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Ageing populations with increased needs, rising costs of traditional services, and new technologies are some factors driving the use of e-health services. A Norwegian study with data from 2015-2016 found that 13.5% had used apps, 7.3% had used social media, and 5% had used video services for health purposes. Little is known about the effects of many online health services, but in general they seem to increase knowledge and make most people feel reassured, although some users feel more anxious or confused after using such tools. Recent technological developments have resulted in new online health services, including AI-based technologies. More updated knowledge regarding the population’s use of e-health services in general and e-mental health services in particular, is needed.
Objectives
The objective here is to provide information about an upcoming large population-based epidemiological study and how it addresses e-health and e-mental health.
Methods
We introduce the upcoming 8th version of the epidemiological Tromsø Study and discuss its importance to the field of e-mental health.
Results
The Tromsø epidemiological study has since 1974 taken place in the Norwegian municipality of Tromsø. It contains information on a range of topics within health and illness, including topics from many medical specialities, psychiatry and substance use. In the upcoming 8th version of the study (2025-2026), more than 33,000 people aged above 40 will be invited to participate. The main questionnaire will include questions relating to a wide variety of topics, including on e-health use. We suspect the importance of e-health and e-mental health have increased lately, and we will examine how the use of e-health may impact mental health.
Conclusions
Community-based studies, such as the Tromsø Study, allow researchers to study associations between many different variables, including mental health and e-health. The upcoming Tromsø 8 study will enable us to study e-health use and its relationship to mental health in a large sample representative of the Norwegian population.
People with schizophrenia on average are more socially isolated, lonelier, have more social cognitive impairment, and are less socially motivated than healthy individuals. People with bipolar disorder also have social isolation, though typically less than that seen in schizophrenia. We aimed to disentangle whether the social cognitive and social motivation impairments observed in schizophrenia are a specific feature of the clinical condition v. social isolation generally.
Methods
We compared four groups (clinically stable patients with schizophrenia or bipolar disorder, individuals drawn from the community with self-described social isolation, and a socially connected community control group) on loneliness, social cognition, and approach and avoidance social motivation.
Results
Individuals with schizophrenia (n = 72) showed intermediate levels of social isolation, loneliness, and social approach motivation between the isolated (n = 96) and connected control (n = 55) groups. However, they showed significant deficits in social cognition compared to both community groups. Individuals with bipolar disorder (n = 48) were intermediate between isolated and control groups for loneliness and social approach. They did not show deficits on social cognition tasks. Both clinical groups had higher social avoidance than both community groups
Conclusions
The results suggest that social cognitive deficits in schizophrenia, and high social avoidance motivation in both schizophrenia and bipolar disorder, are distinct features of the clinical conditions and not byproducts of social isolation. In contrast, differences between clinical and control groups on levels of loneliness and social approach motivation were congruent with the groups' degree of social isolation.
Clinical trials face many challenges with meeting projected enrollment and retention goals. A study’s recruitment materials and messaging convey necessary key information and therefore serve as a critical first impression with potential participants. Yet study teams often lack the resources and skills needed to develop engaging, culturally tailored, and professional-looking recruitment materials. To address this gap, the Recruitment Innovation Center recently developed a Recruitment & Retention Materials Content and Design Toolkit, which offers research teams guidance, actionable tips, resources, and customizable templates for creating trial-specific study materials. This paper seeks to describe the creation and contents of this new toolkit.
The prevalence of mental disorders is considerably higher among incarcerated individuals than in the general population, but this burden is not matched by a proportional use of mental health services. Studies have found that incarcerated males are reluctant to seek help for mental health problems. Gaining knowledge of factors that influence incarcerated individuals to access or avoid professional help for mental health problems is important for tailoring interventions to address the mental health needs of this population. Promoting mental health service utilization among people in prison has the potential to reduce prison suicide rates and increase institutional functioning, thereby providing safer conditions for peers and staff, promoting rehabilitation, and reducing recidivism upon release.
Objectives
This study explores personal, interpersonal, and systemic aspects that motivate incarcerated individuals to approach or avoid seeking help for mental health problems. While prior studies have primarily focused on barriers to help-seeking, this study also sheds light on facilitators for seeking professional help for people in prison.
Methods
Individual in-depth interviews were conducted with sixteen incarcerated males from three prisons in Northern Norway. The data analysis was inspired by Grounded Theory.
Results
The majority of participants shared positive personal perspectives related to professional help-seeking, whereas the barriers were predominantly perceived to be of an interpersonal and systemic nature. Aspects that encouraged help-seeking were: regarding mental health treatment as necessary for successful rehabilitation, sufficient knowledge of when and how to contact mental health services, support from peers, having a higher ranking in the prison hierarchy, health services that are out-reaching, and prior positive experiences with professional help. The barriers to professional help-seeking were: lack of information about when and how to access mental health services, challenges with the self-referral system, perceived unavailability of services, confidentiality issues, and a prison climate that favoured a tough appearance.
Conclusions
The participants appeared to be more positive to seeking professional help for mental health problems than reported in previous studies with incarcerated individuals. Interpersonal and systemic aspects were emphasized by the participants as barriers to accessing mental health services; some participants even perceived these services to be unavailable to them. The results are relevant for designing interventions to promote help-seeking for mental health problems among people in prison.
This chapter presents the hypothesis that working memory and language evolved in tandem. It reviews the evolutionary origins of each of the components of Baddeley’s working memory model and their role in the evolution of language. The chapter reviews the gradualist position that language did evolve slowly from aurally directed early primate calls and notes that the primary purpose of language has always been communication. The chapter also presents the novel idea that the pragmatics of speech (the purposes of speech) also evolved in tandem with the evolution of working memory. The chapter also reviews the saltationist idea that something happened to language more recent than 100,000 years ago, and that is the release of the fifth pragmatic of speech, the subjunctive mood, which expresses wishes and ideas contrary to fact. The subjunctive mood required fully modern working memory capacity, sufficient phonological storage capacity, and an enhanced visuospatial sketchpad, which are also critically involved in episodic memory recall and simulation. The phenotypic result of this genotype meant that thought experiments could be conducted in a recursive manner. We propose that the fruits of Homo sapiens’s cultural explosion, cave art, creative figurines, and highly ritualized burials, were the direct result of the wishes and imaginings that arise from subjunctive thinking and subjunctive language.
The medical case report (CR) is a vital and viable medical genre with a history of more than 3000 years. With a few exceptions, the CR has had a typical format that has been consistent with the ideals of brevity, conciseness, and a matter-of-fact approach. CR in general and psychiatric CR especially, may benefit from more systematically emphasising and integrating relevant biopsychosocial (BPS) aspects.
Objectives
To discuss how to emphasise and integrate the BPS perspective in the CR.
Methods
Drawing on CR literature and our own experience as CR authors, we discuss how a broader BPS approach successfully can be included in the CR format.
Results
Some central factors that could be considered when including a BPS perspective in the CR are: 1) Actively eliciting the patient’s perspective and including this in the final report. 2) Including relevant information about the life and circumstances of the patient beyond the basic demographic information. 3) Making an effort to preserve the patient’s privacy also when more BPS information is included. The psychological and social constituents of the patient’s life should be central in the BPS-inspired psychiatric CR.
Conclusions
The traditional CR has a long-standing history in medicine and follows a typial conscise and brief format. ‘Hard facts’ and biological information have typically filled most of the text. We argue that giving psychological and social information more attention would improve the quality of many CR, and that this is especially relevant for psychiatric CR.
While prison inmates have an increased risk of mental illness, psychiatric services are often less accessible and insufficient for this group. A low level of awareness or a fear of becoming stigmatised could also influence the help-seeking behaviour of some inmates.
Objectives
To study the knowledge and beliefs regarding mental health and mental illness as well as the help-seeking behaviour of inmates in Norwegian prisons.
Methods
We describe a study of help-seeking behaviour and mental health literacy of prisoners. This is a qualitiative study involving in-depth interviews with inmates in prisons in North Norway.
Results
Recruitment and data collection is ongoing. Central topics in the interviews are inmates’ associations regarding positive mental health and how they can enhance their own well-being while in prison, and how other external factors can contribute to increased well-being. Furthermore, the inmates are asked about their attitudes, beliefs, and knowledge regarding mental illness, and what they think might be factors that can contribute to the development of mental illness. Moreover, we cover topics such as the inmates’ beliefs regarding the treatment of mental illness, strategies for handling such health problems, and sources of information regarding mental health and mental illness.
Conclusions
The study will increase knowledge about how prisoners think about mental health and mental illness and the help-seeking behaviours of prison inmates. In a next step, this understanding can be utilized in improving information about well-being, mental illness, and psychiatric services to prisoners.
Understanding the development of specific components of the neonatal immune system is critical to the understanding of the susceptibility of the neonate to specific pathogens [1]. With the increasing survival of extremely premature infants, neonatologists and other physicians caring for these newborns need to be aware of the vulnerability of this population. Furthermore, it is important for neonatologists to be able to differentiate between immune immaturity and the manifestations of a true primary immunodeficiency that present during the neonatal period. Failure to properly identify primary or acquired immunodeficiency diseases can result in delayed diagnosis and treatment, adversely affecting outcomes. This chapter will briefly define the immune immaturity of the neonate and a diagnostic approach for primary immune deficiency diseases that may present in the neonatal period.
We praise Arbib et al.'s Neural organization for its support of the integration of different levels of analysis, while noting that it does not always achieve what it advocates. We extend this approach into an area of neuropsychological activity in need of the structure offered by Organization at the intersection of the conflated fields of executive function and frontal lobe function.
Introduction: Continued smoking by cancer patients causes adverse cancer treatment outcomes, but few patients receive evidence-based smoking cessation as a standard of care.
Aim: To evaluate practical strategies to promote wide-scale dissemination and implementation of evidence-based tobacco cessation services within state cancer centers.
Methods: A Collaborative Learning Model (CLM) for Quality Improvement was evaluated with three community oncology practices to identify barriers and facilitate practice change to deliver evidence-based smoking cessation treatments to cancer patients using standardized assessments and referrals to statewide smoking cessation resources. Patients were enrolled and tracked through an automated data system and received follow-up cessation support post-enrollment. Monthly quantitative reports and qualitative data gathered through interviews and collaborative learning sessions were used to evaluate meaningful quality improvement changes in each cancer center.
Results: Baseline practice evaluation for the CLM identified the lack of tobacco use documentation, awareness of cessation guidelines, and awareness of services for patients as common barriers. Implementation of a structured assessment and referral process demonstrated that of 1,632 newly registered cancer patients,1,581 (97%) were screened for tobacco use. Among those screened, 283 (18%) were found to be tobacco users. Of identified tobacco users, 207 (73%) were advised to quit. Referral of new patients who reported using tobacco to an evidence-based cessation program increased from 0% at baseline across all three cancer centers to 64% (range = 30%–89%) during the project period.
Conclusions: Implementation of quality improvement learning collaborative models can dramatically improve delivery of guideline-based tobacco cessation treatments to cancer patients.
Berseem clover (Trifolium alexandrinum L.) is an important forage legume and is the primary winter forage crop in Pakistan. There are significant gaps in yield potential among varieties of berseem clover, as well as yields obtained at research stations and on-farm. To address this problem a survey of farmers was undertaken in the districts of Kasur and Okara, Punjab, Pakistan to determine the level of knowledge and understanding of berseem forage cultivation and seed production. The study comprised 44% smallholder (<3 ha), 26% medium (3–5 ha) and 30% large farmers (>5 ha) with average age of 42 years. Most farmers had little or no knowledge of the role of seed quality, inoculation with rhizobium, pollination, fertiliser use, irrigation management and the importance of forage nutritional value in improving livestock productivity. Most farmers (56%) had received no input from the government or private sector to improve forage production, relying instead on traditional knowledge. Knowledge of the importance of land preparation (95%), sowing rate (98%) and insect and pest management (75%) was higher than seed selection and fertilisation. Adoption of improved varieties (3%) and production technologies (14%) was low due to various constraints including ignorance, high cost of inputs, lack of availability of inputs in the market and a perceived high level of financial risk. Almost 100% of the respondents agreed that seed of improved varieties was a pre-requisite for higher forage and seed production as well as essential to start village-based forage seed enterprises.
Models of products and design processes are key to interacting with engineering designs and managing the processes by which they are developed. In practice, companies maintain networks of many interrelated models which need to be synthesised in the minds of their users when considering issues that cut across them. This article considers how information from product and design process models can be integrated with a view to help manage these complex interrelationships. A framework highlighting key issues surrounding model integration is introduced and terminology for describing these issues is developed. To illustrate the framework and terminology, selected modelling approaches that integrate product and process information are discussed and organised according to their levels and forms of integration. Opportunities for further work to advance integrated modelling in engineering design research and practice are discussed.
We provide sedimentological, geochemical, mineral magnetic, stable carbon isotope, charcoal, and pollen-based evidence from a guano/clay sequence in Gaura cu Muscă Cave (SW Romania), from which we deduced that from ~ 1230 BC to ~ AD 1240 climate oscillated between wet and dry. From ~ 1230 BC to AD 1000 the climate was wetter than the present, prompting flooding of the cave, preventing bats from roosting, and resulting in a slow rate of clay accumulation. The second half of the Medieval Warm Period (MWP) was generally drier; the cave experienced occasional flash flooding in between which maternity bat roosts established in the cave. One extremely wet event occurred around AD 1170, when Fe/Mn and Ti/Zr ratios show the highest values coincident with a substantial increase of sediment load in the underground stream. The mineral magnetic characteristics for the second part of the MWP indicate the partial input of surface-sourced sediments reflecting agricultural development and forest clearance in the area. Pollen and microcharcoal studies confirm that the overall vegetation cover and human land use have not changed much in this region since the medieval times.
Recognising elements of a ‘modern’ mind or complex cognition in Stone Age archaeology is difficult and often disputed. A key question is whether, and in what way, the thinking of Homo sapiens differs from that of other species/sub-species of hominins. We argue that if the question of whether the modern mind is different from that of our ancestors or other members of the hominin family is to be fully explored, some focus should fall on technologies and behaviours unique to H. sapiens.
Significant progress has been made towards the understanding of the clinical implications of the immature neonatal immune system. With the increasing survival of extremely premature infants, neonatologists and other physicians caring for these patients must be aware of the vulnerability of this patient population. It is important for neonatologists to be able to differentiate between immune immaturity and a true primary immunodeficiency that may present during the neonatal period. Failure to properly identify primary immunodeficiency diseases can result in delayed diagnosis and treatment, which can significantly affect the outcome of the disease. This chapter will briefly define the immune immaturity of the neonate. More specifically, the immune deficiency syndromes that may present during the neonatal period are discussed followed by a stepwise approach on how to properly diagnose and manage neonates with suspected immunodeficiency diseases.
Immaturity of the neonatal immune system
The immaturity of a neonate’s immune response places them at an increased risk for serious infection. An understanding of the development of the neonatal immune system is essential in order to be able to differentiate the clinical manifestations of infection associated with immaturity from those that identify a specific acquired or primary immunodeficiency disease. For further detail on the development of the immune system, the reader should refer to Chapter 3. The immune defects associated with immaturity and their associated susceptibility to specific types of infections are summarized in Table 15.1.
Patients with bipolar disorder exhibit consistent deficits in facial affect identification at both behavioral and neural levels. However, little is known about which stages of facial affect processing are dysfunctional.
Method
Event-related potentials (ERPs), including amplitude and latency, were used to evaluate two stages of facial affect processing: N170 to examine structural encoding of facial features and N250 to examine decoding of facial features in 57 bipolar disorder patients, 30 schizophrenia patients and 30 healthy controls. Three conditions were administered: participants were asked to identify the emotion of a face, the gender of a face, or whether a building was one or two stories tall.
Results
Schizophrenia patients' emotion identification accuracy was lower than that of bipolar patients and healthy controls. N170 amplitude was significantly smaller in schizophrenia patients compared to bipolar patients and healthy controls, which did not differ from each other. Both patient groups had significantly longer N170 latency compared to healthy controls. For N250, both patient groups showed significantly smaller amplitudes compared with controls, but did not differ from each other. Bipolar patients showed longer N250 latency than healthy controls; patient groups did not differ from each other.
Conclusions
Bipolar disorder patients have relatively intact structural encoding of faces (N170) but are impaired when decoding facial features for complex judgments about faces (N250 latency and amplitude), such as identifying emotion or gender.
Carey leaves unaddressed an important evolutionary puzzle: In the absence of a numeral list, how could a concept of natural number ever have arisen in the first place? Here we suggest that the initial development of natural number must have bootstrapped on a material culture scaffold of some sort, and illustrate how this might have occurred using strings of beads.