To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Low self-esteem is an important and potentially modifiable risk factor for the development and outcome of psychotic disorders. The factors involved in low self-esteem in psychotic disorders are not yet fully understood. The current study aims to investigate the cross-sectional and longitudinal associations between (changes in) self-esteem and severity of psychotic symptoms, internalized stigma, negative reaction to antipsychotics, personal recovery, childhood bullying, childhood trauma, and social support in symptomatically remitted first-episode psychosis (FEP) patients.
Methods
Data from the ongoing longitudinal Handling Antipsychotic Medication: Long-term Evaluation of Targeted Treatment study were used. Participants were in symptomatic remission for 3–6 months after the FEP. Cross-sectional associations (N = 299) were investigated through Pearson’s correlations, and longitudinal changes (N = 238) were investigated via linear regressions with inverse probability weighting.
Results
Cross-sectionally, we found that lower self-esteem was related to higher severity of symptoms, higher internalized stigma, higher childhood trauma (specifically emotional neglect), higher childhood bullying, more negative side effects of antipsychotic medication, lower personal recovery, and lower social support. Longitudinally, contrary to our hypothesis, we found that higher baseline internalized stigma, higher childhood trauma (specifically emotional abuse), and a higher baseline negative subjective reaction to antipsychotics predicted an increase in self-esteem after 6 months. Furthermore, a decrease in psychotic symptoms, internalized stigma, and negative subjective reaction to antipsychotics, and an increase in social support predicted an increase in self-esteem.
Conclusions
Early intervention programs for psychotic disorders should target factors related to changes in self-esteem. This might improve self-esteem and thereby promote recovery.
Haemonchus contortus, a highly pathogenic gastrointestinal nematode, significantly impacts small ruminant production, causing substantial economic losses in sheep and goat farming. This study examined the genetic diversity and population structure of 171 H. contortus isolates collected from the abomasa of sheep slaughtered across 8 distinct regions in Xinjiang, China. Using sequence analysis, phylogenetic reconstruction and population genetic analyses of the mitochondrial nad4 gene, we identified 163 haplotypes, with haplotype diversity ranging from 0.995 to 1.000 and nucleotide diversity from 0.02007 to 0.03145. The Tacheng population displayed the highest nucleotide diversity. Analysis of molecular variance revealed that 91.83% of genetic variation occurred within populations, with minimal differentiation among them (Fst: −0.01296 to 0.04274). Neutrality tests (Tajima’s D and Fu’s Fs) indicated no recent population bottlenecks. Phylogenetic and haplotype network analyses showed no distinct geographic clustering, suggesting extensive gene flow, likely facilitated by host movement. These findings provide critical insights into the genetic structure of H. contortus in Xinjiang, informing strategies for managing anthelmintic resistance and controlling this economically significant parasite.
To identify host and clinical risk factors contributing to the development of Clostridioides difficile infection (CDI) among colonized patients.
Design:
Retrospective, matched case-control study.
Setting:
Duke University Health System, including 3 hospitals and affiliated outpatient clinics.
Participants:
Adult patients who underwent ≥2 two-step C. difficile tests (nucleic acid amplification test (NAAT) followed by toxin enzyme immunoassay) between 03/15/2020–12/31/2023. Cases were patients with C. difficile colonization (NAAT+/toxin–) who converted to CDI (NAAT+/toxin+) within 90 days; controls were colonized patients who remained toxin-negative. Cases were matched to controls by date of index testing (±1 year).
Methods:
Data collection encompassed a 90-day “pre-exposure” period preceding index testing and a ≤ 90-day “exposure” period between index and repeat testing. Antibiotic use was stratified by risk for each period. Multivariate conditional logistic regression with forward selection was used to identify predictors of progression.
Results:
Among 2,212 colonized patients, 71 cases and 133 matched controls were identified. Several host and clinical characteristics were independently associated with progression to CDI in our multivariate model. Notably, high-risk antibiotic use across the pre-exposure and exposure periods was associated with greater odds of progression to CDI compared to other patterns of antibiotic use (adjusted odds ratio 2.70; P = .03).
Conclusions:
Sustained exposure to high-risk antibiotics was a strong predictor of the progression from C. difficile colonization to infection, underscoring the need for further research on longitudinal stewardship strategies for CDI prevention, particularly among patients previously identified as colonized.
The fetus and neonate are especially vulnerable to toxic effects of polychlorinated biphenyls (PCBs), that have been shown to perturb behavioral and neuropsychological development. This study aimed to examine the long-term effects of developmental exposure to PCBs. Doses selected were environmentally relevant to those found in epidemiological studies, on the central nervous system (CNS) of adult rat offspring. Pregnant Sprague Dawley rats were fed cookies that contained a mixture of fourteen PCBs or vehicle (corn oil) daily. PCB doses were 0.011 mg/kg maternal body weight/day (“low”) or 1.10 mg/kg maternal body weight/day (“high”), for 42 days throughout gestation and lactation. Adult offspring were euthanized on postnatal day 450. A battery of immunohistochemical markers of brain structure and function were selected to assess possible effects of developmental PCB exposure. Using a 3×2 factorial design (treatment and sex), two-way analysis of variance revealed significant effects of treatment through the CNS, with no main effect of sex or interaction effects. In comparison with controls, both low and high dose developmental PCB exposure significantly (p < 0.05) increased inhibitory enzyme glutamic acid decarboxylase (GAD67) immunoreactivity in the cerebellar vermis, and decreased lipofuscin autofluorescence in the locus coeruleus (LC). Low dose developmental PCB exposure significantly decreased the perimeter of endothelial cells in the periaqueductal gray, ventral orbitofrontal cortex; and decreased lipofuscin in the dorsal striatum, compared to controls. Findings support the Developmental Origins of Health and Disease concept, which broadly posits that early-life perturbations may influence health trajectories over the lifespan.
The knowledge of the Social Determinants of Health (SDH) approach implies Health in All Policies and thorough cultural and social transformations, as well as whole-of-government, whole-of-society policies and governance to address health inequities. Nonetheless, this article argues that in the currently dominant rational decision-making model in health policymaking, these policy implications from the knowledge of the SDH approach would lead to an intrinsic contradiction with the logic of modern bureaucracy based on the legal authority as suggested by Max Weber. Using two examples of social determinants of health — universal health coverage and housing issues — this article demonstrates the potential of the polis model proposed by Deborah Stone to take advantage of the knowledge of the SDH approach to pursue structural policy interventions.
Several studies have been published studying association between parental low birth weight (BW) and neonatal outcomes of their children. To date no systematic review and meta-analysis (SRM) has been published to quantify the impact of maternal and paternal BW on outcomes in the next generation. The aim of this SRM was to analyse the association between parental BW and anthropometric and metabolic outcomes in their children.
Electronic databases were searched for studies documenting BW of parents and children with neonatal outcomes. Primary outcome was to evaluate impact of parental BW on occurrence of LBW in children. Secondary outcomes were to assess impact of parental BW on occurrence of macrosomia, small for gestational age (SGA), preterm labour/delivery, and burden of non-communicable disease in later life.
We screened 54,961 articles, data from 14 studies (320,515 parent–child pairs), which fulfilled all criteria, were analysed. Maternal LBW was associated with higher chances of neonatal LBW [odds ratio (OR)1.95 (95% CI:1.56–2.46); P < 0.01; I2 = 91%], neonatal SGA [OR 2.29(95% CI:1.72–3.05); P < 0.01; I2 = 37%], lower chances of neonatal macrosomia [OR 0.50 (95% CI:0.39–0.65); P < 0.01; I2 = 35%] and had no impact on preterm labour/delivery [OR1.20(95% CI:0.67–2.16); P = 0.53; I2 = 88%]. Maternal macrosomia was associated with higher neonatal macrosomia [OR 2.66 (95% CI:2.44–3.16); P < 0.01; I2 = 48%], lower SGA [OR 0.40(95% CI:0.29–0.53); P < 0.01; I2 = 0%] and preterm labour/delivery [OR 0.77 (95% CI:0.63–0.94); P < 0.01; I2 = 4%]. Paternal but not maternal LBW was predictor of metabolic syndrome and diabetes in adulthood.
Maternal LBW is an important predictor of LBW and SGA in neonates. Maternal macrosomia is an important predictor of neonatal macrosomia; is protective against SGA and preterm labour/childbirth. Neonatal size of parents is reflected in neonatal size of their children.
Patient involvement in health technology assessment (HTA) is nascent globally especially in Asia. The aim was to assess patient awareness, involvement, and learning needs of HTA, particularly in Asia.
Method
An online survey assessed HTA awareness, involvement, and learning needs among patients and caregivers across 33 countries from October 2021 to July 2022.
Results
The survey of 170 participants (127 Asians, 43 non-Asians) revealed that 52.3 percent (89 of 170) were unaware of HTA, only 14.1 percent (24 of 170) engaged in HTA, and only 9.3 percent (15 of 161) had received training. The Asian group exhibited significantly lower HTA awareness (mean score 24.6 vs. 30.4, p < 0.05) and had lower participation rates in HTA discussions (10.2 percent, 13 of 127) compared to the non-Asian group (25.6 percent, 11 of 43) (p < 0.05). Among participants without prior HTA training, 68.5 percent (100 of 146) expressed a learning need.
Conclusion
Patient awareness and involvement in HTA were low globally, particularly in Asia. There was a strong patient learning need for HTA globally.
Preserving viable infective stages of chicken ascarids under laboratory conditions facilitates the maintenance of characterized nematode strains for research purposes. We investigated the survivability of Ascaridia galli eggs exposed to low temperatures and the cryoprotectant dimethyl sulfoxide (DMSO). Two egg developmental stages (unembryonated or fully embryonated) were stored at 4°C, –20°, or –80°C in sterile water or with 5% and 10% DMSO for 1, 2, 4, or 8 weeks. Egg survival was assessed by morphology following post-storage incubation in 0.1 N H2SO4 at 26°C for unembryonated eggs or with a viability dye exclusion test of hatched larvae for the embryonated eggs. The results revealed that neither DMSO nor the hardy chitinous eggshell protected eggs from freezing damage, and not a single egg survived even for 1 week of storage at –20° or –80°C. DMSO at 10% significantly reduced (P < 0.0001) overall egg survival and embryonation capacity with increasing storage time at 4°C compared to water alone. For both egg developmental stages, egg survival was maintained in 5% DMSO at a rate similar to that in water alone. Unembryonated A. galli eggs survived refrigeration better than embryonated eggs with larval viability declining linearly at almost a double rate in the latter (9.75%/week) compared to the former (5.64 %/week). We conclude that DMSO is unlikely to provide cryoprotection for A. galli eggs and also causes concentration-dependent toxicity with increasing exposure time. Furthermore, survival during refrigeration is better for unembryonated than embryonated eggs.
The failure to make LAI the default route over the same oral when both are available is a lost opportunity to improve outcomes for people with schizophrenia. A striking example is the lost opportunity to improve life expectancy. A sophisticated pharmacoepidemiologic study from Sweden matched antipsychotic prescriptions with mortality rates and found that receiving an LAI version improved longevity by about 30% compared to its equivalent oral counterpart. Published a decade ago, it seems to have had little impact within US mental health services. This paper attempts to explain some of the reasons for complacency in adapting LAIs as a preferred approach for oral that have an LAI option available. Hypotheses include (1) not appreciating the importance of accurate information to guide present and future treatment recommendations, (2) considering LAIs primarily for adherence interventions rather than their more general benefit as a superior information platform, (3) how fear of disclosing nonadherence is a primary cause of misinformation, and (4) complacency with status quo acceptance of misinformation without fully appreciating how it harms future outcomes. The outcome benefits that come from changing from the oral to the LAI, if available, will continue. Advances in formulation technology have greatly improved the safety and flexibility of recent LAIs compared to earlier formulations, and formulation advances will allow for additional antipsychotics currently limited to oral formulation to expand to having an LAI version readily available.
According to the WHO in 2024, more than 720,000 people die due to suicide every year. With practical, evidence-based interventions, suicides can be prevented. This book addresses and evaluates those strategies in order to address this global health issue. Written by international experts in the field, this book provides global strategies applicable in both High Income and Low/Middle Income country settings. Chapters cover topics such as decriminalisation, the role of intention, the reasons for the excess of male deaths by suicide in High Income countries, and the relationship between suicide and violence. The book emphasises practicality and accessibility, making it an authoritative guide for practitioners and policy makers around the world. This succinct and evidence-based resource is essential reading for those seeking to develop and implement global suicide prevention strategies.
Structural brain alterations in bipolar disorder (BD) have been widely reported, yet the hierarchical organization of cortical morphometric networks and their molecular and cognitive underpinnings remain unclear.
Methods
We applied the morphometric inverse divergence (MIND) network approach to structural MRI data from 49 BD patients and 119 healthy controls. Principal MIND gradients were derived using diffusion map embedding, followed by multiscale analyses linking gradient alterations to neurotransmitter systems, cognitive-behavioral domains, and transcriptomic profiles from the Allen Human Brain Atlas. Validation was performed in three independent, cross-scanner, cross-race, and cross-age validation datasets.
Results
Bipolar disorder patients showed significant principal gradient alterations in the left rostral middle frontal and lateral occipital cortices, with network-level decreases in the ventral attention and motor networks and increases in frontoparietal and visual networks. Gradient alterations spatially correlated with acetylcholine (VAChT) and GABA (GABAA/BZ) systems, and were associated with cognitive processes involving executive control and visual attention. Transcriptomic analyses identified gene sets enriched for BD-related GWAS loci, expressed predominantly in excitatory and inhibitory neurons, astrocytes, and oligodendrocytes, with preferential enrichment in cortical layers III-IV and developmental windows spanning early fetal to young adulthood.
Conclusions
These findings reveal disrupted hierarchical cortical organization in BD and link macroscale morphometric alterations to specific neurotransmitter systems and transcriptional architectures. The MIND gradient emerges as a potential biomarker bridging structural disruptions with molecular and cognitive mechanisms in BD.
Here we report microfossil helminth analysis of soils/sediments from the Cloudman site, Lake Huron, Michigan, encompassing the Early Late Woodland (AD 500/600–1000) to the early Historic period. Results reveal eggs of the dog nematode Toxocara canis (a first for North America), the human nematode Ascaris lumbricoides, and a species of taeniid cestode, intestinal parasites that could have affected the health of people and their domesticated dogs. The eggs suggest that the presence of dogs at the site remained relatively stable over the c. 1000-year span of this period. The results offer a new line of evidence for possible dog presence and domestication in North America.
Consultation-liaison psychiatry (CLP) refers to the subspecialty of psychiatry and the specialist clinical services that deliver care at the intersection of mental and physical healthcare. CLP services provide specialist medical and multidisciplinary expertise for managing conditions in these areas of mental and physical healthcare overlap, and comorbidity. The Model of Care for CLP was identified as a key priority in Sharing the Vision, the 2020 national mental health policy in Ireland. Following four years of work by a writing group initiated by the Faculty of Liaison Psychiatry at the College of Psychiatrists of Ireland, the Model of Care for CLP in Ireland was launched in May 2025 (Cpsychi H (2025). Consultation-Liaison Psychiatry: A Model of Care for Ireland. Dublin: HSE.).). Consultation-Liaison Psychiatry: A Model of Care for Ireland. Dublin: HSE.). This reflects the collaborative efforts between the Liaison Faculty and the Irish Health Service Executive (HSE). This Model of Care, developed in collaboration with clinicians and patients, the College of Psychiatrists of Ireland, and the HSE, provides a potential template for future collaborations in the development and implementation of National Mental Health policy.
We aim to investigate nutritional management of chyle leaks by a systematic review of the published literature.
Methods
We searched the following databases (Medline, Embase, Cochrane) for literature incorporating nutritional aspects in chyle leak management. We excluded non-English papers, paediatric studies, conference papers, and studies without nutritional intervention.
Results
Among 260 patients (out of 26,270), 81.5.% (n=212/260) achieved chyle leak resolution with nutritional management, while 18.5% (n=48/260) required surgery. Median resolution duration with nutritional management was 8.7 days (range: 4.3 to 22.2), compared to surgical treatment’s median of 32 days (range: 18 to 40).
Conclusion
We recommend use of nutritional management in all patients with chyle leaks. There is no evidence supporting one diet over the other however clinically we suggest starting with medium–chain triglyceride/non–/low–fat diets and moving onto total parenteral nutrition, unless medically indicated otherwise.
The concept partnership has developed since Sherry Arnstein first created the ladder of citizen participation. Within mental health discourse, this was first acknowledged by “A Vision for Change” (2006) and later, through adopting co-production (2017). In 2011, the College of Psychiatrists of Ireland, created a collective called Recovery Experience Forum of Carers and Users of Services (REFOCUS) which became a leading example of partnership between stakeholders in the organisation. However, REFOCUS’s impact on stakeholders needs to be examined.
Methods:
A qualitative investigation using an autoethnography methodology is proposed. The approach allows for the interweaving of personal experiences with culture to create new knowledge. A focus group was conducted, and transcripts were subject to reflexive thematic analysis.
Results:
Seven out of fourteen participants, representing all three stakeholders, were available at time of interview. From the process of reflexive thematic analysis, five themes were constructed. Each with a number of sub-themes attached, which in turn represented stakeholder perspectives regarding REFOCUS.
Discussion:
This paper highlights several issues that need addressing in future research on REFOCUS. The paper demonstrates the continuous presence of stigma within Irish mental health services. However, it also highlights a number of beneficial aspects to REFOCUS including informal peer support, service users, and family member involvement in college activities as well as increasing meaning and purpose in one’s life along with a renewed identity different to that of the service user or family member.
Exposure to certain parasites can occur when hosts encounter clumps of infective larvae during ingestion. Compared to more typical transmission pathways involving the cumulative penetration or ingestion of single larvae, clumped transmission can be expected to lead to complex and variable epidemiological patterns of infection within exposed hosts. We explored this idea in a spatiotemporal survey of wood ants (Formica spp.) infected with metacercariae of the host-manipulating trematode, Dicrocoelium dendriticum. Ant second intermediate hosts are exposed to clumps of cercariae during ingestion of ‘slimeballs’ that are released onto pasture by land snail first intermediate hosts. In a total sample of >650 ants collected during the host-manipulation phase when ants were attached to plants, metacercariae prevalence was 97% and mean intensity was 27 ± 25 (range in intensity = 1–168; variance:mean ratio = 23.1). None of the observed variation in mean metacercariae intensity could be attributed to year (2021, 2022), month (May to August), or nest. Although the recruitment of metacercariae into ants occurred within a narrow window of transmission each summer, the mixed-age structure of our ant samples likely limited our ability to detect seasonal patterns of mean intensity. The absence of significant spatiotemporal patterns in metacercariae intensity in samples of ants likely also reflects infrequent and variable rates of encounter with cercariae-containing slimeballs by individual ants.
Disasters significantly challenge societal resilience, individual psychological health, and sustainable development. This study aimed to culturally adapt the Disaster Adaptation and Resilience Scale (DARS) into Turkish and evaluate its psychometric properties for use in Türkiye. Participants (N = 335) aged 18 and older who had experienced a disaster in the past 5 years completed the Turkish version of the DARS following rigorous translation and expert review procedures. Exploratory and confirmatory factor analyses revealed a 5-factor structure: Problem-Solving, Optimism, Stress Management, Social Resources, and Physical Resources, accounting for 61.3% of the total variance. Internal consistency was high (Cronbach’s Alpha = 0.910), with subscale values ranging from 0.785 to 0.901. Test-retest reliability and discriminant validity were also established. The Turkish DARS is a valid and reliable tool for evaluating disaster-related adaptation and resilience. Its implementation supports sustainable mental health responses and community preparedness in disaster-prone regions.
Early life adversity (ELA) is common and cross-sectionally associated with brain gray matter structure, including cortical thickness, cortical surface area, and subcortical volumes in childhood. However, to which degree ELA influences the trajectory of gray matter macrostructural and microstructural development during childhood and adolescence remains largely unexplored.
Methods
We included 6414 participants from the Adolescent Brain Cognitive Development study at ages 9–11, where 1923 were followed to ages 11–13. We used linear mixed-effects models to test for associations between MRI-derived longitudinal measures of gray matter macro- (cortical thickness, surface area, subcortical volume) or microstructure (T1w/T2w ratio) and trauma exposure, parental acceptance, household abuse, and being resilient or susceptible to trauma in terms of developing an internalizing disorder.
Results
At ages 9–11, higher levels of parental acceptance, trauma exposure, and being trauma resilient were associated with lower levels of cortical thickness. In contrast, being trauma susceptible was negatively related to hippocampal volume and cortical surface area. Longitudinally, more parental acceptance at baseline was associated with more cortical thinning between ages 9–11 and 11–13, while more household abuse was associated with less change in T1w/T2w ratio over time.
Conclusions
Parental acceptance and trauma resilience are linked to accelerated pace of apparent cortical thinning in youth aged 9–13 years, while household abuse is associated with slower microstructural development, as reflected by smaller longitudinal changes in the T1w/T2w ratio. Threat and deprivation may be distinctly associated with gray matter developmental trajectories in late childhood.