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Competing Interests: Competing interests The authors declare that they have no competing interests.

Post-treatment follow-up in women with CIN3 is mandatory due to relapse in up to 15% of patients within 2 years. Standard follow-up care based on hrHPV-DNA/cytology co-testing has high sensitivity but limited specificity. The aim of our proof-of-concept case-control study was to evaluate the performance of the methylation test GynTect ® for the detection of recurrent CIN2/3 during follow-up. Residual clinical material from a recent, prospective, multicenter, observational study was available for further analysis. We studied a sample of 17 cases with recurrent CIN2/3 diagnosed within 24 months of follow-up and 31 controls without recurrence. DNA from cervical scrapes at baseline (immediately before CIN3 surgery) and up to three follow-up visits were analyzed for hrHPV and GynTect ® methylation status. Cytology data were available from the previous study. Overall, 12 cases and 21 controls were GynTect-positive at baseline. In these subgroups, single test sensitivity at first follow-up was 67% (95% CI 39-87%) for GynTect ® compared to 83% (95% CI 55-96%) for hrHPV ( p = 0.50). Single test specificity was significantly higher for GynTect ® (90%, 95% CI 71-98% vs. 62%, 95% CI 40-80%) ( p = 0.03). In a co-testing setting, both hrHPV/cytology and GynTect ® /cytology detected all recurrences. Specificity for GynTect ® /cytology was higher than for hrHPV/cytology, but this difference was not statistically significant. In conclusion, for initially GynTect-positive patients, both hrHPV and GynTect ® tests detected recurrent disease with similar sensitivity, but the GynTect ® assay has a higher specificity. Incident hrHPV infection and/or persisting multifocal hrHPV infections without clinical disease are most likely responsible for the poorer specificity of the hrHPV test. A future prospective validation study will have to show whether GynTect ® /cytology co-testing can outperform hrHPV/cytology co-testing in post-treatment surveillance.

Background: The NiTi alloy, known for its shape memory and superelasticity, is increasingly used in medicine. However, its high nickel content requires enhanced biocompatibility for long-term implants. Low-temperature plasma treatments under glow-discharge conditions can improve surface properties without compromising mechanical integrity., Methods: This study explores the surface modification of a NiTi alloy by oxidizing it in low-temperature plasma. We examine the impact of process temperatures and sample preparation (mechanical grinding and polishing) on the structure of the produced titanium oxide layers. Surface properties, including topography, morphology, chemical composition, and bioactivity, were analyzed using TEM, SEM, EDS, and an optical profilometer. Bioactivity was assessed through the deposition of calcium phosphate in simulated body fluid (SBF)., Results: The low-temperature plasma oxidization produced titanium dioxide layers (29-55 nm thick) with a predominantly nanocrystalline rutile structure. Layer thickness increased with extended processing time and higher temperatures (up to 390 °C), though the relationship was not linear. Higher temperatures led to thicker layers with more precipitates and inhomogeneities. The oxidized layers showed increased bioactivity after 14 and 30 days in SBF., Conclusions: Low-temperature plasma oxidation produces bioactive titanium oxide layers on NiTi alloys, with a structure and properties that can be tuned through process parameters. This method could enhance the biocompatibility of NiTi alloys for medical implants.

Background: Although physical activity (PA) is associated with significant health benefits, only a small percentage of adolescents meet recommended PA levels. This systematic review with meta-analysis explored the modifiable determinants of adolescents' device-based PA and/or sedentary behaviour (SB), evaluated in previous interventions and examined the associations between PA/SB and these determinants in settings., Methods: A search was conducted on five electronic databases, including papers published from January 2010 to July 2023. Randomized Controlled Trials (RCTs) or Controlled Trials (CTs) measuring adolescents' device-based PA/SB and their modifiable determinants at least at two time points: pre- and post-intervention were considered eligible. PA/SB and determinants were the main outcomes. Modifiable determinants were classified after data extraction adopting the social-ecological perspective. Robust Bayesian meta-analyses (RoBMA) were performed per each study setting. Outcomes identified in only one study were presented narratively. The risk of bias for each study and the certainty of the evidence for each meta-analysis were evaluated. The publication bias was also checked., Prospero Id: CRD42021282874., Results: Fourteen RCTs (eight in school, three in school and family, and one in the family setting) and one CT (in the school setting) were included. Fifty-four modifiable determinants were identified and were combined into 33 broader determinants (21 individual-psychological, four individual-behavioural, seven interpersonal, and one institutional). RoBMAs revealed none or negligible pooled intervention effects on PA/SB or determinants in all settings. The certainty of the evidence of the impact of interventions on outcomes ranged from very low to low. Narratively, intervention effects in favour of the experimental group were detected in school setting for the determinants: knowledge of the environment for practicing PA, d = 1.84, 95%CI (1.48, 2.20), behaviour change techniques, d = 0.90, 95%CI (0.09, 1.70), choice provided, d = 0.70, 95%CI (0.36, 1.03), but no corresponding effects on PA or SB were found., Conclusions: Weak to minimal evidence regarding the associations between the identified modifiable determinants and adolescents' device-based PA/SB in settings were found, probably due to intervention ineffectiveness. Well-designed and well-implemented multicomponent interventions should further explore the variety of modifiable determinants of adolescents' PA/SB, including policy and environmental variables., (© 2024. The Author(s).)

Background: Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps., Objective: The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family-based setting., Methods: A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t 0 ) and postintervention (t 1 ) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t 0 and t 1 , families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t 1 , a follow-up assessment (t 2 ) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2)., Results: Overall, 48 families (CG: n=22, 46%, with 68 participants and IG: n=26, 54%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2%, with 4 participants and IG: n=1, 2%, with 4 participants) chose to drop out of the study owing to personal reasons before t 0 . Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30)., Conclusions: Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts., Trial Registration: German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415., International Registered Report Identifier (irrid): RR2-10.2196/20534., (©Kathrin Wunsch, Janis Fiedler, Sebastian Hubenschmid, Harald Reiterer, Britta Renner, Alexander Woll. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 26.04.2024.)

Background: Technological devices can support nursing home employees; however, their perspective is not sufficiently studied. Our aims were thus to (a) examine affinity for technology and technology interaction and related sociodemographic confounders, as well as (b) detect possible requirements and boundary conditions relevant for the development and implementation of assistive technologies among nursing home employees., Methods: We conducted an online survey between May and July of 2022 among 200 nursing home employees in Germany. The survey included two questionnaires, that is, Affinity for Technology Interaction (ATI) and Affinity for Technology-Electronic Devices (TA-EG; subscales TA-EG-Enthusiasm, TA-EG-Competence, TA-EG-Positive Consequences, and TA-EG-Negative Consequences), as well as sociodemographic variables, that is, age, gender, professional groups, education/graduation level. We carried out factorial variance and multiple regression analyses., Results: There were differences between age groups in ATI (lower score with increasing age) and between gender, age, and professional group in TA-EG (lower score for females, participants with higher ages, and nursing home managers). Predictors of ATI were age and professional group, predictors of TA-EG, TA-EG-Enthusiasm, and TA-EG-Competence were gender, age, and professional group. Predictors of TA-EG-Positive Consequences were education and professional group., Conclusions: We observed rather high affinity for technology and technology interaction values overall, and particularly for nursing home employees compared to managers. Significant predictors for technology affinity and interaction may have important implications, for example the perspectives of nursing home employees and managers should be considered separately in the technological design, development, and implementation process. Furthermore, an open dialogue between all stakeholders should be encouraged to increase the probability of actual technology use., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Cervical intraepithelial neoplasia (CIN) grade 2/3 has a high spontaneous regression rate, especially among women ≤29 years of age. To reduce overtreatment, reliable prognostic biomarkers would be helpful. The main aim of this study was to analyze the negative predictive value of the methylation marker panel GynTect ® for lesion regression. In this prospective, multicenter, longitudinal observational proof-of-concept study, women aged ≤29 years with histologically confirmed CIN2 (n = 24) or CIN3 (n = 36) were closely monitored without treatment for up to 24 or 12 months, respectively. The outcome was either regression, persistence, or progression of the lesion. For each patient, a single baseline sample (V0) for cytology, hrHPV detection and methylation analysis was taken. In a primary analysis, the negative predictive value (NPV) of a GynTect ® -negative test result at V0 for regression was determined. We tested the null hypothesis NPV ≤ 70% against the alternative hypothesis NPV ≥ 90%. Twelve of the eighteen GynTect ® -negative CIN2 patients showed regression (NPV = 67%, 90% CI 44-85%, p = 0.53). Of the 27 GynTect ® -negative CIN3 lesions, 15 regressed (NPV = 56%, 90% CI 38-72%, p = 0.92). Although the majority of GynTect ® -negative lesions regressed, the postulated NPV of ≥90% was not observed. Thus, the clinical relevance for an implementation of the GynTect ® assay for patients undergoing watchful waiting remains questionable. Further studies with longer observation periods should be undertaken.

Background: Mobile health (mHealth) apps can promote physical activity; however, the pragmatic nature (ie, how well research translates into real-world settings) of these studies is unknown. The impact of study design choices, for example, intervention duration, on intervention effect sizes is also understudied., Objective: This review and meta-analysis aims to describe the pragmatic nature of recent mHealth interventions for promoting physical activity and examine the associations between study effect size and pragmatic study design choices., Methods: The PubMed, Scopus, Web of Science, and PsycINFO databases were searched until April 2020. Studies were eligible if they incorporated apps as the primary intervention, were conducted in health promotion or preventive care settings, included a device-based physical activity outcome, and used randomized study designs. Studies were assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Pragmatic-Explanatory Continuum Indicator Summary-2 (PRECIS-2) frameworks. Study effect sizes were summarized using random effect models, and meta-regression was used to examine treatment effect heterogeneity by study characteristics., Results: Overall, 3555 participants were included across 22 interventions, with sample sizes ranging from 27 to 833 (mean 161.6, SD 193.9, median 93) participants. The study populations' mean age ranged from 10.6 to 61.5 (mean 39.6, SD 6.5) years, and the proportion of males included across all studies was 42.8% (1521/3555). Additionally, intervention lengths varied from 2 weeks to 6 months (mean 60.9, SD 34.9 days). The primary app- or device-based physical activity outcome differed among interventions: most interventions (17/22, 77%) used activity monitors or fitness trackers, whereas the rest (5/22, 23%) used app-based accelerometry measures. Data reporting across the RE-AIM framework was low (5.64/31, 18%) and varied within specific dimensions (Reach=44%; Effectiveness=52%; Adoption=3%; Implementation=10%; Maintenance=12.4%). PRECIS-2 results indicated that most study designs (14/22, 63%) were equally explanatory and pragmatic, with an overall PRECIS-2 score across all interventions of 2.93/5 (SD 0.54). The most pragmatic dimension was flexibility (adherence), with an average score of 3.73 (SD 0.92), whereas follow-up, organization, and flexibility (delivery) appeared more explanatory with means of 2.18 (SD 0.75), 2.36 (SD 1.07), and 2.41 (SD 0.72), respectively. An overall positive treatment effect was observed (Cohen d=0.29, 95% CI 0.13-0.46). Meta-regression analyses revealed that more pragmatic studies (-0.81, 95% CI -1.36 to -0.25) were associated with smaller increases in physical activity. Treatment effect sizes were homogenous across study duration, participants' age and gender, and RE-AIM scores., Conclusions: App-based mHealth physical activity studies continue to underreport several key study characteristics and have limited pragmatic use and generalizability. In addition, more pragmatic interventions observe smaller treatment effects, whereas study duration appears to be unrelated to the effect size. Future app-based studies should more comprehensively report real-world applicability, and more pragmatic approaches are needed for maximal population health impacts., Trial Registration: PROSPERO CRD42020169102; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=169102., (©Chad Stecher, Bjorn Pfisterer, Samantha M Harden, Dana Epstein, Jakob M Hirschmann, Kathrin Wunsch, Matthew P Buman. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 04.05.2023.)

In this White Paper, we outline recommendations from the perspective of health psychology and behavioural science, addressing three research gaps: (1) What methods in the health psychology research toolkit can be best used for developing and evaluating digital health tools? (2) What are the most feasible strategies to reuse digital health tools across populations and settings? (3) What are the main advantages and challenges of sharing (openly publishing) data, code, intervention content and design features of digital health tools? We provide actionable suggestions for researchers joining the continuously growing Open Digital Health movement, poised to revolutionise health psychology research and practice in the coming years. This White Paper is positioned in the current context of the COVID-19 pandemic, exploring how digital health tools have rapidly gained popularity in 2020-2022, when world-wide health promotion and treatment efforts rapidly shifted from face-to-face to remote delivery. This statement is written by the Directors of the not-for-profit Open Digital Health initiative (n = 6), Experts attending the European Health Psychology Society Synergy Expert Meeting (n = 17), and the initiative consultant, following a two-day meeting (19-20th August 2021).

Introduction: Physical activity among children and adolescents remains insufficient, despite the substantial efforts made by researchers and policymakers. Identifying and furthering our understanding of potential modifiable determinants of physical activity behaviour (PAB) and sedentary behaviour (SB) is crucial for the development of interventions that promote a shift from SB to PAB. The current protocol details the process through which a series of systematic literature reviews and meta-analyses (MAs) will be conducted to produce a best-evidence statement (BESt) and inform policymakers. The overall aim is to identify modifiable determinants that are associated with changes in PAB and SB in children and adolescents (aged 5-19 years) and to quantify their effect on, or association with, PAB/SB., Methods and Analysis: A search will be performed in MEDLINE, SportDiscus, Web of Science, PsychINFO and Cochrane Central Register of Controlled Trials. Randomised controlled trials (RCTs) and controlled trials (CTs) that investigate the effect of interventions on PAB/SB and longitudinal studies that investigate the associations between modifiable determinants and PAB/SB at multiple time points will be sought. Risk of bias assessments will be performed using adapted versions of Cochrane's RoB V.2.0 and ROBINS-I tools for RCTs and CTs, respectively, and an adapted version of the National Institute of Health's tool for longitudinal studies. Data will be synthesised narratively and, where possible, MAs will be performed using frequentist and Bayesian statistics. Modifiable determinants will be discussed considering the settings in which they were investigated and the PAB/SB measurement methods used., Ethics and Dissemination: No ethical approval is needed as no primary data will be collected. The findings will be disseminated in peer-reviewed publications and academic conferences where possible. The BESt will also be shared with policy makers within the DE-PASS consortium in the first instance., Systematic Review Registration: CRD42021282874., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Attention deficit hyperactivity disorder (ADHD) is a very common disorder in children and adults. A connection with sleep disorders, and above all, disorders of the circadian rhythm are the subject of research and debate. The circadian system can be represented on different levels. There have been a variety of studies examining 24-h rhythms at the behavioral and endocrine level. At the molecular level, these rhythms are based on a series of feedback loops of core clock genes and proteins. In this paper, we compared the circadian rhythms at the behavioral, endocrine, and molecular levels between children with ADHD and age- and BMI-matched controls, complementing the previous data in adults. In a minimally invasive setting, sleep was assessed via a questionnaire, actigraphy was used to determine the motor activity and light exposure, saliva samples were taken to assess the 24-h profiles of cortisol and melatonin, and buccal mucosa swaps were taken to assess the expression of the clock genes BMAL1 and PER2 . We found significant group differences in sleep onset and sleep duration, cortisol secretion profiles, and in the expression of both clock genes. Our data suggest that the analysis of circadian molecular rhythms may provide a new approach for diagnosing ADHD in children and adults.

Overweight and obesity, including their prevalence and consequences, reflect a leading public health problem. Studies have already shown that physical activity leads to a reduction in body weight in children and adults. However, the university setting has rarely been investigated. The aim of this review is, therefore, to examine and summarize the effectiveness of physical-activity-based interventions to reduce obesity and overweight in university students. Three databases (PubMed, Scopus, and Web of Science) were searched for relevant studies published in English between January 2010 and February 2022. Quantitative studies conducting a physical-activity-based intervention with overweight or obese university students and reporting changes in BMI were included. Data were described in a narrative synthesis. Out of 16 included studies, 11 reported a significant reduction in BMI. However, all studies except one were able to demonstrate some BMI improvements, whereas all studies reported significant changes in at least one health-related indicator. Aerobic exercises were able to demonstrate the greatest reductions in BMI. This review is the first systematic presentation on the effectiveness of physical-activity-based interventions in overweight and obese university students. Future work should reconsider BMI as the primary outcome if appropriate within the respective study design (i.e., to measure long-term effects). More interventions are needed to improve strategies.

Background: Wearable technology is a leading fitness trend in the growing commercial industry and an established method for collecting 24-hour physical behavior data in research studies. High-quality free-living validation studies are required to enable both researchers and consumers to make guided decisions on which study to rely on and which device to use. However, reviews focusing on the quality of free-living validation studies in adults are lacking., Objective: This study aimed to raise researchers' and consumers' attention to the quality of published validation protocols while aiming to identify and compare specific consistencies or inconsistencies between protocols. We aimed to provide a comprehensive and historical overview of which wearable devices have been validated for which purpose and whether they show promise for use in further studies., Methods: Peer-reviewed validation studies from electronic databases, as well as backward and forward citation searches (1970 to July 2021), with the following, required indicators were included: protocol must include real-life conditions, outcome must belong to one dimension of the 24-hour physical behavior construct (intensity, posture or activity type, and biological state), the protocol must include a criterion measure, and study results must be published in English-language journals. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool with 9 questions separated into 4 domains (patient selection or study design, index measure, criterion measure, and flow and time)., Results: Of the 13,285 unique search results, 222 (1.67%) articles were included. Most studies (153/237, 64.6%) validated an intensity measure outcome such as energy expenditure. However, only 19.8% (47/237) validated biological state and 15.6% (37/237) validated posture or activity-type outcomes. Across all studies, 163 different wearables were identified. Of these, 58.9% (96/163) were validated only once. ActiGraph GT3X/GT3X+ (36/163, 22.1%), Fitbit Flex (20/163, 12.3%), and ActivPAL (12/163, 7.4%) were used most often in the included studies. The percentage of participants meeting the quality criteria ranged from 38.8% (92/237) to 92.4% (219/237). On the basis of our classification tree to evaluate the overall study quality, 4.6% (11/237) of studies were classified as low risk. Furthermore, 16% (38/237) of studies were classified as having some concerns, and 72.9% (173/237) of studies were classified as high risk., Conclusions: Overall, free-living validation studies of wearables are characterized by low methodological quality, large variability in design, and focus on intensity. Future research should strongly aim at biological state and posture or activity outcomes and strive for standardized protocols embedded in a validation framework. Standardized protocols for free-living validation embedded in a framework are urgently needed to inform and guide stakeholders (eg, manufacturers, scientists, and consumers) in selecting wearables for self-tracking purposes, applying wearables in health studies, and fostering innovation to achieve improved validity., (©Marco Giurgiu, Irina Timm, Marlissa Becker, Steffen Schmidt, Kathrin Wunsch, Rebecca Nissen, Denis Davidovski, Johannes B J Bussmann, Claudio R Nigg, Markus Reichert, Ulrich W Ebner-Priemer, Alexander Woll, Birte von Haaren-Mack. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 09.06.2022.)

Background: Children and adolescents increasingly do not meet physical activity (PA) recommendations. Hence, insufficient PA (IPA) and sedentary behavior (SB) among children and adolescents are relevant behavior change domains for using individualized mobile health (mHealth) interventions., Objective: This review and meta-analysis investigated the effectiveness of mHealth interventions on IPA and SB, with a special focus on the age and level of individualization., Methods: PubMed, Scopus, Web of Science, SPORTDiscus, and Cochrane Library were searched for randomized controlled trials published between January 2000 and March 2021. mHealth interventions for primary prevention in children and adolescents addressing behavior change related to IPA and SB were included. Included studies were compared for content characteristics and methodological quality and summarized narratively. In addition, a meta-analysis with a subsequent exploratory meta-regression examining the moderating effects of age and individualization on overall effectiveness was performed., Results: On the basis of the inclusion criteria, 1.3% (11/828) of the preliminary identified studies were included in the qualitative synthesis, and 1.2% (10/828) were included in the meta-analysis. Trials included a total of 1515 participants (mean age (11.69, SD 0.788 years; 65% male and 35% female) self-reported (3/11, 27%) or device-measured (8/11, 73%) health data on the duration of SB and IPA for an average of 9.3 (SD 5.6) weeks. Studies with high levels of individualization significantly decreased insufficient PA levels (Cohen d=0.33; 95% CI 0.08-0.58; Z=2.55; P=.01), whereas those with low levels of individualization (Cohen d=-0.06; 95% CI -0.32 to 0.20; Z=0.48; P=.63) or targeting SB (Cohen d=-0.11; 95% CI -0.01 to 0.23; Z=1.73; P=.08) indicated no overall significant effect. The heterogeneity of the studies was moderate to low, and significant subgroup differences were found between trials with high and low levels of individualization (χ 2 1 =4.0; P=.04; I 2 =75.2%). Age as a moderator variable showed a small effect; however, the results were not significant, which might have been because of being underpowered., Conclusions: Evidence suggests that mHealth interventions for children and adolescents can foster moderate reductions in IPA but not SB. Moreover, individualized mHealth interventions to reduce IPA seem to be more effective for adolescents than for children. Although, to date, only a few mHealth studies have addressed inactive and sedentary young people, and their quality of evidence is moderate, these findings indicate the relevance of individualization on the one hand and the difficulties in reducing SB using mHealth interventions on the other., Trial Registration: PROSPERO CRD42020209417; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209417., (©Hannes Baumann, Janis Fiedler, Kathrin Wunsch, Alexander Woll, Bettina Wollesen. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 11.05.2022.)

With the outbreak of the Corona Virus Disease 19 (Covid-19) in late 2019, governments increasingly imposed containment strategies, including social distancing as well as restricted population movement, potentially having negative impacts on mental and physical health. A growing number of studies have examined the impact of the pandemic on different facets of physical activity (PA); an overview combining these (mixed) results, however, is missing. Thus, the objective of this systematic review and meta-analysis was to investigate whether and to which extent PA changed from before to during the Covid-19 pandemic, taking age, gender, and measurement method into account. The literature search was conducted using PubMed, Web of Science, and Scopus. Results of the main characteristics were descriptively synthesized and analyzed in a meta-analysis quantifying effects of the pandemic on PA divided by age groups, with additional subgroup analyses of the characteristics age, gender, and measurement method being narratively synthesized. Overall, 57 studies with a total sample size of 119,094 participants (N between 10 and 60,560 subjects) from 14 countries worldwide with participants aged between four and 93 years were included. Thirty-two studies revealed a significant decline in PA, whereas only five studies found a significant increase in PA during the Covid-19 pandemic. Fourteen studies revealed mixed results. PA decreased in all age groups, independent of gender. Most self-reported and all device-based measurement methods showed a reduction in PA. However, effects were not found to be significant in all age groups. Nevertheless, the declining trend should be noted and governments should strive to enable PA within periods of pandemic restrictions, or promote alternatives such as digital training to avoid negative health consequences within the population.

Background: The concept of hair transparency has been claimed widely in the Japan (and now it is spreading to Asian) hair color market. Despite the general use of this concept, to date, there is no clear and objective description to accurately explain what it is. In this work, we have decoded and gave clarity to the concept of hair transparency via a technical model (validated for both Japan and China markets) composed of measurable parameters of hair property using a single device., Methodology and Results: A comprehensive study composed of various tests was used, starting with a qualitative identification of key parameters via in-depth workshop discussions with over 40 Japanese stylists and a panel of 12 consumers. These identified parameters (luminosity, color visibility, and Shine) were then translated into technically measurable parameters of the hair fiber (Diffused light intensity, ratio of RGB channel intensities of Diffused light, and luster) via a single instrument-Hair SAMBA (a dual-polarized imaging system). Afterward, 10 carefully selected anchor shades were used as visual stimuli in an online pairwise comparison (PC) study with 100 Japanese stylists to generate quantitative transparency perception data of the swatches. Technical parameters of these swatches were measured by SAMBA and consolidated with the PC output, for the creation and validation of the mathematical model. After, with another PC study (N = 100) in China, with seven shades from Japan study and 6 additional Chinese market shades, the applicability of the model in China market was validated., Conclusion: We have clarified and quantified the concept of hair transparency through a consumer centric approach and with objective data. Our findings will enable the development of optimum transparent shades which better suits consumer needs. Lastly, we would like to highlight the beauty of digitalization in the study: The digital evaluation pathways chosen allowed us to collect quantitative consumer data from two countries for the creation of a robust model under the impact of COVID-19 and would definitely be the way to go for our future consumer evaluation studies., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Until recently, emotional processes have played little role in personality psychology. Based on neuroscientific findings, Davidson and colleagues proposed a theory of emotional styles, postulating six dimensions of emotional life: outlook, resilience, social intuition, self-awareness, sensitivity to context, and attention. Recently, an English version of the Emotional Style Questionnaire (ESQ) was developed and tested for reliability and validity. The aim of the present work was to test the test-retest reliability, internal consistency, construct validity, and criterion validity of the German version of the ESQ. Two separate samples consisting of 365 and 344 subjects took part in an online survey. The results of the two studies indicated satisfactory test-retest reliability and internal consistency. Regarding the construct validity, the results from Study 1 to Study 2 indicate good model fit indices. Although there was a high correlation between the subscales outlook and resilience, the analyses supported the six-factor structure postulated by Davidson and colleagues. Substantial correlations were found between the dimensions of the ESQ and other validated scales, confirming the criterion validity of the questionnaire. Our results suggest that the German version of the ESQ is a reliable and valid measurement of emotional styles. It is a feasible and economical questionnaire that can be applied in various psychology disciplines, such as personality psychology, clinical psychology, industrial psychology or sport and exercise psychology., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Jekauc, Mülberger, Weyland, Ennigkeit, Wunsch, Krell-Roesch and Fritsch.)

Objectives: Engaging in physical activity and exercise have long been shown to have beneficial effects on (psychosocial) stress reactivity. Initial studies could reveal that these positive effects on stress reactivity also exist for a healthy diet. Aim of this study was to examine whether combining a healthy diet and regular exercise can provide additional benefits on psychobiological stress levels. Methods: Forty-two men self-identifying as non-exercisers or regular exercisers between 18 and 30 years were exposed to the Trier Social Stress Test for Groups. Salivary cortisol (sCort) and alpha-amylase (sAA) as biological stress markers, and self-reported momentary stress were repeatedly examined. Questionnaires on regular exercise and dietary intake were completed once. Results: Two-stage hierarchical multiple regressions predicting participants' stress reactivity, i.e. response and recovery, from diet quality, exercise as well as their interaction appeared inconsistent. sCort response was significantly predicted by regular exercise whereas greater sCort recovery was predicted by higher diet quality. In contrast, higher sAA reactivity was predicted by higher diet quality while participants eating less healthy and exercising more showed the most pronounced sAA recovery. None of the other outcome variables was predicted by the interaction. Subjective stress was unrelated to either health behavior. Conclusions: The present examination among an all-male sample emphasized the stress-buffering capabilities of regular exercise and provided initial evidence for a distinct link to healthy diet. Assumed synergistic benefits could, however, not be confirmed. Advances are needed to better understand how individuals profit the most from which behaviors as well as their interactive effects.

Objective: Disturbed regulation of vigilance in the wake state seems to play a key role in the development of mental disorders. It is assumed that hyperactivity in adult ADHD is an attempt to increase a general low vigilance level via external stimulation in order to avoid drowsiness. For depression, the avoidance of stimulation is interpreted as a reaction to a tonic increased vigilance state. Although ADHD is assumed to start during childhood, this vigilance model has been barely tested with children diagnosed for ADHD so far. Methods: Resting-state EEG (8 min) measures from two groups of children diagnosed with either ADHD [ N = 76 (16 female, 60 male), age: (mean/SD) 118/33 months] or depression [ N = 94 (73 female, 21 male), age: 184/23 months] were analyzed. Using the VIGALL toolbox, EEG patterns of vigilance level, and regulation were derived and compared between both groups. In correlation analysis, the relations between vigilance measures, attentional test performance (alertness and inhibition), and mental health symptoms were analyzed. Results: Children with ADHD differed from children with most prominent depressive symptoms in brain arousal regulation and level, but EEG vigilance was not related to behavior problems and not related to the attentional test performance. Brain arousal was dependent on the age of the participant in the whole sample; younger children showed lower vigilance stages than teenagers; this effect was not present when analyzed separately for each diagnostic group. EEG assessment time and received medication had no effect on the EEG vigilance. Discussion: Although based on a small sample, this explorative research revealed that EEG vigilance level is different between children with ADHD and with depression. Moreover, even the standard procedure of the clinical routine EEG (resting state) can be used to differentiate brain arousal states between participants with ADHD and depression. Because routine EEG is not specialized to vigilance assessment, it may not be sufficiently sensitive to find vigilance-symptomatology associations. Further research should address developmental changes in EEG measurements in children and use bigger samples of participants within the same age range., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Berger, Dück, Perin, Wunsch, Buchmann, Kölch, Reis and Marx.)

Objective: The present study aimed to validate the German version of the Conners Early Childhood (EC)™ among German-speaking children. Method: A total of 720 parental and 599 childcare provider ratings of 2- to 6-year-old children were surveyed throughout Germany. Validity was assessed by calculating exploratory factor analyses (EFAs) and confirmatory factor analyses (CFAs), and a series of multivariate analyses of variance (MANOVAs) to analyze associations between Conners EC™ symptom ratings and sociodemographic variables. In addition, parent and childcare provider ratings of Conners EC™ scales were correlated with a number of other well-validated German measures assessing preschoolers' behaviors. Results: Although the EFA yielded different factors than the original scales, CFA revealed acceptable to good model fits. Conclusion: Overall, we confirmed the factor structure of the Conners EC's™ American original within the German validation. The use of the American factor structure is justified and can be recommended to facilitate international research on psychopathology in early childhood.

Children in Germany showed positive physical activity changes during the first Covid-19 lockdown in April 2020, but it is unclear how the changes relate to population density, which we investigated in a longitudinal sample of 1711 youth (4-17 years). For each ten citizens more per km 2 , less positive physical activity changes were observed. For example, a child living in an area with 100 citizens/km 2 increased daily life physical activity by 44.50 min/day, whereas a child living in an area with 3000 citizens/km 2 only engaged in an additional 9.70 min/day. Policymakers should ensure that youth in densely populated areas have access to physical activity opportunities during the pandemic., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

In reply to the comment of Kersting et al [...].

Background: As children show a more complex but less structured movement behavior than adults, assessment of their many spontaneous and impulsive movements is a challenge for physical activity (PA) assessment. Since neither questionnaires nor accelerometers enable optimal detection of all facets of PA, a multimodal, combined approach of self-reported and device-based methods is recommended. Based on the number of days on which the participants reached the physical activity (PA) values given in the WHO guideline, this study examines 1) the difference between self-reported and device-based, measured PA and 2) whether PA differences between age and gender groups obtained by two methods are comparable., Methods: Participants aged 6-17 years were randomly chosen and data were collected representatively at 167 sample points throughout Germany within the Motorik-Modul Study. PA of n = 2694 participants (52.3% female) was measured using the ActiGraph accelerometer (ACC) and a physical activity questionnaire (PAQ). The sample was divided into three age groups (6-10 yrs. n = 788, 11-13 yrs. n = 823, 14-17 yrs. n = 1083). Numbers of days per week with at least 60 min moderate to vigorous PA (MVPA) were analyzed for both methods., Results: Only every 25th respondent (4%) reaches the WHO standard of 60 min MVPA every day if measured with ACC. Self-reported PA was slightly higher (9%) (mean PAQ  = 3.82 days; mean ACC  = 2.34 days; F method  = 915.85; p = <.001; f Cohen  = .64). The differences between the methods are significantly smaller in younger children than in the older age groups (F age  = 264.2, p < .001; f Cohen  = .48). The older the subjects are, the lower is the proportion of those who meet the WHO guideline on each day, with girls meeting the guideline less frequently than boys in all age groups., Conclusion: Children and adolescents living in Germany show a very low adherence to the WHO guideline on PA. While younger children are much more active with their free play, especially children over 10 years of age and especially girls should be the target of programs to increase PA.

Quantification of physical activity (PA) depends on the type of measurement and analysis method making it difficult to compare adherence to PA guidelines. Therefore, test-retest reliability, validity, and stability for self-reported (i.e., questionnaire and diary) and device-based measured (i.e., accelerometry with 10/60 s epochs) PA was compared in 32 adults and 32 children from the SMARTFAMILY study to examine if differences in these measurement tools are systematic. PA was collected during two separate measurement weeks and the relationship for each quality criteria was analyzed using Spearman correlation. Results showed the highest PA values for questionnaires followed by 10-s and 60-s epochs measured by accelerometers. Levels of PA were lowest when measured by diary. Only accelerometry demonstrated reliable, valid, and stable results for the two measurement weeks, the questionnaire yielded mixed results and the diary showed only a few significant correlations. Overall, higher correlations for the quality criteria were found for moderate than for vigorous PA and the results differed between children and adults. Since the differences were not found to be systematic, the choice of measurement tools should be carefully considered by anyone working with PA outcomes, especially if vigorous PA is the parameter of interest.

Background: Physical activity (PA) has beneficial effects on health and health-related quality of life (HRQoL), which is a protective factor of illness and mortality. The purpose of this examination was to investigate if self-reported and device-based measures of PA were related to HRQoL in adolescents., Methods: Participants (N = 1565; 54.3% female; M age  = 14.37 years, SD age  = 1.99) were recruited from 167 sample points across Germany. Adolescents self-reported their PA, supplemented by a 1-week examination of device-based PA using accelerometry. Additionally, they completed the multidimensional KIDSCREEN-27 to assess HRQoL., Results: Results showed that self-reported PA was correlated with overall HRQoL, Physical Well-Being, Psychological Well-Being, Social Support & Peers, and School Environment, whereas device-based PA was only correlated with Physical as well as Psychological Well-Being. Further, self-reported PA significantly predicted all facets of HRQoL except for Autonomy and Parent Relations, whereas device-based PA solely heightened the amount of explained variance in the Physical Well-Being subscale., Conclusions: Findings demonstrate the importance of self-reported PA as it is related to almost all facets of HRQoL. Both measures of PA are not congruent in their relationship with HRQoL and thus implications have to be carefully considered. Future studies should investigate the direct effect of PA on HRQoL and health in a longitudinal approach to account for the causality of effects.

Reduced physical activity (PA) and prolonged screen time (ST) negatively influence health-related quality of life (HRQoL), a protective factor against illness and mortality. Studies addressing the relationship between PA, ST, and mental health in youth are scarce, especially in times with high mental health burdens like the COVID-19 pandemic. The purpose of this examination was to investigate whether PA, ST, and HRQoL before COVID-19 predict PA, ST, and HRQoL during the COVID-19 pandemic. Participants from the Motorik-Modul Study (MoMo; N = 1711; M age = 10.36 (SD = 4.04) years, female = 49.8%; healthy weight = 76.8%) self-reported their PA and ST as well as HRQoL both before and during COVID-19. Relationships of all variables, from before to during COVID-19, were investigated through a path prediction model. Results showed all variables during COVID-19 were predicted by the respective levels before COVID-19, independent of gender and age. Cross-lags revealed a negative influence of before COVID-19 ST on during COVID-19 PA. HRQoL before COVID-19 was positively associated with during COVID-19 PA in children younger than 10 years and females, but not in adolescents and boys. As age- and gender-independent negative influence of before COVID-19 ST on during COVID-19 PA has been detected, health policy may be advised to focus on a general reduction in ST instead of PA enhancement to ensure high PA levels.

Mental health (MH) and behavioral health are fundamental to a good quality of life. Only a few studies have investigated the association between behavioral health (e.g., physical activity (PA), screen time (ST)) and MH from childhood to adolescence. Therefore, we investigated the relationships of PA and ST with MH by sex in an 11-year longitudinal cohort study of German schoolchildren during 2003-2017. A subsample (n = 686; 55.2% female) of participants from the German Motorik-Modul (MoMo) Longitudinal Study who participated in all 3 measurement phases (mean ages: time 1 (baseline; 2003-2006), 5.57 (standard deviation (SD), 1.00) years; time 2 (wave 1; 2009-2012), 11.85 (SD, 1.03) years; time 3 (wave 2; 2014-2017), 16.86 (SD, 1.04) years) were analyzed with regard to PA, ST, and MH (emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, prosocial behavior, and overall strengths and difficulties). Path panel prediction models were fitted with time 1, time 2, and time 3 PA, ST, and MH indicators. PA predicted less television (TV)/video watching in females, and TV/video watching predicted personal computer (PC)/Internet use in both sexes. Behavior and MH results suggested that, for females, higher TV/video watching and PC/Internet use was related to higher MH challenges over the course of maturation. Some preadolescent males' MH challenges increased ST (TV/video watching and PC/Internet use) in adolescence. Researchers should explore innovative and effective methods for reducing childhood ST, especially among females with early signs of MH issues, and addressing preadolescent males' MH challenges., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The aim of this systematic review was to examine where physical activity (PA) takes place and how much time children, adolescents and adults spend being physically active within the identified locations. A systematic literature search was carried out in five electronic databases (PubMed, CINAHL, SPORTDiscus, PsycInfo, Scopus). For inclusion, primary studies had to identify locations of PA using device-based or self-report tools, whereas minutes of PA had to be examined using device-based tools only. Thirty-two studies were included, methodological quality and sex/gender sensitivity of the studies were assessed. The narrative data synthesis revealed that the highest average amount of daily moderate-to-vigorous PA was found in home and recreational locations, followed by school and neighborhood locations. In adults, highest average amount of daily moderate-to-vigorous PA was found in neighborhood and home locations followed by workplace and recreational locations. The majority of studies had a low risk of bias in four out of six domains; eight studies reported significant sex/gender differences in location-based PA. The results indicate that different locations are used for PA to a varying degree across the lifespan. Future research on the promotion of PA should focus on location-specific design features that encourage children, adolescents and adults to be physically active.

Higher education students often suffer from physiological and psychological health problems caused by stress, which may negatively impact their academic performance (AP). Physical activity (PA) can be a promising strategy to buffer these stress-induced complaints. Therefore, the aim of this investigation was to summarize evidence for the tridimensional construct of PA, stress, and AP, as well as to quantify the relationships among these variables. Five databases (PubMed, Scopus, SMEI, ERIC, and Web of Science) were systematically searched in November 2019 for publications that examined PA, stress, and AP of university students, without any restrictions regarding the publication period. The systematic review includes four original research studies with a moderate-to-high risk of bias. Results of included studies were narratively summarized and quantified in a meta-analysis using random effect models. Whereas study results point to a positive relation between PA and AP, relationships between PA and stress seem to be negative, while the relation between stress and AP is undecided. The meta-analysis found no significant associations and considerable heterogeneity of the results. Findings indicate a research gap concerning the connection of PA, stress, and AP in university students. Future studies should use validated measuring tools and consider the timepoint of data collection in order to extract truly stressful periods.

Background: Individual health behavior is related to environmental and social structures. To promote physical activity (PA) effectively, it is necessary to consider structural influences. Previous research has shown the relevance of the built environment. However, sex/gender differences have yet not been considered. The aim of this systematic review was to identify built environmental determinants of PA by taking sex/gender into account., Methods: A systematic literature search was carried out using six electronic databases (PubMed, CINAHL, SportDiscus, PsycInfo, Scopus, Web of Knowledge) to identify studies analyzing the effect of changes in the built environment on PA, taking sex/gender into account. To be included, studies had to be based on quantitative data and a longitudinal study design. Changes in the built environment had to be objectively assessed. The methodological quality of the studies was examined using the QualSyst tool for examining risk of bias., Results: In total, 36 studies published since 2000 were included in this review. The data synthesis revealed that the majority of reviewed studies found the built environment to be a determinant of PA behavior for both, males and females, in a similar way. Creating a new infrastructure for walking, cycling, and public transportation showed a positive effect on PA behavior. Findings were most consistent for the availability of public transport, which was positively associated with overall PA and walking. The improvement of walking and cycling infrastructure had no effect on the overall level of PA, but it attracted more users and had a positive effect on active transportation. In women, the availability of public transport, safe cycling lanes, housing density, and the distance to daily destinations proved to be more relevant with regard to their PA behavior. In men, street network characteristics and road environment, such as intersection connectivity, local road density, and the presence of dead-end roads, were more important determinants of PA., Conclusion: This review sheds light on the relevance of the built environment on PA. By focusing on sex/gender differences, a new aspect was addressed that should be further analyzed in future research and considered by urban planners and other practitioners.

The physical activity enjoyment scale (PACES) is a measurement instrument that is commonly used in monitoring and intervention research to assess how much people enjoy being physically active, as this has been related to physical activity adherence. However, while the measurement properties of PACES are well-researched in the English language, there is a gap of research in the German language, especially when looking at adults. Thus, the purpose of this work was to examine reliability, factorial validity, criterion-related validity, and measurement invariance across sex, age groups and time of the PACES for German-speaking adults. Data was obtained from the Motorik-Modul-Study (MoMo) in which 863 adults (53.5% female; mean age = 20.9 years) were examined. To investigate measurement invariance across age groups, data from 2,274 adolescents (50.5% female; mean age = 14.4 years) was obtained additionally. The study provided a nationwide representative sample for Germany. Results showed high internal consistency of PACES in adults (Cronbach's α = .94). Confirmatory factor analyses confirmed the invariance of the measure across age groups, time, and sex. Criterion-related validity could be shown as the global factor significantly correlated with overall physical activity, physical activity in sports clubs, and leisure-time physical activity. The analyses of factorial structure indicated a method effect for positively and negatively worded items. Correlated uniqueness, latent method factor and a hybrid model were applied to analyze the method effect and results indicated that the method effect of positively worded items was predictive of physical activity independently of the global factor. Overall, it can be concluded that PACES is reliable, valid and invariant measure of physical activity enjoyment to be used in German-speaking adults. Further studies are warranted to examine the factorial structure of the PACES and the consequences of the method effect., Competing Interests: The authors have declared that no competing interests exist.

Background: Numerous smartphone apps are targeting physical activity and healthy eating, but empirical evidence on their effectiveness for initialization and maintenance of behavior change, especially in children and adolescents, is still limited., Objective: The aim of this study was to conceptualize a theory-based and evidence-based mHealth intervention called SMARTFAMILY (SF) that targets physical activity and healthy eating in a collective family-based setting. Subsequently, the app will be refined and re-evaluated to analyze additional effects of just-in-time adaptive interventions (JITAIs) and gamification features., Methods: A smartphone app based on behavior change theories and behavior change techniques was developed and implemented and will be evaluated with family members individually and cooperatively (SF trial). Existing evidence and gained results were used to refine and will be used to re-evaluate the app (SF2.0 trial). Both trials are cluster randomized controlled trials with 3 measurement occasions. The intervention group uses the app for 3 consecutive weeks, whereas the control group receives no treatment. Baseline measurements (T 0 ) and postintervention measurements (T 1 ) include physical activity (ie, self-reported and accelerometry) and healthy eating measurements (ie, self-reported fruit and vegetable intake) as the primary outcomes. The secondary outcomes (ie, self-reported) are intrinsic motivation, behavior-specific self-efficacy, and the family health climate, complemented by an intentional measure in SF2.0. Four weeks following T 1 , a follow-up assessment (T 2 ) is completed by the participants, consisting of all questionnaire items to assess the stability of the intervention effects. Mixed-method analysis of covariance will be used to calculate the primary intervention effects (ie, physical activity, fruit and vegetable intake) while controlling for covariates, including family health climate, behavior-specific self-efficacy, and intrinsic motivation., Results: This study is funded by the German Federal Ministry of Education and Research and ethically approved by the Karlsruhe Institute of Technology. For both trials, it is hypothesized that the apps will positively influence physical activity and healthy eating in the whole family. Furthermore, SF2.0 is expected to produce stronger effects (ie, higher effect sizes) compared to SF. SF app development and piloting are completed. Data acquisition for the SF trial is terminated and discontinued due to the COVID-19 pandemic. SF2.0 app development and piloting are completed, while data acquisition is ongoing. Participant recruitment for the SF 2.0 trial started in February 2020. The results for SF are expected to be published in mid-2021, and the results of SF2.0 are expected to be published in mid-2022., Conclusions: In this study, it is hypothesized that targeting the whole family will facilitate behavior change at the individual level and the family level, as the implemented strategies address changes in daily family life. Furthermore, subsequent app development (SF2.0) with supplementary addition of motivation-enhancing features and a JITAI approach is expected to enhance positive intervention effects., Trial Registration: German Clinical Trials Register DRKS00010415; https://tinyurl.com/yyo87yyu., International Registered Report Identifier (irrid): DERR1-10.2196/20534., (©Kathrin Wunsch, Tobias Eckert, Janis Fiedler, Laura Cleven, Christina Niermann, Harald Reiterer, Britta Renner, Alexander Woll. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 11.11.2020.)

Background: Electronic (eHealth) and mobile (mHealth) health interventions can provide a large coverage, and are promising tools to change health behavior (i.e. physical activity, sedentary behavior and healthy eating). However, the determinants of intervention effectiveness in primary prevention has not been explored yet. Therefore, the objectives of this umbrella review were to evaluate intervention effectiveness, to explore the impact of pre-defined determinants of effectiveness (i.e. theoretical foundations, behavior change techniques, social contexts or just-in-time adaptive interventions), and to provide recommendations for future research and practice in the field of primary prevention delivered via e/mHealth technology., Methods: PubMed, Scopus, Web of Science and the Cochrane Library were searched for systematic reviews and meta-analyses (reviews) published between January 1990 and May 2020. Reviews reporting on e/mHealth behavior change interventions in physical activity, sedentary behavior and/or healthy eating for healthy subjects (i.e. subjects without physical or physiological morbidities which would influence the realization of behaviors targeted by the respective interventions) were included if they also investigated respective theoretical foundations, behavior change techniques, social contexts or just-in-time adaptive interventions. Included studies were ranked concerning their methodological quality and qualitatively synthesized., Results: The systematic search revealed 11 systematic reviews and meta-analyses of moderate quality. The majority of original research studies within the reviews found e/mHealth interventions to be effective, but the results showed a high heterogeneity concerning assessment methods and outcomes, making them difficult to compare. Whereas theoretical foundation and behavior change techniques were suggested to be potential positive determinants of effective interventions, the impact of social context remains unclear. None of the reviews included just-in-time adaptive interventions., Conclusion: Findings of this umbrella review support the use of e/mHealth to enhance physical activity and healthy eating and reduce sedentary behavior. The general lack of precise reporting and comparison of confounding variables in reviews and original research studies as well as the limited number of reviews for each health behavior constrains the generalization and interpretation of results. Further research is needed on study-level to investigate effects of versatile determinants of e/mHealth efficiency, using a theoretical foundation and additionally explore the impact of social contexts and more sophisticated approaches like just-in-time adaptive interventions., Trial Registration: The protocol for this umbrella review was a priori registered with PROSPERO: CRD42020147902 .

Technological and digital progress benefits physical activity (PA) research. Here we compiled expert knowledge on how Ambulatory Assessment (AA) is utilized to advance PA research, i.e., we present results of the 2nd International CAPA Workshop 2019 "Physical Activity Assessment - State of the Science, Best Practices, Future Directions" where invited researchers with experience in PA assessment, evaluation, technology and application participated. First, we provide readers with the state of the AA science, then we give best practice recommendations on how to measure PA via AA and shed light on methodological frontiers, and we furthermore discuss future directions. AA encompasses a class of methods that allows the study of PA and its behavioral, biological and physiological correlates as they unfold in everyday life. AA includes monitoring of movement (e.g., via accelerometry), physiological function (e.g., via mobile electrocardiogram), contextual information (e.g., via geolocation-tracking), and ecological momentary assessment (EMA; e.g., electronic diaries) to capture self-reported information. The strengths of AA are data assessment that near realtime, which minimizes retrospective biases in real-world settings, consequentially enabling ecological valid findings. Importantly, AA enables multiple assessments across time within subjects resulting in intensive longitudinal data (ILD), which allows unraveling within-person determinants of PA in everyday life. In this paper, we show how AA methods such as triggered e-diaries and geolocation-tracking can be used to measure PA and its correlates, and furthermore how these findings may translate into real-life interventions. In sum, AA provides numerous possibilities for PA research, especially the opportunity to tackle within- subject antecedents, concomitants, and consequences of PA as they unfold in everyday life. In-depth insights on determinants of PA could help us design and deliver impactful interventions in real-world contexts, thus enabling us to solve critical health issues in the 21 st century such as insufficient PA and high levels of sedentary behavior., Competing Interests: Conflicts of Interest The authors declare no competing interests. UE-P works as a consultant for Boehringer Ingelheim.

A considerable proportion of high grade cervical intraepithelial lesions (CIN2/3) are known to resolve on their own especially among young women. However, since reliable prognostic markers are still lacking, the diagnosis "CIN3" is still an indication for surgery which may result in overtreatment. It is conceivable that a combination of different, ideally independent molecular markers may provide more reliable results. In the present cross-sectional study two established triage markers, 3q26 amplification and a methylation signature, were evaluated in an age-dependent manner. The patient cohort comprised 60 patients with histologically confirmed CIN2/3 in two equally sized age groups (<30 years, ≥30 years). Cervical scrapes were analyzed by interphase fluorescence in situ hybridization for 3q26 amplification and methylation specific PCR (GynTect®) for six different genome regions. Both assays showed a significantly different pattern of test outcome independent of age (P = .001). Moreover, the combination of both assays differed significantly for double positive and double negative cases when comparing the two age groups: In patients <30 years there were clearly less cases with positive methylation signature and amplification of 3q26 as in women ≥30 years (23% vs 63%, Bonferroni adjusted P = .016). Of particular interest is the finding that double negative results were exclusive for the young age group (0% vs 27%, Bonferroni adjusted P = .020). Since regression of CIN2/3 characteristically occurs among young women it is tempting to speculate that a double negative test result could be prognostic for regression of CIN2/3. This will have to be investigated further in a prospective longitudinal intervention study., (© 2019 The Authors. Genes, Chromosomes & Cancer published by Wiley Periodicals, Inc.)

Background: Several theories have been established to explain physical activity (PA) participation. However, many of these theories might not be applicable to adolescent PA behavior as they require a high level of cognitive reflection. Weiss suggests a model for youth which is based on the theoretical concept of Harter, focusing on self-esteem within social, emotional, and developmental aspects to explain behavior. The aim of this study was to test the original and a social support focused alternative version of the Weiss-Harter-model, and to cross-validate the findings in two separate studies., Methods: Data from two cross-sectional studies was retrieved and the models tested using structural equation modeling. Participants aged 11-17 years were recruited from a school (Study 1: N = 182) and from the German MoMo study (Study 2: N = 2,274). They filled in questionnaires about perceived competence, social support, self-esteem, PA enjoyment, and minutes of moderate-vigorous PA (MVPA)., Results: None of the studies showed a good model fit for the original model [Study 1: CFI = 0.870, RMSEA 0.118 (90% CI 0.081-0.158), χ 2 = 38.7, p < 0.01; Study 2: CFI = 0.871, RMSEA 0.148 (90% CI 0.140-0.155), χ 2 = 1112.6, p < 0.01], explaining only 12% and 17% of MVPA variance, respectively. The alternative model which added the direct paths of social support to MVPA and PA enjoyment had a very good model fit for both Study 1 [CFI = 1.000, RMSEA 0.000 (90% CI 0.000-0.031), χ 2 = 4.8, p > 0.05] and Study 2 [CFI = 0.990, RMSEA 0.043 (90% CI 0.035-0.051), χ 2 = 103.7, p < 0.01]. The addition of these paths led to changes in effect size and directions of other path coefficients, with self-esteem having a small to meaningless impact on MVPA. The revised models accounted for 38% and 42% explained variance in MVPA, respectively., Discussion: The prominent role of self-esteem in the original model could not be confirmed. Instead, the results emphasize the role of social support for PA and PA enjoyment, which is in line with current research. Interventions to increase adolescent PA levels should thus focus more on components of social support instead of self-esteem. Future studies are needed to examine the interplay between social support, PA enjoyment and perceived competence as PA determinants., (Copyright © 2019 Jekauc, Mnich, Niessner, Wunsch, Nigg, Krell-Roesch and Woll.)

Background: Research suggests that physical activity (PA) enhances cognitive performance and prevents stress-related impairments of higher order cognitive functions like working memory (WM) performance. The aim of the current study was to investigate the effect of PA on WM performance after acute stress exposure in preadolescent children., Methods: Regular PA was assessed for seven consecutive days during a typical school week using accelerometers in a sample of 44 preadolescent children (14 girls, M age  = 11.29 years, SD age  = 0.67). Following this period, participants performed an automated operational span (OSPAN) task immediately after being exposed to the Trier Social Stress Test for Children (TSST-C)., Results: Children exhibited prototypical response slopes in salivary cortisol and salivary α-amylase as markers of the endocrine and autonomic stress response immediately after psychosocial stress induction. A subsequent two-way ANOVA comparing high- and low-stress responders revealed a significant interaction between group affiliation and PA level on WM performance for both stress markers. Interestingly, best WM performance was demonstrated in children showing both high PA levels and high cortisol (or low α-amylase, respectively) stress responses., Conclusions: Though patterns differed for salivary cortisol and salivary α-amylase, overall findings suggest that PA buffers the negative effects of stress on cognitive performance in children.

Objective: Previous research suggests beneficial effects of physical exercise on stress reactivity due to cross-stressor adaptions of physiological stress response systems. However, results remain inconclusive and it is unclear whether only regular engagement in exercise modulates these physiological adaptations or if acute bouts of exercise can elicit similar adaptations. Thus, the aim of the current study was to investigate and compare the effects of habitual and acute exercise on physiological stress responses., Methods: 84 male participants between 18 and 30 years (half of them were screened to be habitually high active or low active) were randomized into one of two groups: either an acute exercise intervention group (n = 42 with 50% being habitually high active) which engaged in 30 min of moderate-to-high intensity ergometer bicycling, or a control (placebo exercise) group which engaged in 30 min of light stretching (n = 42 with 50% being habitually high active). Following the intervention period, participants took part in a well validated psychosocial stress paradigm. Saliva samples were taken repeatedly to derive alpha-amylase and cortisol as stress-specific parameters. A multilevel growth curve approach was applied to analyse changes in the stress parameters over time., Results: Both, acute and habitual exercise have shown to be positively related to stress reactivity. In particular, a reduction in stress activation was found for both types of exercise, but only habitual engagement in exercise exhibited a beneficial effect on peak cortisol levels., Conclusions: Taken together, people can profit from regular exercise (i.e. reduced activity of stress-response systems). However, even acute bouts of exercise preceding stress exposure showed beneficial effects on stress reactivity. This finding is particularly important as it may provide a (self-)regulatory mechanism for people facing conceivable acute stress situations., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Electroconvulsive Therapy (ECT) of a 15-year-old female patient suffering from a severe delusional depression: a case report Abstract., Objective: Electroconvulsive Therapy (ECT) is a modern therapy of severe psychiatric disorders. However, ECT is rarely used in treating children and adolescents with psychiatric disorders. This case report refers about a 15-year-old female patient suffering from severe depressive episodes with psychotic symptoms treated with ECT., Method: After unsuccessful combined behavioral therapy and medication, the patient received a total of 11 ECT treatments with right unilateral electrode placement. The severity of depressive symptoms was assessed by self (BDI-II) and external (HDRS21) scores before, during and after treatment., Results: A rapid decline of depressive symptoms was observed., Conclusion: ECT provides a safe and effective method for the treatment of severe depressive disorders in childhood and adolescence and should be included earlier than usual into the standard therapeutic concepts.

Background: HPV DNA testing as a primary screening marker is being implemented in several countries. Due to the high HPV prevalence in the screening population, effective triage strategies for HPV-positive cases are required. The aim of this study was to evaluate the performance of a methylation-specific real-time PCR  assay (GynTect®) comprising six marker regions as a triage test., Results: An analytical sensitivity of 0.1 ng genomic DNA corresponding to 15 SiHa cells was achieved. Absolute specificity was observed in the presence of 20 ng unmethylated genomic DNA. In a clinical setting, cervical scrapes of 306 women showing abnormal colposcopy were tested for cytology, HPV positivity, and the GynTect markers ASTN1, DLX1, ITGA4, RXFP3, SOX17, and ZNF671. Of all women, histopathological data were available. The overall sensitivity for GynTect to detect CIN3+ was 67.7% (95% CI 57.3%-77.1%) whereas sensitivity was significantly higher for women of age ≥ 30 years ( p  = 0.04). All cancer cases ( n  = 5) were detected by GynTect. The overall false positive rate (= 1-specificity) for women with no CIN was 17.4% (95% CI 12.5-23.1%), with a higher proportion among HPV-positive women (24.0%, 95% CI 16.0-33.6%). In a triage screening setting, where all women underwent HPV testing and the HPV positives in addition GynTect testing, the overall sensitivity would slightly decline but specificity would reach the maximum value of 88.7% (95% CI 83.7-92.6%)., Conclusion: The GynTect® assay is a robust easy to use assay with high analytical sensitivity and specificity. Moreover, the performance of the assay based on cervical scrapes provides further evidence for the usefulness of methylation markers to detect HPV-positive women with clinically relevant disease.

Anticipatory motor planning abilities mature as children grow older, develop throughout childhood and are likely to be stable till the late sixties. In the seventh decade of life, motor planning performance dramatically declines, with anticipatory motor planning abilities falling to levels of those exhibited by children. At present, the processes enabling successful anticipatory motor planning in general, as do the cognitive processes mediating these age-related changes, remain elusive. Thus, the aim of the present study was (a) to identify cognitive and motor functions that are most affected by normal aging and (b) to elucidate key (cognitive and motor) factors that are critical for successful motor planning performance in young ( n = 40, mean age = 23.1 ± 2.6 years) and older adults ( n = 37, mean age = 73.5 ± 7.1 years). Results indicate that normal aging is associated with a marked decline in all aspects of cognitive and motor functioning tested. However, age-related declines were more apparent for fine motor dexterity, processing speed and cognitive flexibility. Furthermore, up to 64% of the variance in motor planning performance across age groups could be explained by the cognitive functions processing speed, response planning and cognitive flexibility. It can be postulated that anticipatory motor planning abilities are strongly influenced by cognitive control processes, which seem to be key mechanisms to compensate for age-related decline. These findings support the general therapeutic and preventive value of cognitive-motor training programs to reduce adverse effects associated with high age.

Objectives: The end-state comfort (ESC) effect represents an efficiency constraint in anticipatory motor planning. Although young adults usually avoid uncomfortable postures at the end of goal-directed movements, newer studies revealed that children's sensitivity for ESC is not fully in place before the age of 10 years. In this matter, it is surprising that nothing is known about the development of the ESC effect at older ages. Therefore, the aim of the present study was to examine the development of anticipatory motor planning in older adults., Method: In 2 experiments, a total of 119 older adults (from 60 to 80 years old) performed in an unimanual (Experiment 1) and a bimanual version (Experiment 2) of the bar-transport-task., Results: Across both experiments, the propensity of the ESC effect was significantly lower in the old-old (71-80 years old) as compared with the young-old (60-70 years old) participants., Discussion: Although the performance of the young-old participants in the unimanual and bimanual task was comparable to what has been reported for young adults, the performance of the old-old participants was rather similar to the behavior of children younger than 10 years. Thus, for the first time, evidence is provided for the decrease of the ESC effect in older adults., (© The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The stress-buffering hypothesis postulates that physical activity and exercise can buffer the negative effects of (academic) stress on health. It still remains an open question whether students, who regularly engage in physical activity and exercise within their academic examination period, can successfully diminish these negative effects. Sixty-four subjects participated in this study and completed a total of five surveys, with T1 at the end of the semester break (baseline) and T2-T5 being presented every Friday in the last 4 weeks of the semester (examination period). They were asked to answer questions about their activity level, sleep quality, well-being and affect. Hierarchical linear models showed significant dependencies on time for all dependent measures. The expansion of the model for exercise also showed significant main effects of this predictor on well-being and positive affect (PA) and negative affect. Moreover, significant interactions with time for sleep quality and PA were found. Results suggest that physical activity and exercise in the academic examination period may be able to buffer the negative effects of stress on health-related outcomes. Therefore, activity levels should be maintained in times of high stress to prevent negative effects on sleep, well-being and affect in students., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

A more recent branch of research describes the importance of sleep problems in the development and treatment of mental disorders in children and adolescents, such as attention-deficit hyperactivity disorder (ADHD) and mood disorders (MD). Research about clock genes has continued since 2012 with a focus on metabolic processes within all parts of the mammalian body, but particularly within different cerebral regions. Research has focused on complex regulatory circuits involving clock genes themselves and their influence on circadian rhythms of diverse body functions. Current publications on basic research in human and animal models indicate directions for the treatment of mental disorders targeting circadian rhythms and mechanisms. The most significant lines of research are described in this paper.

The present study examined the developmental trajectories of motor planning and executive functioning in children. To this end, we tested 217 participants with three motor tasks, measuring anticipatory planning abilities (i.e., the bar-transport-task, the sword-rotation-task and the grasp-height-task), and three cognitive tasks, measuring executive functions (i.e., the Tower-of-Hanoi-task, the Mosaic-task, and the D2-attention-endurance-task). Children were aged between 3 and 10 years and were separated into age groups by 1-year bins, resulting in a total of eight groups of children and an additional group of adults. Results suggested (1) a positive developmental trajectory for each of the sub-tests, with better task performance as children get older; (2) that the performance in the separate tasks was not correlated across participants in the different age groups; and (3) that there was no relationship between performance in the motor tasks and in the cognitive tasks used in the present study when controlling for age. These results suggest that both, motor planning and executive functions are rather heterogeneous domains of cognitive functioning with fewer interdependencies than often suggested.

Evidence suggests that people are more likely to recall features of previous plans and use them for subsequent movements, rather than generating action plans from scratch for each movement. The information used for plan recall during object manipulation tasks is stored in extrinsic (object-centered) rather than intrinsic (body-centered) coordinates. The present study examined whether action plan recall processes are influenced by manual asymmetries. Right-handed (Experiment 1) and left-handed (Experiment 2) participants grasped a plunger from a home position using either the dominant or the non-dominant hand and placed it at one of the three target positions located at varying heights (home-to-target moves). Subsequently, they stepped sideways down from a podium (step-down podium), onto a podium (step-up podium), or without any podium present (no podium), before returning the plunger to the home platform using the same hand (target-back-to-home moves). The data show that, regardless of hand and handedness, participants grasped the plunger at similar heights during the home-to-target and target-back-to-home moves, even if they had to adopt quite different arm postures to do so. Thus, these findings indicate that the information used for plan recall processes in sequential object manipulation tasks is stored in extrinsic coordinates and in an effector-independent manner.

The present study examined the development of anticipatory motor planning in an object manipulation task that has been used to successfully demonstrate motor planning in non-human primates (Weiss et al. in Psychol Sci 18:1063-1068, 2007). Seventy-five participants from four different age groups participated in a cup-manipulation task. One group was preschool children (average age of 5.1 years), two groups were primary school children (7.7 and 9.8 years old respectively) and the final group was comprised of adults. The experimental task entailed reaching for a plastic cup that was vertically suspended in an apparatus in either upright or inverted orientation, removing the cup by its stem and then retrieving a small toy from the inside of the cup. When the cup was inverted in the apparatus, evidence for anticipatory motor planning could be achieved by initially gripping the stem using an inverted (thumb-down) grip posture. We found that when the cup was in upright orientation, all participants reached for the cup using an upright grip (i.e., thumb-up posture). However, when the cup was inverted in the apparatus, only adults consistently used an inverted grasping posture, though the percentage of inverted grips among participants did increase with age. These results suggest a protracted development for anticipatory motor planning abilities in children. Surprisingly, the performance of adults on this task more closely resembles the performance of several nonhuman primate species as opposed to children even at approximately 10 years of age. We discuss how morphological constraints on flexibility may help account for these findings.