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.
Mental disorders are intergenerationally associated, particularly affecting adolescent offspring. However, the extent of such intergenerational associations among adult women in China remains unclear. This study aimed to examine the intergenerational associations of depression and anxiety between two adult female generations.
Methods
This cross-sectional study included 2,130 grandmother-mother dyads from the Grandmothers, Mothers, and Their Children’s Health study. Depression and anxiety of the grandmaternal (G0) and maternal (G1) generations were assessed using the 10-item version of the Center for Epidemiologic Studies Depression Scale and the 7-item Generalized Anxiety Disorder Scale, respectively, with scores of 10 or higher defined as depression and anxiety. Statistical analyses included logistic regression, negative binomial regression, and restricted cubic spline analyses.
Results
A total of 11.4% G0 and 11.5% G1 participants reported depression, and 4.1% G0 and 3.1% G1 participants reported anxiety. Depression in G0 was associated with 4.29-fold (95% CI: 3.09–5.94) and 3.50-fold (95% CI: 1.98–6.01) higher odds of depression and anxiety in G1, respectively, while anxiety in G0 was associated with 3.95-fold (95% CI: 2.41–6.35) and 5.47-fold (95% CI: 2.64–10.60) higher odds of depression and anxiety in G1, respectively; dose–response relationships were also observed. In addition, the intergenerational association of depression was stronger among G0 participants residing in rural areas, whereas G0 depression and anxiety were more strongly associated with anxiety in G1 among those with higher household income.
Conclusions
Mental disorders were intergenerationally associated between mothers and their adult daughters. These findings emphasize the importance of family-based interventions for mental health.
Despite the growing global burden of mental health conditions, nationally representative data in low- and middle-income countries remain limited. Using data from the 2024 Uganda National Population and Housing Census, this study examined the prevalence and distribution of probable mental health conditions among persons aged 10 years and older in Uganda, while assessing variations by sex, place of residence and sub-region. We conducted a descriptive secondary analysis of publicly available census tabulations (2024 Volume I, Section 6.5). The analytic population comprised 31,389,721 individuals aged 10 years and older. Mental health outcomes were based on self-reported symptoms synthesised by the Uganda Bureau of Statistics into six indicators of probable mental health conditions, such as general psychological distress, depression, anxiety, bipolar disorder, psychosis and suicidality, rather than clinical diagnoses. Among persons aged 10 years and older, 3,773,915 (12.0%) reported probable general psychological distress. Probable depressive condition affected 2,444,272 (7.8%), followed by probable bipolar condition 1,262,088 (4.0%) and probable anxiety condition 1,201,182 (3.8%). Higher prevalence was observed among females and rural residents. Substantial sub-regional variation was observed across all outcomes, with the prevalence of general psychological distress ranging from ~8% in Madi, Sebei and Ankole to over 16% in Teso. The 2024 census suggests a substantial and uneven distribution of probable mental health conditions in Uganda and underscores the need for geographically targeted, equity-oriented mental health strategies, as well as stronger integration of mental health into primary healthcare systems.
Does democratic public diplomacy work in authoritarian societies and, if so, when? I investigate the impact of the US Embassy in China’s online advocacy of American democracy through two survey experiments conducted during the first Trump administration. The results show that American public diplomacy can improve Chinese audiences’ attitudes toward the United States, not in relatively normal times but when the US international image is under threat. This novel finding suggests that public diplomacy may function more as a “shield” to maintain residual credibility than as a “sword” for proactive influence, expanding our understanding of how public diplomacy works. At the same time, the embassy’s messaging had little effect on Chinese audiences’ attitudes toward democracy, views on China, or behavioral intentions such as protest, regardless of the US image. This general silence greeting the democratic sound underscores the challenges of democracy promotion in a rising authoritarian power, at least in the short term, while also undermining authoritarian governments’ frequent attempts to blame domestic grievances on “foreign forces.” The findings illuminate both the potential and limits of democratic public diplomacy.
To examine the relationship between access to routine primary healthcare (PHC) and receipt of dental visits.
Background:
PHC plays a vital role in promoting overall health and connecting patients to preventive services. Regular dental visits are crucial for preventing oral health issues and managing chronic diseases associated with oral health. However, disparities in healthcare access may influence the likelihood of individuals receiving necessary dental care.
Methods:
Data from 8, 727 participants ≥ 20 years in the 2017–2020 National Health and Nutritional Examination Survey were used for cross-sectional analysis. Logistic regressions explored the relationship between PHC and ‘past-year dental visits’, while controlling for sociodemographics.
Findings:
84% of the study population had access to routine PHC, and 63% had a past-year dental visit. Adults with PHC were significantly more likely to have had a past-year dental visit (OR = 2.24; 95% CI: 1.76–2.84). This was true for women, the oldest adult age group, and those with the highest educational levels. Black study participants were less likely to have had a past-year dental visit (OR = 0.55; 95% CI: 0.54, 0.83), so were the unmarried and those without health insurance.
Conclusion:
Access to routine PHC significantly increases the likelihood of a past-year dental visit, with gender, age, and educational levels having strongest effects. However, Black adults remain less likely to utilize dental services, even with access to routine PHC and health insurance. Strengthening the physician-dentist patient partnership through integrated delivery models of care that embed oral health services with primary care could be key.
The Senior Coordinator for Gender Equality and Women’s Empowerment at the United States Agency for International Development (USAID) was established during the first administration of Barack Obama to coordinate gender equality policy and programs across USAID bureaus and missions. Susan Markham (SM) was appointed Senior Coordinator during the second Obama administration, 2014–2017, while Jamille Bigio (JB) served in this role during the administration of President Joe Biden, 2021–2025. This is a slightly edited version of an interview that took place with Mona Lena Krook (MLK) via Zoom on March 23, 2026.
Longitudinal research on the development of deception across the lifespan remains limited, particularly regarding trajectories of lie-telling and their associations with later problems. The current study aimed to address this gap using longitudinal data of 3,017 Quebec francophone children (47.2% girls, 52.8% boys, aged ∼6 years). Growth mixture modeling identified distinct trajectories of parent and teacher reported lie-telling from ages 6 to 19 years, with reports showing links to early aggressive-disruptive behavior. Trajectories of perceived lying by parents and teachers were also associated with antisocial personality disorder and criminal records in early adulthood. Findings suggest that identifying patterns of observed lying may inform theoretical understanding of the developmental evolution and interpersonal significance of deception over time, as well as highlight potential long-term interventions for problematic lying.
The Bureau of Democracy, Human Rights, and Labor (DRL) at the United States Department of State focuses on the interlocking issues of democracy, human rights, and workers’ rights. It is also responsible for producing annual reports on the state of human rights in countries around the world. During the administration of Joe Biden, Tambria Schroeder (TS) was the Gender Equality Policy Advisor, and Andrea Gillespie (AG) served as Senior Advisor in the Office of the Special Envoy to Advance the Human Rights of LGBTQI+ Persons and in the Office of Multilateral and Global Affairs. This is an edited and compiled version of interviews that took place with Mona Lena Krook (MLK) via Zoom on January 8, 2026, and January 27, 2026.
The effect of sound change and analogy upon inflectional paradigms has been traditionally described through Sturtevant’s Paradox, which states that sound change is regular but generates irregularity, whereas analogy is irregular but generates regularity. While past work has explored trends in sound change and analogy qualitatively, quantitative investigation with large data sets remains underexploited. We tackle this by exploring the effects of sound change and analogy from Latin to French in large etymologically paired inflected lexicons containing the complete paradigms of 310 verbs with 11,593 total forms. We employ a novel method combining the automated application of historical sound changes and entropy-based quantitative analysis to examine separately the effects of sound change and analogy. The results confirm the role of some oft-cited predictors of analogy like token frequency and morphological regularity, but offer no support for others like markedness. Results also confirm the complexifying role of sound change, and the simplifying role of analogy, on aspects of morphological complexity like the number of inflection classes and the amount of allomorphy, but suggest that these forces have no comparable effect on more modern measures of complexity like average conditional entropies between inflected forms.
This book examines how the capability approach offers fresh ways to think about work, well-being, and social justice. It argues that work should not only provide income but also empower people to achieve their life goals, develop skills, and participate fully in society. Drawing on research and real-world examples, Jac van der Klink and Sebastiaan Rothmann show how organisations and policies can enhance employees' health, satisfaction, and capabilities. The chapters explore how human resource management, public administration, and organisational leadership can create fairer workplaces by removing barriers that limit potential, improving the quality of work, and ensuring access to opportunities for all. A key theme is equity: work should reduce disparities and foster inclusion across gender, socio-economic, and cultural divides. Timely and relevant, the text appeals to academics, practitioners, policymakers, and advocates seeking practical ways to make work more meaningful. This title is also available Open Access on Cambridge Core.
To characterize institutional masking policies for healthcare personnel (HCP) and identify factors informing masking decisions in the post–COVID-19 pandemic era.
Design:
Cross-sectional, survey-based study.
Setting:
Healthcare institutions participating in the Society for Healthcare Epidemiology of America (SHEA) and Association for Professionals in Infection Control and Epidemiology (APIC) Research Networks.
Participants:
One representative per institution, including infection preventionists, hospital epidemiologists, or healthcare administrators, knowledgeable about organizational masking policies.
Methods:
A structured, web-based survey was distributed through the SHEA/APIC Research Networks. Survey domains included institutional characteristics, masking strategies outside of transmission-based precautions, epidemiologic and operational factors influencing masking decisions, and mask types required. Responses were collected anonymously via REDCap over a six-week period and analyzed descriptively.
Results:
A total of 172 unique healthcare institutions completed the survey (41% response rate, n = 172/425). Most respondents were infection preventionists (65%) or hospital epidemiologists (25%). The most common masking approach was a seasonal or situational risk-based strategy (57%), while 7% of institutions reported no formal masking policy. Among institutions using seasonal or situational masking, decisions were most frequently informed by outbreaks or clusters (37%), public health guidance (33%), and HCP illness/absenteeism (27%). Most institutions reported no fixed epidemiologic thresholds for masking decisions. When masking was required, surgical masks were most commonly used (98%).
Conclusions:
Masking policies and decision-making criteria vary widely across healthcare institutions, reflecting a lack of standardized operational guidance. These findings underscore the need for consensus-based, data-driven frameworks to support consistent, transparent, and evidence-informed masking policies in healthcare settings.
Plasmodium vivax RH5-interactive putative protein (RIPR) is present in micronemes and might participate in erythrocyte invasion. In this study, the polymorphism of pvripr gene was examined. In 7 P. vivax isolates from southern Mexico (SM), the pvripr gene was amplified and sequenced. Other pvripr sequences were retrieved from PlasmoDB; 15 from SM and 78 from other locations. The genetic parameters, deviation from neutrality, Z selection test, haplotype networks, FST index of differentiation and the amino acid substitutions were analysed. The phylogenetic tree of 22 SM isolates suggested 2 genetic groupings, and these isolates had lower nucleotide diversity (n = 22; π = 0.0007, Hd = 0.671) than Colombian, Peruvian and Asian parasites (π = 0.0011–0.0017, Hd > 0.9). The haplotype network of Mexican pvripr had haplotypes separated by 1–13 mutational steps among them, and a complex structure was observed in parasites from Peru, Colombia and China. No significant deviation from neutrality was estimated; however, Tajima’s D values across 3′ segment were negative in parasites from all locations. The Z test was significantly positive only for Latin American parasites, and the codon-level selection analysis showed several codons with dN–dS positive values in East Asia and Southeast Asia parasites. Given the lack of long-term in vitro culture for P. vivax, in silico epitope mapping across global sequences provides a pragmatic, hypothesis-generating framework. Globally, 12 polymorphic residues involved charged amino acid changes, many within predicted B-cell epitopes, consistent with immune-mediated selection on PvRIPR.
Nonalcoholic fatty liver disease (NAFLD) is frequently associated with depression, anxiety, and chronic fatigue syndrome (CFS). Major depression and NAFLD are accompanied by low-grade inflammation, increased atherogenicity, and insulin resistance. There is a paucity of data on serum tryptophan and tryptophan catabolites (TRYCATs) in relation to these symptoms in patients with NAFLD. This study aims to determine the relationships between the severity of NAFLD, the severity of the above neuropsychiatric symptoms and neuro-immune, metabolic, and TRYCAT pathway biomarkers.
Methods
This case–control study included 56 patients with Grade 1 NAFLD, 52 with Grade 2 NAFLD, and 60 healthy controls. We assessed serum insulin, tryptophan, kynurenine, 3-hydroxykynurenine, kynurenic acid, indoleamine 2,3-dioxygenase 1 (IDO1), interleukin (IL)-6, IL-10, HOMA2 insulin resistance index (HOMA2IR), and atherogenic indices.
Results
The severity of depression, anxiety, and fibro-fatigue symptoms was significantly higher in NAFLD than in controls and in grade 2 as compared with grade 1 NAFLD. The atherogenic and HOMA2IR indices increased significantly from controls to grade 1 and then to grade 2. Serum tryptophan, kynurenine, kynurenic acid, and 3-OH-kynurenine were significantly lower in NAFLD and especially in grade 2 than in controls, while IL-6 and IL-10 were higher in grade 2 NAFLD than in controls. The rating scale scores were significantly and positively correlated with liver tests, atherogenicity, and HOMA2 indices, and inversely with tryptophan and TRYCATs.
Conclusions
Affective and fibro-fatigue symptoms due to NAFLD might be mediated by the cumulative neurotoxic effects of lipids, IR, and lowered anti-inflammatory and antioxidant effects of the TRYCAT pathway.
Since the late twentieth century, institutional autonomy has become a major issue in the relationship between the government and higher education institutions, with autonomy being presented as a virtuous option that satisfied both government’s regulatory aims and institutional capacities to develop in an increasingly dynamic and complex sector. Due to concerns about the effectiveness of higher education, the development of autonomy was increasingly linked to a market-like logic, with a growing emphasis on competition and efficiency. Thus, what was initially regarded as a path to emancipation of institutions from government’s influence became a mode of relationship that could curtail previous dimensions of autonomy. One of the major regulatory dimensions that helps understand the reversals and nuances of institutional autonomy is funding. Like other regulatory dimensions, recent decades have seen the emergence of new forms of funding that have influenced institutional governance and management. In this text, we analyse these trends in European higher education by mapping changes in governments’ approaches to the sector, specifically the evolution of funding mechanisms and how these highlight a shift in the pendulum between degrees of autonomy and modes of government’s influence in institutions.
Burnout arises from prolonged, unresolved work-related stress and adversely affects professional performance and overall well-being. Resident doctors and medical students are particularly vulnerable because of the demands of balancing clinical, academic and related responsibilities.
Aims
This study aimed to assess self-reported burnout and related stressors among UK resident doctors and medical students, and estimate the economic impact of burnout-related absenteeism among resident doctors.
Method
Self-report questionnaires assessing burnout and related stressors were distributed to UK resident doctors and medical students. A total of 2793 responses were received: 1439 (51.5%) from resident doctors and 1354 (48.5%) from medical students. Economic losses from absenteeism were calculated with a human capital approach.
Results
Burnout was reported by 70% (n = 1008) of resident doctors and 65.7% (n = 889) of medical students. Notably, 56.8% (n = 573) and 79.3% (n = 705) of resident doctors and medical students affected by burnout, respectively, were unaware of available support services. Relocation stress (85.1% of residents and 62.6% of students), financial stress (53.9% of residents and 57.8% of students) and poor work–life balance (32.1% of residents and 20.7% of students) were commonly reported. The annual economic burden of absenteeism related to burnout among resident doctors was estimated to reach £251.5 million.
Conclusions
Burnout among UK resident doctors and medical students may reflect a combination of underlying factors, including financial strain, relocation stress and difficulties with work–life balance. These findings underscore the need for targeted interventions that support well-being and address financial and relocation challenges, which may, in turn, help prevent burnout and improve retention within the medical workforce. Reducing burnout and associated stressors may also help lessen its economic impact, allowing resources to be redirected towards patient care.
Is it permissible to implicate non-epistemic values in the ‘core’ of scientific reasoning? This paper offers an appraisal of Parker’s (2024) Epistemic Projection Approach (EPA) prescribing acceptable relations between epistemic and non-epistemic values in research conduct. Non-epistemic values are granted a role in determining epistemic characteristics for a research project but are meant to be ‘screened off’ from core research decisions via epistemic projection. This discussion takes the EPA for a test drive. We identify three challenges to its conceptual and practical viability and show how EPA currently lacks resources to address them, indicating a need for further development.
If a complex X is a subcomplex of a diagrammatically reducible (DR) 2-complex Y that has locally indicable fundamental group, then X has locally indicable fundamental group. This is a consequence of the Corson–Trace characterization of diagrammatic reducibility. In this article, we use a Corson–Trace-like characterization of diagrammatic reducibility away from a subcomplex to obtain a considerable stronger result. We apply this to the question of local indicability in the context of Whitehead’s asphericity conjecture. We show that an injective labeled oriented tree that is DR of degree 2, and all its quotients are as well, is locally indicable.
The latitudinal patterns of the phylogenetic, functional and numerical interaction specificity (PIS, FIS and NIS, respectively) of fleas and mammals in their interaction networks, from 4 biogeographic realms, were investigated at the intraspecific, interspecific and community levels to understand whether the spatial variation of interaction specificity followed the predictions of a latitudinal specialization gradient. In fleas, no latitudinal pattern of PIS was detected. Flea FIS varied with latitude in all realms at the intraspecific level and in 2 realms at the interspecific and community levels. Latitudinal trends in NIS were detected in all realms (except Neotropics) at the intraspecific level and in the Old World realms at both higher levels. In hosts, PIS varied with latitude in the Afrotropics and the Nearctic at the intraspecific level and in the Afrotropics at the interspecific and community levels. FIS demonstrated a latitudinal trend in the Nearctic at the intraspecific level and in the Palearctic at the community level. Relationships between latitude and NIS were found in all realms (except Neotropics) at the intraspecific level and in the Old World realms at the interspecific and community levels. The directions of the latitudinal pattern of the same specificity facet could be positive or negative. They differed between fleas and hosts, realms and organizational levels. The occurrence and direction of the latitudinal specialization gradient are explained by the combined actions of evolutionary, historical and ecological factors. Pooling data from regions with different biogeographical histories and landscape structures, for a macroecological analysis, may produce spurious results.
Climate-related worry is increasingly recognized as a mental health concern and a potential correlate of pro-environmental behavior (PEB). However, little is known about these associations in the Global South or the potential role of mindfulness. This crosssectional study examined relationships among climate change anxiety, psychological distress, mindfulness, and PEB in 340 university students (aged 19–25 years) from Islamabad and Rawalpindi, Pakistan. Data were collected between January and June 2024 using validated measures of climate change anxiety (Climate Change Anxiety Scale), psychological distress (DASS-21), dispositional mindfulness (MAAS), and PEB. Analyses included bivariate correlations, block-wise linear regression, and mediation models (PROCESS Model 4; 5,000 bootstrap resamples). Climate change anxiety was positively correlated with psychological distress (r = .47, p < .001) and indirectly associated with lower PEB through distress (ab = −.09, 95% CI [−.15, −.04]). Regression analyses showed that mindfulness was positively associated with PEB (β = .27, p < .001), whereas distress (β = −.22, p = .002) and climate change anxiety (β = −.18, p = .018) were negatively associated with PEB. Mindfulness was indirectly associated with higher PEB through lower distress (ab = .11, 95% CI [.05, .19]) and lower climate change anxiety (ab = .08, 95% CI [.02, .15]), while also showing a direct positive association with PEB. These findings highlight mindfulness as a relevant factor for understanding climate-related distress and environmental engagement among young adults.
Low dietary diversity is a predictor of depression in high-income countries, but evidence from low-income settings where poor nutrition and depression often co-occur is scarce. We examined the association between dietary diversity and depression in rural Western Kenya. We conducted a cross-sectional analysis of data collected between June and August 2025 from 311 participants enrolled in a group-based microfinance (‘BIGPIC’) program. Depression was measured using twenty-item Centre for Epidemiologic Studies for Depression Scale, and dietary diversity was assessed based on the consumption of five food groups in the previous 24 hours using a validated scale. We used linear regression models to estimate the association between high dietary diversity and depression scores and assessed effect measure modification by wealth status. Quantile regression was used to examine variation across the distributions of depression scores. Higher dietary diversity was associated with lower depression scores (adjusted β (95 % CI): −3·49 (–6·62, −0·38)). This association was stronger among individuals with lower wealth (adjusted β (95 % CI): −6·00 (–10·46, −1·42)), compared with those with high wealth (adjusted β (95 % CI): −0·53 (–4·76, 3·68); Wald P–value for interaction = 0·0003). Effect sizes were larger at higher quantiles across 75th (Q75: β = −7·56; 95 % CI: −12·82, −2·27) and 90th (Q90: β = −6·01; 95 % CI: −12·43, 0·43) quantiles, though estimates were imprecise. These findings suggest that greater dietary diversity may be associated with improved mental health, particularly among socio-economically vulnerable individuals, and those with severe depression. Future work using longitudinal and quasi-experimental designs are needed to strengthen causal inference and clarify underlying mechanisms.