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Adolescent depression often presents with somatic complaints, and its clinical manifestation is strongly shaped by cultural context. In non-western districts, psychological distress is frequently expressed through physical symptoms; a tendency that, combined with mental health stigma and culturally influenced health beliefs, complicates accurate detection, diagnosis and treatment. Standardised diagnostic tools developed in Western populations may overlook culturally specific symptom patterns, contributing to under-recognition and inadequate care. Despite the global impact of adolescent depression, cross-cultural symptom-level studies remain limited, hindering the development of culturally responsive mental health strategies.
Aims
This study aims to compare somatic-depressive symptom networks in Chinese and Rwandan adolescents using symptom-level network analysis, to identify culturally distinct central and bridge symptoms, and to assess structural differences between symptom networks across groups.
Method
A cross-sectional sample of 3830 adolescents (China: n = 2017, mean age 15.35 ± 1.56; Rwanda: n = 1813, mean age 15.80 ± 1.90) completed culturally adapted versions of the Patient Health Questionnaires for somatic symptoms (PHQ-15) and depression (PHQ-9). Gaussian Graphical Models were estimated in R to construct symptom networks. Centrality measures (expected influence and bridge expected influence) were used to identify influential symptoms within each group. Network Comparison Tests were conducted to examine differences in global strength and network structure, and bootstrapping was employed to assess network stability.
Results
Depressive symptoms were more prevalent among Rwandan adolescents (54.6%) than among Chinese adolescents (29.2%), whereas somatic symptoms were more commonly reported by Chinese participants (71.0% v. 64.0%). Low energy and sleep problems emerged as key bridge symptoms in both groups. Cultural differences were observed in central symptoms: psychomotor impairment and chest pain were central symptoms in Rwanda, whereas dizziness and headaches were central in China. Network structure differed significantly between groups (S = 0.99, p < 0.05), with culturally specific symptom connections.
Conclusions
The findings revealed distinct central and bridge symptoms in Chinese and Rwandan adolescents, reflecting culturally patterned architectures of symptom expression and distress reporting. These results highlight the need for culturally adapted screening tools and symptom-level interventions that target culture-specific symptoms to improve adolescent mental health care globally.
Contemporary just war theory is increasingly remote from the grounded realities of warfare. This is problematic because it diminishes the utility of just war theory as an action-guiding framework. This article asks how just war theorists can better incorporate the lived experience of war into their analysis. The argument it develops places war writing front and center. Drawing inspiration from Martha Nussbaum’s argument that moral philosophers should use the literary works of writers such as Henry James to fill out and work through their own positions, it proposes that just war theorists should engage war memoirs in a similar manner. This argument is substantiated via a close reading of Frank Richards’s World War I memoir, Old Soldiers Never Die. By incorporating experience into their ethical frame, this article concludes, just war theorists will be better able to account for the ambiguity and messiness of combat—ambiguity and messiness that simply fall out of the frame when the ethical questions that war generates are examined from a detached perspective.
Children with cyanotic CHD experience chronic hypoxaemia and recurrent medical interventions that may adversely affect health-related quality of life.
Aims:
To compare health-related quality of life between children with cyanotic CHD and healthy peers in Sulaimani, Iraq.
Methods:
A hospital-based case–control study was conducted between October 2023 and April 2024, including 200 children with cyanotic CHD and 200 age- and sex-comparable healthy controls aged 3–13 years. Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL™), including the Generic Core Scale Version 4.0 and the Cardiac Module Version 3.0, through parent-reported interviews. Group differences were examined using independent-samples t-tests and analysis of covariance, adjusting for age, sex, peripheral oxygen saturation (SpO2), and educational level.
Results:
Children with cyanotic CHD had significantly lower health-related quality-of-life scores across all domains compared with healthy children (all p-values < 0.001). After adjustment, the largest differences were observed in physical functioning and total quality of life, with large effect sizes (partial η2 = 0.50 and 0.63, respectively). Mean SpO2 levels were also significantly lower among children with cyanotic CHD (p < 0.001).
Conclusions:
Cyanotic CHD was independently associated with substantial impairment in quality of life across physical and psychosocial domains. Lower peripheral oxygen saturation (SpO2) was independently associated with poorer health-related quality of life. These findings support integrating health-related quality-of-life assessment and multidisciplinary care into the routine management of children with cyanotic CHD.
When religion and politics become entangled with each other, which one has the upper hand? Do politicians simply instrumentalize religion for their own purposes? Or does involvement with religion constrain what politicians can get away with? If it does, is that because of the content of religious doctrine? Or is it simply because religious movements, like any other coordinated movements of citizens, have political weight?
While the neoliberalisation of social democracy has been extensively studied, the embrace of neoliberal ideas and policies by Christian Democratic parties has received far less attention. This article examines the contested early stages of neoliberalisation among West German and Austrian Christian Democrats during the 1970s and 1980s. Focusing on two prominent advocates of neoliberalism within these parties – Franz Josef Strauß and Wolfgang Schüssel – it traces the influence of their ideas at a time when Christian Democrats were in opposition and seeking to renew their electoral appeal. Particular attention is paid to the role of the transnationalisation of Christian Democracy in facilitating the gradual diffusion and adoption of neoliberal positions. By doing so, the article sheds light on an understudied chapter in the history of Christian Democracy, one that is crucial for understanding both the transformation of Christian Democracy since the post-war era and the long-term development of centre-right parties in Europe.
Addicts, an already vulnerable population, can be made worse off by certain kinds of popular and well-intentioned research programs and beliefs about addiction, agency, and responsibility. Perspectives of backwards-facing responsibility that focus on blameworthiness and liability highlight the injustices that addicts have faced. Likewise, the disease model of addiction, pursued as an alternative to the stigmatization and moralization of the choice model, takes responsibility away from the addict. However, each of these fails to help the addict to recover or to care for herself. If anything, embracing these perspectives and models can rob addicts of agency and lead them to further suffering. Drawing on feminist philosophy, this paper shows there is good evidence for us to reconsider those models and perspectives, and instead ask what kind of understandings about addiction aid in fostering agency and recovery.
L’affaire Canada et Pays-Bas c Syrie devant la Cour internationale de Justice (CIJ) repose sur des accusations de violations systématiques de la Convention contre la torture et autres peines ou traitements cruels, inhumains ou dégradants par la Syrie. Ces violations s’inscrivent pourtant dans un contexte également marqué par des atteintes massives au droit international humanitaire (DIH), qui ne font toutefois pas l’objet de la procédure engagée devant la Cour. Cette absence soulève une question: pourquoi le DIH, cadre juridique de référence en situation de conflit armé, n’a-t-il pas également été mobilisé dans cette affaire ? Pour y répondre, l’article met d’abord en lumière le rôle que la CIJ peut jouer dans la promotion du respect du DIH, avant d’examiner les contraintes juridictionnelles qui ont empêché l’invocation de ce régime juridique dans cette affaire. Après avoir identifié ces contraintes, il analyse comment le DIH pourrait néanmoins jouer un rôle indirect dans la procédure, notamment comme outil interprétatif. L’article soutient que, même en l’absence de compétence directe de la Cour pour en connaître, un tel recours au DIH contribuerait à en promouvoir le respect. Au-delà de cette dimension interprétative, l’article s’intéresse enfin aux mécanismes complémentaires susceptibles de soutenir la mise en œuvre du DIH et la lutte contre l’impunité en Syrie. Il conclut que, bien que la procédure engagée devant la CIJ constitue une avancée importante pour la justice internationale, elle demeure insuffisante sans une mobilisation parallèle du DIH et d’autres mesures complémentaires. Pour autant, loin de représenter une occasion définitivement manquée de renforcer le respect du DIH, cette affaire devrait plutôt être envisagée comme une étape vers une approche plus globale, où l’action contentieuse intentée devant la CIJ s’articulerait avec d’autres efforts afin de garantir une justice plus large et renforcer le respect du droit international des droits humains et du DIH en Syrie.
The infection fatality risk indicates the probability of death among infected individuals. The age-dependent heterogeneity of infection fatality risk is crucial for severity assessment and prioritization of countermeasures. However, infection fatality risk estimation requires infection data from a large-scale seroepidemiological survey combined with either direct ascertainment of deaths caused by infection or excess mortality estimates. To overcome the difficulty in ascertaining death, we propose an alternative approach to estimating the age-specific infection fatality risk for SARS-CoV-2 using medicolegal death investigation data in Tokyo with systematic post-mortem polymerase chain reaction testing. We integrated (i) polymerase chain reaction positivity among all deceased individuals at the Tokyo Medical Examiner’s Office, (ii) age-specific all-cause mortality risks from vital statistics, and (iii) age-stratified cumulative infection risks derived from seroepidemiological surveys. Infection fatality risk was computed using Bayes’ theorem. Results showed that infection fatality risk increased steeply with age. Our estimates (0.02% for ages 0–39 years, 0.30%–0.50% for ages 40–64 years, and 3.8%–4.2% for those aged ≥65 years) were consistent with published pre-vaccination meta-analytic estimates. Systematic testing within medicolegal death investigation systems can provide rapid, age-resolved severity assessments, improving the timeliness and comparability of infection fatality risk estimation across jurisdictions.
Cognitive complaints in body dysmorphic disorder (BDD) remain poorly characterized. This study examined subjective cognitive complaints across clinical and community BDD samples.
Methods
A two-stage exploratory design was used. Study 1 included a clinically diagnosed BDD sample (n = 15) and healthy controls (n = 29). Study 2 comprised a large international community sample reporting clinically significant BDD symptoms (N = 433). Participants completed BodyThink, an exploratory BDD-focused measure of subjective cognitive complaints. In Study 1, additional clinical and performance-based cognitive measures contextualized subjective reports.
Results
Across both studies, endorsed items spanned multiple cognitive domains, with processing speed, attention, memory, executive functioning, and social cognition items consistently reported. Processing speed complaints were particularly salient. In Study 1, individuals with BDD reported markedly elevated cognitive complaints relative to controls, with large group differences (d = 1.64–1.95) on both BodyThink and an established measure of subjective cognition. Cognitive complaints showed a preliminary association with perceived social self-efficacy (ρ = −.71) but not with BDD symptom severity, objective cognitive performance, or emotional distress. Across both samples, social cognition items were disproportionately endorsed during symptom exacerbation.
Conclusions
Individuals with BDD reported markedly elevated cognitive complaints relative to controls, with substantial individual variation. Patterns were broadly consistent across symptom severity, with social cognition difficulties showing greater salience during symptom exacerbation. The variability in complaints highlights the importance of individualized assessment, while associations with perceived social self-efficacy suggest that cognitive complaints may reflect negatively biased self-appraisals that may be relevant to treatment engagement.
Given a countable group A with trivial bounded cohomology for all semi-separable coefficients and any group $\Gamma$, we prove that the bounded cohomology of certain restricted verbal wreath products $\Gamma \wr^{_W} A$ vanishes in positive degrees, for all semi-separable coefficients. Examples of such verbal wreath products include the standard restricted wreath product (extending a recent result by Monod for lamplighters groups) as well as verbal wreath products arising from n-solvable, n-nilpotent and k-Burnside ($k = 2,3,4,6$) verbal products. Moreover, we prove that the stable commutator length of any verbal wreath product $\Gamma \wr^{_W} A$ vanishes. As an application, we show that every group of type $F_p$ isometrically embeds into a group of type $F_p$ with vanishing bounded cohomology in degree $n\geq 1$ for all semi-separable coefficients.
Researchers have speculated that proficiency in a language could affect the production of both referential and beat gestures. The primary purpose of the present study was to test whether bilinguals produced more referential and beat gestures than monolinguals, particularly in their second language. We also tested for possible effects of culture on gesture production by comparing speakers of both Farsi and Canadian French (on the one hand; English on the other). In the present study, Farsi–English bilinguals’ gesture production when telling a story was compared to that of French–English bilinguals and English monolinguals. We found effects of proficiency on gesture production: participants tended to use more beats in their second language than in their first. We also found effects of culture: Farsi–English bilinguals used fewer referential gestures in both languages than the other participants. We discuss these results in light of the multiple factors that contribute to gesture production.