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The aim of the present study is to use the syndemic framework to investigate the risk of contracting HIV in the US population. Cross-sectional analyses are from The National Health and Nutrition Examination Survey. We extracted and aggregated data on HIV antibody test, socio-demographic characteristics, alcohol use, drug use, depression, sexual behaviours and sexually transmitted diseases from cycle 2009–2010 to 2015–2016. We carried out weighted regression among young adults (20–39 years) and adults (40–59 years) separately. In total, 5230 men and 5794 women aged 20–59 years were included in the present analyses. In total, 0.8% men and 0.2% women were tested HIV-positive. Each increasing HIV risk behaviour was associated with elevated odds of being tested HIV-positive (1.15, 95% CI 1.15–1.15) among young adults and adults (1.61, 95% CI 1.61–1.61). Multi-faceted, community-based interventions are urgently required to reduce the incidence of HIV in the USA.
Although injuries have been linked to worse mental health, little is known about this association among the general population in low- and middle-income countries (LAMICs). This study examined the association between injuries and depression in 40 LAMICs that participated in the World Health Survey.
Cross-sectional information was obtained from 212 039 community-based adults on the past 12-month experience of road traffic and other (non-traffic) injuries and depression, which was assessed using questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview. Multivariable logistic regression analysis and meta-analysis were used to examine associations.
The overall prevalence (95% CI) of past 12-month traffic injury, other injury, and depression was 2.8% (2.6–3.0%), 4.8% (4.6–5.0%) and 7.4% (7.1–7.8%), respectively. The prevalence of traffic injuries [range 0.1% (Ethiopia) to 5.1% (Bangladesh)], and other (non-traffic) injuries [range 0.9% (Myanmar) to 12.1% (Kenya)] varied widely across countries. After adjusting for demographic variables, alcohol consumption and smoking, the pooled OR (95%CI) for depression among individuals experiencing traffic injury based on a meta-analysis was 1.72 (1.48–1.99), and 2.04 (1.85–2.24) for those with other injuries. There was little between-country heterogeneity in the association between either form of injury and depression, although for traffic injuries, significant heterogeneity was observed between groups by country-income level (p = 0.043) where the pooled association was strongest in upper middle-income countries (OR = 2.37) and weakest in low-income countries (OR = 1.46).
Alerting health care providers in LAMICs to the increased risk of worse mental health among injury survivors and establishing effective trauma treatment systems to reduce the detrimental effects of injury should now be prioritised.
Cognitive deficits are an important factor in the pathogenesis of psychosis. Subjective cognitive complaints (SCCs) are often considered to be a precursor of objective cognitive deficits, but there are no studies specifically on SCC and psychotic experiences (PE). Thus, we assessed the association between SCC and PE using data from 48 low- and middle-income countries.
Community-based cross-sectional data of the World Health Survey were analysed. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 to 10 with higher scores representing more severe SCC. The Composite International Diagnostic Interview was used to identify past 12-month PE. Multivariable logistic regression and mediation analyses were performed.
The final sample consisted of 224 842 adults aged ⩾18 years [mean (SD) age 38.3 (16.0) years; 49.3% males]. After adjustment for sociodemographic factors, a one-unit increase in the SCC scale was associated with a 1.17 (95% CI 1.16–1.18) times higher odds for PE in the overall sample, with this association being more pronounced in younger individuals: age 18–44 years OR = 1.19 (95% CI 1.17–1.20); 45–64 years OR = 1.15 (95% CI 1.12–1.17); ⩾65 years OR = 1.14 (95% CI 1.09–1.19). Collectively, other mental health conditions (perceived stress, depression, anxiety, sleep problems) explained 43.4% of this association, and chronic physical conditions partially explained the association but to a lesser extent (11.8%).
SCC were associated with PE. Future longitudinal studies are needed to understand temporal associations and causal inferences, while the utility of SCC as a risk marker for psychosis especially for young adults should be scrutinised.
Despite the benefits of being active for people with mild cognitive impairment (MCI) on cognition and the acknowledgement that MCI is a critical period for intervening to prevent dementia, little is known about the actual sedentary levels in people with MCI. This study investigates correlates of sedentary behavior (SB) in people with MCI.
This was a cross-sectional study.
Data from the World Health Organization’s Study on Global Ageing and Adult Health were analyzed.
Individuals aged ≥50 years with MCI were included.
SB was assessed by the Global Physical Activity Questionnaire. Associations between SB levels and the correlates were examined using multivariable linear and logistic regressions.
4,082 individuals aged ≥50 years with MCI (64.4 ± 17.0 years; 55.1% female) were included. The prevalence of high SB (i.e., ≥8 hours/day) was 14.0% (95%CI = 12.2%–16.0%), while the time spent sedentary was 262 ± 290 minutes/day. Correlates significantly associated with being sedentary ≥8 hours/day and time spent sedentary per day were, older age, being unemployed, depression, sleep problems, obesity (vs. normal weight), diabetes, stroke, poor self-rated health, and lower levels of social cohesion.
Future research exploring interventions to reduce SB in people with MCI should target the identified sociodemographic and mental and physical health correlates, while the promotion of social cohesion may have the potential to increase the efficacy of future public health initiatives.
Death ideation (thinking about/wishing for one's own death, thinking that one would be better off dead) is linked to an increased mortality risk. However, comparatively little is known about more general thoughts of death (GTOD) where no wish to die or life value is expressed. This study examined whether GTOD predicted mortality in a community-based cohort of older adults.
Data came from the Komo-Ise cohort study in Gunma prefecture, Japan. The analytic sample comprised 8208 individuals (average age 61.3 (range 47–77)) who were asked in wave 2 of the study in 2000 if they had ‘Thought about death more than usual, either your own, someone else's or death in general?’ in the past 2 weeks. Death data were obtained from the municipal resident registration file. Cox proportional hazards regression analysis was used to examine associations.
During the follow-up period (2000–2008), there were 672 deaths. In a model adjusted for baseline covariates, GTOD were significantly associated with all-cause mortality (hazards ratio 1.66, 95% confidence interval 1.20–2.29). Stratified analyses showed an association between GTOD and mortality in men, older subjects (⩾70 years), married individuals and those with higher social support.
GTOD are associated with an increased mortality risk among older citizens in Japan. Research is now needed to determine the factors underlying this association and assess the clinical relevance of screening for GTOD in older individuals.
Data on the relationship between intelligence quotient (IQ) and violence perpetration are scarce and nationally representative data from the UK adult population is lacking. Therefore, our goal was to examine the relationship between IQ and violence perpetration using nationally representative community-based data from the UK.
We analyzed cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey. IQ was estimated using the National Adult Reading Test (NART). Violence perpetration referred to being in a physical fight or having deliberately hit anyone in the past 5 years. We conducted logistic regression analysis to assess the association between IQ (exposure variable) and violence perpetration (outcome variable).
There were 6872 participants aged ⩾16 years included in this study. The prevalence of violence perpetration decreased linearly with increasing IQ [16.3% (IQ 70–79) v. 2.9% (IQ 120–129)]. After adjusting for demographic and behavioral factors, childhood adversity, and psychiatric morbidity, compared with those with IQ 120–129, IQ scores of 110–119, 100–109, 90–99, 80–89, and 70–79 were associated with 1.07 [95% confidence interval (CI) 0.63–1.84], 1.90 (95% CI 1.12–3.22), 1.80 (95% CI 1.05–3.13), 2.36 (95% CI 1.32–4.22), and 2.25 (95% CI 1.26–4.01) times higher odds for violence perpetration, respectively.
Lower IQ was associated with violence perpetration in the UK general population. Further studies are warranted to assess how low IQ can lead to violence perpetration, and whether interventions are possible for this high-risk group.
Evidence suggests that skin picking disorder (SPD) could be a prevalent condition associated with comorbidity and psychosocial dysfunction. However, just a few studies have assessed the prevalence and correlates of SPD in samples from low- and middle-income countries. In addition, the impact of SPD on quality of life (QoL) dimension after multivariable adjustment to potential confounders remains unclear.
Data were obtained from a Brazilian anonymous Web-based research platform. Participants provided sociodemographic data and completed the modified Skin Picking–Stanford questionnaire, the Hypomania Checklist (HCL-32), the Patient Health Questionnaire-9 (PHQ-9), the Fagerström Test for Nicotine Dependence, Alcohol Use Disorder Identification Test (AUDIT), Symptom Checklist-90-Revised inventory (SCL-90R), early trauma inventory self report–short form, and the World Health Organization quality of life abbreviated scale (WHOQOL-Bref). Associations were adjusted to potential confounders through multivariable models.
For our survey, 7639 participants took part (71.3% females; age: 27.2±7.9 years). The prevalence of SPD was 3.4% (95% CI: 3.0–3.8%), with a female preponderance (P<0.001). In addition, SPD was associated with a positive screen for a major depressive episode, nicotine dependence, and alcohol dependence, as well as suicidal ideation. Physical and psychological QoL was significantly more impaired in participants with SPD compared to those without SPD, even after adjustment for comorbidity.
In this large sample, SPD was a prevalent condition associated with co-occurring depression, nicotine, and alcohol dependence. In addition, SPD was independently associated with impaired physical and psychological QoL. Public health efforts toward the early recognition and treatment of SPD are warranted.
Ceramic fiber–matrix composites (CFMCs) are exciting materials for engineering applications in extreme environments. By integrating ceramic fibers within a ceramic matrix, CFMCs allow an intrinsically brittle material to exhibit sufficient structural toughness for use in gas turbines and nuclear reactors. Chemical stability under high temperature and irradiation coupled with high specific strength make these materials unique and increasingly popular in extreme settings. This paper first offers a review of the importance and growing body of research on fiber–matrix interfaces as they relate to composite toughening mechanisms. Second, micropillar compression is explored experimentally as a high-fidelity method for extracting interface properties compared with traditional fiber push-out testing. Three significant interface properties that govern composite toughening were extracted. For a 50-nm-pyrolytic carbon interface, the following were observed: a fracture energy release rate of ∼2.5 J/m2, an internal friction coefficient of 0.25 ± 0.04, and a debond shear strength of 266 ± 24 MPa. This research supports micromechanical evaluations as a unique bridge between theoretical physics models for microcrack propagation and empirically driven finite element models for bulk CFMCs.
It is well known that negative ageing perceptions have various detrimental effects on indicators of successful ageing, but less is known about the role of social support networks and loneliness in ageing perceptions. The objective of this study was therefore to assess the association of social networks, relationship quality and loneliness with negative ageing perceptions in late life. Cross-sectional data on 6,912 adults aged ⩾50 years from the first wave of the Irish Longitudinal Study on Ageing (TILDA) were analysed. Ageing perceptions were assessed with the Brief Ageing Perceptions Questionnaire. Information on social support networks, loneliness and socio-demographics were obtained using standard questions. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression scale. Multivariable linear regression was conducted to assess the associations. Social isolation, poor relationship quality (with spouse, children, other family members or friends) and loneliness were all significantly associated with negative ageing perceptions even after adjustment for all potential confounders including depressive symptoms. Our study indicates that targeting integration into social support networks and improving relationship quality may potentially reduce the extent to which older individuals adopt negative ageing perceptions. Future studies with prospective design are warranted to understand the temporal direction and causal association of social support networks and loneliness with negative ageing perceptions.
Given the important health benefits of physical activity (PA) and the higher risk for physical inactivity in people with anxiety, and the high prevalence of anxiety and low PA among the elderly, there is a need for research to investigate what factors influence PA participation among anxious older individuals. We investigated PA correlates among community-dwelling adults aged ≥ 65 years with anxiety symptoms in six low- and middle-income countries.
Cross-sectional data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. PA level was assessed by the Global Physical Activity Questionnaire. 980 participants with anxiety (mean age 73.3 years; 62.4% females) were grouped into those who do and do not (low PA) meet the 150 minutes of moderate-to-vigorous PA per week recommendation. Associations between PA and the correlates were examined using multivariable logistic regressions.
The prevalence of low PA was 44.9% (95% CI = 39.2–50.7%). Older age, male gender, less consumption of alcohol, mild cognitive impairment, pain, a wide range of somatic co-morbidities, slow gait, weak grip strength, poor self-rated health, and lower levels of social cohesion were identified as significant positive correlates of low PA.
Our data illustrate that a number of sociodemographic and health factors are associated with PA levels among older people with symptoms of anxiety. The promotion of social cohesion may increase the efficacy of public health initiatives, while from a clinical perspective, somatic co-morbidities, cognitive impairment, pain, muscle strength, and slow gait need to be considered.
Depression and pain are leading causes of global disability. However, there is a paucity of multinational population data assessing the association between depression and pain, particularly among low- and middle-income countries (LMICs) where both are common. Therefore, we investigated this association across 47 LMICs.
Community-based data on 273 952 individuals from 47 LMICs were analysed. Multivariable logistic and linear regression analyses were performed to assess the association between the International Classification of Diseases, 10th Revision depression/depression subtypes (over the past 12 months) and pain in the previous 30 days based on self-reported data. Country-wide meta-analysis adjusting for age and sex was also conducted.
The prevalence of severe pain was 8.0, 28.2, 20.2, and 34.0% for no depression, subsyndromal depression, brief depressive episode, and depressive episode, respectively. Logistic regression adjusted for socio-demographic variables, anxiety and chronic medical conditions (arthritis, diabetes, angina, asthma) demonstrated that compared with no depression, subsyndromal depression, brief depressive episode, and depressive episode were associated with a 2.16 [95% confidence interval (CI) 1.83–2.55], 1.45 (95% CI 1.22–1.73), and 2.11 (95% CI 1.87–2.39) increase in odds of severe pain, respectively. Similar results were obtained when a continuous pain scale was used as the outcome. Depression was significantly associated with severe pain in 44/47 countries with a pooled odds ratio of 3.93 (95% CI 3.54–4.37).
Depression and severe pain are highly comorbid across LMICs, independent of anxiety and chronic medical conditions. Whether depression treatment or pain management in patients with comorbid pain and depression leads to better clinical outcome is an area for future research.
Despite the known heightened risk and burden of various somatic diseases in people with depression, very little is known about physical health multimorbidity (i.e. two or more physical health co-morbidities) in individuals with depression. This study explored physical health multimorbidity in people with clinical depression, subsyndromal depression and brief depressive episode across 43 low- and middle-income countries (LMICs).
Cross-sectional, community-based data on 190 593 individuals from 43 LMICs recruited via the World Health Survey were analysed. Multivariable logistic regression analysis was done to assess the association between depression and physical multimorbidity.
Overall, two, three and four or more physical health conditions were present in 7.4, 2.4 and 0.9% of non-depressive individuals compared with 17.7, 9.1 and 4.9% among people with any depressive episode, respectively. Compared with those with no depression, subsyndromal depression, brief depressive episode and depressive episode were significantly associated with 2.62, 2.14 and 3.44 times higher odds for multimorbidity, respectively. A significant positive association between multimorbidity and any depression was observed across 42 of the 43 countries, with particularly high odds ratios (ORs) in China (OR 8.84), Laos (OR 5.08), Ethiopia (OR 4.99), the Philippines (OR 4.81) and Malaysia (OR 4.58). The pooled OR for multimorbidity and depression estimated by meta-analysis across 43 countries was 3.26 (95% confident interval 2.98–3.57).
Our large multinational study demonstrates that physical health multimorbidity is increased across the depression spectrum. Public health interventions are required to address this global health problem.
Effective conservation of global species diversity requires a clear understanding of spatial scales that support overall diversity across broad scales. Abandonment of semi-natural grasslands has increased their fragmentation and decreased their areal extent. We quantified diversity patterns of plant communities in Japan across hierarchical scales to facilitate the development of an effective nationwide strategy for conserving species diversity in remnant semi-natural grasslands. We applied additive partitioning of plant species diversity, using a nested hierarchical design at three spatial scales (quadrat, grassland, and western and eastern regions of Japan) for three groups of plant species (all species, grassland species and national Red Listed species). We consistently found lower proportions of among-quadrats diversity, and higher proportions of among-grasslands diversity and between-regions diversity in the overall diversity of the entire species complement than would be expected by chance. The high contribution of among-grasslands diversity to overall diversity suggests that each grassland had a unique species content. The second-ranking contributor to overall diversity differed between grassland species and Red Listed species: the second-ranking contributor for grassland species was diversity at the among-quadrats scale but the second-ranking contributor for all species and for Red Listed species was diversity at the between-regions scale. Thus, effective conservation of diversity of the entire species complement in remnant semi-natural grasslands requires preservation of beta diversity in individual grasslands. Our findings highlight the importance of strengthening local preservation and restoration activities within each grassland, and of nationwide strategies for conserving Red Listed species in remnant semi-natural grassland communities.
The co-existence of depression and psychotic experiences (PEs) is associated with more pronounced adverse health outcomes compared to depression alone. However, data on its prevalence and correlates are lacking in the general adult population, and there is no published data on its association with chronic physical conditions.
Cross-sectional, community-based data from 201 337 adults aged ⩾18 years from 47 low- and middle-income countries from the World Health Survey were analyzed. The presence of past 12-month PE and DSM-IV depression was assessed with the Composite International Diagnostic Interview (CIDI). Information on six chronic medical conditions (chronic back pain, edentulism, arthritis, angina, asthma, diabetes) were obtained by self-report. Multivariable logistic regression analysis was performed.
The crude overall prevalence of co-morbid depression/PEs was 2.5% [95% confidence interval (CI) 2.3–2.7%], with the age- and sex-adjusted prevalence ranging from 0.1% (Sri Lanka, Vietnam) to 9.03% (Brazil). Younger age, urban setting, current smoking, alcohol consumption, and anxiety were significant correlates of co-existing depression/PEs. Co-occurring depression/PEs was associated with significantly higher odds for arthritis, angina, and diabetes beyond that of depression alone after adjusting for sociodemographics, anxiety, and country, with odds ratios (depression/PEs v. depression only) being: arthritis 1.30 (95% CI 1.07–1.59, p = 0.0086); angina 1.40 (95% CI 1.18–1.67, p = 0.0002); diabetes 1.65 (95% CI 1.21–2.26, p = 0.0017).
The prevalence of co-existing depression/PEs was non-negligible in most countries. Our study suggests that when depression/PE or a chronic condition (e.g. arthritis, angina, diabetes) is detected, screening for the other may be important to improve clinical outcomes.
The self-assembly of known good dies (KGDs) on substrates using the liquid capillary method is shown to be a promising technology to achieve three-dimensional (3D) heterogeneous system integration and packaging. Firstly, the effects of the edge structures of self-assembled substrates and chips on alignment accuracies were investigated. When hydrophobic sidewalls with 10-µm-height steps were applied to both chips and assembly sites formed on substrates, the alignment accuracy within 1.0 µm was realized. The alignment accuracies were within 2.0 µm using either substrates or chips having 10-µm-height step structures with hydrophobic sidewalls. Self-assembly of 12-ch vertical-cavity surface-emitting lasers (VCSELs) with a long rectangle shape on glass substrates were also demonstrated. Separation of assembly sites into twelve areas enhanced the resultant force acting on the VCSEL short edge. The enhanced resultant force provided the high alignment accuracies within 2.0 μm. After the self-assembly of the VCSEL and the subsequent thermal compression, the chips successfully exhibited no degradation of their current–voltage (I–V) characteristics and appropriate 850-nm light emission. We demonstrated self-assembly and microbump bonding using non-conductive film (NCF)-covered dies with Cu/Sn microbumps for high-throughput and high-yield multichip-to-wafer 3D integration. The self-assembly of the NCF-covered dies provided high alignment accuracy within 1.1 μm on average. After the self-assembly of NCF-coved dies and thermal compression, microbump chains composed of 7396 bump joints were successfully obtained, resulting in good electrical properties of 32 mΩ/joint without any bridge shorts and failures. The variations of microbump joint resistance were maintained within 5% of the initial value after thermal cycle testing of even 1000 cycles.
Studies on whether the co-occurrence of psychotic experiences (PEs) and depression confers a more pronounced decrement in health status and function compared with depression alone are scarce in the general adult population.
Data on 195 479 adults aged ⩾18 years from the World Health Survey were analysed. Using the World Mental Health Survey version of the Composite International Diagnostic Interview (CIDI), depression in the past 12 months was categorized into four groups: depressive episode, brief depressive episode, subsyndromal depression, and no depression. Past 12-month psychotic symptoms were assessed using four questions on positive symptoms from the CIDI. Health status across seven domains (cognition, interpersonal activities, sleep/energy, self-care, mobility, pain/discomfort, vision) and interviewer-rated presence of a mental health problem were assessed. Multivariable logistic and linear regression analyses were performed to assess the associations.
When compared with those with no depression, individuals with depression had higher odds of reporting at least one PE, and this was seen across all levels of depression severity: subsyndromal depression [odds ratio (OR) 2.38, 95% confidence interval (CI) 2.02–2.81], brief depressive episode (OR 3.84, 95% CI 3.31–4.46) and depressive episode (OR 3.75, 95% CI 3.24–4.33). Having coexisting PEs and depression was associated with a higher risk for observable illness behavior and a significant decline in health status in the cognition, interpersonal activities and sleep/energy domains, compared with those with depression alone.
This coexistence of depression and PEs is associated with more severe social, cognitive and sleep disturbances, and more outwardly apparent illness behavior. Detecting this co-occurrence may be important for treatment planning.
To overcome various concerns due to scaling-down device size in future large-scale integration (LSI), it is indispensable to introduce a new concept of heterogeneous three-dimensional (3D) integration in which various kinds of device chips with different sizes, devices, and materials are vertically stacked. To achieve such heterogeneous 3D integration, the key technology of self-assembly and electrostatic (SAE) bonding has been developed. The heterogeneous 3D integration technology with the SAE bonding method has enabled 3D heterogeneous stacking of different types of chips such as the compound semiconductor device chip, photonic device chip, and spintronic device chip on complementary metal oxide semiconductor chips. A 3D image sensor with extremely fast processing speed and a 3D microprocessor with a self-test and self-repair function for future automatic driving vehicles are typical examples of heterogeneous 3D LSIs which we fabricated by the SAE bonding method.
The tip of a Si rod was melted by laser diode (LD) irradiation and we succeeded in dropping small Si droplets by vibration of the Si rod using a piezo actuator. We confirmed multiple small Si droplets under a condition of the resonance frequency of 5.8 kHz for the rod length of 6.0 mm. We observed ejection of droplets from a cone edge of molten Si and the minimum width of the solidified Si was ∼ 1 μ m in diameter. The solidified Si show high crystallinity with the Raman scattering TO phonon band of 515.6 cm-1.