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An animal's social behaviour both influences and changes in response to its parasites. Here we consider these bidirectional links between host social behaviours and parasite infection, both those that occur from ecological vs evolutionary processes. First, we review how social behaviours of individuals and groups influence ecological patterns of parasite transmission. We then discuss how parasite infection, in turn, can alter host social interactions by changing the behaviour of both infected and uninfected individuals. Together, these ecological feedbacks between social behaviour and parasite infection can result in important epidemiological consequences. Next, we consider the ways in which host social behaviours evolve in response to parasites, highlighting constraints that arise from the need for hosts to maintain benefits of sociality while minimizing fitness costs of parasites. Finally, we consider how host social behaviours shape the population genetic structure of parasites and the evolution of key parasite traits, such as virulence. Overall, these bidirectional relationships between host social behaviours and parasites are an important yet often underappreciated component of population-level disease dynamics and host–parasite coevolution.
Background: Acute respiratory infections (ARIs) are a key target to improve antibiotic use in the outpatient setting. The Core Elements of Outpatient Antibiotic Stewardship provide a framework for improving antibiotic use, but data on safety and effectiveness of interventions to improve antibiotic use are limited. We report the impact of Core Elements implementation within Veterans’ Healthcare Administration clinics on antibiotic prescribing and patient outcomes. Methods: The intervention targeting treatment of uncomplicated ARIs (sinusitis, pharyngitis, bronchitis, and viral upper respiratory infections [URIs]) in emergency department and primary care settings was initiated within 10 sites between September 2017 and January 2018. The intervention was developed using the Core Elements and included local site champions, audit-and-feedback with peer comparison, and academic detailing. We evaluated the following outcomes: per-visit antibiotic prescribing rates overall and by diagnosis; appropriateness of treatment; 30-day ARI revisits; 30-day infectious complications (eg,, pneumonia,); 30-day adverse medication effects; 90-day Clostridium difficile infection (CDI); and 30-day hospitalizations. Multilevel logistic regression was used to calculate rate ratios (RR) with 95% CI for each outcome in the postintervention period (12 months) compared to the preintervention period (39–42 months). Results: There were 14,020 uncomplicated ARI visits before the intervention and 4,866 uncomplicated ARI visits after the intervention. The proportions of uncomplicated ARI visits with antibiotics prescribed were 59.17% before the intervention versus 44.34% after the intervention. A trend in reduced antibiotic prescribing for ARIs throughout the entire (before and after) observation period was evident (0.92; 95% CI, 0.90–0.94); however, a significant reduction in antibiotic prescribing after the intervention was identified (0.74; 95% CI, 0.59–0.93). Per-visit antibiotic prescribing rates decreased significantly for bronchitis and URI (0.54; 95% CI, 0.44–0.65), pharyngitis (0.76; 95% CI, 0.67–0.86), and sinusitis (0.92; 95% CI, 0.85–1.0). Appropriate therapy for pharyngitis increased (1.43; 95% CI, 1.21–1.68), but appropriate therapy for sinusitis remained unchanged (0.92; 95% CI, 0.85–1.0) after the intervention. Complications associated with antibiotic undertreatment were not different after the intervention: ARI-related revisit rates (1.01; 95% CI, 0.98–1.05) and infectious complications (1.01; 95% CI, 0.79–1.28). A potential benefit of improved antibiotic use included a reduction in visits for adverse medication effects (0.82; 95% CI, 0.72–0.94). Furthermore, 90-day CDI events were too sparse to model: preintervention incidence was 0.08% and postintervention incidence was 0.06%. Additionally, 30-day hospitalizations were significantly lower in the postintervention period (0.79; 95% CI, 0.72–0.87). Conclusions: Implementation of the Core Elements was safe and effective and was associated with reduced antibiotic prescribing rates for uncomplicated ARIs, improvements in diagnosis-specific appropriate therapy, visits for adverse antibiotic effects, and 30-day hospitalization rates. No adverse events were noted in ARI-related revisit rates or infectious complications. CDI rates were low and unchanged.
Systematic reviews and meta-analyses suggest that behaviour change interventions have modest effect sizes, struggle to demonstrate effect in the long term and that there is high heterogeneity between studies. Such interventions take huge effort to design and run for relatively small returns in terms of changes to behaviour.
So why do behaviour change interventions not work and how can we make them more effective? This article offers some ideas about what may underpin the failure of behaviour change interventions. We propose three main reasons that may explain why our current methods of conducting behaviour change interventions struggle to achieve the changes we expect: 1) our current model for testing the efficacy or effectiveness of interventions tends to a mean effect size. This ignores individual differences in response to interventions; 2) our interventions tend to assume that everyone values health in the way we do as health professionals; and 3) the great majority of our interventions focus on addressing cognitions as mechanisms of change. We appeal to people’s logic and rationality rather than recognising that much of what we do and how we behave, including our health behaviours, is governed as much by how we feel and how engaged we are emotionally as it is with what we plan and intend to do.
Drawing on our team’s experience of developing multiple interventions to promote and support health behaviour change with a variety of populations in different global contexts, this article explores strategies with potential to address these issues.
In times of crisis, people have historically had to band together to overcome. What happens when they cannot? This article examines the reality of people forced to isolate from one another during one of the most turbulent events of their lives: the COVID-19 pandemic. Connecting the dots of topics including fear, social stigmas, global public response and previous disease outbreaks, this article discusses the negative mental health effects that individuals and communities will likely suffer as the result of social distancing, isolation and physical infection.
We review recent advances in algorithms for quadrature, transforms, differential equations and singular integral equations using orthogonal polynomials. Quadrature based on asymptotics has facilitated optimal complexity quadrature rules, allowing for efficient computation of quadrature rules with millions of nodes. Transforms based on rank structures in change-of-basis operators allow for quasi-optimal complexity, including in multivariate settings such as on triangles and for spherical harmonics. Ordinary and partial differential equations can be solved via sparse linear algebra when set up using orthogonal polynomials as a basis, provided that care is taken with the weights of orthogonality. A similar idea, together with low-rank approximation, gives an efficient method for solving singular integral equations. These techniques can be combined to produce high-performance codes for a wide range of problems that appear in applications.
Nonadherence is the Achilles heel of effective psychiatric treatment. The meaning of the term “adherence” has evolved over time and is now associated with a variety of definitions and measurement methods. This has resulted in a poorly operationalized and non-standardized term that is often interpreted differently by providers and patients.
This abstract aims to: 1) describe changes in the concept of adherence; 2) present a more comprehensive definition of adherence which recognizes the influence of patient-provider transactions; 3) introduce dynamic adherence, a six-phase model, which incorporates the influence of transactional processes and econometrics on patients’ adherence decisions; and 4) provide recommendations for providers to improve their relationships with patients and in turn, medication adherence.
A review of the scientific mental health literature.
Despite the prevalence, seriousness, and costs associated with medication nonadherence, the construct of adherence remains poorly operationalized and lacks cogent standardization. Drawing from psychiatric research, a dynamic model of medication adherence across six phases is presented.
This model of adherence highlights the importance of the patient-provider relationship and the transactional processes that comprise what is a dynamic developmental system. Dynamic adherence is intended to foster movement toward a more coherent and unified set of definitions and clinical strategies that will provide the potential to more fully elucidate the risk and protective mechanisms impacting adherence, and the subsequent development and refinement of best practices in increasing the odds of stable medication adherence.
The relationship between health beliefs regarding formal mental health services, practical variables (time, affordability, transportation), stigma, and use of internet support groups in lieu of formal treatment has received little empirical attention.
The study examines the relationship between health beliefs, practical variables, stigma, and engagement in internet support groups among adults.
The study addresses whether beliefs regarding formal mental health services, having the time, finances, and transportation to use them, and the social consequences of being identified as having a mental health problem influence the use of internet support groups.
Data were analyzed from 2,532 respondents who endorsed perceiving the need for but not receiving formal mental health treatment in the National Survey on Drug Use and Health (2008). Binary logistic regression was used to examine the relationships between health beliefs, practical variables, stigma, and the use of internet support groups.
The strongest positive predictors of internet support group use were fear of being hospitalized/taking medications (AOR = 8.252, CI = 8.170–8.334), lack of transportation (AOR = 2.313, CI = 2.271–2.357), and insufficient insurance coverage (AOR = 2.640, CI = 2.610–2.670). The strongest negative predictors of internet support group use were lack of belief in the efficacy of formal treatment (AOR = .629, CI = .618–.641), fearing that others would find out (AOR = .660, CI = .645–.675), and not thinking formal treatment was needed at the time (AOR = .681, CI = .665–.696).
Using the internet for relief from mental health symptoms has proliferated, yet has received little empirical attention. Research is needed to examine the implications of using internet technology rather than formal mental health treatment.
Non-adherence to psychosocial and behavioral treatment is a significant public health problem that presents a barrier to recovery and effective treatment. An estimated 20-70% of individuals who initiate psychosocial mental health services discontinue treatment prior to the clinicians’ recommendation. Empirically supported, evidence-based stand alone or adjunctive psychosocial interventions treat an increasingly wide range of mental health conditions; however, a core underlying assumption of most, if not all, interventions is that clients will fully and actively engage in the treatment protocol. While the influence of medication adherence has been more fully investigated, psychosocial treatment adherence has received less scientific attention.
Study aims include: (1) conceptualize and categorize psychosocial treatment adherence, (2) examine predictors that influence adherence to psychosocial treatments, (3) identify treatment response patterns that relate to adherence, (4) summarize measures of adherence, and (5) describe existing interventions to enhance psychosocial treatment adherence.
Peer-reviewed publications on psychosocial and behavioral treatment adherence were searched using Medline and PsycINFO electronic databases between 1980 and 2013.
It is crucial that clinicians and researchers systematically consider the role of adherence in their intervention protocols, including: (1) identifying and assessing barriers that may place clients at higher risk for non-adherence; (2) measuring multiple forms of adherence in their work; (3) addressing identified barriers with their clients; (4) considering factors within their practice or approach that can be modified to reduce barriers to adherence; and (5) adding adjunctive adherence strategies or interventions to prospectively promote psychosocial treatment adherence.
Discussions about the state of Irish fiction during and after the Celtic Tiger often centred on the issue of cliché, as detractors criticised writers for rehearsing timeworn tropes instead of addressing the vertiginous upheavals of the boom and bust. This chapter considers the gendered and generic underpinnings of that claim. More than an aesthetic pitfall, cliché serves as a constitutive feature of post-Celtic Tiger women’s fiction. In Anne Enright’s The Forgotten Waltz (2011) and Tana French’s Broken Harbor (2012), narrators draw upon conventions derived from post-war genre fiction in order to reinforce fraying narratives of bourgeois happiness and success. While cliché provides temporary narrative and affective ballast amid recession, it also enmeshes women novelists within ongoing debates about the value of genre in an evolving literary marketplace.
I was an average student in everything except geography, where I seemed to excel at understanding landforms and developed a thirst for knowledge and a joy of a developing vocabulary. Who wouldn’t want to know about castellated ramparts, subduction zones and podsolisation! I struggled with science but felt it was so important to develop and test hypotheses – and biology field studies were a small but joyful part of my school career. I am an English West Country girl and delighted in coastal habitats; on the coast at Studland I identified my first grass – Townsend’s Cord grass – of course! To my shame, at that stage in my career, I didn’t understand the ethos and discipline of making biological records and I note that this discipline remains absent from our school curricula.
Although not all small babies are truly growth restricted, the fetus that struggles to reach its full growth potential is at substantial risk of fetal and neonatal complications, even more so if not identified antenatally as a faltering fetus. As with most pregnancy complications, the risk of fetal growth restriction (FGR) is increased in twin pregnancies, and more so in monochorionic twin pregnancies. Around 19.7% of monochorionic twin pregnancies are complicated by FGR, compared with only 10.5% of dichorionic twin pregnancies . They also experience a higher incidence of perinatal mortality associated with growth restriction – 75.1/1000 compared with 33.0/1000 .
Nudging is a strategy used in behavioral economics to influence consumer decision-making through subtle changes in the choice environment. Recently, behavioral economists have been testing the use of nudge techniques to encourage healthier foods for high risk individuals. Food insecure individuals have an elevated risk of obesity and non-communicable diseases and would benefit from eating more nutrients dense foods for prevention and treatment. To promote more nutrient dense foods for food insecure individuals, Feeding America created a list of Foods to Encourage (F2E). This study evaluated the efficacy of nudge interventions in promoting two selected F2E at client-choice food pantries in Massachusetts. The objective of this study was to determine if the nudge interventions increased the take-rate of the targeted F2E: carrots and brown rice. Nudge interventions were implemented at three client-choice food pantries. Carrots were subjected to a “recipe nudge” in which recipe cards were placed next to the product. Brown rice underwent a placement nudge, which entailed moving the product to the proximal end of the display at waist height within easy reach and line of sight. Data was collected three times pre-intervention and three times post-intervention at each site to determine if the nudge had an impact on take rate. This study took place at three suburban food pantries in the Greater Boston area. The total number of shoppers observed before intervention was 402 and after intervention was 417. The main outcome was the take-rate of the products determined by the number of shoppers who selected the foods before and after intervention. Analyses were performed using IBM SPSS Version 24 (Armonk, NY). Odds ratios were calculated to determine the effect of the intervention with a logistic regression controlling for the site. The take-rate of brown rice increased significantly post-placement intervention. The odds ratio for brown rice was 1.940 (95% CI = 1.318 to 2.857). The take rate of other types of rice did not change post-intervention. The take rate for fresh carrots also increased significantly post recipe card intervention. The odds ratio for carrots was 1.519 (95% CI = 1.129 to 2.044). The results of this study indicate a favorable effect of nudges on the take rate of nutrient dense products and could support the use of nudges as a strategy to promote the distribution of healthy food in client-choice food pantries.
It is widely believed that there is strong association between physiological stress and an individual's social status in their social hierarchy. This has been claimed for all humans cross-culturally, as well as in non-human animals living in social groups. However, the relationship between stress and social status has not been explored in any egalitarian hunter–gatherer society; it is also under investigated in exclusively female social groups. Most of human evolutionary history was spent in small, mobile foraging bands of hunter–gatherers with little economic differentiation – egalitarian societies. We analysed women's hair cortisol concentration along with two domains of women's social status (foraging reputation and popularity) in an egalitarian hunter–gatherer society, the Hadza. We hypothesized that higher social status would be associated with lower physiological indicators of stress in these women. Surprisingly, we did not find any association between either foraging reputation or popularity and hair cortisol concentration. The results of our study suggest that social status is not a consistent or powerful predictor of physiological stress levels in women in an egalitarian social structure. This challenges the notion that social status has the same basic physiological implications across all demographics and in all human societies.
According to Turnbull's 1972 ethnography The Mountain People, the Ik of Uganda had a culture of selfishness that made them uncooperative. His claims contrast with two widely accepted principles in evolutionary biology, that humans cooperate on larger scales than other species and that culture is an important facilitator of such cooperation. We use recently collected data to examine Ik culture and its influence on Ik behaviour. Turnbull's observations of selfishness were not necessarily inaccurate but they occurred during a severe famine. Cooperation re-emerged when people once again had enough resources to share. Accordingly, Ik donations in unframed Dictator Games are on par with average donations in Dictator Games played by people around the world. Furthermore, Ik culture includes traits that encourage sharing with those in need and a belief in supernatural punishment of selfishness. When these traits are used to frame Dictator Games, the average amounts given by Ik players increase. Turnbull's claim that the Ik have a culture of selfishness can be rejected. Cooperative norms are resilient, and the consensus among scholars that humans are remarkably cooperative and that human cooperation is supported by culture can remain intact.