At-risk Groups Research Articles

Is a 12-week home-based functional teletraining for individuals with type 2 diabetes an alternative for blood glucose control?

BackgroundVirtual or Tele-exercise programs have emerged due to safety concerns of COVID-19 contamination for at-risk groups. However, blood glucose (BG) comparisons concerning in-person and virtual exercise programs need to be scientifically researched. Understanding and monitoring home-based teletraining effects on glycemia is vital for safe management of people with type-2 diabetes (T2DM). Purpose: To verify a 12-week functional teletraining on the capillary BG and compare it with in-person exercise before the COVID-19 pandemic in people with T2DM. MethodsT2DM participants underwent tele-exercise during the COVID-19 pandemic. It consisted of functional training (functional resistance training (FRT) for 12 weeks, 2 times a week, ∼60 min). Capillary BG was performed before and after (pre-post) each exercise session. The pre-post ΔBG for each session was considered for statistical analysis. Friedman's test with repetitive measures over time was performed to compare the ΔBG of the teletraining and the results of these participants before the pandemic. The minimum detectable difference was performed to verify clinical ΔBG for each session over the weeks. ResultsSimilar responses were seen over time without a statistical time effect after the programs (p = 0.177). A noticeable minimum difference of 24.5 mg/dL was observed in the in-person group post-session in all sessions. The virtual group showed a minimum detectable difference of 21.1 mg/dL post-session with clinical relevance over the 12 weeks. ConclusionDespite the teletraining being twice weekly and the in-person program thrice weekly, both exhibited similar outcomes over time, with the virtual program showing significant clinical improvements in BG after each session.

Self Identifying Mental Health Status and Get Guidance For Support Using AI

In recent years, an awareness has emerged about the importance of the individual in mental health and treatment. Mental health problems are common among college students around the world; Therefore, identifying at-risk groups will help provide services. Self-diagnosis of mental illness is an important step in recognizing and addressing personal health. Our goal is to develop a screening tool to identify students at risk for mental illness. Students are taught to use assessment tools to distinguish between those at reduced and increased risk of mental illness. Psychological services should be provided to students at risk. Despite the prevalence of psychological problems, problems such as fear of decision-making and lack of information often make it difficult for people to define themselves. The person may deny or ignore symptoms, which may delay the person's intervention and make the situation worse. Empowering people with mental health knowledge and resources can enable them to take part in their own health. As well as personal benefits, self-expression can promote understanding and acceptance and contribute to a culture of empathy and support. Artificial Intelligence (AI) technology holds both great promise and potential pitfalls in transforming mental health. This article discusses the current limitations of artificial intelligence, areas where further research is needed, and how it can improve healthcare by considering the ethical fairness of intellectual technology. As AI technology continues to evolve and improve, it may be able to help psychiatrists reclassify mental disorders beyond what is currently specified in the DSM-5, identifying these problems in their early or prodromal stages so that interventions can be implemented. . Quality and personalized treatment based on individual characteristics. However, caution must be exercised to avoid overinterpretation of preliminary results, and more studies must be conducted to close the gap in scientific expertise on mental health and treatment.

Anthocyanins and Type 2 Diabetes: An Update of Human Study and Clinical Trial.

Anthocyanins are phenolic compounds occurring in fruits and vegetables. Evidence from pre-clinical studies indicates their role in glucose level regulation, gut microbiota improvement, and inflammation reduction under diabetic conditions. Therefore, incorporating these research advancements into clinical practice would significantly improve the prevention and management of type 2 diabetes. This narrative review provides a concise overview of 18 findings from recent clinical research published over the last 5 years that investigate the therapeutic effects of dietary anthocyanins on diabetes. Anthocyanin supplementation has been shown to have a regulatory effect on fasting blood glucose levels, glycated hemoglobin, and other diabetes-related indicators. Furthermore, increased anthocyanin dosages had more favorable implications for diabetes treatment. This review provides evidence that an anthocyanin-rich diet can improve diabetes outcomes, especially in at-risk groups. Future research should focus on optimal intervention duration, consider multiple clinical biomarkers, and analyze anthocyanin effects among well-controlled versus poorly controlled groups of patients with diabetes.

Modern vs traditional indigenous diet preference in Gauteng region, South Africa: A public health concern?

The prevalence of non-communicable diseases still represents a public health concern in South Africa, of which eating habits are some of the main risk factors. A modern diet consisting of the consumption of highly processed foods high in fat, salt and caloric sweeteners and low in fibre is recognised as unhealthy. This study was conducted to assess the penchant of the population for these types of foods rather than traditional indigenous foods known to be healthier. This research was undertaken in the Gauteng region, which is the most urbanized province in the country. This study consisted of a quantitative research survey conducted in 2019 with 1527 participants (Asians, Black, Coloured, Indians and White) aged 18 and above who had lived in the province for at least two years. The results revealed that 30–40 % were neutral on the issue. Despite half (54.4 %) indicating that it was good to mix traditional and modern foods, a clear preference for modern food was noticed for 35.7 % of respondents, with 32.2 % reporting not being concerned that traditional foods have been replaced by modern foods. The traditional indigenous food consumption (TIFC) appeared to depend on monthly total household income, residential area, and settlement category. Participants with specific economic comfort consumed less. Race and number of people in the participants' households also significantly affected the TIFC (p < 0.05). Participants of white ethnicity and those living in a household of a maximum of 02 people displayed the lowest TIFC. In comparison to those who strongly disagree, participants with a neutral opinion about the idea of mixing eating habits were also the most neutral concerning preference for a modern diet (OR: 10.95, 95 % CI 7.00–17.12) and nutrition transition (OR: 14.66, 95 % CI 9.09–23.64). Sensitisation about healthy eating habits among the identified at-risk and target groups is undoubtedly a need in the region to avoid a resurgence of modern diet-related diseases.

Promoting transdisciplinary collaboration in academia: uniting for climate-resilient health

In a world where some regions are directly experiencing the effects of the climate change, while others are more vulnerable; this article dives into the deep and frequently catastrophic impact of the climate change on vulnerable countries. This review emphasizes the need for transdisciplinary academic collaboration, including social scientists, healthcare professionals, engineers, policy experts, and climate scientists, and underscores academia’s potential role in advancing climate-resilient health systems in these areas. The study promotes inclusive research that prioritizes at-risk groups, involves communities, and supports culturally sensible methodologies. Beyond their traditional tasks, academia has an obligation for action, learning, innovation, and change. To address the complex health concerns brought on by the planetary crisis, collaboration across academic fields and in tandem with communities, governments, and international organizations is crucial. Ongoing collaboration between academia, governments, and stakeholders is crucial to developing healthcare systems and technologies that are climate resilient. The complex role of academia involves developing pioneering solutions in healthcare for a sustainable future, advocating for policies based on evidence, and educating the next generation of professionals.

A Deviance Regulation Theory Intervention Affects the Association Between Narcissistic Traits and Alcohol Harm Reduction Strategies in College Students

Background: College students continue to report problematic alcohol use. To mitigate adverse outcomes, recent studies have employed harm reduction strategies known as Protective Behavioral Strategies (PBS). Deviance Regulation Theory (DRT), an impression management intervention, has been used to promote the use of PBS. DRT relies on impression management to modify behavior. This may be especially important for individuals with higher levels of trait narcissism. Method: College student drinkers (n = 132) were randomly assigned to receive a positive message about PBS users, a negative message about non-PBS users, or control. Participants reported on current PBS use norms, daily alcohol use, PBS use, and any alcohol-related problems experienced during the previous week for the next 10 weeks. Results: Data were analyzed using multilevel regression to examine PBS use across time by condition. When PBS norms were low, narcissism was strongly associated with lower rates of PBS use in the control group. If individuals received a positive or negative message, the association between narcissism and PBS use was diminished, among individuals with low PBS norms. There were no significant differences at mean or high levels of norms, indicating the messaging was only important for the highest risk group (i.e., those with low PBS norms). Discussion: The results of this study suggest that message framing may be effective at reducing the robust negative association between narcissism and PBS use for individuals with low PBS norms. Positive messages about individuals that use PBS may be one approach to mitigating problematic alcohol consumption in this at-risk group.

Sexually transmitted infection and teenage pregnancy in adolescents having parents with schizophrenia: a retrospective cohort study of 64,350 participants.

The risks of sexually transmitted infections (STIs) and teenage pregnancy in the offspring of parents with schizophrenia remain unknown. From the Taiwan National Health Insurance Research Database, 5,850 individuals born between 1980 and 1999 having any parent with schizophrenia and 58,500 age-, sex-, income- and residence-matched controls without parents with severe mental disorders were enrolled in 1996 or on their birthdate and followed up to the end of 2011. Those who contracted any STI or became pregnant in adolescence during the follow-up period were identified. Cox regression analyses demonstrated that offspring of parents with schizophrenia (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 1.02-1.44), especially daughters (HR: 1.30, 95% CI: 1.06-1.58), were more likely to contract any STI later in life than the control comparisons. In addition, daughters of parents with schizophrenia had an elevated risk of being pregnant in their adolescence (HR: 1.47, 95% CI: 1.29-1.67) compared with those having no parents with severe mental disorders. The positive relationship between parental schizophrenia and offspring STIs and teenage pregnancy necessitates clinicians and public health officers to closely monitor the sexual health in the offspring of parents with schizophrenia so that optimal and prompt preventive measures can be taken in the at-risk group.

Early Access to First-Seizure Clinics, Subsequent Outcomes, and Factors Associated With Attendance

First-seizure clinics (FSCs) aim to deliver prompt specialist care to patients with new-onset undifferentiated seizure events. To determine whether FSC attendance and time to FSC are associated with subsequent health care utilization and mortality and to investigate factors associated with FSC nonattendance. This was a record-linkage, retrospective, cohort study of patients who booked appointments at 2 FSCs between 2007 and 2018. Patients' records were linked to state-wide administrative databases between 2000 and 2021. The setting comprised the FSCs of 2 major metropolitan public hospitals in Melbourne, Australia, providing national inpatient and outpatient adult epilepsy services. Of patients who booked appointments at the FSCs, those who were successfully linked for analysis were included in the study. Patients who recorded only canceled appointments were excluded from analysis of outcomes. Study data were analyzed from January 2000 to December 2021. FSC attendance. Subsequent all-cause and seizure-related emergency department (ED) presentations and hospital admissions. Of 10 162 patients with appointments at FSCs, 9392 were linked for analysis, with mean (SD) follow-up time 6.9 (2.8) years after FSC referral. A total of 703 patients were excluded. Among 9392 linked patients, 5398 were male (57.5%; mean [SD] age, 59.7 [11.2] years). FSC attendance was associated with reduced subsequent all-cause emergency presentations (adjusted incidence rate ratio [aIRR], 0.72; 95% CI, 0.66-0.79) and all-cause hospitalization (aIRR, 0.81; 95% CI, 0.75-0.88). Those who attended at the first-scheduled appointment, compared with those who attended only a rescheduled, delayed appointment, had reduced subsequent all-cause emergency presentations (aIRR, 0.83; 95% CI, 0.76-0.91), all-cause hospitalization (aIRR, 0.71; 95% CI, 0.65-0.79), seizure-related presentations (aIRR, 0.40; 95% CI, 0.33-0.49), and mortality (hazard ratio, 0.82; 95% CI, 0.69-0.98). Male sex was associated with nonattendance (adjusted relative risk [aRR], 1.12; 95% CI, 1.03-1.22), as were injury at emergency presentation (aRR, 1.12; 95% CI, 1.01-1.24), psychiatric comorbidity (aRR, 1.68; 95% CI, 1.55-1.81), previous seizure-related presentations (aRR, 1.35; 95% CI, 1.22-1.49), and delays (>14 days) between FSC referral and appointment (aRR, 1.35; 95% CI, 1.18-1.54). Hospitalization at referral was associated with reduced nonattendance (aRR, 0.80; 95% CI, 0.72-0.90), as were non-English language preference (aRR, 0.81; 95% CI, 0.69-0.94), distance greater than 6 mi from home to clinic (aRR, 0.85; 95% CI, 0.76-0.95), and physical comorbidity (aRR, 0.80; 95% CI, 0.72-0.89). Results of this cohort study suggest that FSC attendance, particularly early attendance, was associated with reduced rates of subsequent hospital utilization. This knowledge may support adequately resourcing FSCs to improve equitable, timely access. Future study directions include assessing interventions that may support FSC attendance for at-risk groups.

The use of parent-completed questionnaires to investigate developmental outcomes in large populations of children exposed to antiseizure medications in pregnancy.

This study was undertaken to assess the utility of the Ages and Stages Questionnaire-3rd Edition (ASQ-3) and the Vineland Adaptive Behavior Scales-2nd Edition (VABS-II) as neurodevelopmental screening tools for infants exposed to antiseizure medications in utero, and to examine their suitability for use in large-population signal generation initiatives. Participants were women with epilepsy who were recruited from 21 hospitals in England and Northern Ireland during pregnancy between 2014 and 2016. Offspring were assessed at 24 months old using the Bayley Scales of Infant Development-3rd Edition (BSID-III), the VABS-II, and the ASQ-3 (n = 223). The sensitivity and specificity of the ASQ-3 and VABS-II to identify developmental delay at 24 months were examined, using the BSID-III to define cases. The ASQ-3 identified 65 children (29.1%) as at risk of developmental delay at 24 months using standard referral criteria. Using a categorical approach and standard referral criteria to identify delay in the ASQ-3 and BSID-III at 24 months, the ASQ-3 showed excellent sensitivity (90.9%) and moderate specificity (74.1%). Utilizing different cut-points resulted in improved properties and may be preferred in certain contexts. The VABS-II exhibited the strongest psychometric properties when borderline impairment (>1 SD below the mean) was compared to BSID-III referral data (sensitivity = 100.0%, specificity = 96.6%). Both the ASQ-3 and VABS-II have good psychometric properties in a sample of children exposed to antiseizure medications when the purpose is the identification of at-risk groups. These findings identify the ASQ-3 as a measure that could be used effectively as part of a tiered surveillance system for teratogenic exposure by identifying a subset of individuals for more detailed investigations. Although the VABS-II has excellent psychometric properties, it is more labor-intensive for both the research team and participants and is available in fewer languages than the ASQ-3.

Variations in healthcare utilization for mental health problems prior to suicide by socioeconomic status: a Norwegian register-based population study

BackgroundSuicide poses a major public health challenge, claiming around 650 lives annually in Norway. There is limited understanding of mental healthcare utilization patterns preceding suicide, particularly relating to socioeconomic status (SES). This study analyzes mental health service use among Norwegian citizens aged 20–64 from 2009 to 2021, emphasizing disparities related to SES.MethodsThis is a population-wide registry-based study. We include mental health consultations with both primary and specialist healthcare services, and investigate patterns of service use regarding educational attainment, employment status and income and compare this to the population in general. All suicides in the period (N = 4731) are included in the study. The aim is to investigate potential discrepancies in service use the year and month preceding suicide, seeking to enhance targeted preventive interventions.ResultsOur results show significant variations in healthcare use for mental health problems the last year preceding suicide, according to the components of SES, for both men and women. Those with higher education utilize the mental healthcare services prior to suicide to a higher degree than men and women with high school education or less, whereas employed men and men with high income level have significantly lower mental healthcare usage prior to suicide both the last year and month compared to the non-employed men and men with low-income level. Employed women also had a lower mental healthcare usage, whereas the results regarding income are not significant for women.ConclusionMental healthcare use prior to suicide varies across the SES components. Notably, the SES groups exhibit heterogeneity, with gendered patterns. Targeted interventions for low consultation rates among employed men, and men with high income and lower education are needed, while women, and men in at-risk groups, such as the non-employed and those with low income, demonstrate higher mental healthcare utilization, warranting comprehensive suicide prevention measures.

Canine Outcomes and Length of Stay in a Midwestern Shelter Affected by Breed Specific Legislation

Breed specific legislation (BSL) is intended to restrict or reduce the ownership of selected breeds of dogs within a municipality. These laws frequently aim at “bully breeds” such as the American Pit Bull Terrier and other pure or mixed breeds with similar phenotypic characteristics which are heavily represented in shelters nationwide. This study describes differences in outcomes and length of stay (LOS) for banned dogs versus dogs of other breeds in a managed admission municipal shelter subject to BSL. It was hypothesized that dogs subject to legislation would have fewer live outcomes and a longer LOS when compared to non-legislated dogs. Retrospective outcome data from 1/1/2022 through 12/31/2022 was analyzed. The study population included 764 adult dogs of which 118 were affected by legislation. The legislated and non-legislated groups were found to be demographically equivalent considering age group, sex, previous alteration status, and intake frequency, but legislated dogs had a significantly heavier body weight compared to non-legislated dogs. Initial Pearson Chi-Square testing revealed a statistically significant increase in euthanasia for legislated dogs and adoptions for non-legislated dogs. After controlling for body weight, there was a statistically significant increase in adoption for the non-legislated group, and increased return to owner (RTO) for legislated dogs, however there wasn’t a statistically significant difference in total live outcomes. Mann-Whitney U Testing demonstrated a statistically significant increase in LOS for legislated dogs compared to non-legislated dogs in the full study population, but after controlling for weight their LOS was no longer significantly different. In the body weight controlled group however, LOS was still significantly longer for legislated dogs versus non-legislated dogs with adoption and RTO outcomes. Euthanasia reasons were evaluated for 80 dogs whose first outcome was euthanasia. Pearson Chi Square testing showed legislated dogs in this group were no more likely to be euthanized for aggression than the non-legislated dogs. In this population, dogs subject to BSL were less likely to be adopted but more likely to RTO. It is suspected shelter staff prevented euthanasia of some legislated dogs through heightened efforts to facilitate RTO even though there was not a formal protocol in place to do so. After controlling for body weight, LOS was equivalent between legislated and non-legislated groups, although the legislated dogs did experience increased LOS before live outcomes. Importantly, legislated dogs were not significantly more likely to be euthanized due to aggressive behavior than non-legislated dogs in this population. These findings indicate that dogs targeted by BSL should be considered an at-risk group within the shelter population and shelters should endeavor to develop specific strategies to reduce LOS and provide best outcomes for these dogs. In many jurisdictions, overturning BSL could be a powerful approach to protecting this at-risk population.

Knowledge and Needs of Theology Students on Voice and Vocal Hygiene at a South African Institution of Higher Education

Preachers are professional voice users (PVUs) who regularly experience high vocal demands, often leading to vocal difficulties or disorders. Research has established that this often occurs due to a lack of sufficient knowledge of the vocal mechanism and vocal hygiene in this population. Student preachers are therefore also considered to be a potential at-risk group for the development of vocal difficulties once they enter the occupation. This study therefore aimed to determine the knowledge and needs of theology students at a South African institution of higher education regarding voice production and vocal hygiene. A cross-sectional online survey using non-probability purposive and convenience sampling was distributed to participants through email to obtain data on the education, training, needs, and knowledge of voice production, vocal hygiene, and voice use among the participants. A clear need was observed for education and training on vocal health and hygiene amongst the study population. The participants presented with limited knowledge about voice production and vocal hygiene; however, they also reported to not regularly implement this limited knowledge in day-to-day voice use or practice. This study found a willingness among participants to learn more about voice and vocal hygiene. This study confirmed that theology students, as future PVUs, receive minimal-to-no training on voice and vocal hygiene, despite their increased risk for voice difficulties.

At-risk patient documentation and naloxone dispersal for a rural statewide EMS "Naloxone Leave Behind" program.

For successful Naloxone Leave Behind (NLB) programs, Emergency Medical Services (EMS) must identify patients at-risk for opioid overdose. We describe the first year of Vermont's NLB program and report rates of EMS documentation of at-risk patients with subsequent distribution of NLB kits in the subgroup of those refusing transport to an emergency department (ED). This retrospective cohort review of all EMS encounters over 1 year compared on-scene EMS documented to retrospective chart reviewidentified at-risk patients eligible for NLB kit dispersal. EMS was educated to identify at-risk patients through statewide mandatory training modules. At-risk patients were identified by electronic chart review using the same training criteria. As per protocol, patients identified as at-risk by EMS who refuse ED transport are eligible for NLB. NLB-appropriate patients by retrospective chart review without NLB protocol use documentation by EMS were considered "missed." Of 110,701 EMS encounters, 2507 (2.4%) were at-risk by chart review. Among these, 793 refused transport to an ED. In this chart-review at-risk non-transported group, EMS documented 407 (51.3%) patients as at-risk by documenting use of the NLB protocol. Of these 407, EMS provided 141 (34.6%) with NLB kits. Fifteen (3.7%) patients refused kits. There were 386 (48.7%) potentially "missed" opportunities for NLB dispersal. EMS documented 51.3% of patients eligible for NLB dispersal, with 34.6% receiving kits. There was no documentation for 48.7% of chart-review at-risk patients, suggesting "missed" distribution opportunities. This study highlights the need for improved EMS identification of at-risk patients, EMS documentation adherence, and NLB kit provision.

Investigating incidence of and factors associated with SARS-CoV-2 infection over a nine-month period in a highly-vaccinated healthcare worker cohort.

Healthcare workers (HCWs) are at increased risk of SARS-CoV-2 infection. This risk persists despite the implementation of mitigating factors, including vaccination. The ongoing impact of incident SARS-CoV-2 infection and symptomatic COVID-19 disease in vaccinated healthcare workers is poorly understood. We aimed to describe the epidemiology of incident SARS-CoV-2 infections, as well as investigating the serological, clinical and demographic factors associated with developing infection. This was a multi-centre prospective longitudinal study followed a HCW cohort over a nine-month period. Spike and nucleocapsid SARS-CoV-2 antibodies were measured at enrolment. Vaccination status, demographics, and medical history were collated. Incident infection over the study period was recorded. Multivariable regression models investigated factors associated with nucleocapsid antibody status, incident infection, and symptomatic infection. 1,260 participants took part, of whom n = 1,006 were anti-nucleocapsid antibody positive. Negative anti-nucleocapsid antibody was associated with older age and having a known SARS-CoV-2 acquisition risk. There were n = 274 (22%) incident infections, with n = 225 (87%) diagnosed using antigen tests. Incident infections were associated with lower anti-nucleocapsid titres, increased time since previous SARS-CoV-2 infection, and having a known acquisition risk, but were not associated with vaccination status. This study demonstrates a high rate of incident SARS-CoV-2 infection amongst healthcare workers, despite broad vaccine coverage. There is a shift in diagnostics, from PCR to antigen testing. We identify at-risk groups for incident infection, and these should continue be targeted as part of risk reduction campaigns. Vaccination status and prior infection status alone are not surrogates for protection.

Physician wellbeing and burnout in emergency medicine in Switzerland.

Emergency physicians are the most at-risk medical specialist group for burnout. Given its consequences for patient care and physician health and its resulting increased attrition rates, ensuring the wellbeing of emergency physicians is vital for preserving the integrity of the safety net for the healthcare system that is emergency medicine. In an effort to understand the current state of practicing physicians, this study reviews the results of the first national e-survey on physician wellbeing and burnout in emergency medicine in Switzerland. Addressed to all emergency physicians between March and April 2023, it received 611 complete responses. More than half of respondents met at least one criterion for burnout according to the Maslach Burnout Inventory - Human Services Survey (59.2%) and the Copenhagen Burnout Inventory (54.1%). In addition, more than half reported symptoms suggestive of mild to severe depression, with close to 20% screening positively for moderate to severe depression, nearly 4 times the incidence in the general population, according to the Patient Health Questionnaire-9. We found that 10.8% of respondents reported having considered suicide at some point in their career, with nearly half having considered this in the previous 12 months. The resulting high attrition rates (40.6% of respondents had considered leaving emergency medicine because of their working conditions) call into question the sustainability of the system. Coinciding with trends observed in other international studies on burnout in emergency medicine, this study reinforces the fact that certain factors associated with wellbeing are intrinsic to emergency medicine working conditions.

Disentangling the acute subjective effects of classic psychedelics from their enduring therapeutic properties.

Recent research with classic psychedelics suggests significant therapeutic potential, particularly for neuropsychiatric disorders. A mediating influence behind symptom resolution is thought to be the personal insight - at times, bordering on the mystical - one acquires during the acute phase of a psychedelic session. Indeed, current clinical trials have found strong correlations between the acute subjective effects (ASE) under the influence of psychedelics and their enduring therapeutic properties. However, with potential barriers to widespread clinical implementation, including the healthcare resource-intensive nature of psychedelic sessions and the exclusion of certain at-risk patient groups, there is an active search to determine whether ASE elimination can be accompanied by the retention of persisting therapeutic benefits of these class of compounds. Recognizing the aberrant underlying neural circuitry that characterizes a range of neuropsychiatric disorders, and that classic psychedelics promote neuroplastic changes that may correct abnormal circuitry, investigators are rushing to design and discover compounds with psychoplastogenic, but not hallucinogenic (i.e., ASE), therapeutic potential. These efforts have paved the discovery of 'non-psychedelic/subjective psychedelics', or compounds that lack hallucinogenic activity but with therapeutic efficacy in preclinical models. This review aims to distill the current evidence - both clinical and preclinical - surrounding the question: can the ASE of classic psychedelics be dissociated from their sustained therapeutic properties? Several plausible clinical scenarios are then proposed to offer clarity on and potentially answer this question.

Exploring early life social and executive function development in infants and risk for autism: a prospective cohort study protocol of NICU graduates and infants at risk for cerebral palsy

BackgroundDelays in early social and executive function are predictive of later developmental delays and eventual neurodevelopmental diagnoses. There is limited research examining such markers in the first year of life. High-risk infant groups commonly present with a range of neurodevelopmental challenges, including social and executive function delays, and show higher rates of autism diagnoses later in life. For example, it has been estimated that up to 30% of infants diagnosed with cerebral palsy (CP) will go on to be diagnosed with autism later in life.MethodsThis article presents a protocol of a prospective longitudinal study. The primary aim of this study is to identify early life markers of delay in social and executive function in high-risk infants at the earliest point in time, and to explore how these markers may relate to the increased risk for social and executive delay, and risk of autism, later in life. High-risk infants will include Neonatal Intensive Care Unit (NICU) graduates, who are most commonly admitted for premature birth and/or cardiovascular problems. In addition, we will include infants with, or at risk for, CP. This prospective study will recruit 100 high-risk infants at the age of 3–12 months old and will track social and executive function across the first 2 years of their life, when infants are 3–7, 8–12, 18 and 24 months old. A multi-modal approach will be adopted by tracking the early development of social and executive function using behavioural, neurobiological, and caregiver-reported everyday functioning markers. Data will be analysed to assess the relationship between the early markers, measured from as early as 3–7 months of age, and the social and executive function as well as the autism outcomes measured at 24 months.DiscussionThis study has the potential to promote the earliest detection and intervention opportunities for social and executive function difficulties as well as risk for autism in NICU graduates and/or infants with, or at risk for, CP. The findings of this study will also expand our understanding of the early emergence of autism across a wider range of at-risk groups.

Prevalence and risk factors of depression and anxiety in primary care.

Anxiety and depressive disorders are highly prevalent mental health conditions worldwide. However, little is known about their specific prevalence in primary care settings. This study aimed to determine the prevalence of depression and anxiety in the primary care population and identify associated patient characteristics. We conducted a cross-sectional study using stratified sampling by age with a self-administered questionnaire survey in Singapore's National Health-care Group Polyclinics from December 2021 to April 2022. A total score of Patient Health Questionnaire-9 (PHQ-9) ≥10 represents clinical depression, and a total score of Generalised Anxiety Disorder-7 (GAD-7) ≥10 indicates clinical anxiety. Multivariable logistic regression was used to identify the factors associated with depression and anxiety. A total of 5694 patients were approached and 3505 consented to the study (response rate=61.6%). There was a higher prevalence of coexisting clinical depression and anxiety (DA) (prevalence=5.4%) compared to clinical depression only (3.3%) and clinical anxiety only (1.9%). The odds of having DA were higher among those aged 21-39 years (odds ratio [OR] 13.49; 95% confidence interval [CI] 5.41-33.64) and 40-64 years (OR 2.28; 95% CI 1.03-5.03) compared to those ≥65 years. Women had higher odds of having DA (OR 2.33; 95% CI 1.54-3.50) compared to men. Respondents with diabetes had higher odds of having DA (OR 1.78; 95% CI 1.07-2.94) compared to those without diabetes. Coexisting clinical depression and anxiety are significantly present in the primary care setting, especially among younger individuals, patients with diabetes and women. Mental health screening programmes should include screening for both depression and anxiety, and target these at-risk groups.

Self-reported suicidal behaviour among people living with disabilities: prevalence and associated factors from a cross-sectional nation-wide survey in Bangladesh

BackgroundDisability marginalises a large portion of Bangladesh’s population. Global pre- and post-pandemic research evidently states that, this group is more prone to develop mental health problems, which increases the risk of self-harm and suicide among them. It is crucial to comprehend and mitigate the mental health challenges among the people with disabilities which in turn can promote their greater participation in community, and in national socioeconomic development. However, currently there is limited information available, regarding the suicidal behaviour of this group in Bangladesh. Therefore, this study aimed to investigate the prevalence and contributing factors of suicidal behaviour among people with disabilities.MethodA cross-sectional survey was conducted during September and October 2022, among the participants who had selected disabilities, by using probability proportional to size sampling technique across all eight divisions of Bangladesh. A semi-structured questionnaire comprising information about sociodemographic, lifestyle, health; and Suicidal Behaviour Questionnaire-Revision (SBQ-R) was used. The association between the determinants and mental health outcome was investigated using the Chi-square test, and the contributing factors were investigated using the multiple binary logistic regression.ResultAbout 10.45% of the participants reported to have suicidal behaviour (e.g., suicidal ideation, attempts, completed suicide), considering the cut-off score as 7 for the SBQ-R in the study period. Approximately, 40% respondents mentioned suicidal ideation in their lifetime, whereas, 9.01% had suicidal ideation over the past 12 months. Additionally, 8.87% of the person with disabilities, mentioned about their suicidal intent to the family members, and 5.94% reported the likelihood of suicide in the future. Being female, having multiple disabilities, and not being connected with family and friends were found to be significantly associated with suicidal behaviour.ConclusionThis research demonstrates the significance of treating mental health issues and expanding accessibility to pre-existing services to lessen the impact of the limitations generated by disabilities. Policymakers can utilize this baseline findings to design large scale research and develop measures for suicide prevention, and management for at-risk groups.

Understanding engagement in diet and dementia prevention research among British South Asians: a short report of findings from a patient and public involvement group.

Dementia is a global public health challenge. Evidence suggests that individuals from South Asian communities are an at-risk group for dementia, partly as a result of early and cumulative exposure to known dementia risk factors, such as obesity and type 2 diabetes. There needs to be more culturally appropriate community engagement to increase awareness of dementia and identify better strategies to encourage participation in dementia-related research. We aimed to better understand the barriers and facilitators towards engaging with, and participating in, diet and dementia related research among British South Asians. This was achieved using a public and patient involvement (PPI) approach. A community-based, engagement event involving information sharing from experts and roundtable discussions with South Asian communities (n = 26 contributors) was held in June 2023 in Newcastle-upon-Tyne, UK. Collaboration from preidentified PPI representatives (n = 3) informed the content and structure of PPI activities, as well as recruitment. Data were synthesised using template analysis, a form of codebook thematic analysis. This involved deductively analysing data using relevant a priori themes, which were expanded upon, or modified, via inductive analysis. The findings highlighted the importance of trust, representation and appreciation of cultural barriers as facilitators to engagement in diet and dementia risk reduction research. Consideration of language barriers, time constraints, social influences and how to embed community outreach activities were reported as driving factors to maximise participation. This PPI work will inform the design and co-creation of a culturally adapted dietary intervention for brain health in accordance with the Medical Research Council and National Institute for Health and Care Research guidance for developing complex interventions.