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Auditory verbal hallucinations (AVH), or voice-hearing, can be a prominent symptom during fluctuating mood states in bipolar disorder (BD).
The current study aimed to: (i) compare AVH-related distress in BD relative to schizophrenia (SCZ), (ii) examine correlations between phenomenology and voice beliefs across each group, and (iii) explore how voice beliefs may uniquely contribute to distress in BD and SCZ.
Participants were recruited from two international sites in Australia (BD=31; SCZ=50) and the UK (BD=17). Basic demographic-clinical information was collected, and mood symptoms were assessed. To document AVH characteristics, a 4-factor model of the Psychotic Symptoms Rating Scale and the Beliefs about Voices Questionnaire-Revised were used. Statistical analyses consisted of group-wise comparisons, Pearson’s correlations and multiple hierarchical regressions.
It was found that AVH-related distress was not significantly higher in BD than SCZ, but those with BD made significantly more internal attributions for their voices. In the BD group, AVH-related distress was significantly positively correlated with malevolence, omnipotence and resistance, However, only resistance, alongside mania and depressive symptoms, significantly contributed to AVH-related distress in BD.
Our findings have several clinical implications, including identification of voice resistance as a potential therapeutic target to prioritise in BD. Factoring in the influence of mood symptoms on AVH-related distress as well as adopting more acceptance-oriented therapies may also be of benefit.
To examine differences in noticing and use of nutrition information comparing jurisdictions with and without mandatory menu labelling policies and examine differences among sociodemographic groups.
Cross-sectional data from the International Food Policy Study (IFPS) online survey.
IFPS participants from Australia, Canada, Mexico, United Kingdom and USA in 2019.
Adults aged 18–99; n 19 393.
Participants in jurisdictions with mandatory policies were significantly more likely to notice and use nutrition information, order something different, eat less of their order and change restaurants compared to jurisdictions without policies. For noticed nutrition information, the differences between policy groups were greatest comparing older to younger age groups and comparing high education (difference of 10·7 %, 95 % CI 8·9, 12·6) to low education (difference of 4·1 %, 95 % CI 1·8, 6·3). For used nutrition information, differences were greatest comparing high education (difference of 4·9 %, 95 % CI 3·5, 6·4) to low education (difference of 1·8 %, 95 % CI 0·2, 3·5). Mandatory labelling was associated with an increase in ordering something different among the majority ethnicity group and a decrease among the minority ethnicity group. For changed restaurant visited, differences were greater for medium and high education compared to low education, and differences were greater for higher compared to lower income adequacy.
Participants living in jurisdictions with mandatory nutrition information in restaurants were more likely to report noticing and using nutrition information, as well as greater efforts to modify their consumption. However, the magnitudes of these differences were relatively small.
The aim of this work was to apply the well established standards for patients suffering from diagnoses classed as Severe Mental Illness (SMI) to patients with a diagnosis of emotionally unstable personality disorder (EUPD) in our EUPD psychotherapy service. This patient population is also known to suffer lower life expectancy and greater physical comorbidities than the general population, and indeed than patients with other personality disorders, and this represents part of the holistic care we hope to offer in our service. In order to bring this in line, we were aiming for an annual medical review including: height, weight, blood pressure, blood tests including lipids, up to date information about alcohol and substance misuse.
One month before a patient's 6-week and 12-month review we liaised with their general practitioner (GP) for the above information. We then followed up as needed. In the first cycle of this work (January through July 2022) we found that we were able to establish contact with patients' GPs and there was qualitative evidence from patient testimonials about improved relationships with their GPs. However, the information that we were receiving was not complete - 0% had all the information that was requested.
Following discussion in the team, a proforma was developed to make it as clear as possible to the GP which information we were seeking. We more proactively engaged GPs and patients' other physical care teams, including neurology teams. Where patients had home monitoring equipment like a blood pressure cuff or scales, we also collected information from these. Compliance was reviewed again at the end of the next six-month cycle (August 2022-January 2023).
Between the first cycle, from January 2022 through July 2022 and the second cycle from August 2022 through January 2023, we improved compliance toward the target of having all these data points documented for all patients from 0 to 57%. This included 100% compliance for blood pressure and pulse measures and 86% compliance for documented weight.
We also note improved relationship between patients and GPs and other healthcare professionals including a patient testimonial “Having not had the support of Waterview dedicated staff and the group I probably would not attend any of the hospital appointments.”
Introducing the proforma significantly improved compliance with physical health monitoring targets from 0 to 57%. Further work within the team and with GPs including education on the diagnosis may improve this further.
Understanding the distribution and extent of suitable habitats is critical for the conservation of endangered and endemic taxa. Such knowledge is limited for many Central African species, including the rare and globally threatened Grey-necked Picathartes Picathartes oreas, one of only two species in the family Picathartidae endemic to the forests of Central Africa. Despite growing concerns about land-use change resulting in fragmentation and loss of forest cover in the region, neither the extent of suitable habitat nor the potential species’ distribution is well known. We combine 339 (new and historical) occurrence records of Grey-necked Picathartes with environmental variables to model the potential global distribution. We used a Maximum Entropy modelling approach that accounted for sampling bias. Our model suggests that Grey-necked Picathartes distribution is strongly associated with steeper slopes and high levels of forest cover, while bioclimatic, vegetation health, and habitat condition variables were all excluded from the final model. We predicted 17,327 km2 of suitable habitat for the species, of which only 2,490 km2 (14.4%) are within protected areas where conservation designations are strictly enforced. These findings show a smaller global distribution of predicted suitable habitat forthe Grey-necked Picathartes than previously thought. This work provides evidence to inform a revision of the International Union for Conservation of Nature (IUCN) Red List status, and may warrant upgrading the status of the species from “Near Threatened” to “Vulnerable”.
To evaluate and synthesize the evidence base on barriers and facilitators to accessing and using community-based social care in dementia.
Mixed-methods systematic review.
Community-based social care (such as day care, respite care, paid home care, and peer support groups).
People living with dementia and unpaid carers.
Seven databases were searched in March 2022, including English and German evidence published from 2000 focusing on inequalities in community-based social care for dementia across the globe. Titles and abstracts were screened by two reviewers, with all full texts screened by two reviewers also. Study quality was assessed using QualSyst.
From 3,904 screened records, 39 papers were included. The majority of studies were qualitative, with 23 countries represented. Barriers and facilitators could be categorized into the following five categories/themes: situational, psychological, interpersonal, structural, and cultural. Barriers were notably more prominent than facilitators and were multifaceted, with many factors hindering or facilitating access to social care linked together.
People with dementia and carers experience significant barriers in accessing care in the community, and a varied approach on multiple levels is required to address systemic and individual-level barriers to enable more equitable access to care for all.
The 2014-2016 Ebola Virus Disease (EVD) outbreak in West Africa resulted in 28,000 infected and over 10,000 deaths. Sierra Leone was one of the hardest hit countries. The purpose of this study is to examine the coping strategies employed by those most affected by EVD and its related stressors in Sierra Leone.
228 EVD-infected individuals, EVD-affected individuals, and community leaders were recruited using purposive maximum variation sampling. Key-informant interviews (n=42) and focus group discussions (n=27) were conducted across five districts in Sierra Leone. Data were analyzed and coded inductively by a team of researchers, using Thematic Content Analysis using NVivo (k=0.80 or above for interrater reliability).
Participants described stressors, coping and support on four levels: individual, family, community, and society. On the individual level, theft and spoiled belongings were leading sources of stress while faith and spirituality were main sources of coping and support. On the familial level, lack of financial resources and inability to work emerged as primary stressors, while engaging with family was a main source of support. On the community level, social exclusion emerged as a prominent stressor and community reintegration as a source of support. On the societal level, participants' lack of governmental support and termination of support from NGOs emerged as stressors, and provision of formal material assistance as a source of support.
In a widespread public health crisis, understanding people’s perceptions of the most salient stressors and sources of support can inform future responses. In this study, participants experienced stressors and support across multiple levels of the social ecology, such as grief and faith, household financial pressure and kinship care, and formal material resources for survivors. Results also showed the importance of community-led initiatives that addressed material needs, as well as social acceptance and social support.
Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, “Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease,” includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.
Physical activity (PA) may help maintain brain structure and function in aging. Since the intensity of PA needed to effect cognition and cerebrovascular health remains unknown, we examined associations between PA and cognition, regional white matter hyperintensities (WMH), and regional cerebral blood flow (CBF) in older adults.
Forty-three older adults without cognitive impairment underwent magnetic resonance imaging (MRI) and comprehensive neuropsychological assessment. Waist-worn accelerometers objectively measured PA for approximately one week.
Higher time spent in moderate to vigorous PA (MVPA) was uniquely associated with better memory and executive functioning after adjusting for all light PA. Higher MVPA was also uniquely associated with lower frontal WMH volume although the finding was no longer significant after additionally adjusting for age and accelerometer wear time. MVPA was not associated with CBF. Higher time spent in all light PA was uniquely associated with higher CBF but not with cognitive performance or WMH volume.
Engaging in PA may be beneficial for cerebrovascular health, and MVPA in particular may help preserve memory and executive function in otherwise cognitively healthy older adults. There may be differential effects of engaging in lighter PA and MVPA on MRI markers of cerebrovascular health although this needs to be confirmed in future studies with larger samples. Future randomized controlled trials that increase PA are needed to elucidate cause-effect associations between PA and cerebrovascular health.
We examined the influence of racial and ethnic identity of residents and housing market economic conditions on redlining. Data were extracted from archival area description forms from the Home Owners’ Loan Corporation for 568 Ohio neighborhoods from 1934–1940. Logistic regression analysis was used to analyze the relationships between neighborhood characteristics and redlining. Bivariate results indicated a strong association between the presence of African American residents and neighborhood redlining (OR = 40.9, 95% CI 22.9-72.8). Multivariable analysis demonstrated that some neighborhood characteristics were contributors to the decision to redline, including homes in poor condition (OR = 4.3, 95% CI 1.2-15.1), home vacancy (OR = 1.4, 95% CI 1.1-1.6), and housing prices (per thousand dollars) (OR = 0.7, 95% CI 0.4-1.2). Adjusting for these and other factors, the presence of African American residents remained a powerful predictor of redlining (OR = 13.8, 95% CI 4.4-42.8). Racial discrimination was the overriding factor in decisions to redline neighborhoods.
James Wilkie's The Mexican Revolution: Federal Expenditure and Social Change Since 1910 is an industrious attempt to get beneath the conventional wisdom about the changes wrought by the Mexican Revolution. The author's careful compilation of budgetary data should sharply challenge the longstanding and widespread assumptions that: (a) useful historical material from Latin America does not exist in statistical form, and (b) even if it did exist, the mystical qualities of Latin culture defy all efforts at measurement. Wilkie has shown that—with luck, perseverence, and imagination—data can be found. One hopes that his example will encourage other students of the area to seek out similar data and reap further intellectual benefits from quantitative analysis: hypothesis-testing, measurement of trends, and rigorous comparison.
Despite an elevated risk of psychopathology stemming from COVID-19-related stress, many essential workers stigmatise and avoid psychiatric care. This randomised controlled trial was designed to compare five versions of a social-contact-based brief video intervention for essential workers, differing by protagonist gender and race/ethnicity.
We examined intervention efficacy on treatment-related stigma (‘stigma’) and openness to seeking treatment (‘openness’), especially among workers who had not received prior mental healthcare. We assessed effectiveness and whether viewer/protagonist demographic concordance heightened effectiveness.
Essential workers (N = 2734) randomly viewed a control video or brief video of an actor portraying an essential worker describing hardships, COVID-related anxiety and depression, and psychotherapy benefits. Five video versions (Black/Latinx/White and male/female) followed an identical 3 min script. Half the intervention group participants rewatched their video 14 days later. Stigma and openness were assessed at baseline, post-intervention, and at 14- and 30-day follow-ups. Trial registration: NCT04964570.
All video intervention groups reported immediately decreased stigma (P < 0.0001; Cohen's d = 0.10) and increased openness (P < 0.0001; d = 0.23). The initial increase in openness was largely maintained in the repeated-video group at day 14 (P < 0.0001; d = 0.18), particularly among viewers without history of psychiatric treatment (P < 0.0001; d = 0.32). Increases were not sustained at follow-up. Female participants viewing a female protagonist and Black participants viewing a Black protagonist demonstrated greater openness than other demographic pairings.
Brief video-based interventions improved immediate stigma and openness. Greater effects among female and Black individuals viewing demographically matched protagonists emphasise the value of tailored interventions, especially for socially oppressed groups. This easily disseminated intervention may proactively increase care-seeking, encouraging treatment among workers in need. Future studies should examine intervention mechanisms and whether linking referrals to psychiatric services generates treatment-seeking.
Loneliness is linked to many negative health outcomes and places strain on the economy and the National Health Service in the United Kingdom. To combat these issues, the determinants of loneliness need to be fully understood. Although friendships have been shown to be particularly important in relation to loneliness in older adults, this association has thus far not been explored more closely. Our exploratory study examines the relationship between number of friends and loneliness, depression, anxiety and stress in older adults. Data were obtained from 335 older adults via completion of an online survey. Measures included loneliness (UCLA Loneliness Scale version 3), depression, anxiety and stress (Depression Anxiety Stress Scales DASS-21). Participants also reported their number of close friends. Regression analyses revealed an inverse curvilinear relationship between number of friends and each of the measures tested. Breakpoint analyses demonstrated a threshold for the effect of number of friends on each of the measures (loneliness = 4, depression = 2, anxiety = 3, stress = 2). The results suggest that there is a limit to the benefit of increasing the number of friends in older adults for each of these measures. The elucidation of these optimal thresholds can inform the practice of those involved in loneliness interventions for older adults. These interventions can become more targeted; focusing on either establishing four close friendships, increasing the emotional closeness of existing friendships or concentrating resources on other determinants of loneliness in this population.
This study compared the per capita annual global incidence rate of disasters caused by natural hazards with the annual world real gross domestic product, GDP (per global capita), as reported during 1961 through 2020.
Sixty (60) values for the world real GDP per global capita (in constant 2015 $USD) were compared to corresponding annual values for global incidence rates for five natural disaster subgroups and then for a total of twelve individual disaster types that comprise the subgroups; each expressed as an annual global incidence rate (in terms of annual incidence per 100,000 persons). Calculations of multiple linear regression, ANOVA, and Pearson’s correlation coefficient were performed for comparing population-adjusted values for GDP to corresponding values.
Four out of five hydrological and meteorological disasters were found to have a positive correlation with GDP. Results of the analysis revealed a relatively high degree of correlation between world GDP and the annual incidence of flood and storm disasters (P = 6.21 × 10−10 and P = 4.23 × 10−4, respectively). The annual incidence of heat waves and cold weather disasters also appeared to correlate with GDP (P = .002 and P = .019, respectively). In comparison, wet landslides indicated no such correlation (P = .862). No significant associations were found among the seven other individual biological, climatological, and geophysical disasters and GDP.
The global incidence of four extreme weather (hydrometeorological) disasters appear to be positively associated with world real GDP during 1961-2020. These findings contradict previous postulates that the risk of disaster incidence is inversely associated with the capacity of the population.
Prisons are susceptible to outbreaks. Control measures focusing on isolation and cohorting negatively affect wellbeing. We present an outbreak of coronavirus disease 2019 (COVID-19) in a large male prison in Wales, UK, October 2020 to April 2021, and discuss control measures.
We gathered case-information, including demographics, staff-residence postcode, resident cell number, work areas/dates, test results, staff interview dates/notes and resident prison-transfer dates. Epidemiological curves were mapped by prison location. Control measures included isolation (exclusion from work or cell-isolation), cohorting (new admissions and work-area groups), asymptomatic testing (case-finding), removal of communal dining and movement restrictions. Facemask use and enhanced hygiene were already in place. Whole-genome sequencing (WGS) and interviews determined the genetic relationship between cases plausibility of transmission.
Of 453 cases, 53% (n = 242) were staff, most aged 25–34 years (11.5% females, 27.15% males) and symptomatic (64%). Crude attack-rate was higher in staff (29%, 95% CI 26–64%) than in residents (12%, 95% CI 9–15%).
Whole-genome sequencing can help differentiate multiple introductions from person-to-person transmission in prisons. It should be introduced alongside asymptomatic testing as soon as possible to control prison outbreaks. Timely epidemiological investigation, including data visualisation, allowed dynamic risk assessment and proportionate control measures, minimising the reduction in resident welfare.
Faulted and fractured systems form a critical component of fluid flow, especially within low-permeable reservoirs. Therefore, developing suitable methodologies for acquiring structural data and simulating flow through fractured media is vital to improve efficiency and reduce uncertainties in modelling the subsurface. Outcrop analogues provide excellent areas for the analysis and characterization of fractures within the reservoir rocks where subsurface data are limited. Variation in fracture arrangement, distribution and connectivity can be obtained from 2D fractured cliff sections and pavements. These sections can then be used for efficient discretization and homogenization techniques to obtain reliable predictions on permeability distributions in the geothermal reservoirs. Fracture network anisotropy in the Malm reservoir unit is assessed using detailed structural analysis and numerical homogenization of outcrop analogues from an open pit quarry within the Franconian Basin, Germany. Several events are recorded in the fracture networks from the Late Jurassic the Alpine Orogeny and are observed to be influenced by the Kulmbach Fault nearby with a reverse throw of 800 m. The fractured outcrops are digitized for fluid flow simulations and homogenization to determine the permeability tensors of the networks. The tensors show differences in fluid transport direction where fracture permeability is controlled by orientation compared to a constant value. As a result, it is observed that the orientation of the tensor is influenced by the Kulmbach Fault, and therefore faults within the reservoirs at depth should be considered as important controls on the fracture flow of the geothermal system.