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There are few evidence-based interventions to support caregiver mental health developed for low- and middle-income countries. Nae Umeed is a community-based group intervention developed with collaboratively with local community health workers in Uttarakhand, India primarily to promote mental wellbeing for caregivers and others. This pre–post study aimed to evaluate whether Nae Umeed improved mental health and social participation for people with mental distress, including caregivers. The intervention consisted of 14 structured group sessions facilitated by community health workers. Among 115 adult participants, 20% were caregivers and 80% were people with disability and other vulnerable community members; 62% had no formal education and 92% were female. Substantial and statistically significant improvements occurred in validated psychometric measures for mental health (12-Item General Health Questionnaire, Patient Health Questionnaire-9) and social participation (Participation Scale). Improvements occurred regardless of caregiver status. This intervention addressed mental health and social participation for marginalised groups that are typically without access to formal mental health care and findings suggest Nae Umeed improved mental health and social participation; however, a controlled community trial would be required to prove causation. Community-based group interventions are a promising approach to improving the mental health of vulnerable groups in South Asia.
Spatial capture–recapture models have been widely used to estimate densities of species where individuals can be uniquely identified, but alternatives have been developed for estimation of densities for unmarked populations. In this study we used camera-trap records from 2018 to estimate densities of a species that does not always have individually identifiable marks, Baird's tapir Tapirus bairdii, in the Sierra Madre de Chiapas, southern Mexico. We compared the performance of the spatial capture–recapture model with spatial mark–resight and random encounter models. The density of Baird's tapir did not differ significantly between the three models. The estimate of density was highest using the random encounter model (26/100 km2, 95% CI 12–41) and lowest using the capture–recapture model (8/100 km2, 95% CI 4–16). The estimate from the spatial mark–resight model was 10/100 km2 (95% CI 8–14), which had the lowest coefficient of variation, indicating a higher precision than with the other models. Using a second set of camera-trap data, collected in 2015–2016, we created occupancy models and extrapolated density to areas with potential occupancy of Baird's tapir, to generate a population estimate for the whole Sierra Madre de Chiapas. Our findings indicate the need to strengthen, and possibly expand, the protected areas of southern Mexico and to develop an action plan to ensure the conservation of Baird's tapir.
Reconstructions of prehistoric vegetation composition help establish natural baselines, variability, and trajectories of forest dynamics before and during the emergence of intensive anthropogenic land use. Pollen–vegetation models (PVMs) enable such reconstructions from fossil pollen assemblages using process-based representations of taxon-specific pollen production and dispersal. However, several PVMs and variants now exist, and the sensitivity of vegetation inferences to PVM selection, variant, and calibration domain is poorly understood. Here, we compare the reconstructions, parameter estimates, and structure of a Bayesian hierarchical PVM, STEPPS, both to observations and to REVEALS, a widely used PVM, for the pre–Euro-American settlement-era vegetation in the northeastern United States (NEUS). We also compare NEUS-based STEPPS parameter estimates to those for the upper midwestern United States (UMW). Both PVMs predict the observed macroscale patterns of vegetation composition in the NEUS; however, reconstructions of minor taxa are less accurate and predictions for some taxa differ between PVMs. These differences can be attributed to intermodel differences in structure and parameter estimates. Estimates of pollen productivity from STEPPS broadly agree with estimates produced for use in REVEALS, while comparison between pollen dispersal parameter estimates shows no significant relationship. STEPPS parameter estimates are similar between the UMW and NEUS, suggesting that STEPPS parameter estimates are transferable between floristically similar regions and scales.
The autonomic nervous system is a dynamic system intimately involved with the function of every organ in the body. In addition, it plays a key role in integrative function, such as control of the circulation and regulation of body temperature. Its motor (efferent) components, consist of the parasympathetic nervous system with a cranial and sacral spinal outflow, and the sympathetic nervous system with a thoraco-lumbar spinal outflow (Fig. 52.1). However, there is interaction at various levels of the neural axis. Thus, virtually every afferent in the body, through relays at a cerebral or spinal level, influences function of the autonomic nervous system. Centres in the brain can activate autonomic pathways directly or by stimulating spinal autonomic centres. There are multiple neurotransmitters at different synapses and ganglia that are better defined in the periphery than centrally (Fig. 52.2). Complex processes at parasympathetic and sympathetic nerve terminals influence the synthesis, release and re-uptake of various transmitters (Figs 52.3 and 52.4). The autonomic supply to the gut and pelvic viscera (enteric nervous system) additionally is richly endowed with peptides, amines and purines involved in neurotransmission and neuromodulation; they also have direct effects, especially upon the gastrointestinal tract and splanchnic circulation.
Classification of autonomic disorders
An outline classification is provided (Table 52.1). There are primary disorders where the etiology is not known; examples are pure autonomic failure (PAF) and multiple system atrophy (MSA). A large number of secondary autonomic disorders may be hereditary, associated with disease (such as diabetes mellitus), due to a specific deficit (dopamine beta-hydroxylase deficiency) or the result of trauma. A variety of drugs, poisons and toxins cause autonomic dysfunction by directly influencing sympathetic or parasympathetic activity, or by causing an autonomic neuropathy. In neurally mediated syncope, autonomic function is intermittently abnormal with either overactivity (such as increased vagal tone causing bradycardia) or underactivity (sympathetic withdrawal causing hypotension); the most common is vasovagal syncope. A recently described disorder is postural tachycardia syndrome (PoTS).
In many of these autonomic disorders there is involvement of different organs or systems. Some are localized, predominantly affecting one organ, area or system, such as the pupil in the Holmes–Adie syndrome, the face in Horner's syndrome and sweat glands in essential hyperhidrosis.
Characteristic features follow dysfunction affecting the sympathetic and parasympathetic nervous systems.
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