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The macro-social and environmental conditions in which people live, such as the level of a country’s development or inequality, are associated with brain-related disorders. However, the relationship between these systemic environmental factors and the brain remains unclear. We aimed to determine the association between the level of development and inequality of a country and the brain structure of healthy adults.
Methods
We conducted a cross-sectional study pooling brain imaging (T1-based) data from 145 magnetic resonance imaging (MRI) studies in 7,962 healthy adults (4,110 women) in 29 different countries. We used a meta-regression approach to relate the brain structure to the country’s level of development and inequality.
Results
Higher human development was consistently associated with larger hippocampi and more expanded global cortical surface area, particularly in frontal areas. Increased inequality was most consistently associated with smaller hippocampal volume and thinner cortical thickness across the brain.
Conclusions
Our results suggest that the macro-economic conditions of a country are reflected in its inhabitants’ brains and may explain the different incidence of brain disorders across the world. The observed variability of brain structure in health across countries should be considered when developing tools in the field of personalized or precision medicine that are intended to be used across the world.
Marine microorganisms play a crucial role in biogeochemical cycles, especially in the surface microlayer (SML), which differs from adjacent subsurface waters (SSW). In this study, we sampled the SML and SSW at 20 sites along the western Antarctic Peninsula during the summers of 2015 and 2019, examining microbial, viral and environmental differences. We focused on phototrophic protists, specifically Phaeocystis-like species, known for their high dimethylsulphoniopropionate (DMSP) contents, which can be released through viral lysis. DMSP is a precursor to dimethylsulphide (DMS), a gas influencing Earth’s climate. We hypothesized a significant relationship between Phaeocystis-like abundance and DMSP concentration, with strong interactions with their specific viruses (V4) in the SML. Most biotic variables showed higher mean values in the SML, although these differences often were not statistically significant. DMSP concentrations correlated with Phaeocystis-like species abundance in both layers (R2 = 0.482, P ≤ 0.01; R2 = 0.532, P ≤ 0.01, respectively), whereas V4 abundance significantly correlated with Phaeocystis-like species only in the SML (R2 = 0.572, P ≤ 0.01). These results suggest stronger interactions between viruses and DMSP-rich hosts in the SML, potentially increasing DMS emissions to the atmosphere and impacting climate regulation.
Electronic health records (EHRs), increasingly available in low- and middle-income countries (LMICs), provide an opportunity to study transdiagnostic features of serious mental illness (SMI) and its trajectories.
Aims
Characterise transdiagnostic features and diagnostic trajectories of SMI using an EHR database in an LMIC institution.
Method
We conducted a retrospective cohort study using EHRs from 2005–2022 at Clínica San Juan de Dios Manizales, a specialised mental health facility in Colombia, including 22 447 patients with schizophrenia (SCZ), bipolar disorder (BPD) or severe/recurrent major depressive disorder (MDD). Using diagnostic codes and clinical notes, we analysed the frequency of suicidality and psychosis across diagnoses, patterns of diagnostic switching and the accumulation of comorbidities. Mixed-effect logistic regression was used to identify factors influencing diagnostic stability.
Results
High frequencies of suicidality and psychosis were observed across diagnoses of SCZ, BPD and MDD. Most patients (64%) received multiple diagnoses over time, including switches between primary SMI diagnoses (19%), diagnostic comorbidities (30%) or both (15%). Predictors of diagnostic switching included mentions of delusions (odds ratio = 1.47, 95% CI 1.34–1.61), prior diagnostic switching (odds ratio = 4.01, 95% CI 3.7–4.34) and time in treatment, independent of age (log of visit number; odds ratio = 0.57, 95% CI 0.54–0.61). Over 80% of patients reached diagnostic stability within 6 years of their first record.
Conclusions
Integrating structured and unstructured EHR data reveals transdiagnostic patterns in SMI and predictors of disease trajectories, highlighting the potential of EHR-based tools for research and precision psychiatry in LMICs.
Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for major depressive disorder (MDD), but initial outcomes can be modest.
Aims
To compare SSRI dose optimisation with four alternative second-line strategies in MDD patients unresponsive to an SSRI.
Method
Of 257 participants, 51 were randomised to SSRI dose optimisation (SSRI-Opt), 46 to lithium augmentation (SSRI+Li), 48 to nortriptyline combination (SSRI+NTP), 55 to switch to venlafaxine (VEN) and 57 to problem-solving therapy (SSRI+PST). Primary outcomes were week-6 response/remission rates, assessed by blinded evaluators using the 17-item Hamilton Depression Rating Scale (HDRS-17). Changes in HDRS-17 scores, global improvement and safety outcomes were also explored. EudraCT No. 2007-002130-11.
Results
Alternative second-line strategies led to higher response (28.2% v. 14.3%, odds ratio = 2.36 [95% CI 1.0–5.6], p = 0.05) and remission (16.9% v. 12.2%, odds ratio = 1.46, [95% CI 0.57–3.71], p = 0.27) rates, with greater HDRS-17 score reductions (−2.6 [95% CI −4.9 to −0.4], p = 0.021]) than SSRI-Opt. Significant/marginally significant effects were only observed in both response rates and HDRS-17 decreases for VEN (odds ratio = 2.53 [95% CI 0.94–6.80], p = 0.067; HDRS-17 difference: −2.7 [95% CI −5.5 to 0.0], p = 0.054) and for SSRI+PST (odds ratio = 2.46 [95% CI 0.92 to 6.62], p = 0.074; HDRS-17 difference: −3.1 [95% CI −5.8 to −0.3], p = 0.032). The SSRI+PST group reported the fewest adverse effects, while SSRI+NTP experienced the most (28.1% v. 75%; p < 0.01), largely mild.
Conclusions
Patients with MDD and insufficient response to SSRIs would benefit from any other second-line strategy aside from dose optimisation. With limited statistical power, switching to venlafaxine and adding psychotherapy yielded the most consistent results in the DEPRE'5 study.
Before a binary system enters into a common envelope (CE) phase, accretion from the primary star onto the companion star through Roche Lobe overflow (RLOF) will lead to the formation of an accretion disk, which may generate jets. Accretion before and during the CE may alter the outcome of the interaction. Previous studies have considered different aspects of this physical mechanism. Here we study the properties of an accretion disk formed via 3D hydrodynamic simulations of the RLOF mass transfer between a 7 M$_{\odot}$, red supergiant star and a 1.4 M$_{\odot}$, neutron star companion. We simulate only the volume around the companion for improved resolution. We use a 1D implicit mesa simulation of the evolution of the system during 30 000 yr between the on-set of the RLOF and the CE to guide the binary parameters and the mass-transfer rate, while we simulate only 21 yr of the last part of the RLOF in 3D using an ideal gas quasi-isothermal equation of state. We expect that a pre-CE disk under these parameters will have a mass of $\sim 5\times 10^{-3}$ M$_{\odot}$ and a radius of $\sim40\ R_\odot$ with a scale height of $\sim 5\ R$$_{\odot}$. The temperature profile of the disk is shallower than that predicted by the formalism of Shakura and Sunyaev, but more reasonable cooling physics would need to be included. We stress test these results with respect to a number of physical and numerical parameters, as well as simulation choices, and we expect them to be reasonable within a factor of a few for the mass and 15% for the radius. We also contextualise our results within those presented in the literature, in particular with respect to the dimensionality of simulations and the adiabatic index. We discuss the measured accretion rate in the context of the Shakura and Sunyaev formalism and debate the viscous mechanisms at play, finishing with a list of prospects for future work.
Studies conducted during the COVID-19 pandemic found high occurrence of suicidal thoughts and behaviours (STBs) among healthcare workers (HCWs). The current study aimed to (1) develop a machine learning-based prediction model for future STBs using data from a large prospective cohort of Spanish HCWs and (2) identify the most important variables in terms of contribution to the model’s predictive accuracy.
Methods
This is a prospective, multicentre cohort study of Spanish HCWs active during the COVID-19 pandemic. A total of 8,996 HCWs participated in the web-based baseline survey (May–July 2020) and 4,809 in the 4-month follow-up survey. A total of 219 predictor variables were derived from the baseline survey. The outcome variable was any STB at the 4-month follow-up. Variable selection was done using an L1 regularized linear Support Vector Classifier (SVC). A random forest model with 5-fold cross-validation was developed, in which the Synthetic Minority Oversampling Technique (SMOTE) and undersampling of the majority class balancing techniques were tested. The model was evaluated by the area under the Receiver Operating Characteristic (AUROC) curve and the area under the precision–recall curve. Shapley’s additive explanatory values (SHAP values) were used to evaluate the overall contribution of each variable to the prediction of future STBs. Results were obtained separately by gender.
Results
The prevalence of STBs in HCWs at the 4-month follow-up was 7.9% (women = 7.8%, men = 8.2%). Thirty-four variables were selected by the L1 regularized linear SVC. The best results were obtained without data balancing techniques: AUROC = 0.87 (0.86 for women and 0.87 for men) and area under the precision–recall curve = 0.50 (0.55 for women and 0.45 for men). Based on SHAP values, the most important baseline predictors for any STB at the 4-month follow-up were the presence of passive suicidal ideation, the number of days in the past 30 days with passive or active suicidal ideation, the number of days in the past 30 days with binge eating episodes, the number of panic attacks (women only) and the frequency of intrusive thoughts (men only).
Conclusions
Machine learning-based prediction models for STBs in HCWs during the COVID-19 pandemic trained on web-based survey data present high discrimination and classification capacity. Future clinical implementations of this model could enable the early detection of HCWs at the highest risk for developing adverse mental health outcomes.
Migration and forced displacement are remodeling cities and countries. The number of people being displaced due to war, persecution, serious human rights violations and disturbance in social and political order has increased exponentially. Colombia is a vivid example of a massive mixed migration crisis, receiving refugees from Venezuela, crossed by migrants of various origins and a protracted internal displacement affecting mostly its Pacific Region.
Objectives:
The purpose of this study is to showcase the field experience of the Colombian EMT Hospital Barco San Raffaele through its response to two forced displacement crises: (1) in Colombia’s Pacific Region, and (2) Venezuelan refugees, aiming at providing evidence for the improvement of EMTs Type1 Standards of care.
Method/Description:
Mix method case study methodology is employed to describe a complex phenomenon of mixed-migration. Data is gathered from response reports, program activities, clinical presentations; data will be analyzed using triangulation method, allowing comparison between adaption of health services, configuration of teams, legal frameworks, using the surge capacity components (4S) and current standards of care for Type1 EMTs.
Results/Outcomes:
Preliminary analysis shows the need to adapt services and configure teams to respond to volatile contexts; collaboration, negotiation, coordination, interoperability with local institutions, organizations and community leaders prove to be key to ensure credibility, access, and quality of care.
Conclusion:
Enabling factors such as legal frameworks have a major impact/influence in ensuring access to care to displaced populations, facilitating or preventing responses. EMTs Type 1 Standards of care must be adapted if teams are to respond to this worldwide phenomenon.
Antarctic terrestrial ecosystems, covering less than 1% of the continent, are under increasing anthropogenic threats, particularly from climate change and tourism. This study focuses on the impact of human trampling on soil microbial communities in Barrientos Island (South Shetlands archipelago), a frequently visited location. Soil samples were collected within and at the edge of two established paths representing varying levels of human disturbance. Physical and chemical analyses revealed significant differences between the paths, potentially creating anaerobic conditions favorable for specific microbial taxa. Thus, microbial communities also differed between the paths. Aerobic heterotrophic taxa were dominant in the less disturbed path, while anaerobic taxa such as Bacteroidetes vadinHA17 thrived in the more compacted path. Although alpha diversity indices did not differ, beta diversity analyses showed notable distinctions, particularly between the paths rather than trampled and untrampled areas. These findings suggest that microbial communities may recover following the stop of human activity, but also that indigenous microbial communities or other overlooked factors may be influencing the recovery potential. This study thus offers a starting point for similar research, as it highlights the need for further investigation to determine whether human trampling or other environmental factors are primarily responsible for these differences.
Achieving sustainability on the ground poses a challenge in decoding globally defined goals, such as sustainable development goals, and aligning them with local perspectives and realities. This decoding necessitates the understanding of the multifaceted dimensions of the sustainability challenges in a given context, including their underlying causes. In case studies from Brazilian drylands, we illustrate how an enhanced multiscale participatory method, combined with systems thinking tools, can shed light on systemic structures that currently entrench unsustainable development trajectories. This method offers insights into co-designing potential pathways toward sustainable futures and unlocking transformative capacities of the local population.
Technical summary
Translating United Nations global sustainable development goals (SDGs) into actions that address local realities and aspirations is an urgent challenge. It requires new thinking and approaches that foster the discussion about the main challenges to implementing the SDGs at multiple levels. This paper presents a novel multiscale participatory approach that combines the popular Three Horizons diagram with the formalism of causal loop diagrams in systems thinking. We present results from six multi-stakeholder dialogues held across drylands in Brazil with a focus on desired futures aligned with SDGs. Focusing on identifying the root causes and systemic structures of unsustainability, participants identified lock-ins, leverage points, and interventions for how these could be changed. The core lock-ins are the discontinuity of public policies, and the historical land and power concentration reinforced by the current expansion of large-scale agricultural, mining, and energy projects. The proposed interventions are structural and – if implemented – would contribute to achieving SDGs in an integrated manner. The unique approach developed in this study can provide leverage as it bridges the inclusivity of participatory visioning with the change potential of systems thinking tools to tackle root causes and unleash societal transformations.
Social media summary
We are not achieving SDGs. Understanding root causes of unsustainability is critical to move toward sustainable and just futures.
This cross-sectional ecological study described fruit and vegetable (F&V) intake variability across 144 cities in 8 Latin American countries and by city-level contextual variables. Data sources came from health surveys and census data (Argentina, Brazil, Chile, Colombia, El Salvador, Guatemala, Mexico, and Peru). Self-reported frequency of F&V intake was harmonised across surveys. Daily F&V intake was considered as consumption 7 d of the week. Using a mixed-effects model, we estimated age and sex-standardised city prevalences of daily F&V intake. Through Kruskal–Wallis tests, we compared city F&V daily intake prevalence by tertiles of city variables related to women’s empowerment, socio-economics, and climate zones. The median prevalence for daily F&V intake was 55.7% across all cities (22.1% to 85.4%). Compared to the least favourable tertile of city conditions, F&V daily intake prevalence was higher for cities within the most favourable tertile of per capita GDP (median = 65.7% vs. 53.0%), labour force participation (median = 68.7% vs. 49.4%), women achievement-labour force score (median = 63.9% vs. 45.7%), and gender inequality index (median = 58.6% vs. 48.6%). Also, prevalences were higher for temperate climate zones than arid climate zones (median = 65.9% vs. 50.6%). No patterns were found by city level of educational attainment, city size, or population density. This study provides evidence that the prevalence of daily F&V intake varies across Latin American cities and may be favoured by higher socio-economic development, women’s empowerment, and temperate weather. Interventions to improve F&V intake in Latin America should consider the behaviour disparities related to underlying local social, economic, and climate zone characteristics.
We introduce a versatile high-repetition-rate solid tape target system suitable for relativistic laser-plasma driven secondary sources. We demonstrate the operation and stability monitoring based on a petawatt laser focused at 1 Hz. Experiments were carried out at the VEGA-3 laser system of the Centro de Láseres Pulsados facility where results for different tape materials and thicknesses are presented. Experimental proton spectra were recorded by a Thomson parabola spectrometer and a time-of-flight detector. In addition, non-invasive detectors, such as a target charging monitor and ionization chamber detectors, were tested as metrology for the stability of the source. Degradation of the proton signal at high-repetition-rate operation was observed and it was solved by online optimization of the relative focus position of the target and laser beam parameters. We report the use of the tape target for bursts of 1000 shots at 1 Hz with mean cut-off energies of about 10 MeV in optimized interaction conditions.
Objectives: Studies in PD have traditionally focused on motor features, however, interest in non-motor manifestations has increased resulting in improved knowledge regarding the prognosis of the disease. Although several studies have explored the incidence of dementia in PD cohorts, these studies have been conducted mainly in reference centers in high-income countries (HIC). In this study we aimed to analyze the prevalence of cognitive impairment in people with parkinsonism and PD and its association with incident dementia in a population- based study, of elderly from six Latin American countries.
Methods: This report consists of the analysis of data from a follow-up of 12,865 elderly people aged 65 years or older, carried out by 10/66 Dementia Research Group. Residents of urban and rural areas, from six low and middle- income countries (Cuba, Dominican Republic, Puerto Rico, Venezuela, Mexico and Peru). Exposures include parkinsonism and PD defined according to the UK Parkinson’s Disease Society Brain Bank diagnostic criteria. Cognitive impairment was the main exposure and dementia was measured through the dementia diagnosis algorithm from 10/66 DRG.
Results: At baseline, the overall prevalence of cognitive impairment was 14% (n = 1,581), in people with parkinsonism and PD, it was of 30.0% and 26.2%, respectively. Parkinsonism and PD were individually associated with prevalent and incident dementia after controlling for age, sex, and education. The pooled odds ratios from a fixed-effects meta-analysis were 2.2 (95% CI: 1.9 – 2.6) for parkinsonism and 1.9 (95% CI: 1.4 – 2.4) for PD. Regarding incident dementia, the pooled sub-Hazard ratio estimated using a competing risk model was 1.5 (95% CI: 1.2 –1.9) for parkinsonism and 1.5 (95% CI: 1.0 – 2.2) forPD.
Conclusions: Parkinsonism and PD were associated cross-sectionally with the presence of cognitive impairment, and prospectively with incident dementia in elderly people in the community population of Latin America studied. Systematic screening for cognitive impairment and dementia with valid tools in PD patients may help with earlier detection of those at highest risk for adverse outcomes. Identifying modifiable risk factors could potentially lead to efficient interventions even in advanced stages of PD.
Objectives: Because of the continued transition to older populations, various strategies have been developed to estimate the social impact and burden of health care. Regarding mental health, a strategy in the elderly is the measurement of neuropsychiatric symptoms (NPS), these include a wide range of behavioral and psychological manifestations. These are more frequent in the presence of some diseases, such as neurodegenerative syndromes, among which dementias and Parkinson’s disease (PD) stand out. The present study seeks to analyze the frequency of NPS, its relationship with the presence or absence of neurodegenerative syndromes and some characteristics of the elderly and caregivers.
Methods: This is an analysis of data from 12,865 elderly people evaluated within the protocols of the Dementia Research Group 10/66 in 6 Latin American countries (Cuba, Dominican Republic, Puerto Rico, Mexico, Venezuela and Peru). The presence or absence of parkinsonism, dementia and parkinsonism plus dementia (PDD) was identified through previously validated and published Methods. The NPS were assessed using the 12-symptom questionnaire version of the Neuropsychiatric Inventory. Other characteristics such as age, sex and education, in patients and caregivers; socioeconomic status, disability and comorbidities in the elderly; relationship with the elderly, needs and care-burden were assessed in careers.
Results: The most frequent symptoms were depression and sleep disorders in the four groups (without non-NDS neurodegenerative syndromes, parkinsonism, dementia and PDD, ranging from 23% to 49%. About a third of the elderly with parkinsonism, half of those with dementia, and 3 out of 5 of the elderly with PDD had 3 or more NPS. The odds ratios (OR) of each NPS measure by multivariate logistic regression models shown OR from 1.4 to 1.9 in the presence of parkinsonism; between 1.7 and 9.3 in the presence of dementia; and between 1.9 and 10.2 in the presence of PDD.
Conclusions: From a clinical and public mental health perspective, it is necessary to implement systematic Methods for NPS screening, as well as develop support strategies for families and caregivers, mainly of those with neurodegenerative syndromes.
Triatomines (Hemiptera: Heteroptera: Reduviidae) are hematophagous insects, well-known for their vectorial role in transmitting Trypanosoma cruzi Chagas (Kinetoplastida: Trypanosomatidae) parasites, the etiological agent of Chagas disease. Trapping these insects would limit human-triatomine interaction and, thus, control the disease. In this context, there is a critical need for effective lures to control triatomines. Through double-choice bioassays, we investigated the preference of Triatoma infestans Klug, T. pallidipennis Stal, and Rhodnius prolixus Stal triatomines for: (a) volatiles from fermented products (various fermentation types and substrates) and (b) commercial insect lures. Furthermore, we identified the chemical composition of these volatiles through headspace collection using Solid Phase Micro Extraction coupled with Gas Chromatograph-Mass Spectrometer (HS-SPME-GC-MS). Volatiles from lactic fermentation and certain fermented fruits, along with commercial lures, attracted triatomines, while other products exhibited possible repellent or dislodging properties. These findings hold promise for the control of triatomines and, ultimately, Chagas disease.
Evaluating the impact of patient involvement in health technology assessments (HTA) may help improve practices and avoid ineffective activities. Evaluation, however, continues to be infrequent, inconsistent, and often only relates to process quantity or quality. The Patient and Citizen Involvement in HTA Interest Group (PCIG) within Health Technology Assessment International set out to contextualize this impact to support evaluation.
Methods
Given the lack of established methodology to measure impact, the team performed a qualitative analysis of first-hand accounts about perceived changes in HTA due to involvement of patient stakeholders. A questionnaire was developed, piloted, and rolled out to collect personal perspectives from stakeholders with relevant experience. The stories were analyzed in the aggregate to identify themes in the data.
Results
From January 2019 to September 2021, twenty-four responses were collected through PCIG’s network. Responses (including one joint industry-HTA body submission) came from patient representatives (12), HTA bodies (11), and industry representatives (2) from North America (5), South America (3), Europe (13), and Asia Pacific (3). Based on themes commonly reported, a three-domain framework for evaluating impact is proposed: impact on basis of HTA result or recommendation, impact on HTA body, and impact on patient participants. The framework includes components under each domain to support reporting.
Conclusions
Using the Three-Domain Impact Framework may be useful in identifying, evaluating, and communicating the value of patient involvement in HTA. Enhancing and increasing reporting practices may improve transparency and facilitate process improvements for meaningful integration of patient stakeholders into HTA appraisals across jurisdictions.
Adults of the genus Posthodiplostomum, Dubois, 1936 are parasites of fish-eating birds, mainly of the family Ardeidae, and are globally distributed. The genus currently comprises 35 species, although recent molecular evidence has shown that the diversity of the genus is underestimated since several candidate species have been recognized. In the Neotropical region of Mexico, at least 6 Posthodiplostomum lineages have been detected with metacercaria stages recovered from unrelated fish hosts. Here, we obtained adult specimens of Posthodiplostomum from 6 fish-eating birds representing 2 families (Butorides virescens, Ardea herodias, Nycticorax nycticorax, Tigrisoma mexicanum – Ardeidae, and Rynchops niger and Leucophaeus atricilla – Lariidae) from 4 localities in southern Mexico. Specimens were sequenced for 2 nuclear (28S and ITS1–5.8S–ITS2) and 1 mitochondrial (cox1) molecular marker. Phylogenetic analyses allowed us to link metacercariae and adult specimens and recognized a lineage, which was described morphologically. The new species can be distinguished from its congeners by its prosoma morphology and body size; this is the first described species in the Neotropical region of Mexico. Additionally, new host and locality records for P. macrocotyle and P. pricei are presented, expanding their geographical distribution range in the Americas.