Racism is increasingly recognised as a key contributor to poor mental health. However, the existing literature primarily focuses on its effects on adults.

To identify literature on the association between experiences of racism and mental health in children and young people in the UK.

Inclusion criteria were: (a) peer-reviewed publications containing original data; (b) UK-based research; (c) included examination of associations between mental health and experiences of direct or indirect racism (quantitative or qualitative); (d) inclusion of an assessment of mental health outcomes; (e) participant ages up to and including 18 years of age or (if the range went beyond 18) with a mean age of 17 years or less. Six databases were searched between 2000 and 2022; an initial 11 522 studies were identified with only eight meeting the inclusion criteria.

Five of the identified studies provided quantitative data and three provided qualitative data. The majority of studies (7/8) focused on children and young people aged 10 years and over; only one focused on children under the age of 10 years. Measurements of racism varied among the studies providing quantitative data. Only four studies directly focused on the effects of racism on the mental health of children and young people.

Although the included studies highlighted potential negative impacts of experiences of racism on children and young people in the UK, this review shows the lack of available literature to inform policy and practice. No studies examined the impact of internalised racism, systemic and institutional racism, or intersectionality.

The COVID-19 pandemic posed an unprecedented global challenge, with past evidence suggesting negative psychological effects with the additional concern that social and physical restrictions might disproportionately affect adolescents.

To explore mental health and its wider determinants in young people in the UK during 1 year of the COVID-19 pandemic (August 2020–August 2021).

A representative sample of 11 898 participants (48.7% female) aged between 13 and 19 years (mean = 16.1) participated in five waves of data collection. Using validated self-reported questionnaires for loneliness, anxiety and depression, this survey measured the extent and nature of the mental health impacts of the coronavirus pandemic and help-seeking behaviours, and changes over time.

Young people experienced higher levels of anxiety during the summer and fall 2020, followed by higher levels of depression during the winter 2020–2021, with loneliness gradually increasing then peaking during the spring and summer of 2021. Young people who were older, female, with pre-existing mental-health issues and experiencing financial difficulties were at higher risk of anxiety, depression and loneliness. Help-seeking behaviours reduced the risk of depression and loneliness.

The COVID-19 pandemic had substantial impact on young people, whether on their mental health, their social contacts and interactions or their perspective on what the future holds for them. Young people strongly advocated for better teacher training, and a better integration of mental health services, particularly within their schools.

Research for development (R4D) projects are designed to enhance the research community's contribution to implementation of the 2030 Agenda of the United Nations. We studied seven R4D projects that specifically addressed Sustainable Development Goal (SDG) 15 (life on land) in 14 contexts across Asia, Africa, and South America. We then analyzed how these projects interacted with other SDGs. Our findings reveal that the positive and negative interactions between project objectives and SDG targets vary significantly across contexts, highlighting the importance of considering local conditions when designing and implementing R4D initiatives.

We analyze how the objectives of research for development (R4D) projects that focus on a particular Sustainable Development Goal (SDG) – SDG 15 (life on land) – interact with the targets of other SDGs. We studied seven R4D projects in 14 contexts across Asia, Africa, and Latin America, comparing expert judgement of interactions between project objectives and SDG targets. Our findings indicate that the success of these projects depends largely on whether they are also working toward SDG targets other than those contained in SDG 15. In particular, working toward targets contained within SDGs on poverty, hunger, water, energy, production and consumption, and global partnerships – was often considered indivisible from the project objectives. Further, while all of the projects focused on SDG 15, our findings suggest that addressing only this goal is not sufficient. A range of other targets that were a priori not the immediate focus of the projects were revealed as ‘crucial’ to the project objectives across contexts. Finally, we list several implications, such as the need for policies to integrate local realities and the need for environmental R4D projects to adopt a holistic scope, particularly in terms of (a) securing social foundations, (b) building enabling institutions, and (c) negotiating competing claims on land.

What can we learn from land-related research for development projects and their links to the SDGs in concrete contexts?

Concern that self-harm and mental health conditions are increasing in university students may reflect widening access to higher education, existing population trends and/or stressors associated with this setting.

To compare population-level data on self-harm, neurodevelopmental and mental health conditions between university students and non-students with similar characteristics before and during enrolment.

This cohort study linked electronic records from the Higher Education Statistics Agency for 2012–2018 to primary and secondary healthcare records. Students were undergraduates aged 18 to 24 years at university entry. Non-students were pseudo-randomly selected based on an equivalent age distribution. Logistic regressions were used to calculate odds ratios. Poisson regressions were used to calculate incidence rate ratios (IRR).

The study included 96 760 students and 151 795 non-students. Being male, self-harm and mental health conditions recorded before university entry, and higher deprivation levels, resulted in lower odds of becoming a student and higher odds of drop-out from university. IRRs for self-harm, depression, anxiety, autism spectrum disorder (ASD), drug use and schizophrenia were lower for students. IRRs for self-harm, depression, attention-deficit hyperactivity disorder, ASD, alcohol use and schizophrenia increased more in students than in non-students over time. Older students experienced greater risk of self-harm and mental health conditions, whereas younger students were more at risk of alcohol use than non-student counterparts.

Mental health conditions in students are common and diverse. While at university, students require person-centred stepped care, integrated with local third-sector and healthcare services to address specific conditions.

Childhood adversity is associated with increased later mental health problems and suicidal behaviour. Opportunities for earlier healthcare identification and intervention are needed.

To determine associations between hospital admissions for childhood adversity and mental health in children who later die by suicide.

Population-based longitudinal case-control study. Scottish in-patient general and psychiatric records were summarised for individuals born 1981 or later who died by suicide between 1991 and 2017 (cases), and matched controls (1:10), for childhood adversity and mental health (broadly defined as psychiatric diagnoses and general hospital admissions for self-harm and substance use).

Records were extracted for 2477 ‘cases’ and 24 777 ‘controls’; 2106 cases (85%) and 13 589 controls (55%) had lifespan hospitalisations. Mean age at death was 23.7; 75.9% were male. Maltreatment or violence-related childhood adversity codes were recorded for 7.6% cases aged 10–17 (160/2106) versus 2.7% controls (371/13 589), odds ratio = 2.9 (95% CI, 2.4–3.6); mental health-related admissions were recorded for 21.7% cases (458/2106), versus 4.1% controls (560/13 589), odds ratio = 6.5 (95% CI, 5.7–7.4); 80% of mental health admissions were in general hospitals. Using conditional logistic models, we found a dose-response effect of mental health admissions <18y, with highest adjusted odds ratio (aOR) for three or more mental health admissions: aORmale = 8.17 (95% CI, 5.02–13.29), aORfemale = 15.08 (95% CI, 8.07–28.17). We estimated that each type of childhood adversity multiplied odds of suicide by aORmale = 1.90 (95% CI, 1.64–2.21), aORfemale = 2.65 (95% CI, 1.94–3.62), and each mental health admission by aORmale = 2.06 (95% CI, 1.81–2.34), aORfemale = 1.78 (95% CI, 1.50–2.10).

Our lifespan study found that experiencing childhood adversity (primarily maltreatment or violence-related admissions) or mental health admissions increased odds of young person suicide, with highest odds for those experiencing both. Healthcare practitioners should identify and flag potential ‘at-risk’ adolescents to prevent future suicidal acts, especially those in general hospitals.

People under the care of mental health services are at increased risk of suicide. Existing studies are small in scale and lack comparisons.

To identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with mental health services.

This population-based study includes people who died by suicide in the year following a mental health services contact in Wales, 2001–2015 (cases), paired with similar patients who did not die by suicide (controls). We linked the National Confidential Inquiry into Suicide and Safety in Mental Health and the Suicide Information Database – Cymru with primary and secondary healthcare records. We present results of conditional logistic regression.

We matched 1031 cases with 5155 controls. In the year before their death, 98.3% of cases were in contact with healthcare services, and 28.5% presented with self-harm. Cases had more emergency department contacts (odds ratio 2.4, 95% CI 2.1–2.7) and emergency hospital admissions (odds ratio 1.5, 95% CI 1.4–1.7), but fewer primary care contacts (odds ratio 0.7, 95% CI 0.6–0.9) and out-patient appointments (odds ratio 0.2, 95% CI 0.2–0.3) than controls. Odds ratios were larger in females than males for injury and poisoning (odds ratio: 3.3 (95% CI 2.5–4.5) v. 2.6 (95% CI 2.1–3.1)).

We may be missing existing opportunities to intervene, particularly in emergency departments and hospital admissions with self-harm presentations and with unattributed self-harm, especially in females. Prevention efforts should focus on strengthening routine care contacts, responding to emergency contacts and better self-harm care. There are benefits to enhancing clinical audit systems with routinely collected data.

To identify the main foods determining SFA intakes and model the impact of food exchanges to improve compliance with dietary fat recommendations in Irish children.

Estimated food and nutrient intakes were obtained from a cross-sectional study, the National Children’s Food Survey II. Participants were categorised into low, medium and high SFA consumers, and the contribution of food categories to SFA intakes was compared. A food-exchange model was developed, whereby a selected range of high SFA foods was exchanged with lower SFA or unsaturated fat alternatives.

Participants were randomly selected from primary schools throughout the Republic of Ireland.

A representative sample of 600 Irish children (5–12 years).

The main determinants of low and high SFA consumers were milk, cheese and butter. These foods, including snack foods and meat and meat products, were considered exchangeable foods within the model. Compared with baseline data, modelled intakes for total fat, SFA, MUFA and trans-fat presented decreases of 3·2, 2·7, 1·6 and < 0·1 % of total energy (% TE), respectively. PUFA, n-6, n-3 and alpha-linolenic acid showed increases of 1·0, 0·8, 0·2 and 0·1 % TE, respectively. Compliance with total fat, MUFA and trans-fat recommendations remained adequate (100 %). Adherence to SFA and PUFA recommendations improved from 18 to 63 % and 80 to 100 %, respectively.

The food-exchange model decreased SFA intakes and increased PUFA intakes, suggesting modest dietary changes to children’s diets can effectively improve their overall dietary fat profile.

To investigate the source and transmission dynamics of an endoscope-associated New Delhi metallo-β-lactamase-producing Klebsiella pneumonia (NDM-KP) outbreak.

Epidemiological and genomic investigation.

Academic acute care hospital in New Jersey.

Five patients with active NDM-KP infection identified on clinical isolates, and four NDM-KP colonized patients identified via rectal swab screening.

Over a twelve-month period, nine patients were identified with NDM-KP infection or colonization. Whole-genome sequencing (WGS) revealed that all of the identified cases were related by 25 mutational events or less. Seven of the cases were linked to gastrointestinal endoscopic procedures (four clinical cases and three positive screens among patients exposed to endoscopes suspected of transmission). Two cases demonstrated delayed transmission that occurred five months after the initial outbreak, likely through shared usage of a non-therapeutic gastroscope without an elevator channel.

Although all endoscope cultures in our investigation were negative, the epidemiological link to gastrointestinal endoscopes, the high degree of relatedness via WGS, and the identification of asymptomatic NDM-KP colonization among patients exposed to shared endoscopes make the endoscopic mode of transmission most likely. This investigation highlights the probable transmission of NDM-KP via a gastroscope without an elevator channel, observed several months after an initial outbreak. We hypothesize that persistent mechanical defects may have contributed to the delayed device-related transmission of NDM-KP.

Male rectal and anal cancer patients demonstrate high rates of sexual dysfunction. This pilot randomized controlled trial tested a psychoeducational intervention designed to improve psychosexual adjustment.

Rectal or anal cancer patients were randomized to a Sexual Health Intervention for Men (intervention) or to a referral and information control (control). The intervention included control activities plus 4 sexual health intervention sessions every 4–6 weeks and 3 brief telephone calls timed between these sessions. Assessments were completed pre-intervention (baseline) and 3 months (follow-up 1) and 8 months (follow-up 2) post-intervention. Differences were assessed with statistical significance and Cohen’s d effect sizes (d = 0.2, small effect; d = 0.5, moderate effect; d = 0.8, large effect).

Ninety subjects enrolled. Forty-three participants completed at least 1 follow-up assessment (intervention, n = 14; control n = 29). At follow-up 1, men in intervention, compared to control, improved on all domains of the International Index of Erectile Function (IIEF) (p < 0.001 to p < 0.05) and demonstrated large effects (d = 0.8 to d = 1.5). Similarly, at follow-up 2, changes in all domains of the IIEF except the orgasm domain were either statistically significant or marginally statistically significant (p = 0.01 to p = 0.08) and demonstrated moderate to large treatment effects for intervention versus control (d = 0.5 to d = 0.8). Men in the intervention, compared to control, demonstrated decreased sexual bother at follow-up 1 (p = 0.009, d = 1.1), while Self-Esteem and Relationship (SEAR) total scores and the SEAR sexual relationship subscale demonstrated moderate increases for intervention versus control (d = 0.4 to d = 0.6).

This study provides initial evidence for combining a psychoeducational intervention with medical interventions to address sexual dysfunction following rectal and anal cancer. Trials register number: NCT00712751 (date of registration: 7/10/2008).

This study aimed to evaluate the proportion of Irish medical students exposed to ‘badmouthing’ of different specialities and to ascertain: the degree of criticism of specialities based on the seniority of clinical or academic members of staff; if ‘badmouthing’ influenced student career choice in psychiatry; and attitudes of medical students towards psychiatry as a speciality and career choice.

Medical students in three Irish universities were invited to complete an online survey to determine the frequency and effect of non-constructive criticism on choice of medical specialty. The online questionnaire was distributed to Royal College of Surgeons in Ireland (RCSI), University of Galway (UoG) and University College Dublin (UCD) in the academic year 2020–2021.

General practice (69%), surgery (65%) and psychiatry (50%) were the most criticised specialties. Criticism was most likely to be heard from medical students. 46% of students reported reconsidering a career in psychiatry due to criticism from junior doctors. There was a positive perception of psychiatry with 27% of respondents considering psychiatry as a first-choice specialty.

Criticism of psychiatry by doctors, academics and student peers negatively influences students’ career choice, which could be contributing to recruitment difficulties in psychiatry.

This article takes stock of the 2030 Agenda and focuses on five governance areas. In a nutshell, we see a quite patchy and often primarily symbolic uptake of the global goals. Although some studies highlight individual success stories of actors and institutions to implement the goals, it remains unclear how such cases can be upscaled and develop a broader political impact to accelerate the global endeavor to achieve sustainable development. We hence raise concerns about the overall effectiveness of governance by goal-setting and raise the question of how we can make this mode of governance more effective.

A recent meta-analysis on the political impact of the Sustainable Development Goals (SDGs) has shown that these global goals are moving political processes forward only incrementally, with much variation across countries, sectors, and governance levels. Consequently, the realization of the 2030 Agenda for Sustainable Development remains uncertain. Against this backdrop, this article explores where and how incremental political changes are taking place due to the SDGs, and under what conditions these developments can bolster sustainability transformations up to 2030 and beyond. Our scoping review builds upon an online expert survey directed at the scholarly community of the ‘Earth System Governance Project’ and structured dialogues within the ‘Taskforce on the SDGs’ under this project. We identified five governance areas where some effects of the SDGs have been observable: (1) global governance, (2) national policy integration, (3) subnational initiatives, (4) private governance, and (5) education and learning for sustainable development. This article delves deeper into these governance areas and draws lessons to guide empirical research on the promises and pitfalls of accelerating SDG implementation.

As SDG implementation lags behind, this article explores 5 governance areas asking how to strengthen the global goals.

Patients and their families often ask clinicians to estimate when full-time care (FTC) will be needed after Alzheimer's Disease (AD) is diagnosed. Although a few algorithms predictive algorithms for duration to FTC have been created, these have not been widely adopted for clinical use due to questions regarding precision from limited sample sizes and lack of an easy, user friendly prediction model. Our objective was to develop a clinically relevant, data-driven predictive model using machine learning to estimate time to FTC in AD based on information gathered from a) clinical interview alone, and b) clinical interview plus neuropsychological data.

The National Alzheimer's Coordinating Center dataset was used to examine 3,809 participants (M age at AD diagnosis = 76.05, SD = 9.76; 47.10% male; 87.20% Caucasian) with AD dementia who were aged >50 years, had no history of stroke, and not dependent on others for basic activities of daily living at time of diagnosis based on qualitative self or informant report. To develop a predictive model for time until FTC, supervised machine learning algorithms (e.g., gradient descent, gradient boosting) were implemented. In Model 1, 29 variables captured at the time of AD diagnosis and often gathered in a clinical interview, including sociodemographic factors, psychiatric conditions, medical history, and MMSE, were included. In Model 2, additional neuropsychological variables assessing episodic memory, language, attention, executive function, and processing speed were added. To train and test the algorithm(s), data were split into a 70:30 ratio. Prediction optimization was examined via cross validation using 1000 bootstrapped samples. Model evaluation included assessment of confusion matrices and calculation of accuracy and precision.

The average time to requiring FTC after AD diagnosis was 3.32 years (Range = 0.53-14.57 years). For the clinical interview only model (Model 1), younger age of onset, use of cholinesterase inhibitor medication, incontinence, and apathy were among the clinical variables that significantly predicted duration to FTC, with the largest effects shown for living alone, a positive family history of dementia, and lower MMSE score. In Model 2, the clinical predictors remained significant, and lower Boston Naming Test and Digit-Symbol Coding scores showed the largest effects in predicting duration to FTC among the neuropsychological measures. Final prediction models were further tested using five randomly selected cases. The average estimated time to FTC using the clinical interview model was within an average of 5.2 months of the recorded event and within an average of 5.8 months for the model with neuropsychological data.

Predicting when individuals diagnosed with AD will need FTC is important as the transition often carries significant financial costs related to caregiving. Duration to FTC was predicted by clinical and neuropsychological variables that are easily obtained during standard dementia evaluations. Implementation of the model for prediction of FTC in cases showed encouraging prognostic accuracy. The two models show promise as a first step towards creation of a user friendly prediction calculator that could help clinicians better counsel patients on when FTC after AD diagnosis may occur, though the development of separate models for use in more diverse populations will be essential.

The purpose of the present study was to study the clinical significance of fluctuations in cognitive impairment status in longitudinal studies of normal aging and dementia. Several prior studies have shown fluctuations in cognition in longitudinal studies is associated with greater risk of conversion to dementia. The present study defines “reverters” as participants who revert between cognitive normality and abnormality according to the Clinical Dementia Rating (CDRTM). A defining feature of the CDR at the Knight Alzheimer’s Disease Research Center (Knight ADRC) at Washington University in St. Louis is that the CDR is calculated by clinicians blinded to cognitive data and any prior assessments so that conclusions are drawn free of circularity and examiner bias. We hypothesized reverters, when compared to cognitively normal participants who remain unimpaired, would have worse cognition, abnormal biomarkers, and would eventually progress to a stable diagnosis of cognitive impairment.

From ongoing studies of aging and dementia at the Knight ADRC, we selected cognitively normal participants with at least three follow-up visits. Participants fell into three categories: stable cognitively normal (“stable CN”), converters to stable dementia (“converters”), and reverters. Cognitive scores at each visit were z-scored for comparison between groups. A subset of participants had fluid biomarker data available including cerebrospinal fluid (CSF) amyloid and phosphorylated-tau species, and plasma neurofilament light chain (NfL). Mixed effect models evaluated group relationships between biomarker status, APOE £4 status, and CDR progression.

930 participants were included in the study with an average of 5 years of follow-up (Table 1). 661 participants remained cognitively normal throughout their participation while 142 progressed to stable dementia and 127 participants had at least one instance of reversion. Compared to stable CN, reverters had more abnormal biomarkers at baseline, were more likely to carry an APOE £4 allele, and had better cognitive performance at baseline (Table 2, Figure 1). Compared to converters, reverters had less abnormal biomarkers at baseline, were less likely to carry an APOE £4 allele, and had overall better cognitive performance at baseline. In longitudinal analyses, cognitive trajectories of reverters exhibited a larger magnitude of decline compared to stable CNs but the magnitude of decline was not as steep as converters.

Our results confirm prior studies that showed reversion in cognitive status, when compared to stable cognitive normality, is associated with worse overall genetic, biomarker and cognitive outcomes. Longitudinal analyses demonstrated reverters show significantly more decline than stable participants and a higher likelihood of eventual conversion to a stable dementia diagnosis. Reverters’ cognitive trajectories appear to occupy a transitional phase in disease progression between that of cognitive stability and more rapid and consistent progression to stable dementia. Identifying participants in the preclinical phase of AD who are most likely to convert to symptomatic AD is critical for secondary prevention clinical trials. Our results suggest that examining intraindividual variability in cognitive impairment using unbiased, longitudinal CDR scores may be a good indicator of preclinical AD and predict eventual conversion to symptomatic AD.