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68 Neurocognitive Functioning and Symptoms of Psychosis in Precariously Housed Adults with Multimorbidity
- Anna M. Petersson, Kristina M. Gicas, Chantelle J. Giesbrecht, Andrea A. Jones, Tari Buchanan, Wendy Loken Thornton, Megan McLarnon, William G. Honer, Allen E. Thornton
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 852-853
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Objective:
In persons with severe psychiatric disorders, distinct neurocognitive profiles hold differential associations to positive, negative and disorganized symptom dimensions of psychosis. These patterns portend specific functional outcomes, treatment efficacy, and prognoses. Similar associations have not been established in multimorbid samples in which persons present with a complex array of psychiatric symptoms. The objective of this study was to (1) establish neurocognitive profiles in a multimorbid, marginalized sample and (2) investigate their pattern(s) of association with psychiatric symptom dimensions and psychosocial outcomes.
Participants and Methods:Participants (n=370; Mage = 45 years; 74% male) were precariously housed, substance-using adults with multimorbidity, recruited from Single-Room Occupancy hotels and a community court within the Downtown Eastside of Vancouver, BC, Canada. Data were collected as part of a longitudinal examination consisting of annual, bi-annual, and monthly neurocognitive, psychosocial, and psychiatric assessments. Neurocognitive scores were combined into five cognitive domains (Attentional Control [AC]; Processing Speed [PS]; Fluid Reasoning [Problem Solving and Reversal Learning; Gf]; Encoding and Retrieval [ER]; and Decision Making [DM]) and submitted to a latent profile analysis. The resulting profiles capturing neurocognition were validated on sociodemographic and clinical variables. Finally, the profiles were compared across previously validated, population-distinct factors derived from the Positive and Negative Syndrome Scale (PANSS), as well as on measures of psychosocial functioning.
Results:An optimal goodness-of-fit was reached for a three-profile model (BLRT=127.86, p=.01). Profile 1 (n=207, 55.9%) showed stronger neurocognition (all p<.05), with a within-profile strength in Gf (p<.001). With the exception of ER, Profile 2 (n=109, 29.5%) exhibited inferior neurocognition across all indicators compared to Profile 1 (all p <.05); yet showed a relative, within-profile strength in Gf (p < .01). Profile 3 (n=54, 14.6%) generally displayed comparable impairments to Profile 2. Additionally, their performance on Gf was remarkably low compared to Profiles 1 and 2 (p<.001). Psychiatrically, compared to Profile 1, Profile 2 exhibited more positive/disorganized symptoms and general psychopathology, as well as higher total PANSS (all p <.05), whereas Profile 3 showed the poorest insight/awareness (p<.01). Profiles 2 and 3 had lower levels of adaptive functioning and work productivity compared to Profile 1 (all p<.01).
Conclusions:Three neurocognitive profiles were detected in a sample of precariously housed adults with multimorbidity: one profile of comparatively higher neurocognitive capacity, with less symptoms of psychosis and better psychosocial functioning; a second profile of comparatively poorer neurocognition and psychosocial functioning, with more symptoms of psychosis; and a third profile with a severe deficit in fluid reasoning and poor insight and awareness. Given their poor insight, the third profile may be comprised of particularly vulnerable persons at greater risk of unmet healthcare needs. Interventions to improve these individuals' understanding of their personal health risks might facilitate their capacity to access services. Conversely, individuals from Profile 2 may benefit from outreach programs focusing on medication access and adherence to address their symptoms of psychosis. In sum, our findings suggest that the confluence of neurocognition and psychiatric symptoms may implicate unique treatment approaches and outcomes in precariously-housed persons with multimorbid conditions.
10 Subtyping Serial Position Score Profiles to Investigate the Nature of Memory Impairment in Homeless and Precariously Housed Persons
- Katie C. Benitah, Kristina M. Gicas, Paul W. Jones, Anna M. Petersson, Allen E. Thornton, Tari Buchanan, William G. Honer
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 528-529
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Objective:
Cognitive dysfunction is prominent in homeless and precariously housed persons, and memory dysfunction is the most pervasive domain. The presence of multimorbid physical and mental illness suggests that several underlying mechanisms of memory impairment may be at play. The serial position phenomenon describes the tendency to best recall the beginning (primacy effect) and last (recency effect) words on a supra-span wordlist. Recency recall engages executive and working-memory systems, whereas primacy recall depends on long-term memory. This study investigates memory dysfunction in a homeless and precariously housed sample by identifying and characterizing unique subtypes of serial position profiles on a test of verbal memory.
Participants and Methods:Data were used from a 20-year study of homeless and precariously housed adults recruited from an impoverished neighbourhood in Vancouver, Canada. Participants were sub-grouped according to their serial position profile on the Hopkins Verbal Learning Test-Revised using a latent profile analysis (LPA; n = 411). Paired samples t-tests were conducted to determine differences in percent recall from each word-list region within classes. Linear regression analyses were used to examine between-class differences in mean serial position scores and other cognitive measures (memory, attention, processing speed, cognitive control). Covariates included age, sex, and education.
Results:LPA identified two profiles characterized by (1) reduced primacy relative to recency (RP; n = 150); and (2) reduced recency relative to primacy (RR; n = 261). Pairwise comparisons within the RP class showed that recency was better than primacy (p < .001, d = .66) and middle recall (p < .001, d = .52), with no difference between primacy and middle recall (p = .68, d = .04). All pairwise comparisons differed within the RR class (primacy > middle recall: p < .001, d = 1.85; primacy > recency recall: p < .001, d = 1.32; middle > recency recall: p < .05, d = .132). The RP class had worse performance on measures of total immediate (ß = .47, p < .001) and delayed verbal recall (ß = .32, p < .001); processing speed (ß = .20, p < .001); and cognitive control (ß = .22, p < .001). The RR class made more repetition errors (ß = .25, p < .001).
Conclusions:These findings support substantial heterogeneity in memory functioning in homeless and precariously housed individuals. The RP profile was characterized by poorer cognitive functioning across several domains, which suggests multiple contributions to memory impairment, including dysfunction of long-term memory circuitry. The RR profile with their higher number of repetition errors, may experience difficulties with self-monitoring in verbal learning. Subsequent studies will explore the neurobiological underpinnings of these subgroups to further characterize profiles and identify targets for cognitive intervention.
44 Cognitive Intraindividual Variability as a Predictor of Functional Outcomes in a Sample of Precariously Housed Individuals
- Michelle J Blumberg, Anna Petersson, Paul W Jones, Allen E Thornton, William G Honer, Tari Buchanan, Kristina M Gicas
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 724-725
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Objective:
Precariously housed individuals are exposed to multiple adverse factors negatively impacting neurocognitive functioning. Additionally, this population is subjected to poor life outcomes, such as impaired psychosocial functioning. Neurocognitive functioning plays an important role in psychosocial functioning and may be especially critical for precariously housed individuals who face numerous barriers in their daily lives. However, few studies have explicitly examined the cognitive determinants of functional outcomes in this population. Cognitive intraindividual variability (IIV) involves the study of within-person differences in neurocognitive functioning and has been used as marker of frontal system pathology. Increased IIV has been associated with worse cognitive performance, cognitive decline, and poorer everyday functioning. Hence, IIV may add to the predictive utility of commonly used neuropsychological measures and may serve as an emergent predictor of poor outcomes in at-risk populations. The objective of the current study was to examine IIV as a unique index of the neurocognitive contributions to functional outcomes within a large sample of precariously housed individuals. It was hypothesized that greater IIV would be associated with poorer current (i.e., baseline) and long-term (i.e., up to 12 years) psychosocial functioning.
Participants and Methods:Four hundred and thirty-seven adults were recruited from single-room occupancy hotels located in the Downtown Eastside of Vancouver, Canada (Mage = 44 years, 78% male) between November 2008 and November 2021. Baseline neurocognitive functioning was assessed at study enrolment. Scores from the Social and Occupational Functioning Assessment Scale (SOFAS), the Role Functioning Scale (RFS), the physical component score (PCS) and the mental component score (MCS) of the 36-Item Short Form Survey Instrument were obtained at participants’ baseline assessments and at their last available follow-up assessment to represent baseline and long-term psychosocial functioning, respectively. Using an established formula, an index of IIV was derived using a battery of standardized tests that broadly assessed verbal learning and memory, sustained attention, mental flexibility, and cognitive control. A series of multiple linear regressions were conducted to predict baseline and long-term social and role functioning (average across SOFAS and RFS scores), and PCS and MCS scores from IIV. In each of the models, we also included common predictors of functioning, including a global cognitive composite score, age, and years of education.
Results:The IIV index and the global composite score did not explain a significant proportion of the variance in baseline and long-term social and role functioning (p > .05). However, IIV was a significant predictor of baseline (B = -3.84, p = .021) and long-term (B = -3.58, p = .037) PCS scores, but not MCS scores (p > .05). The global composite score did not predict baseline or long-term PCS scores.
Conclusions:IIV significantly predicted baseline and long-term physical functioning, but not mental functioning or social and role functioning, suggesting that IIV may be a sensitive marker for limitations in everyday functioning due to physical health problems in precariously housed individuals. Critically, the present study is the first to show that IIV may be a useful index for predicting poor long-term health-related outcomes in this population compared to traditional neuropsychological measures.
Sudden-Onset Disaster Mass-Casualty Incident Response: A Modified Delphi Study on Triage, Prehospital Life Support, and Processes
- Joe Cuthbertson, Eric Weinstein, Jeffrey Michael Franc, Peter Jones, Hamdi Lamine, Sabina Magalini, Daniele Gui, Kristina Lennquist, Federica Marzi, Alessandro Borrello, Pietro Fransvea, Andrea Fidanzio, Carlos Yanez Benítez, Gerhard Achaz, Bob Dobson, Nabeela Malik, Michael Neeki, Ronald Pirrallo, Rafael Castro Delgado, Giacomo Strapazzon, Marcelo Farah Dell’Aringa, Hermann Brugger, Chaim Rafalowsky, Marcello Marzoli, Giovanni Fresu, Knut Magne Kolstadbraaten, Stenn Lennquist, Jonathan Tilsed, Ilene Claudius, Piyapan Cheeranont, Rachel Callcut, Miklosh Bala, Anthony Kerbage, Luis Vale, Norman Philipp Hecker, Roberto Faccincani, Luca Ragazzoni, Marta Caviglia
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue 5 / October 2023
- Published online by Cambridge University Press:
- 07 September 2023, pp. 570-580
- Print publication:
- October 2023
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The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements. These findings will be utilized in the development of evidence-based prehospital mass-casualty incident response tools and guidelines.
Some observations on the temporal patterns in the surplus process of an insurer
- Yang Miao, Kristina P. Sendova, Bruce L. Jones, Zhong Li
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- Journal:
- British Actuarial Journal / Volume 28 / 2023
- Published online by Cambridge University Press:
- 25 May 2023, e4
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In this paper, we explore potential surplus modelling improvements by investigating how well the available models describe an insurance risk process. To this end, we obtain and analyse a real-life data set that is provided by an anonymous insurer. Based on our analysis, we discover that both the purchasing process and the corresponding claim process have seasonal fluctuations. Some special events, such as public holidays, also have impact on these processes. In the existing literature, the seasonality is often stressed in the claim process, while the cash inflow usually assumes simple forms. We further suggest a possible way of modelling the dependence between these two processes. A preliminary analysis of the impact of these patterns on the surplus process is also conducted. As a result, we propose a surplus process model which utilises a non-homogeneous Poisson process for premium counts and a Cox process for claim counts that reflect the specific features of the data.
A Modified Delphi Study to Improve Prehospital Mass Casualty Incident Response
- Joseph Cuthbertson, Eric Weinstein, Jeffrey Franc, Sabina Magalini, Daniele Gui, Peter Jones, Kristina Montan, Roberto Faccincani, Luca Ragazzoni, Marta Caviglia
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue S1 / May 2023
- Published online by Cambridge University Press:
- 13 July 2023, p. s180
- Print publication:
- May 2023
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Introduction:
The Novel Integrated Toolkit for Enhanced Pre-Hospital Life Support and Triage in Challenging and Large Emergencies (NIGHTINGALE) project was awarded to a consortium to design an innovative toolkit featuring different technological solutions for prehospital mass casualty incident (MCI) response. Translational science (T) methodology was undertaken to develop evidence-based guidelines for MCI response.
Method:The consortium was divided into three work groups (WGs) MCI Triage, Prehospital Life Support and Damage Control and Prehospital Processes. Each WG previously collected data through the project T1 scoping review stage to provide the foundation for the initial T2 modified Delphi draft statements to present to WG internal focus groups for content and NIGHTINGALE study objectives. Their refined statements proceeded to WG specific external focus groups for further editing to be clear and concise for the following modified Delphi consensus rounds. Final WG statements were presented to modified Delphi experts for their consensus using the STAT59 platform with instruction to rank each statement on a seven-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤1.0.
Results:After three modified Delphi rounds, 18 of 24 statements attained consensus by the MCI Triage experts, eight of 25 by the Prehospital and Life Support and Damage Control experts, and 23 of 28 by the Prehospital Processes experts.
Conclusion:The three work groups will utilize consensus statements during the NIGHTINGALE project T3 phase to create evidence-based MCI response guidelines.
SHEA Neonatal Intensive Care Unit (NICU) White Paper Series: Practical approaches for the prevention of central-line–associated bloodstream infections
- Part of
- Martha Muller, Kristina A. Bryant, Claudia Espinosa, Jill A. Jones, Caroline Quach, Jessica R. Rindels, Dan L. Stewart, Kenneth M. Zangwill, Pablo J. Sánchez
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 44 / Issue 4 / April 2023
- Published online by Cambridge University Press:
- 04 March 2022, pp. 550-564
- Print publication:
- April 2023
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This document is part of the “SHEA Neonatal Intensive Care Unit (NICU) White Paper Series.” It is intended to provide practical, expert opinion, and/or evidence-based answers to frequently asked questions about CLABSI detection and prevention in the NICU. This document serves as a companion to the CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Prevention of Infections in Neonatal Intensive Care Unit Patients. Central line-associated bloodstream infections (CLABSIs) are among the most frequent invasive infections among infants in the NICU and contribute to substantial morbidity and mortality. Infants who survive CLABSIs have prolonged hospitalization resulting in increased healthcare costs and suffer greater comorbidities including worse neurodevelopmental and growth outcomes. A bundled approach to central line care practices in the NICU has reduced CLABSI rates, but challenges remain. This document was authored by pediatric infectious diseases specialists, neonatologists, advanced practice nurse practitioners, infection preventionists, members of the HICPAC guideline-writing panel, and members of the SHEA Pediatric Leadership Council. For the selected topic areas, the authors provide practical approaches in question-and-answer format, with answers based on consensus expert opinion within the context of the literature search conducted for the companion HICPAC document and supplemented by other published information retrieved by the authors. Two documents in the series precede this one: “Practical approaches to Clostridioides difficile prevention” published in August 2018 and “Practical approaches to Staphylococcus aureus prevention,” published in September 2020.
Characterisation of age and polarity at onset in bipolar disorder
- Janos L. Kalman, Loes M. Olde Loohuis, Annabel Vreeker, Andrew McQuillin, Eli A. Stahl, Douglas Ruderfer, Maria Grigoroiu-Serbanescu, Georgia Panagiotaropoulou, Stephan Ripke, Tim B. Bigdeli, Frederike Stein, Tina Meller, Susanne Meinert, Helena Pelin, Fabian Streit, Sergi Papiol, Mark J. Adams, Rolf Adolfsson, Kristina Adorjan, Ingrid Agartz, Sofie R. Aminoff, Heike Anderson-Schmidt, Ole A. Andreassen, Raffaella Ardau, Jean-Michel Aubry, Ceylan Balaban, Nicholas Bass, Bernhard T. Baune, Frank Bellivier, Antoni Benabarre, Susanne Bengesser, Wade H Berrettini, Marco P. Boks, Evelyn J. Bromet, Katharina Brosch, Monika Budde, William Byerley, Pablo Cervantes, Catina Chillotti, Sven Cichon, Scott R. Clark, Ashley L. Comes, Aiden Corvin, William Coryell, Nick Craddock, David W. Craig, Paul E. Croarkin, Cristiana Cruceanu, Piotr M. Czerski, Nina Dalkner, Udo Dannlowski, Franziska Degenhardt, Maria Del Zompo, J. Raymond DePaulo, Srdjan Djurovic, Howard J. Edenberg, Mariam Al Eissa, Torbjørn Elvsåshagen, Bruno Etain, Ayman H. Fanous, Frederike Fellendorf, Alessia Fiorentino, Andreas J. Forstner, Mark A. Frye, Janice M. Fullerton, Katrin Gade, Julie Garnham, Elliot Gershon, Michael Gill, Fernando S. Goes, Katherine Gordon-Smith, Paul Grof, Jose Guzman-Parra, Tim Hahn, Roland Hasler, Maria Heilbronner, Urs Heilbronner, Stephane Jamain, Esther Jimenez, Ian Jones, Lisa Jones, Lina Jonsson, Rene S. Kahn, John R. Kelsoe, James L. Kennedy, Tilo Kircher, George Kirov, Sarah Kittel-Schneider, Farah Klöhn-Saghatolislam, James A. Knowles, Thorsten M. Kranz, Trine Vik Lagerberg, Mikael Landen, William B. Lawson, Marion Leboyer, Qingqin S. Li, Mario Maj, Dolores Malaspina, Mirko Manchia, Fermin Mayoral, Susan L. McElroy, Melvin G. McInnis, Andrew M. McIntosh, Helena Medeiros, Ingrid Melle, Vihra Milanova, Philip B. Mitchell, Palmiero Monteleone, Alessio Maria Monteleone, Markus M. Nöthen, Tomas Novak, John I. Nurnberger, Niamh O'Brien, Kevin S. O'Connell, Claire O'Donovan, Michael C. O'Donovan, Nils Opel, Abigail Ortiz, Michael J. Owen, Erik Pålsson, Carlos Pato, Michele T. Pato, Joanna Pawlak, Julia-Katharina Pfarr, Claudia Pisanu, James B. Potash, Mark H Rapaport, Daniela Reich-Erkelenz, Andreas Reif, Eva Reininghaus, Jonathan Repple, Hélène Richard-Lepouriel, Marcella Rietschel, Kai Ringwald, Gloria Roberts, Guy Rouleau, Sabrina Schaupp, William A Scheftner, Simon Schmitt, Peter R. Schofield, K. Oliver Schubert, Eva C. Schulte, Barbara Schweizer, Fanny Senner, Giovanni Severino, Sally Sharp, Claire Slaney, Olav B. Smeland, Janet L. Sobell, Alessio Squassina, Pavla Stopkova, John Strauss, Alfonso Tortorella, Gustavo Turecki, Joanna Twarowska-Hauser, Marin Veldic, Eduard Vieta, John B. Vincent, Wei Xu, Clement C. Zai, Peter P. Zandi, Psychiatric Genomics Consortium (PGC) Bipolar Disorder Working Group, International Consortium on Lithium Genetics (ConLiGen), Colombia-US Cross Disorder Collaboration in Psychiatric Genetics, Arianna Di Florio, Jordan W. Smoller, Joanna M. Biernacka, Francis J. McMahon, Martin Alda, Bertram Müller-Myhsok, Nikolaos Koutsouleris, Peter Falkai, Nelson B. Freimer, Till F.M. Andlauer, Thomas G. Schulze, Roel A. Ophoff
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- Journal:
- The British Journal of Psychiatry / Volume 219 / Issue 6 / December 2021
- Published online by Cambridge University Press:
- 25 August 2021, pp. 659-669
- Print publication:
- December 2021
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Background
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
AimsTo examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
MethodGenome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
ResultsEarlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
ConclusionsAAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Dynamic networks of psychotic symptoms in adults living in precarious housing or homelessness
- Andrea A. Jones, Kristina M. Gicas, Sara Mostafavi, Melissa L. Woodward, Olga Leonova, Fidel Vila-Rodriguez, Ric M. Procyshyn, Alex Cheng, Tari Buchanan, Donna J. Lang, G. William MacEwan, William J. Panenka, Alasdair M. Barr, Allen E. Thornton, William G. Honer
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- Journal:
- Psychological Medicine / Volume 52 / Issue 13 / October 2022
- Published online by Cambridge University Press:
- 18 January 2021, pp. 2559-2569
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Background
People living in precarious housing or homelessness have higher than expected rates of psychotic disorders, persistent psychotic symptoms, and premature mortality. Psychotic symptoms can be modeled as a complex dynamic system, allowing assessment of roles for risk factors in symptom development, persistence, and contribution to premature mortality.
MethodThe severity of delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content was rated monthly over 5 years in a community sample of precariously housed/homeless adults (n = 375) in Vancouver, Canada. Multilevel vector auto-regression analysis was used to construct temporal, contemporaneous, and between-person symptom networks. Network measures were compared between participants with (n = 219) or without (n = 156) history of psychotic disorder using bootstrap and permutation analyses. Relationships between network connectivity and risk factors including homelessness, trauma, and substance dependence were estimated by multiple linear regression. The contribution of network measures to premature mortality was estimated by Cox proportional hazard models.
ResultsDelusions and unusual thought content were central symptoms in the multilevel network. Each psychotic symptom was positively reinforcing over time, an effect most pronounced in participants with a history of psychotic disorder. Global connectivity was similar between those with and without such a history. Greater connectivity between symptoms was associated with methamphetamine dependence and past trauma exposure. Auto-regressive connectivity was associated with premature mortality in participants under age 55.
ConclusionsPast and current experiences contribute to the severity and dynamic relationships between psychotic symptoms. Interrupting the self-perpetuating severity of psychotic symptoms in a vulnerable group of people could contribute to reducing premature mortality.
Chapter 43 - Connection, Compassion, and Community
- from Part IV - Wellness Interventions
- Edited by Waguih William IsHak
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- The Handbook of Wellness Medicine
- Published online:
- 18 September 2020
- Print publication:
- 20 August 2020, pp 515-524
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Summary
Neuroscience reveals that human beings are interdependent creatures, hardwired for empathy and relationship. Natural selection has favored prosocial traits like empathy, kindness, sharing, cooperative play, mutual understanding, perspective taking, and trust [1, 2]. Social connection is central to both physical and mental well-being and increased survival [1, 3]. Conversely, social isolation is correlated with myriad deleterious consequences to health and longevity. Nervous system development, genetic expression, and health are integrally dependent on social connection [4, 5]. Children who are raised within secure environments with healthy bonds of presence, attunement, and resonance and trust will develop a neural framework that promotes receptivity, flexibility, self-understanding, mindful awareness, empathy (the ability to feel with others), and compassion (the feeling that arises when confronted with another’s suffering and desire to alleviate that suffering).
Cognitive decline and mortality in a community-based sample of homeless and precariously housed adults: 9-year prospective study
- Kristina M. Gicas, Andrea A. Jones, Allen E. Thornton, Anna Petersson, Emily Livingston, Kristina Waclawik, William J. Panenka, Alasdair M. Barr, Donna J. Lang, Fidel Vila-Rodriguez, Olga Leonova, Ric M. Procyshyn, Tari Buchanan, G. William MacEwan, William G. Honer
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- Journal:
- BJPsych Open / Volume 6 / Issue 2 / March 2020
- Published online by Cambridge University Press:
- 11 February 2020, e21
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Background
Homeless and precariously housed individuals experience a high burden of comorbid illnesses, and excess mortality. Cross-sectional studies report a high rate of cognitive impairment. Long-term trajectories have not been well investigated in this group.
AimsTo longitudinally assess risks for premature and/or accelerated cognitive ageing, and the relationship with early mortality in homeless and precariously housed people.
MethodThis is a 9-year community-based study of 375 homeless and precariously housed individuals from Vancouver, Canada. Annual cognitive testing assessed verbal learning and memory, and inhibitory control. Linear mixed-effects models examined associations between clinical risk factors (traumatic brain injury, psychotic disorders, viral exposure, alcohol dependence) and cognitive change over 9 years. Cox regression models examined the association between cognition and mortality.
ResultsTraumatic brain injury and alcohol dependence were associated with decline in verbal memory. Inhibitory control declined, independent of risk factors and to a greater extent in those who died during the study. Better inhibitory control was associated with a 6.6% lower risk of mortality at study entry, with a 0.3% greater effect for each year of life. For each one-point increase in the Charlson Comorbidity Index score at study entry, the risk of mortality was 9.9% higher, and was consistent across age. Adjusting for comorbidities, inhibitory control remained a significant predictor of mortality.
ConclusionsFindings raise the possibility of a premature onset, and accelerated trajectory, of cognitive ageing in this group of homeless and precariously housed people. Traumatic brain injury, alcohol dependence and cognition could be treatment priorities.
Contributors
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- By Kristina Bentley, Richard Calland, Nyasha Chingore, Ben Cousins, Jackie Dugard, David Fig, Liesl Gerntholtz, Beth Goldblatt, Adam Habib, Ruth Hall, Zaheera Jinnah, Peris Jones, Malcolm Langford, Sandra Liebenberg, Jennifer MacLeod, Tshepo Madlingozi, Tara Polzer Ngwato, Solange Rosa, Stuart Wilson, Rachel Wynberg
- Edited by Malcolm Langford, Universitetet i Oslo, Ben Cousins, University of the Western Cape, South Africa, Jackie Dugard, University of the Witwatersrand, Johannesburg, Tshepo Madlingozi, University of Pretoria
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- Socio-Economic Rights in South Africa
- Published online:
- 05 December 2013
- Print publication:
- 18 November 2013, pp vii-xii
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Contributors
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- By Isabella Aboderin, W. Andrew Achenbaum, Katherine R. Allen, Toni C. Antonucci, Sara Arber, Claudine Attias‐Donfut, Paul B. Baltes, Sandhi Maria Barreto, Vern L. Bengtson, Simon Biggs, Joanna Bornat, Julie B. Boron, Mike Boulton, Clive E. Bowman, Marjolein Broese van Groenou, Edna Brown, Robert N. Butler, Bill Bytheway, Neena L. Chappell, Neil Charness, Kaare Christensen, Peter G. Coleman, Ingrid Arnet Connidis, Neal E. Cutler, Sara J. Czaja, Svein Olav Daatland, Lia Susana Daichman, Adam Davey, Bleddyn Davies, Freya Dittmann‐Kohli, Glen H. Elder, Carroll L. Estes, Mike Featherstone, Amy Fiske, Alexandra Freund, Daphna Gans, Linda K. George, Roseann Giarrusso, Chris Gilleard, Jay Ginn, Edlira Gjonça, Elena L. Grigorenko, Jaber F. Gubrium, Sarah Harper, Jutta Heckhausen, Akiko Hashimoto, Jon Hendricks, Mike Hepworth, Charlotte Ikels, James S. Jackson, Yuri Jang, Bernard Jeune, Malcolm L. Johnson, Randi S. Jones, Alexandre Kalache, Robert L. Kane, Rosalie A. Kane, Ingrid Keller, Rose Anne Kenny, Thomas B. L. Kirkwood, Kees Knipscheer, Martin Kohli, Gisela Labouvie‐Vief, Kristina Larsson, Shu‐Chen Li, Charles F. Longino, Ariela Lowenstein, Erick McCarthy, Gerald E. McClearn, Brendan McCormack, Elizabeth MacKinlay, Alfons Marcoen, Michael Marmot, Tom Margrain, Victor W. Marshall, Elizabeth A. Maylor, Ruud ter Meulen, Harry R. Moody, Robert A. Neimeyer, Demi Patsios, Margaret J. Penning, Stephen A. Petrill, Chris Phillipson, Leonard W. Poon, Norella M. Putney, Jill Quadagno, Pat Rabbitt, Jennifer Reid Keene, Sandra G. Reynolds, Steven R. Sabat, Clive Seale, Merril Silverstein, Hannes B. Staehelin, Ursula M. Staudinger, Robert J. Sternberg, Debra Street, Philip Taylor, Fleur Thomése, Mats Thorslund, Jinzhou Tian, Theo van Tilburg, Fernando M. Torres‐Gil, Josy Ubachs‐Moust, Christina Victor, K. Warner Shaie, Anthony M. Warnes, James L. Werth, Sherry L. Willis, François‐Charles Wolff, Bob Woods
- Edited by Malcolm L. Johnson, University of Bristol
- Edited in association with Vern L. Bengtson, University of Southern California, Peter G. Coleman, University of Southampton, Thomas B. L. Kirkwood, University of Newcastle upon Tyne
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- Book:
- The Cambridge Handbook of Age and Ageing
- Published online:
- 05 June 2016
- Print publication:
- 01 December 2005, pp xii-xvi
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13 - Pollinator-mediated assortative mating: causes and consequences
- Edited by Lars Chittka, Queen Mary University of London, James D. Thomson, University of Toronto
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- Book:
- Cognitive Ecology of Pollination
- Published online:
- 13 August 2009
- Print publication:
- 28 May 2001, pp 259-273
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Summary
A typical animal pollinator forages non-randomly among plants in a community, using floral cues to recognize the available options. The tendency of individual foragers to restrict their visits to a subset of the available flowering species increases the proportion of pollen grains that arrive on appropriate stigmas. Pollinators partition themselves among plants in several ways, with the common result of assortative mating according to floral type. First, I discuss the evolutionary implications of assortative mating, in light of recent models that emphasize its importance for species divergence, then review the ways in which pollinator behavior contributes to assortative mating among floral types. Finally, I consider how the different forms of non-random pollinator behavior might influence floral evolution and plant speciation.
There is a long-standing tradition of thought that visitation by different pollinators drives divergence of floral form and provides reproductive isolation among incipient plant species (reviewed by Waser, this volume). However, pollinators rarely specialize completely on a single floral type (plant species or distinct phenotype within a species), leading some investigators to question the role of pollinators in the radiation of the angiosperms, and to suggest that floral evolution is largely decoupled from plant speciation (Waser 1998; Chittka et al. 1999). None the less, the remarkable radiation of angiosperms in parallel with pollinators (Grimaldi 1999), and findings that plant families with animal pollination are more speciose than those with abiotic pollination (Dodd et al. 1999), suggest that animal pollination was a key innovation in flowering plant evolution.