Spatial orientation is achieved by integrating visual, vestibular and proprioceptive cues. Individuals that rely strongly upon visual cues to facilitate spatial orientation are termed visually dependent. Heightened visual reliance commonly occurs in patients following vestibular dysfunction and can influence clinical outcome. Additionally, psychological factors, including anxiety, are associated with poorer clinical outcome following vestibular dysfunction. Given that visual dependency measures are affected by psychological and contextual influences, such as time pressure, we investigated the interaction between time pressure and anxiety upon visual dependency in healthy controls and vestibular migraine patients. Visual dependency was assessed using a “Rod and Disk” task at baseline and under time pressure (3 s to complete the task). Non‐situational (trait) and situational (state) anxiety levels were quantified using the Spielberg State‐Trait Anxiety Inventory. We calculated the change in visual dependency (VD) [∆VD = VDtime pressure − VDbaseline] and correlated it with participants’ trait anxiety scores. We observed a significant negative correlation between trait anxiety and the change in VD (R2 = .393, p < .001) in healthy controls and a positive correlation in dizzy patients (R2 = .317, p < .001). That is, healthy individuals that were more anxious became less visually dependent under time pressure (i.e., more accurate), whereas less anxious individuals became more visually dependent. The reverse was observed in vestibular migraine patients. Our results illustrate that anxiety can differentially modulate task performance during spatial orientation judgements under time pressure in healthy individuals and dizzy patients. These findings have potential implications for individualised patient rehabilitation therapies.

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Underestimating the true impact of obesityThe ever-increasing burden that obesity exerts on population health was recently explored in The Lancet Public Health by Solja Nyberg and colleagues. 1 The authors measured the loss of diseasefree years attributable to major noncommunicable diseases (NCDs) in obese adults compared with those who were normal weight. Individuals lost 3-4 more disease-free years if they were mildly obese and 7-8 more disease-free years if they were severely obese. These results show the alarming extent of obesity's impact on health; however, the true effect is likely to be even higher than reported.The decision to use the six commonest NCDs could have led to an underestimation of the true effect size because obesity contributes a large morbidity burden through diseases not included in their analysis, such as musculoskeletal conditions and depression. 2 Lower back pain has been extensively linked to increased bodymass index 3 and is the leading cause of disability-adjusted life-year loss globally. 4 Furthermore, as shown by the authors, the effect of their chosen conditions, particularly type 2 diabetes, was likely to be underestimated as only data from hospital and death registries were used. This data selection omits the huge burden of obesity-associated morbidity that exists solely in primary care. 5 It also could explain part of the considerable difference in disease-free years lost between mild and severe obesity; co-morbid conditions suffered by those with mild obesity are less likely to be severe enough to require inpatient management.The effect of obesity through NCDs is likely to be more alarming than reported and this effect permeates through all social classes. More must be done through public health policy to tackle all levels of obesity.We declare no competing interests.

Objective: To determine self-reported incidences of health and safety hazards among persons who ride rentable electric scooters (e-scooters), knowledge of e-scooter laws, and attitudes and perceptions of the health and safety of e-scooter usage. Methods: A cross-sectional survey of n= 561 e-scooter riders and non-riders was conducted during June of 2019. Results: Almost half of respondents (44%) report that e-scooters pose a threat to the health and safety of riders. Riders and non-riders disagree regarding the hazards that e-scooters pose to pedestrians. Among riders, 15% report crashing or falling off an e-scooter. Only 2.5% of e-scooter riders self-report that they always wear a helmet while riding. Conclusions: E-scooter riders report substantial rates of harmful behavior and injuries. Knowledge of e-scooter laws is limited, and e-scooters introduce threats to the health and safety of riders, pedestrians on sidewalks, and automobile drivers. Enhanced public health interventions are needed to educate about potential health risks and laws associated with e-scooter use and to ensure health in all policies. Additionally, greater consideration should be given to public health, safety, and injury prevention when passing relevant state and local e-scooter laws.