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Methamphetamine use disorder (MUD) has risen among women globally and is disproportionately higher in prisons. In Indonesia, correctional facilities still lack any structured and evidence-based psychological therapy. To address this gap, we developed the Indonesia Substance Use Reduction for Female Therapy (Indo-SURFT).
Methods:
A single-arm unblinded design with a 3-month follow-up was conducted among incarcerated women with MUD. Participants completed 12 sessions over six weeks. Assessments included user perception ratings, Addiction Severity Index (ASI), Visual Analog Scale for craving, University of Rhode Island Change Assessment Scale, Self-Reporting Questionnaire-20 (SRQ-20), and WHO Quality-of-Life Brief (WHOQOL-BREF).
Results:
A total of 33 incarcerated women with MUD participated and the median age was 35 (21–57). All of the participants had complete attendance during the 6-week program. By week 12, participants rated the Indo-SURFT module as useful (Mdiff = 0.484, 95%CI [0.235, 0.732], p < 0.001, d = 0.482). Employment-related ASI scores improved post-intervention (B = −0.076, p = 0.002) and at follow-up (B = −0.106, p = 0.004). Psychiatric domain of ASI remained stable post-intervention but increased after follow-up (B = 0.200, p ≤ 0.001). Craving declined post-treatment but rose at follow-up (B = 1.247, p = 0.036). SRQ-20 increased over time, while WHOQOL-BREF declined.
Conclusions:
Indo-SURFT is tolerable and feasible for women with MUD in incarceration. Participants highly rated the module and delivery. The module demonstrates initial improvement in functional domain and curbs craving level during treatment. Maintenance sessions may be required to fully maintain and enhance improvements. These findings support Indo-SURFT’s as a potential intervention but requires further multisite investigation to enhance generalizability.
To examine systemic challenges to health system resilience in Puerto Rico following Hurricane Maria, focusing on resource, management, and policy domains.
Methods
Semi-structured interviews (n = 62) were conducted from January to April 2023 with health care professionals, patients, community leaders, nonprofits, and government stakeholders using purposive sampling. Interviews were conducted in Spanish, transcribed, translated, and thematically analyzed.
Results
Resource failures centered on prolonged power outages (mean 62.7 days; up to 300 days), which cascaded into water, transport, and communication breakdowns. These disruptions endangered patients through interrupted surgeries, inoperable imaging, oxygen shortages, and infection control failures. Management challenges included depleted stockpiles, staff burnout, and workforce migration, which extended wait times to 6-8 months. Coordination was inconsistent, with duplication of aid in some areas and neglect in others, while top-down governance slowed response. Policy constraints compounded vulnerabilities: health insurance pre-authorizations delayed urgent care, capped Medicaid funds, and lack of federal parity, limited preparedness, and centralized aid distribution left rural communities underserved.
Conclusions
Puerto Rico’s health system resilience was undermined by interdependent failures across infrastructure, management, and policy. Building resilience will require investment in decentralized power, reforms to emergency insurance protocols, stronger inter-agency coordination, and equitable federal financing to ensure preparedness for future climate-related disasters.
In a parasitological survey conducted in 2025 at a fish farm in Kunming, southwest China, a new diplozoid species was discovered on Garra surgifrons, representing the first record of a diplozoid previously reported from fish within the genus Garra in China. Morphological and molecular evidence confirm that the new species is clearly differentiated from Paradiplozoon bingolensis, the only diplozoid previously reported from Garra fishes. Phylogenetic analyses place the new species at the basal position of Chinese Paradiplozoon species. Considering the natural distribution of its host in Yunnan province and adjacent areas of Myanmar and Laos, southwestern China and Southeast Asia may represent important centres of origin and diversification for East Asian Paradiplozoon species. This study highlights the underestimated diversity, host specificity and biogeographic structure of diplozoids in East Asia and underscores the need for expanded sampling in Yunnan and neighbouring Southeast Asian regions.
Although peer support is increasingly used in mental health services worldwide, service users’ experiences have been studied mostly in high-income countries. The current study examined service users’ experiences of peer support in the UPSIDES Trial, delivered across diverse cultural and resource contexts, including high, middle and low-income countries. Semi-structured interviews were conducted with 33 service users across six study sites (Germany [two sites], Uganda, Tanzania, Israel, and India) and analyzed using thematic analysis to identify patterns in participants’ experiences. To capture diverse perspectives, service users were purposively sampled based on pre–post changes in social inclusion and personal recovery, with participants randomly selected from the top and bottom 20% (‘high’ and ‘low’ responders). Four themes emerged: (1) adaptable settings and intervention flexibility; (2) ‘active ingredients’ such as mutuality, reciprocity, and role-modeling; (3) positive intra-personal, inter-personal, and behavioral outcomes; and (4) barriers, including mismatches, unmet expectations, unclear boundaries and challenges to continuity. The study highlights shared relational elements of peer support alongside context-specific adaptations. Findings reinforce its value as a complementary, person-centred service with global relevance, while pointing to challenges including improving matching, reducing dropout, and clarifying expectations. Site-specific aspects are discussed, offering insights for global implementation.
Although lithium has been used effectively as a medication to treat bipolar and major depressive disorders, there are limited data defining lithium use patterns during pregnancy.
Aims
To investigate trends and patterns of lithium prescribing in the perinatal period (before, during and after pregnancy) among pregnancies in the UK.
Method
We conducted a population-based study using primary healthcare records from the Clinical Practice Research Datalink GOLD, analysing 752 112 pregnancies during the period 1995–2018. We assessed the prevalence and patterns of lithium prescriptions, including discontinuation, continuation and dosage. Maternal characteristics were defined for lithium non-users and users, and between those who continued and discontinued use.
Results
From 1995 to 2018, the prevalence of lithium prescribing per 10 000 pregnancies was 3.02 (95% CI: 2.64, 3.44) before pregnancy, 1.89 (95% CI: 1.59, 2.23) during pregnancy and 2.81 (95% CI: 2.44, 3.21) postpartum. Prescribing during pregnancy was low across the study period, with the most recent prevalence in 2018 of 1.03 (95% CI: 0.26, 4.11) per 10 000 pregnancies. Among 337 pregnancies with perinatal lithium prescribing, 48.4% involved a diagnosis of bipolar disorder. Of 227 pregnancies where lithium was prescribed preconception, 15.4% continued treatment throughout pregnancy; discontinuation occurred before pregnancy in 20.7%, and during second or third trimester in 30.8%; 33.0% followed other prescribing patterns. Women who discontinued lithium were more likely to be younger, have a body mass index ≥30 kg/m2, a diagnosis of bipolar disorder, a history of smoking and >10 primary care consultations in the 12 months preconception, compared with those who continued treatment.
Conclusions
Lithium prescribing during pregnancy in the UK is uncommon and discontinuation is frequent, particularly in the later stages of pregnancy. These findings highlight the need for proactive perinatal mental healthcare strategies and close clinical monitoring, to reduce unintentional first-trimester exposure while ensuring continuity of care for maternal mental health.
Zoonotic parasites are a growing concern in regions where humans, domestic animals and wildlife live in close proximity. Understanding parasite communities overlap across hosts is essential for understanding transmission risks. In this study, we used sedimentation technique followed by microscopy, and molecular techniques for the identification of strongylid nematodes, Strongyloides, and protists in vervet monkeys (Chlorocebus pygerythrus, N = 75), household latrines (N = 25), dogs (Canis lupus familiaris, N = 25) and livestock (Ncows = 9, Ngoats = 7, Npigs = 9) at Lake Nabugabo, Uganda to compare parasite assemblages across hosts within the same habitat. We identified 33 unique parasite taxa with 18 in dogs, 14 in livestock and 10 each in vervets and latrine samples. There was a significant difference in the parasite infection rate between vervets (88%), latrines (24%), livestock (44%) and dogs (40%). Samples harboured at least 7 known genera of strongylid nematodes, with Ancylostoma, Murshidia and Oesophagostomum being the most prevalent. Protists diversity varied across hosts. Species-specific Cryptosporidium taxa occurred in dogs, goats (Capra aegagrus hircus) and pigs (Sus scrofa domesticus), and C. andersoni was detected in both dogs (4%) and cows (Bos taurus, 8%). Giardia intestinalis assemblage A was found in vervets (1.3%), dogs (16%) and latrine samples (12%). Enterocytozoon bieneusi occurred only in latrine samples, while Encephalitozoon sp. occurred only in vervets (4%). Our results show limited overlap between vervets and other hosts but highlight shared Giardia among animals and latrine samples, indicating key points of potential zoonotic transmission in this human-modified landscape.
Despite rising life expectancies and growing attention to the increasing proportion of older persons in rich democracies, we still know surprisingly little about how people develop after 60. This book proposes an integrative approach to development in older age that expands sociocultural psychology across the life course. It shows that people develop into older age while acting, feeling, remembering, imagining, and moving in the spaces where they live and interact with others. The diversity and singularity of ageing trajectories is also studied, highlighting how deeply the environment can guide and support as well as expand upon or offer resources to older persons. The author demonstrates the role of carefully designed social and institutional settings and well-planned ageing policies in fostering 'ageing in place'. By exploring housing, formal and informal care networks, and everyday arrangements that help older persons live meaningful lives, this volume speaks to anyone concerned with ageing.
Differences in testes arrangement and length of post-testicular region between Australian specimens of Paraschistorchis seychellesiensis sensu Magro, Cutmore, Carrasson & Cribb, 2023 and the original description of Paraschistorchis seychellesiensis (Toman, 1989) Blend, Karar & Dronen, 2017 from the Indian Ocean have raised a question whether such variations are intraspecific or interspecific variations. To address this, in-depth morphological descriptions and species delimitation analyses were conducted using a combination of comparative morphology, multivariate classification analyses, and host-parasite data. The Australian population of P. seychellesiensis differs from all known species of Paraschistorchis Blend, Karar & Dronen, 2017 by a broad linguiform body, a ventral sucker noticeably smaller than the oral sucker, a subquadrate pharynx that is partly dorsal to the oral sucker, and testes arrangement in a cluster configuration, as well as its distinct spatial clustering within all multivariate classification analyses without any intrusion into the space occupied by another cluster. Furthermore, the distinctive extension of the anterior vitellarium, significant differences in anterior testis/ovary ratios, and egg sizes indicate that Australian and Indian specimens of P. seychellesiensis are two distinct species. The apparent comparatively distant geographic localities, each with distinct ecosystems (Seychelles Islands vs Great Barrier Reef [GBR], Australia), are an interesting outcome of the recognition of separate species. Accordingly, Paraschistorchis australiensisn. sp. is established to accommodate this Australian record. Given the detailed review and newly added data provided herein, we discuss the nature of the excretory vesicle within schistorchiines and amend the key to the recognized species of Paraschistorchis.
Military veterans (ex-serving members of the Armed Services) experience unique physical and mental health challenges, with diet playing a critical role in chronic disease management and well-being. This review aimed to evaluate veterans’ dietary intake against nutrient reference values (NRV) relevant to age and sex. A systematic search of CINAHL, MedLine, Scopus, PubMed and AMED (January 2024, updated March 2025) identified 1268 records; thirty-three studies (n 654 323) met inclusion criteria. Eligible designs included cross-sectional, cohort, quasi-experimental and randomised controlled trials. Data were extracted using the Joanna Briggs critical appraisal checklist, indicating low risk of bias. Across studies, veterans’ intake of fibre, folate, vitamin D, Ca, potassium, fruits, vegetables, wholegrains and legumes was consistently inadequate, with overall diet quality rated poor to average. BMI ranged widely, and veterans reported high rates of mood disorders and low quality-of-life scores. These findings highlight key nutrients and dietary patterns that might be considered and targeted in dietary and lifestyle interventions for promoting the physical and mental health of veterans.
The coexistence of substance use disorders (SUD) and other mental disorders – commonly referred to as dual disorders (DD) – is highly prevalent and clinically significant. Although various terms have been used over time (e.g., psychiatric comorbidity, dual pathology), the lack of a standardised definition has created inconsistencies in diagnosis, communication, research, and treatment. Epidemiological studies estimate that 30–80% of individuals with SUD have co-occurring psychiatric disorders, with prevalence depending on the substance involved, gender, age, and the population studied (general population, people in emergency rooms, mental health addiction facilities, harm reduction facilities, prison). Compared to individuals with a single disorder, people with DD exhibit more severe psychopathological symptoms, higher suicide risk, increased relapse rates, poorer treatment adherence, more medical comorbidities, and worse psychosocial outcomes, including unemployment, homelessness, and social exclusion. Despite extensive evidence, both SUD and other mental disorders often remain underdiagnosed and undertreated, partly due to diagnostic complexities such as overlapping symptomatology and the syndromic nature of psychiatric classifications. Additional barriers include the structural separation between mental health and addiction services and limited integrated care expertise. The “wrong door syndrome” exemplifies how patients are frequently directed to services unable to address both conditions, leading to suboptimal outcomes. Furthermore, individuals with DD are often excluded from clinical research, limiting the evidence base for tailored interventions. Improving the detection and treatment of DD is a major challenge for mental health and addiction systems. Integrated, holistic treatment approaches from the outset are essential to optimise outcomes for this highly vulnerable population.
While chrono-nutrition behaviours are inter-related, few studies examined patterns of chrono-nutrition behaviours using a comprehensive set of these behaviours. This study aimed to identify chrono-nutrition behaviour patterns and examine their associations with sociodemographic characteristics, diet quality and obesity. This cross-sectional study included 1047 Japanese adults aged 20–69 years. Using 11-d diaries of eating, chrono-nutrition behaviours (such as frequency and timing of eating) were evaluated for workdays and non-workdays separately. Principal component analysis identified four patterns: ‘early, large breakfast on workdays’, ‘skipping breakfast on non-workdays’, ‘frequent snacking with small dinner’ and ‘early last eating with large lunch’. Female sex was associated with the ‘frequent snacking with small dinner’ and ‘early last eating with large lunch’ patterns; male sex was associated with the ‘skipping breakfast on non-workdays’ pattern. Age was positively associated with the ‘skipping breakfast on non-workdays’ and ‘early last eating with large lunch’ patterns. Having a full-time paid job was associated positively with the two patterns characterised mainly by breakfast but inversely with the remaining two patterns. After adjustment for potential confounders, none of the four patterns were significantly associated with diet quality (Healthy Eating Index-2020 score), general obesity (BMI ≥ 25 kg/m2) or abdominal obesity (waist circumference ≥ 90 cm for males; ≥ 80 cm for females). In conclusion, this study suggests that different chrono-nutrition behaviour patterns were differentially associated with sociodemographic characteristics, but not with diet quality or obesity. Further research is needed to clarify if the patterning approach is useful to comprehensively interrogate chrono-nutrition behaviours.
Electroconvulsive therapy (ECT) is an established intervention for severe or treatment-resistant psychiatric illnesses, including depression, schizophrenia, mania and catatonia. Despite its efficacy, concerns over its risks have contributed to ongoing stigma and hesitancy regarding its use. Traditional clinical trials have demonstrated the superiority of ECT in symptom reduction compared with other treatments, yet are impractical for assessing rare or long-term outcomes. Observational studies using administrative health data can assess rare or long-term outcomes, but are limited by confounding/bias. This review synthesises evidence from studies utilising administrative health data and modern statistical methods to address clinically relevant questions about ECT’s association with (a) dementia, (b) major adverse cardiovascular/cerebrovascular events, (c) suicide deaths and (d) all-cause mortality. Most studies indicate that, after adjusting for confounding, ECT does not increase the risk of dementia or major adverse cardiovascular/cerebrovascular events. Furthermore, ECT is likely associated with a substantial reduction in suicide mortality and all-cause mortality. Although observational studies cannot fully eliminate unmeasured confounding, the consistency of the findings from diverse investigators and congruence with clinical trials and neuroimaging studies lends support to their validity. These modern observational studies have yielded results that reinforce ECT’s safety and efficacy supporting its position as a life-saving treatment.