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ObjectivesResearch has linked mindfulness to improved mental health, yet the mechanisms underlying this relationship are not well understood. This study explored the mediating role of emotion regulation strategies and sleep in the relationship between mindfulness and symptoms of depression, anxiety and psychological distress during the COVID-19 pandemic.MethodsAs detailed in this study’s pre-registration (osf.io/k9qtw), a cross-sectional research design was used to investigate the impact of mindfulness on mental health and the mediating role of emotion regulation strategies (i.e., cognitive reappraisal, rumination and suppression) and insomnia. A total of 493 participants from the general population answered an online survey and were included in the final analysis. The online survey consisted of the short form of the Five-Facets Mindfulness Questionnaire (FFMQ-SF), the Impact of Event Scale-revised (IES-R), the Generalised Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire (PHQ-8), the Emotion Regulation Questionnaire (ERQ), the short form of the Rumination Response Scale (RSS-SF), and the Insomnia Severity Index (ISI).ResultsStructural equation modelling revealed that mindfulness was related to lower symptoms of depression, anxiety and psychological distress, both directly and indirectly. Mindfulness was negatively associated with rumination and insomnia. As hypothesised, models revealed that the associations between mindfulness and depression, anxiety and psychological distress were significantly mediated by its negative associations with rumination and insomnia. Our findings also demonstrated that rumination was related to increased insomnia symptoms, which in turn was associated with increased mental health problems, indicating a mediated mediation. Mindfulness was also positively associated with cognitive reappraisal and negatively associated with suppression, which were, respectively, negatively and positively associated with depressive symptoms, and thus functioned as specific mediators of the association between mindfulness and depression.ConclusionOur findings suggest that rumination and insomnia operate transdiagnostically as interrelated mediators of the effects of mindfulness on mental health, whereas cognitive reappraisal and suppression function as specific mediators for depression. These insights emphasise the importance of targeting emotion regulation and sleep in mindfulness interventions for improving mental health. Limitations and implications for practice are discussed.

Pre- and post-term children show increased autism risk. Little is known about gestational age (GA) prevalence among autistic children, and their respective autism phenotype. We compared prevalence of pre-, full- and post-term birth between a population-derived sample of N = 606 (137 females, 22.61%) autistic children and adolescents (mean age = 14.01, SD = 3.63, range 3–24) from the Netherlands Autism Register, and matched controls from the Dutch birth register. Autism phenotype and comorbid symptoms were assessed with the AQ-short and SDQ questionnaires. Using logistic regression, we found higher prevalence of pre- and post-term birth among autistic individuals but no phenotypical differences across GA groups. Autism risk was particularly elevated for post-term children, highlighting the need for closer investigation of autism on the whole GA range.

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Introduction: Children who experienced mild perinatal adversity (i.e., born late preterm or small for gestational age) are at increased risk for delays in early numeracy and literacy, which increases inequality in educational opportunities. However, this group showed increased susceptibility to the characteristics of their educational environment for literacy, especially for those born late preterm. Intervening in this group may thus be particularly beneficial, provided that their educational environment is highly structured. Delays in numeracy and mathematics are most firmly acknowledged in these children. It remains unclear if these children are also more susceptible to their educational numeracy environment. We test the hypothesis of increased susceptibility to characteristics of their educational environment in the field of numeracy.Methods: We tested the efficacy of a digital intervention of two to 3 months, which focused on visual spatial skills in a large randomized controlled trial in a sample of five-to-six-year-old kindergarten pupils from 140 elementary schools. About 45% of all participants showed delays in numeracy, of whom n = 67 (11%) were born late preterm, n = 157 (26%) were born small for gestational age, and n = 389 (63%) had no mild perinatal adversities. Pupils were assigned to a guiding and structured intervention focused on visual spatial skills (n = 294) or a control program (n = 319), targeting literacy skills. Results: The intervention did not show a main effect. The program was not effective in children small for gestational age, but it was for children born late preterm (Cohen’s d = .71, CI = .07–1.36), showing stronger numeracy skills compared to term-born peers in the intervention condition. Early numeracy skills in children born late preterm fell behind compared to term-born peers in the control condition.Conclusion: A highly structured educational numeracy environment, using repetition and adaptive feedback benefited early numeracy skills of late preterm children. These children outperformed their peers in early numeracy skills, while those in the control condition fell behind. Findings align with earlier findings on promoting early literacy in this group through an equivalent literacy intervention. A relatively simple and cost-effective intervention thus may help reduce the risk of educational inequality for children born late pre-term.

Objectives Remote consultations were common in general practice during the COVID-19 pandemic. This approach may have affected access to GP care for people with low socio-economic status: this group has a high prevalence of chronic conditions and a higher mortality rate due to COVID-19. This study explores the association of sociodemographic and health factors with the decision to contact a GP practice, and care utilisation, among patients in low-income neighbourhoods in the Netherlands. Design Cross-sectional survey study. Setting General practice in low-income neighbourhoods in the Netherlands. Participants Patients from low-income neighbourhoods were selected from fourteen general practices on the basis of ethnic background, chronic disease or health literacy. Participants were stratified according to categories of these background characteristics to obtain equal numbers per category. A total of 213 surveys were retained for analysis. Main outcome measures Need for GP contact, decision to contact a GP practice, and GP service utilisation. Results Forty-five percent (N = 88) of the participants experienced health problems for which they wished to consult their GP at the start of the outbreak of COVID-19. A majority of them (81%) had contact with a GP service. The need to contact the GP was significantly associated with financial difficulties (OR 2.20 CI (1.10 to 4.39)). An interaction effect was found of health literacy with concerns about COVID-19 with in respondents with low health literacy a significant association between concerns about COVID-19 and a need for a GP appointment (OR 5.33 CI (2.09 to 13.59)) and absence of a significant association in the higher health literacy group (OR 1.14 CI (0.51 to 2.56)) . Moreover, 56% (N = 74) of the participants received remote care at least one time during the first wave of COVID-19. Female participants used remote care more often (OR 3.22 CI (1.57 to 6.59)) and participants aged 50 and over used remote care less often (OR 0.46 CI (0.21 to 0.97)). Conclusion Many patients in low-income neighbourhoods were able to consult a GP, often remotely. However from the equity perspective, access to GP care should be safeguarded for patients with health problems, financial difficulties and low health literacy because of their greater need to consult a GP during times of crisis.

Background Worldwide the Covid-19 pandemic resulted in drastic behavioral measures and lockdowns. Vaccination is widely regarded as the true and only global exit strategy; however, a high vaccination coverage is needed to contain the spread of the virus. Vaccination rates among young people are currently lacking. We therefore studied the experienced motivations and barriers regarding vaccination in young people with the use of the health belief model. Methods We conducted a correlational study, based on a convenience sample. At the vaccination location, directly after vaccination, 194participants(16–30 years) who decided to get vaccinated at a pop-up location several weeks after receiving a formal invitation, filled out a questionnaire regarding their attitudes towards vaccination based on concepts defined in the health belief model. We used these concepts to predict vaccination hesitancy. Results Younger participants and participants with lower educational levels report higher levels of hesitancy regarding vaccination (low education level = 38.9%, high education level = 25.4%). Perceived severity (Mhesitancy = .23, Mno hesitancy = .37) and susceptibility (Mhesitancy = .38, Mno hesitancy = .69) were not associated with hesitancy. Health related and idealistic benefits of vaccination were negatively associated with experienced hesitancy (Mhesitancy = .68, Mno hesitancy = -.37), while individualistic and practical benefits were not associated with hesitancy (Mhesitancy = -.09, Mno hesitancy = .05). Practical barriers were not associated with hesitancy (Mhesitancy = .05, Mno hesitancy = -.01), while fear related barriers were strongly associated with hesitancy (Mhesitancy = -.60, Mno hesitancy = .29). Conclusions Health related, and idealistic beliefs are negatively associated with experienced hesitancy about vaccination, while fear related barriers is positively associated with experienced hesitancy. Future interventions should focus on these considerations, since they can facilitate or stand in the way of vaccination in young people who are doubting vaccination, while not principally opposed to it.

Lighting illegal fireworks inside soccer stadiums is a worldwide and persistent problem. Despite rules and regulations as well as rigorous enforcement, the use of illegal fireworks in football stadium is increasing rather than decreasing. Little is yet known about the causes and predictors of this behavior, preventing the development of effective interventions or communication strategies. We therefore conducted a qualitative study, using semistructured interviews with both supporters of a large Dutch soccer club who participated in lighting fireworks, and with professionals who dealt with illegal fireworks in daily practice. Semi-structures interviews were based on hooliganism literature as well as the COM-B model. We concluded that hooliganism and lighting illegal are distinctly different phenomena, although they share some underlying constructs. From a behavioral perspective, using the COM-B model as a framework, reflective motivation was identified as the strongest facilitator of lighting fireworks, which appeared to be an important part of supporter life and shared culture. Quick interventions that target automatic behavior, such as nudges, will probably thus not be successful in changing this behavior. Supporters suggest compromise between supporters and professionals as preferred future direction. Reported feelings of stigmatization by and feeling unappreciated by professionals, could interfere with successful implementation of this direction. Professionals however contradict negative to have judgements of supporters. Building a bridge between supporters and professionals should be a first step towards a solution.