Fourth Wave Research Articles

Psychological distress among unemployed migrants settling in southwestern Spain: A cross-sectional study.

Migrants living in the informal settlements of Southern Spain tend to have precarious employment and poor living conditions, making then vulnerable to mental health issues. This study aimed to assess psychological distress in a sample of unemployed migrants residing in informal settlements in the province of Huelva (southern Spain), during the fourth wave of the COVID-19 pandemic. A descriptive cross-sectional study was conducted during the months of April to June 2021, through a heteroadministered questionnaire, in informal settlements. The measurement instrument was the General Health Questionnaire (GHQ-12), used to analyze psychological distress, and other sociodemographic and health-related variables. Univariate and bivariate descriptive data analysis were performed, using the nonparametric statistics Mann-Whitney U test, Kruskal-Wallis H test, and Tau β correlation. A categorical regression analysis was performed to study the relationship between psychological distress and the rest of the variables. The sample consisted of 317 subjects, 83.9% of whom were males, and the mean age was 33.4 years (SD = 10.7 years). The mean score obtained in the GHQ-12 questionnaire was 13.69 points (SD = 3.86). Significant differences were found between levels of psychological distress and substance abuse (H = 14.085; P = .049), people who wished to stay in Spain (t = 6987; P = .049), people who experienced isolation due to COVID-19 contact (t = 1379.5; P = .001), people who needed medical assistance due to COVID-19 (t = 7.990; P = .018), and those who reported having chronic illnesses (t = 2686.5, P = .02). The mean score of psychological distress indicates general high levels of psychological distress. Participants who had experienced isolation due to COVID-19 contact, who consumed substances, and who had chronic illnesses reported the highest levels of psychological distress.

SARS-CoV-2 vaccine uptake and risks of severe COVID-19 disease among people prescribed opioid agonist therapy in Scotland

BackgroundThere is limited evidence quantifying the risk of severe COVID-19 disease among people with opioid dependence. We examined vaccine uptake and severe disease (admission to critical care or death with...

Using the theory of planned behavior to predict parents' disclosure of donor conception to their children: a longitudinal study.

Can the application of the theory of planned behavior (TPB) help predict heterosexual parents' disclosure of donor conception to their children? Parents with a stronger will to act in accordance with social norms favoring disclosure were more likely to start the disclosure process within the next 5-9 years. In contrast to single mothers by choice and same-sex couples, heterosexual couples need to make an active decision to disclose their use of donor conception to their child. While disclosure at an early age is encouraged by international guidelines, many heterosexual-couple parents struggle with this. A previous study has found an association between parental scores of TPB factors and disclosure intention, but so far, no study has applied the TPB to predict parents' disclosure behavior. The present study is based on the fourth and fifth waves of data collection (T4 and T5) in a nation-wide longitudinal study. Participating parents had conceived through identity-release oocyte donation (n = 68, response rate 65%) and sperm donation (n = 62, response rate 56%) as part of a heterosexual couple. The present study is part of the prospective longitudinal Swedish Study on Gamete Donation (SSGD). Consecutive recruitment of couples starting oocyte or sperm donation treatment was conducted at all seven fertility clinics providing gamete donation in Sweden during a 3-year period (2005-2008). Participants were requested to complete postal surveys at five time points. The present study includes heterosexual-couple parents following oocyte or sperm donation who participated at the two latest time points when their children were 7-8 years old (T4), and 13-17 years old (T5). At T4, participants completed the study-specific TPB Disclosure Questionnaire (TPB-DQ) measuring attitudes and intentions to disclose the donor conception to the child, and disclosure behavior was assessed at both T4 and T5. Data from those participants who had not yet disclosed at T4 were analyzed using survival analysis with Cox regressions. Forty participants had not disclosed the donor conception to their children at T4 and, out of these, 13 had still not disclosed at T5. We found a significant association between scores of the TPB factor Subjective norms at T4 and their subsequent disclosure behavior at T5 (HR = 2.019; 95% CI: 1.36-3.01). None of the other factors were significantly associated with disclosure behavior. The present study concerns heterosexual-couple parents with children conceived following treatment with gametes from open-identity donors, which limits the generalizability of our findings to other groups and contexts. Other limitations include the risk of systematic attrition due to the longitudinal study design and decreased statistical power due to few participants. Our findings highlight the importance of perceived subjective norms for parents' disclosure behavior and indicate that the co-parent's opinion about disclosure is of particular relevance in this regard. Counselors should focus on supporting prospective parents to initiate and maintain a healthy and open dialogue about concerns around building a family with donor conception. The study was funded by the Swedish Research Council. The authors have no competing interests to declare. N/A.

Reference intervals of circulating secretoneurin concentrations determined in a large cohort of community dwellers: the HUNT study.

Secretoneurin (SN) is a novel cardiac biomarker that associates with the risk of mortality and dysfunctional cardiomyocyte Ca2+ handling in heart failure patients. Reference intervals for SN are unknown. SN was measured with a CE-marked ELISA in healthy community dwellers from the fourth wave of the Trøndelag Health Study (HUNT4) conducted in 2017-2019. The common, sex and age specific 90th, 95th, 97.5th and 99th percentiles were calculated using the non-parametric method and outlier exclusion according to the Reed test. The applicability of sex and age specific reference intervals were investigated using Harris and Boyd test. We also estimated the percentiles in a subset with normal findings on echocardiographic screening. The total cohort included 887 persons (56.4 % women). After echocardiographic screening 122 persons were excluded, leaving a total of 765 persons (57.8 % women). The 97.5th percentile (95 % CI in brackets) of SN was 59.7 (57.5-62.1) pmol/L in the total population and 58.6 (57.1-62.1) pmol/L after echocardiography screening. In general, slightly higher percentiles were found in women and elderly participants, but less than 4 % in these subgroups had concentrations deviating from the common 97.5th percentile. Low BMI or eGFR was also associated with higher concentrations of SN. Upper reference limits for SN were similar amongst healthy adult community dwellers regardless of prescreening including cardiac echocardiography or not. Women and elderly showed higher concentrations of SN, but the differences were not sufficiently large to justify age and sex stratified upper reference limits.

Spatiotemporal dynamics of cholera epidemics in Ethiopia: 2015–2021

Since the onset of the seventh cholera pandemic, Ethiopia has been affected by recurrent epidemics. However, the epidemiology of cholera in this country remains poorly understood. This study aimed to describe cholera outbreak characteristics in Ethiopia from 2015 to 2021. During this period, Ethiopia experienced four epidemic waves. The first wave involved nationwide outbreaks during the second half of 2016 followed by outbreaks predominantly affecting Somali Region in 2017. The second wave primarily affected Tigray and Afar Regions. During the third wave, multiple smaller-scale outbreaks occurred during 2019. The fourth wave was limited to Bale Zone (Oromia Region) in 2021. Overall, a north to south shift was observed over the course of the study period. Major cholera transmission factors included limited access to safe water and sanitation facilities. Severe weather events (drought and flooding) appear to aggravate cholera diffusion. Cholera transmission between Ethiopia and nearby countries (Kenya and Somalia), likely plays a major role in regional cholera dynamics. Overall, this study provides the first understanding of recent spatiotemporal cholera dynamics in Ethiopia to inform cholera control and elimination strategies.

Economic Considerations and Public Support for Environment Policy in East and Southeast Asia

Abstract The “environment–economy trade-off” is a key question in research on public opinion on environmental policies. While evidence from Western economies suggests that individuals are more supportive of environmental initiatives when the macroeconomic situation is favorable, little is known about how environmental policy preferences are shaped by economic factors in East and Southeast Asian countries. Using a survey dataset consisting of 12 countries based on the fourth wave of the Asian Barometer Survey (ABS), we investigate how environmental policy preferences are associated with multiple aspects of economic consideration. In a pooled multilevel analysis, we find that personal economic conditions and perceptions are more consistently associated with greater support for environmental initiatives than objective and subjective national economic conditions. However, an analysis of the heterogeneous effect shows that the effect of individual economic situations is only partially identifiable among lower-middle or upper-income countries in our sample, signaling the complexity of qualifying the relationship between economic considerations and environmental attitudes in a cross-country context.

On the complex relationship between resilience and hair cortisol levels in adolescence despite parental physical abuse: a fourth wave of resilience research

IntroductionTo understand the family’s role in adolescents’ mental health development and the connection to neurodevelopmental disorders related to experienced parental physical abuse, we first explored resilience pathways longitudinally and secondly, connected the identified patterns to adolescents’ hair cortisol levels that are rooted in the hypothalamic–pituitary–adrenal axis as the main stress response system and connected brain structure alterations.MethodsWe analyzed longitudinal online questionnaire data for three consecutive high school years (from seventh to ninth grade) and four survey waves from a representative sample of n = 1609 high school students in Switzerland on violence–resilience pathways. Furthermore, we collected students’ hair samples from a subsample of n = 229 at survey wave 4. About 30% of the participating adolescents had been physically abused by their parents. Out of the overall sample, we drew a subsample of adolescents with parental abuse experiences (survey wave 1 n = 509; survey wave 2 n = 506; survey wave 3 n = 561; survey wave 4 n = 560).ResultsDespite the odds, about 20–30% of adolescents who have experienced parental physical abuse escaped the family violence cycle and can be called resilient. By applying a person-oriented analytical approach via latent class and transition analysis, we longitudinally identified and compared four distinct violence–resilience patterns. We identified violence resilience as a multidimensional latent construct, which includes hedonic and eudaimonic protective and risk indicators. Because resilience should not solely be operationalized based on the lack of psychopathology, our latent construct included both feeling good (hedonic indicators such as high levels of self-esteem and low levels of depression/anxiety and dissociation) and doing well (eudaimonic indicators such as high levels of self-determination and self-efficacy as well as low levels of aggression toward peers).DiscussionThe present study confirmed that higher cortisol levels significantly relate to the comorbid pattern (internalizing and externalizing symptoms), and further confirmed the presence of lasting alterations in brain structures. In this way, we corroborated the insight that when studying the resilience pathways and trajectories of abused adolescents, biological markers such as hair cortisol significantly enhance and deepen the understanding of the longitudinal mechanisms of psychological markers (e.g., self-determination, self-esteem, self-efficacy) that are commonly applied in questionnaires.

Confucian Culture and Democratic Values: An Empirical Comparative Study in East Asia

Abstract Many studies have been conducted on the link between Confucianism and democratic values in East Asia, but they have failed to account for the complex character of Confucianism and the possible impact of political systems. This study re-measures Confucian values into four dimensions—authoritarianism, familialism, collectivism, and harmoniousness—based on data from the fourth wave of the Asian Barometer survey. It then uses a multi-layer linear regression model to examine the relationship between the Confucian cultural values and the democratic values held by people in six East Asian societies at both the macro and micro levels. The findings demonstrate an asymmetrical pattern in the relationship between the various dimensions of Confucian cultural values and the democratic values of East Asia, collectivist values do not affect democratic values, while familial and authoritarian values have a significant and negative correlation with democratic values. Harmonious values have a significant and positive correlation with democratic values. In addition, there is a significant positive correlation between democratic institutions and the democratic values, and the relationship between the values of harmoniousness and collectivism and democratic values varies across countries with different political systems. This offers insightful material for reflection as we reconsider the connection between Confucianism and democracy in East Asia.

Habilidades metacognitivas y autoeficacia académica: planteamiento relacional en el contexto pregradual

Self-determination theories have managed to describe self-efficacy as the element in which dimensions such as analysis, supervision and human conscience converge. From the theory of social learning, it is considered as a condition associated with metacognition in its dimensions of supervision and correction. The relationship between metacognitive skills and academic self-efficacy is studied. The method was quantitative correlational, integrating 260 students from the education career of universities in Lima, after the period of the fourth wave of infections by Covid-19. Significant relationship indices have been found between the variables analyzed, based on finding better metacognitive skills and the best use of metacognition in performance (r = .821; p < 0.01); as well as with the situational expectations factors (r = .783; p < 0.01); and personal expectations (r = .576; p < 0.01).

Stress and burnout in the context of workplace psychosocial factors among mental health professionals during the later waves of the COVID-19 pandemic in Hungary.

While literature is abundant on the negative mental health impact of the COVID-19 outbreak, few studies focus on the Central and Eastern European region. We examined stress, burnout, and sleeping troubles among mental health professionals in the context of psychosocial risk factors related to participation in COVID care during the fourth and fifth waves. Mental health professionals (N=268) completed an online cross-sectional survey in Hungary, between November 2021 and April 2022. Of the respondents, 58.2% directly participated in COVID care. The main data collection instrument was the Copenhagen Psychosocial Questionnaire (COPSOQ II), including 20 subscales on work-related psychosocial factors and 3 outcome scales (stress, burnout, and sleeping troubles). We added a question on competence transgression, and items on sociodemographic and professional background. Participation in COVID care was associated with higher work pace (59.08 versus 49.78), more role conflicts (55.21 versus 45.93), lower scores on the influence at work (38.18 versus 51.79), predictability (44.71 versus 57.03), reward (55.82 versus 65.03), role clarity (70.19 versus 75.37), social support from supervisor (59.24 versus 65.55), job satisfaction (54.36 versus 62.84), trust regarding management (55.89 versus 67.86), justice and respect (44.51 versus 54.35) scales. Among those involved in COVID care, only the stress score was higher (47.96 vs. 42.35) in the total sample; however, among psychiatrists, both stress (52.16 vs. 38.60) and burnout scores (58.30 vs. 47.06) were higher. Stepwise multiple regression revealed that work-family conflict, emotional demands and workplace commitment were independent predictors of higher stress and burnout scores; furthermore, competence transgression had a significant effect on stress, and being a psychiatric specialist had a significant effect on burnout. These models explained 40.5% of the variance for stress and 39.8% for burnout. During the fourth and fifth waves, although COVID care was more well-organized, psychiatrists, as specialist physicians responsible for the quality of the care, were still experiencing challenges regarding their competence and influence at work, which may explain their increased levels of stress and burnout.

The complex link between socioeconomic deprivation and COVID-19. Evidence from small areas of Catalonia

This ecological study assesses the association between the incidence rate of COVID-19 confirmed cases and socioeconomic deprivation in the Catalan small areas for the first six waves of the pandemic. The association is estimated using Poisson regressions and, in contrast to previous studies, considering that the relationship is not linear but rather depends on the degree of deprivation. The results show that the association between deprivation and incidence varied between waves, not only in intensity but also in its sign. Although it was insignificant in the first, third and fourth waves, the association was positive and significant in the second, becoming significantly negative in the fifth and sixth waves. Interestingly, the evidence suggests that the link between both magnitudes was not homogeneous throughout the distribution of deprivation, the pattern also varying between waves. The results are discussed in view of the role of non-pharmacological interventions and vaccination, as well as potential biases (for example that associated with differences between population groups in the propensity to be tested in each wave).

Regional trends in the number of COVID-19 cases

AbstractIn this study, we analysed the novel coronavirus disease (COVID-19) cases data to investigate the regional infection trends in Japan. There had been seven outbreaks by October 2022 in Japan. In each outbreak, the number of COVID-19 cases has increased at different rates in different regions. The prefectural infection ratio is defined using COVID-19 cases data. We calculate the prefectural infection ratio and study the characteristic of each pandemic wave. The prefectural order of infection progression is estimated in each past wave of the COVID-19 pandemic. This study shows that the infection spread from the Kanto region in the fourth pandemic wave and the infection spread simultaneously from four regions in the sixth wave. It is also found that the infection situation trend in Okinawa differs from that in the other regions.

Patterns of polydrug use among Black Americans who misuse opioids.

In the United States, opioid-related deaths involving polydrug use are now more prevalent than those involving only opioids. What often goes unnoticed is that deaths involving more than one substance are increasing more rapidly among Black Americans than Whites. Unfortunately, little research attention is paid to understanding opioid-related polydrug use patterns among Black Americans. As a result, less is known regarding which drug combinations are most common among this population and their reasons for co-using certain drugs. Therefore, the objective of this mixed methods study was to identify which substances were most commonly co-used with opioids among Black Americans, while also capturing their motives for combining opioids with other drugs. This study used data from the Florida Minority Health Study, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of Black Americans who misuse opioids. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida. Analyses revealed that opioids were most commonly combined with alcohol, cocaine, and methamphetamine, respectively. Opioids were co-used with alcohol in an attempt to enhance the desired effect (i.e., intoxication), while stimulants and opioids were combined to counteract the undesirable side effects of the other. This study begins to answer the question of which/why substances are combined with opioids among Black Americans and should inform behavioral health interventions targeted at this population. Data on this topic are especially timely as the United States goes through the current fourth wave of the opioid crisis that is characterized by deaths due to polydrug use. These findings invite further study using nationally representative data to determine the extent to which polydrug using patterns differ across racial/ethnic groups.

Clinical and Laboratory Features and Maternal Outcomes in Pregnant Women with Critical Lung Damage in the COVID-19

Introduction. The spread of the delta strain of the SARS-CoV-2 virus during the third and fourth waves of the pandemic led to the fact that a large cohort of pregnant women and maternity women needed respiratory support, standard treatment methods had no effect, and negative outcomes for the mother and fetus has increased.Purpose of the study. The aim is to determine clinical and laboratory features and maternal outcomes in pregnant women with the coronavirus disease 2019 (COVID-19) and critical lung damage.Materials and methods. A comparative study was conducted, followed by a retrospective analysis of clinical and laboratory features, maternal outcomes in 56 pregnant women with COVID-19 treated in this maternity hospital in the first-fourth wave of the pandemic. The research method is continuous, sequential. The first group (main) consisted of 28 women with severe or extremely severe form of the course of COVID-19 and critical lung damage (more 75 %); The second group (comparison) — 28 pregnant women with a moderate form of the disease and lung damage of 25–50 %. Screening assessment of the degree of endogenous intoxication was carried out. The severity of the disease was determined by the evaluation scale National Early Warning Score (NEWS).Results. Laboratory parameters of patients at admission and at the height of the disease have statistically significant differences in the general blood test, such as higher levels of leukocytes, eosinophils, rod-shaped neutrophils, hemoglobin, as well as lymphopenia and monocytopenia in women of the main group at the height of the disease. At the same time, the hematological indices of intoxication in the main group exceed the value of these indicators in the comparison group by two times. Patients of both groups had high levels of acute-phase markers of inflammation — C-reactive protein and ferritin, — an indicator of tissue destruction of lactate dehydrogenase, however, both at admission and at the height of the disease, these indicators were statistically significantly higher in the group of women with critical lung damage. In general, 20/28 patients (71.4 %) of group 1 had an extremely severe course of the disease, 8/28 (28.6 %) had a severe course. In second group, 28/28 patients (100 %) had moderate-severe NCI (p = 0.000), while recovery was noted in all of them. Outcomes of COVID-19 in women with critical lung damage: recovered — 25/28 (89 %); 3/28 (10.7 %) the patients died from complications of COVID-19 of an extremely severe degree.Discussion. The most frequent laboratory anomaly was leukocytosis and a rod-shaped shift in the midst of the disease in women with critical lung damage, as well as a statistically significant increase in the level of C-reactive protein, lactate dehydrogenase, D-dimer. Pulmonary complications (parapneumonic pleurisy, pneumothorax, pneumomediastinum, hydrothorax, lung abscess) and extrapulmonary complications (encephalopathy, panic attacks, acute liver injury, sepsis, thromboembolic complications) were observed only with critical lung damage.Conclusion. In the laboratory, at the height of the disease, in the group of pregnant women with critical lung damage, leukocytosis and stab shift are statistically significantly more common. Hematological indices of intoxication, leukocyte and hematological, confirm endogenous intoxication at the height of the disease. A statistically significantly higher level of aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, D-dimer is determined upon admission to the hospital and at the height of the disease as markers of systemic inflammatory response and cytolysis, which demonstrates the defeat of several organ systems simultaneously.

Understanding the determinants of household cooking-fuel choice in sub-Saharan Africa: evidence from Nigeria

Abstract Overreliance on traditional cooking fuels by agricultural households poses a significant obstacle to achieving the United Nations Sustainable Development Goal 7 by 2030 in Nigeria. Despite the emerging recognition of remittances as a crucial factor influencing cooking-fuel choices in the energy-transition literature, there is a paucity of studies examining this influence in Nigeria. Using data from 4400 agricultural households sourced from the fourth wave of the Nigerian Living Standard Measurement Survey data sets, this study examined the influence of remittances on cooking-fuel choices, among other factors in Nigeria. Employing descriptive statistics and the multinomial logit regression model, the analysis reveals that traditional cooking fuels, including wood, crop residue and animal dung, continue to dominate the cooking-fuel landscape. The empirical result of the multinomial logit model showed that households that receive remittances are more likely to use modern cooking fuels. Furthermore, wealthier, more educated households with access to electricity are more likely to use modern and transitional cooking fuels than traditional cooking fuels. Based on the findings, the study suggests the incentivization of remittances into the country through the reduction in associated transaction costs and accelerated public infrastructural investment in affordable electricity and good road networks to connect rural areas to gas-supply networks to drive the transition to modern cooking energy. Additionally, educational and awareness campaigns about the health risks associated with traditional cooking energy, particularly indoor air pollution, should be encouraged, especially in rural areas.

Cumulative Exposure to Social Isolation and Longitudinal Changes in Life Satisfaction among Older Adults

This study examines the longitudinal association between cumulative exposure to social isolation and life satisfaction and whether this association differs by gender. Using seven waves of the Korean Longitudinal Study of Aging from 2006 to 2018 (3,543 adults aged 65 or older), fixed effects models were estimated. Cumulative social isolation was longitudinally associated with a decline in life satisfaction in older adults. Gender-specific analyses revealed that older women exposed to cumulative social isolation continued to experience a decline in life satisfaction up to the fourth and subsequent waves of exposure (relative to the initial wave in which there was no social isolation; b = −13.038, p < .001). In contrast, a decline in life satisfaction associated with cumulative social isolation was less pronounced among older men ( b = −6.200 for the fourth and subsequent waves of exposure, p < .05). Cumulative social isolation can be a persistent risk factor for life satisfaction in older adults, particularly older women. The study’s findings hold important implications for programs aimed at reducing social isolation and improving psychological well-being among older adults.

Surfing the fourth wave: An examination of faculty motivation(s) to participate in SoTL

AbstractThe purpose of this survey‐based research study was to assess factors that higher education faculty identify as enabling and inhibiting their participation in the Scholarship of Teaching and Learning (SoTL) across multiple U.S‐based institutions of higher education. Within the current “fourth wave” of SoTL, we identify the need for differentiated strategies to facilitate the participation of a wider range of faculty in emerging questions of teaching, learning, and scholarship.

Navigating the waves in Colombia: a cohort study of inpatient care during four COVID-19 waves

IntroductionUnderstanding the intricate dynamics between different waves of the COVID-19 pandemic and the corresponding variations in clinical outcomes is essential for informed public health decision-making. Comprehensive insights into these fluctuations can guide resource allocation, healthcare policies, and the development of effective interventions. This study aimed to compare the characteristics and clinical outcomes of COVID-19 at peak transmission points by including all patients attended during the first four pandemic waves in a referral center in Colombia. Material and methodsIn a prospective observational study of 2733 patients, clinical and demographic data were extracted from the Fundacion Valle de Lili's COVID-19 Registry, focusing on ICU admission, Invasive Mechanical Ventilation (IMV), length of hospital stay, and mortality. ResultsOur analysis unveiled substantial shifts in patient care patterns. Notably, the proportion of patients receiving glucocorticoid therapy and experiencing secondary infections exhibited a pronounced decrease across waves (p < 0.001). Remarkably, there was a significant reduction in ICU admissions (62.83% vs. 51.23% vs. 58.23% vs. 46.70 %, p < 0.001), Invasive Mechanical Ventilation (IMV) usage (39.25% vs. 32.22% vs. 31.22% vs. 21.55 %, p < 0.001), and Length of Hospital Stay (LOS) (9 vs. 8 vs. 8 vs. 8 days, p < 0.001) over the successive waves. Surprisingly, hospital mortality remained stable at approximately 18‒20 % (p > 0.05). Notably, vaccination coverage with one or more doses surged from 0 % during the initial waves to 66.71 % in the fourth wave. ConclusionsOur findings emphasize the critical importance of adapting healthcare strategies to the evolving dynamics of the pandemic. The reduction in ICU admissions, IMV utilization, and LOS, coupled with the rise in vaccination rates, underscores the adaptability of healthcare systems. Hospital mortality's persistence may warrant further exploration of treatment strategies. These insights can inform public health responses, helping policymakers allocate resources effectively and tailor interventions to specific phases of the pandemic.

From the Courts, to the Streets, to the University: Fighting to Save Gender Studies in Pakistan, 2018–2023

Abstract: This article traces the recent growing contestation leveled against the discipline of gender studies in Pakistan. In 2020 a petition was filed in Lahore High Court against the teaching of gender studies in higher education institutions across Pakistan that should be seen as part of the national backlash initiated against feminist struggles/movements in Pakistan. Documenting the narratives of five founding heads of WGS departments through in-depth interviews, I have analyzed how WGS has not only historically but also in contemporary times encountered challenges at various levels. In addition to those interviews (primary data), I also relied on secondary sources to unearth those contestations against WGS. It is reflected in this research that WGS has journeyed through different phases, encountering antagonism and resistance, and eventually received acceptance as a field of study in a society like Pakistan, which is highly patriarchal. Though it has gained acceptance over the period, the struggle experienced by the practitioners and scholars of WGS has remained constant. They are labeled as anti-culturalists and anti-religious and stereotyped as "Westerners" toeing the Western philosophy being part of WGS. These allegations are augmented by the arguments around the scope and marketability of WGS reflecting the systemic realities of the neoliberal economic order, where education is valued on its market and commercial basis. Though the Aurat March of 2018, as theorized by feminist scholars, started the fourth wave of women's rights activism in Pakistan, it faced a huge backlash from the state and society alike. Since WGS vehemently supports women and gender rights activism and movements in general, in Pakistan the backlash was also directed against WGS. It is argued and theorized that the growing contestation and backlash to the Aurat March and WGS in Pakistan should be seen in a global context in recent years where anti-gender discourses (coupled with transphobia) are widely shared and disseminated. This article, therefore, situates these challenges faced by WGS within these local and global realities.

Current wave of opioid crisis run by fentanyl combinations

The fourth wave of the opioid crisis continues to grow increasingly complex, dominated by “fentanyl plus” combinations of drugs that, in some cases, predictably follow historical patterns, and in others, turn logic on its ear. A leading national researcher on drug‐using behavior told ADAW that unlike fentanyl's original imposition into the drug supply, many of the combinations that have emerged since then appear to be demand‐driven, though the “why” of the demand is often hard to pinpoint.