence of depression. Additionally, poor health and hunger during childhood, as well as illiteracy or lack of education, were associated with depression in both men and women. Cumulative life course exposure to social and material disadvantage and current material, social, and health conditions explain the higher frequency of depression in women.

Correlations between childhood trauma and depression, anxiety, and stress levels in nurses

Machines acting as artificial agents are increasingly operating in environments populated by human beings, and are interacting directly with people. In order for artificial agents to be accepted by society, they must act in a manner that reflects society's norms. Since a society's norms are grounded in ethical rules of behaviour, artificial agents will also need to follow ethical norms of the society in which they operate, if they are to be accepted by human agents. In addition to an artificial agent's goals, tasks and actions for which it is designed such as operating as a care giver or an autonomous vehicle, an artificial agent needs to also incorporate ethical considerations when choosing which task to perform. To achieve this, an ethical component needs to be added to the artificial agent's programming. I present one such approach to achieve this based on Kent Beck's Test-Driven Development methodology

An important measure of brain health is the integrity of white matter connectivity structures that link brain regions. Studies have found an association between poorer sleep quality and decreased white matter integrity. Stress is among the strongest predictors of sleep quality. This study aimed to evaluate the association between sleep quality and white matter and to test if the relationship persisted after accounting for stress. White matter microstructures were measured by diffusion tensor imaging in a population of Old Order Amish/Mennonite (N=240). Sleep quality was determined by the Pittsburgh Sleep Quality Index. Current stress levels were measured by the perceived stress scale. Exposure to lifetime stress was measured by the lifetime stressor inventory. Microstructures of four white matter tracts: left and right anterior limbs of internal capsule, left anterior corona radiata, and genu of corpus callosum were significantly correlated with sleep quality (all p ≤ 0.001). The current stress level was a significant predictor of sleep quality (p ≤ 0.001) while lifetime stress was not. PSQI remained significantly associated with white matter integrity in these frontal tracts (all p < 0.01) after accounting for current stress and lifetime stress, while current and lifetime stress were not significant predictors of white matter in any of the four models. Sleep quality did not have any substantial mediation role between stress and white matter integrity. Sleep quality was significantly associated with several frontal white matter tracts that connect brain structures important for sleep regulation regardless of current or past stress levels.

This study provides the first objective data documenting neurocognitive impairment in long-term survivors of childhood osteosarcoma. To examine neurocognitive, neurobehavioral, emotional, and quality-of-life outcomes in long-term survivors of childhood osteosarcoma. Cross-sectional cohort study at an academic research hospital, with prospective treatment and chronic health predictors. Outcome data were collected from June 2008 to August 2014. Data analysis was completed in April 2015. Survivors of osteosarcoma recruited from the St Jude Lifetime Cohort Study were compared with community controls. Neurocognitive function, neurobehavioral symptoms, emotional distress, and quality of life. Outcomes were examined in relation to pharmacokinetic indices of methotrexate exposure and current chronic health conditions, which were assessed through medical examination and coded according to Common Terminology Criteria for Adverse Events, Version 4.03. Eighty survivors of osteosarcoma (mean [SD] age, 38.9 [7.6] years; time since diagnosis, 24.7 [6.6] years; 42% female) were compared with 39 community controls (age, 39.0 [11.7] years; 56% female). Survivors demonstrated lower mean scores in reading skills (-0.21 [95% CI, -0.32 to -0.10] vs 0.05 [95% CI, -0.13 to 0.23]; P = .01), attention (-0.78 [95% CI, -1.32 to -0.24] vs 0.24 [95% CI, -0.07 to 0.55]; P = .002), memory (-0.24 [95% CI, -0.48 to 0] vs 0.27 [95% CI, -0.08 to 0.62]; P = .01), and processing speed (-0.15 [95% CI, -0.35 to 0.05] vs 0.74 [95% CI, 0.44 to 1.03]; P < .001). Results of pharmacokinetic analysis showed that high-dose methotrexate maximum plasma concentration (estimate = 0; P = .48), median clearance (estimate = -0.11; P = .76), and median/cumulative exposure (estimate = 0; P = .45) were not associated with neurocognitive outcomes. Any grade 3 or 4 Common Terminology Criteria for Adverse Events cardiac, pulmonary, or endocrine condition was associated with poorer memory (t = 2.93; P = .006) and slower processing speed (t = 3.03; P = .002). Survivor-reported poor general health was associated with decreased sustained attention (estimate = 0.24; P = .05) and processing speed (estimate = 0.34; P = .005). Long-term survivors of osteosarcoma are at risk for neurocognitive impairment, which is related to current chronic health conditions and not to original treatment with high-dose methotrexate. Prospective longitudinal studies are needed to identify onset and progression of impairment to inform optimal interventions.

Introduction: A number of studies published by the World Trade Center Health Registry (Registry) document the prevalence of injuries sustained by victims of the World Trade Center Disaster (WTCD) on 9/11. Injury occurrence during or in the immediate aftermath of this event has been shown to be a risk factor for long-term adverse physical and mental health status. More recent reports of ongoing physical health and mental health problems and overall poor quality of life among survivors led us to undertake this qualitative study to explore the long-term impact of having both disaster-related injuries and peri-event traumatic exposure on quality of life in disaster survivors. Methods: Semi-structured, in-depth individual telephone interviews were conducted with 33 Registry enrollees who reported being injured on 9/11/01. Topics included: extent and circumstance of the injury(ies), description of medical treatment for injury, current health and functional status, and lifestyle changes resulting from the WTCD. The interviews were recorded, transcribed, and inductively open-coded for thematic analysis.Results: Six themes emerged with respect to long term recovery and quality of life: concurrent experience of injury with exposure to peri-event traumatic exposure (e.g., witnessing death or destruction, perceived life threat, etc.); sub-optimal quality and timeliness of short- and long-term medical care for the injury reported and mental health care; poor ongoing health status, functional limitations, and disabilities; adverse impact on lifestyle; lack of social support; and adverse economic impact. Many study participants, especially those reporting more serious injuries, also reported self-imposed social isolation, an inability to participate in or take enjoyment from previously enjoyable leisure and social activities and greatly diminished overall quality of life.Discussion: This study provided unique insight into the long-term impact of disasters on survivors. Long after physical injuries have healed, some injured disaster survivors report having serious health and mental health problems, economic problems due to loss of livelihood, limited sources of social support, and profound social isolation. Strategies for addressing the long-term health problems of disaster survivors are needed in order to support recovery.