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      Mechanisms of Music Impact: Autonomic Tone and the Physical Activity Roadmap to Advancing Understanding and Evidence-Based Policy

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          Abstract

          Research demonstrates that both music-making and music listening have an ability to modulate autonomic nervous system activity. The majority of studies have highlighted acute autonomic changes occurring during or immediately following a single session of music engagement. Several studies also suggest that repeated music-making and listening may have longer-term effects on autonomic tone—the prevailing balance of sympathetic vs. parasympathetic activity. Autonomic imbalance is associated with a range of neurodegenerative and neurodevelopmental disorders, mental health conditions and non-communicable diseases. Established behavioral interventions capable of restoring healthy autonomic tone (e.g., physical activity; smoking cessation) have demonstrated remarkable efficacy in broadly promoting health and preventing disease and up to 7.2 million annual deaths. Accordingly, this article proposes that music’s suggested ability to modulate autonomic tone may be a key central mechanism underpinning the broad health benefits of music-making and listening reported in several recent reviews. Further, this article highlights how physical activity research provides a relevant roadmap to efficiently advancing understanding of music’s effects on both autonomic tone and health more broadly, as well as translating this understanding into evidence-based policy and prescriptions. In particular, adapting FITT— Frequency, Intensity, Timing, Type—criteria to evaluate and prescribe music-making and listening in observational and intervention studies has excellent prospective utility.

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          Inflammation and cancer.

          Recent data have expanded the concept that inflammation is a critical component of tumour progression. Many cancers arise from sites of infection, chronic irritation and inflammation. It is now becoming clear that the tumour microenvironment, which is largely orchestrated by inflammatory cells, is an indispensable participant in the neoplastic process, fostering proliferation, survival and migration. In addition, tumour cells have co-opted some of the signalling molecules of the innate immune system, such as selectins, chemokines and their receptors for invasion, migration and metastasis. These insights are fostering new anti-inflammatory therapeutic approaches to cancer development.
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            Developing and evaluating complex interventions: the new Medical Research Council guidance

            Evaluating complex interventions is complicated. The Medical Research Council's evaluation framework (2000) brought welcome clarity to the task. Now the council has updated its guidance
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              Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

              Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation.
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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                27 August 2021
                2021
                : 12
                : 727231
                Affiliations
                [1] 1Institute of Music Physiology and Musicians’ Medicine, Hannover University of Music, Drama and Media , Hannover, Germany
                [2] 2Prince of Wales Clinical School, University of New South Wales , Sydney, NSW, Australia
                Author notes

                Edited by: Stephen Clift, Canterbury Christ Church University, United Kingdom

                Reviewed by: Graham Frederick Welch, University College London, United Kingdom; Helena Daffern, University of York, United Kingdom

                *Correspondence: J. Matt McCrary, j.matt.mccrary@ 123456gmail.com

                This article was submitted to Health Psychology, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2021.727231
                8429896
                34512483
                4d075c57-4cd6-41c4-8c6d-7852fa603512
                Copyright © 2021 McCrary and Altenmüller.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 18 June 2021
                : 09 August 2021
                Page count
                Figures: 1, Tables: 1, Equations: 0, References: 81, Pages: 9, Words: 0
                Funding
                Funded by: Alexander von Humboldt-Stiftung 10.13039/100005156
                Categories
                Psychology
                Perspective

                Clinical Psychology & Psychiatry
                non-communicable diseases,fitt,music listening,music-making,exercise physiology

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