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It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
The recent expansion of cross-cultural research in the social sciences has led to increased discourse on methodological issues involved when studying culturally diverse populations. However, discussions have largely overlooked the challenges of construct validity – ensuring instruments are measuring what they are intended to – in diverse cultural contexts, particularly in developmental research. We contend that cross-cultural developmental research poses distinct problems for ensuring high construct validity owing to the nuances of working with children, and that the standard approach of transporting protocols designed and validated in one population to another risks low construct validity. Drawing upon our own and others’ work, we highlight several challenges to construct validity in the field of cross-cultural developmental research, including (1) lack of cultural and contextual knowledge, (2) dissociating developmental and cultural theory and methods, (3) lack of causal frameworks, (4) superficial and short-term partnerships and collaborations, and (5) culturally inappropriate tools and tests. We provide guidelines for addressing these challenges, including (1) using ethnographic and observational approaches, (2) developing evidence-based causal frameworks, (3) conducting community-engaged and collaborative research, and (4) the application of culture-specific refinements and training. We discuss the need to balance methodological consistency with culture-specific refinements to improve construct validity in cross-cultural developmental research.
Most studies aiming to quantify carbon stocks in tropical forests have focused on aboveground biomass, omitting carbon in soils and woody debris. Here, we quantified carbon stocks in soils up to 3 m depth, woody debris, and aboveground and belowground tree biomass for the 25-ha Amacayacu Forests Dynamics plot in the northwestern Amazon. Including soils to 3 m depth, total carbon stocks averaged 358.9 ± 24.2 Mg C ha−1, of which soils contributed 53%, biomass 44.2%, and woody debris 2.7%. When only including soils to 0.5 m depth, carbon stocks diminished to 222.1 Mg C ha−1 and biomass became the largest contributor. Among 1-ha subplots, total carbon stocks were correlated with soil carbon stocks at ≥0.5 m depth, belowground biomass of all trees, and aboveground biomass of trees ≥60 cm DBH. Our results support the assumption of biomass as the likely largest carbon source associated with land use change in northwestern Amazonia. However, mining and erosion following land use change could also promote a significant release of carbon from soil, the largest carbon stock. To improve the global carbon balance, we need to better quantify total carbon stocks and dynamics in tropical forests beyond aboveground biomass.
Preschool anxiety is highly prevalent and well known to predict risk for future psychopathology. The present study explores whether a diagnosis of an anxiety disorder in preschool interacts with (a) social skills and (b) cognitive ability to longitudinally predict psychopathology, two well-known protective factors, among a sample of 207 children measured at preschool (Mage = 4.34 years) and early childhood (Mage = 6.61 years). To assess social skills and cognitive ability, we utilized the Social Skills Rating Scale and the Differential Abilities Scale, respectively. To assess psychopathology, we utilized the parent report of the Preschool Age Psychiatric Assessment. Hierarchical linear regression models revealed significant interactions between both social skills and cognitive ability with preschool anxiety. We observed that social skills protected against emergent psychopathology for both children with and without anxiety, although this association was stronger for children with preschool anxiety. Contrastingly, cognitive ability served as a protective factor against future psychopathology primarily among children without preschool anxiety. Results from this study identify targets for future intervention and inform our understanding of how preschool anxiety, a common disorder among young children, shapes future psychopathology risk in childhood.
Understanding characteristics of healthcare personnel (HCP) with SARS-CoV-2 infection supports the development and prioritization of interventions to protect this important workforce. We report detailed characteristics of HCP who tested positive for SARS-CoV-2 from April 20, 2020 through December 31, 2021.
Methods:
CDC collaborated with Emerging Infections Program sites in 10 states to interview HCP with SARS-CoV-2 infection (case-HCP) about their demographics, underlying medical conditions, healthcare roles, exposures, personal protective equipment (PPE) use, and COVID-19 vaccination status. We grouped case-HCP by healthcare role. To describe residential social vulnerability, we merged geocoded HCP residential addresses with CDC/ATSDR Social Vulnerability Index (SVI) values at the census tract level. We defined highest and lowest SVI quartiles as high and low social vulnerability, respectively.
Results:
Our analysis included 7,531 case-HCP. Most case-HCP with roles as certified nursing assistant (CNA) (444, 61.3%), medical assistant (252, 65.3%), or home healthcare worker (HHW) (225, 59.5%) reported their race and ethnicity as either non-Hispanic Black or Hispanic. More than one third of HHWs (166, 45.2%), CNAs (283, 41.7%), and medical assistants (138, 37.9%) reported a residential address in the high social vulnerability category. The proportion of case-HCP who reported using recommended PPE at all times when caring for patients with COVID-19 was lowest among HHWs compared with other roles.
Conclusions:
To mitigate SARS-CoV-2 infection risk in healthcare settings, infection prevention, and control interventions should be specific to HCP roles and educational backgrounds. Additional interventions are needed to address high social vulnerability among HHWs, CNAs, and medical assistants.
Area-based conservation is a widely used approach for maintaining biodiversity, and there are ongoing discussions over what is an appropriate global conservation area coverage target. To inform such debates, it is necessary to know the extent and ecological representativeness of the current conservation area network, but this is hampered by gaps in existing global datasets. In particular, although data on privately and community-governed protected areas and other effective area-based conservation measures are often available at the national level, it can take many years to incorporate these into official datasets. This suggests a complementary approach is needed based on selecting a sample of countries and using their national-scale datasets to produce more accurate metrics. However, every country added to the sample increases the costs of data collection, collation and analysis. To address this, here we present a data collection framework underpinned by a spatial prioritization algorithm, which identifies a minimum set of countries that are also representative of 10 factors that influence conservation area establishment and biodiversity patterns. We then illustrate this approach by identifying a representative set of sampling units that cover 10% of the terrestrial realm, which included areas in only 25 countries. In contrast, selecting 10% of the terrestrial realm at random included areas across a mean of 162 countries. These sampling units could be the focus of future data collation on different types of conservation area. Analysing these data could produce more rapid and accurate estimates of global conservation area coverage and ecological representativeness, complementing existing international reporting systems.
To characterize residential social vulnerability among healthcare personnel (HCP) and evaluate its association with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection.
Design:
Case–control study.
Setting:
This study analyzed data collected in May–December 2020 through sentinel and population-based surveillance in healthcare facilities in Colorado, Minnesota, New Mexico, New York, and Oregon.
Participants:
Data from 2,168 HCP (1,571 cases and 597 controls from the same facilities) were analyzed.
Methods:
HCP residential addresses were linked to the social vulnerability index (SVI) at the census tract level, which represents a ranking of community vulnerability to emergencies based on 15 US Census variables. The primary outcome was SARS-CoV-2 infection, confirmed by positive antigen or real-time reverse-transcriptase– polymerase chain reaction (RT-PCR) test on nasopharyngeal swab. Significant differences by SVI in participant characteristics were assessed using the Fisher exact test. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) for associations between case status and SVI, controlling for HCP role and patient care activities, were estimated using logistic regression.
Results:
Significantly higher proportions of certified nursing assistants (48.0%) and medical assistants (44.1%) resided in high SVI census tracts, compared to registered nurses (15.9%) and physicians (11.6%). HCP cases were more likely than controls to live in high SVI census tracts (aOR, 1.76; 95% CI, 1.37–2.26).
Conclusions:
These findings suggest that residing in more socially vulnerable census tracts may be associated with SARS-CoV-2 infection risk among HCP and that residential vulnerability differs by HCP role. Efforts to safeguard the US healthcare workforce and advance health equity should address the social determinants that drive racial, ethnic, and socioeconomic health disparities.
Lake settlements, particularly crannogs, pose several contradictions—visible yet inaccessible, widespread yet geographically restricted, persistent yet vulnerable. To further our understanding, we developed the integrated use of palaeolimnological (scanning XRF, pollen, spores, diatoms, chironomids, Cladocera, microcharcoal, biogenic silica, SEM-EDS, stable-isotopes) and biomolecular (faecal stanols, bile acids, sedaDNA) analyses of crannog cores in south-west Scotland and Ireland. Both can be effective methods sets for revealing occupation chronologies and identifying on-crannog activities and practices. Strong results from sedaDNA and lipid biomarker analyses demonstrate probable on-site animal slaughter, food storage and possible feasting, suggesting multi-period, elite site associations, and the storage and protection of valuable resources.
Presenting the findings of a major Economic and Social Research Council (ESRC) project into urban austerity governance in eight cities across the world, this book offers comparative reflections on the myriad experiences of collaborative governance and its limitations.
Discontinuation of antipsychotic medication may be linked to high risk of relapse, hospitalization and mortality. This study investigated the use and discontinuation of antipsychotics in individuals with first-episode schizophrenia in relation to cohabitation, living with children, employment, hospital admission and death.
Methods
Danish registers were used to establish a nationwide cohort of individuals ⩾18 years with schizophrenia included at the time of diagnosis in1995–2013. Exposure was antipsychotic medication calculated using defined daily dose and redeemed prescriptions year 2–5. Outcomes year 5–6 were analysed using binary logistic, negative binomial and Cox proportional hazard regression.
Results
Among 21 351, 9.3% took antipsychotics continuously year 2–5, 38.6% took no antipsychotics, 3.4% sustained discontinuation and 48.7% discontinued and resumed treatment. At follow-up year 6, living with children or employment was significantly higher in individuals with sustained discontinuation (OR 1.98, 95% CI 1.53–2.56 and OR 2.60, 95% CI 1.91–3.54), non-sustained discontinuation (OR 1.25, 95% CI 1.05–1.48 and 2.04, 95% CI 1.64–2.53) and no antipsychotics (OR 2.00, 95% CI 1.69–2.38 and 5.64, 95% CI 4.56–6.97) compared to continuous users. Individuals with non-sustained discontinuation had more psychiatric hospital admissions (IRR 1.27, 95% CI 1.10–1.47) and longer admissions (IRR 1.68, 95% CI 1.30–2.16) year 5–6 compared to continuous users. Mortality during year 5–6 did not differ between groups.
Conclusion
Most individuals with first-episode schizophrenia discontinued or took no antipsychotics the first years after diagnosis and had better functional outcomes. Non-sustained discontinuers had more, and longer admissions compared to continuous users. However, associations found could be either cause or effect.
Research among non-industrial societies suggests that body kinematics adopted during running vary between groups according to the cultural importance of running. Among groups in which running is common and an important part of cultural identity, runners tend to adopt what exercise scientists and coaches consider to be good technique for avoiding injury and maximising performance. In contrast, among groups in which running is not particularly culturally important, people tend to adopt suboptimal technique. This paper begins by describing key elements of good running technique, including landing with a forefoot or midfoot strike pattern and leg oriented roughly vertically. Next, we review evidence from non-industrial societies that cultural attitudes about running associate with variation in running techniques. Then, we present new data from Tsimane forager–horticulturalists in Bolivia. Our findings suggest that running is neither a common activity among the Tsimane nor is it considered an important part of cultural identity. We also demonstrate that when Tsimane do run, they tend to use suboptimal technique, specifically landing with a rearfoot strike pattern and leg protracted ahead of the knee (called overstriding). Finally, we discuss processes by which culture might influence variation in running techniques among non-industrial societies, including self-optimisation and social learning.
Our book details and documents the impact of austerity governance on a selection of cities. Yet for some commentators, cities and urban spaces remain the ‘new theatres of struggle’ in our contemporary condition (Hamel, 2014). This chapter critically assesses the forms of social and political resistance that emerged across the eight cities in our study. Building on themes introduced in Chapters 1 and 2, it argues that cities serve as crucibles for a diverse set of political contestations, responses and initiatives, but they exhibit differential capacities to shape their environments. Indeed, it demonstrates the complex ‘mix’ of political traditions, institutions, socio-economic structures, practices and ideological systems that come together to constitute the city as a political engine. In so doing, we draw particular attention to the shifting locus of resistance to austerity across communities and neighbourhoods. Our analysis and evaluation suggest that the future projection of cities as ‘spaces of hope’ rests on the twin challenges of ‘scaling up’ neighbourhood protests into broad and anti-systemic political projects, while reinvesting in the construction of progressive relations with the local state that open local spaces of manoeuvre to challenge national regimes of austerity.
Against this background, we turn first to our initial presentation and discussion of the eight cities, focusing on Melbourne, Barcelona and Nantes, whose distinctive characteristics provide the parameters for the analysis of all the cases. We then examine and describe the cases of Athens, Baltimore, Dublin, Leicester and Montréal, analysed here as in Chapter 1 through the lens of austerity realism. Finally, we focus on the cities of Barcelona and Nantes, which we deem to be exemplary cases of cities that have most contributed to social and political change, both in terms of the development of creative governance arrangements, and with respect to the social movements and political groups that have emerged within and beyond the official spaces of politics. Our characterization and evaluation establish the potentials, limits and contingency of new urban struggles and politics, whose forms are shaped by a concatenation of variables at multiple levels of analysis, and we conclude by setting out the challenges faced by these incipient and in many cases fleeting forms.
The reality of austerity in our eight case study cities and elsewhere has been strongly shaped by a phenomenon, long studied by geographers and recognized across the social sciences as well as by practitioners in policy making, politics and activism: social, political and institutional spaces are structured through a hierarchy of spatial scales that is not pregiven but socially constructed. Emphasizing scale in this manner confirms an intuitive assumption we make on a daily basis – when we go to work from our home, or when we go on vacation – that ‘spaces across the world differ from one another’ (Brenner, 2009: 27). What might sound trivial, is an important marker in the way we understand the world around us. How, then, does scale matter specifically? We all know the concept of scale from the ways we use a map or a measuring tape. In this colloquial usage, we presuppose that there is a natural quality to the concept: we rely on its truth as given. If you use a map for a cycling trip, and its scale tells you that one centimetre on the map represents ten kilometres, you assume that if you plan a trip represented by five centimetres on the map, it means that the distance you will travel is, in fact, 50 kilometres in reality (never mind the hills and valleys).
While this ‘natural’ understanding of scale underlies its use in this chapter, we add to it the notion that scale in social life is, for the most part, not a given but socially constructed. Being part of the general vocabulary with which we seek to understand the uneven spatial development of modern society, scale reveals its true explanatory power when we realize that it is a plastic concept that is subject to interpretation and negotiation. When we use scale in this manner, we refer to ‘the vertical differentiation of social relations among, for instance, global, supranational, national, regional, urban and/or local levels’ (Brenner, 2009: 31). We say: scale is socially constructed and use participles such as ‘scaling’ or ‘rescaling’ to refer to the more or less intentional activity to shape this ‘vertical differentiation.’ Political decision makers and activists refer to the scale of government at which they want their action to count: the nation state, the region, the county, the municipality.
Economic migration flows, accelerated by globalization, have substantially increased the cultural and ethnic diversity of Western societies with high GDP economies. As a large part of these migration flows are motivated by the aspirations of those living in the Global South, or the majority world, to improve their living conditions in more economically prosperous countries, the result in the host societies is not only a substantial increase in ethnic and cultural diversity, but also greater social challenges in accommodating difference as well as the policy challenges of addressing socio-spatial inequalities that already exist in cities. The rapid growth of inwards migration not only poses a formidable challenge from the point of view of intercultural relations, but also for the social and spatial cohesion of the destination societies. The resulting inequalities add to the racialized geographies of the early 21st century in many Western countries. The different kinds of migrants coming from the Global South – labour migrants, refugees, asylum seekers – and the places in which they concentrate, together with the local disadvantage created by histories of racism and colonialism of the last century, are amongst the most vulnerable to the dynamics of social marginalization and stigma. These dynamics have been exacerbated in many Western cities since the 2008 Global Economic Crisis (GEC) and the introduction of austerity policies discussed throughout the book.
This chapter discusses the way that (neoliberal) austerity has impacted social, racial and cultural inequalities and the ability of collaboration to support more inclusive democratic cities or resist exclusions. The basic premise is that cities play a fundamental role in the dynamics of social inclusion or exclusion of economic migrants and other racial and ethnic minorities, and in the way that societies cope with the challenge of recognizing and accommodating cultural diversity. This is due to at least three phenomena: first, cities are the places where the vast majority of the newcomers settle and where the greatest cultural and racial diversity can be found; second, cities concentrate a wide array of services and infrastructures and are the site of policy that creates or removes opportunity for the social inclusion of migrants and minorities – for example schools, social services, health and community centres, sport and cultural facilities, parks and squares, urban revitalization, public transport or migrant settlement services;