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In psychiatry, there is a drive to reduce institutionalization, the risk of which starts with the index admission. In first-episode psychosis (FEP), the proportion of people admitted to hospital at initial presentation is still unknown.
Methods
This systematic review aimed to determine the proportion of people with FEP who are admitted at initial presentation (within 30 days from point of first contact with psychiatry) and the influence of individual, clinical, and service factors on admission risk. Four databases were searched from inception until June 2023: PubMed, Embase, PsycINFO, and CINAHL. The pooled proportion of people admitted was calculated using a random-effects model. Analyses were further stratified according to individual, clinical, and service factors.
Results
Of 7,455 abstracts screened, 18 studies with 19,854 participants were included. The proportion of people admitted overall was 51% (k = 18, 95% confidence interval [CI]: 37–65%; I2: 99.56%). The proportion admitted involuntarily was 31% (k = 6, 95% CI: 23–40%; I2: 95.26%). Sub-analyses for sex, diagnosis, and early intervention service access did not show significant differences between groups. The proportion of people with a short duration of untreated psychosis (DUP) admitted was 59% (k = 2, 95% CI: 56–63%) vs. 37% (k = 2, 95% CI: 33–41%) for long DUP, which was significant (p < 0.001). High inter-study heterogeneity was observed.
Conclusions
Results demonstrate that over half of the people are hospitalized when initially presenting for FEP, a high proportion, with consequences for individuals and health services at large. First, service contact must be prioritized as an opportunity for appropriate intervention, to either avoid unwarranted hospitalizations or if hospitalization is required, to ensure the application of focused therapeutic objectives within intended timeframes.
This paper proposes a conceptual model of decision-making tying specific preferences to broader individual goals. Specifically, we consider terminal goals, representing fundamental objectives, and instrumental goals, serving as complexity-reducing intermediate steps toward achieving terminal goals and determining eventual preferences. Notably, the hierarchical goal structure allows for contextual misalignments between different instrumental goals, which may lead to suboptimal decisions – as evaluated from an outside perspective. Thus, applied to the discussion about nudging and paternalism, the model provides a methodological justification for paternalistic interventions as it is compatible with arguments in favour of interventions aimed to correct such choices.
Understanding consumers' food wasting behaviours is crucial to reducing food waste. This study aimed to adapt the Food Wasting Behaviours Questionnaire (FWBQ) to Turkish and evaluate its validity and reliability. A cross-sectional study was conducted with 421 adults, preceded by a pilot study with 30 individuals to assess the intelligibility of the questionnaire. Exploratory factor analysis (EFA) was performed on a subsample of 219 participants, followed by confirmatory factor analysis (CFA) on an independent subsample of 202 participants. Reliability was assessed using Cronbach’s Alpha (CA), and test–retest reliability was evaluated with the intraclass correlation coefficient (ICC) in a separate group of 100 participants. As a result of EFA, a six-factor structure emerged—diverging from the original five-factor model of the FWBQ—indicating that in the Turkish context, planning meals and planning shopping behaviours formed distinct dimensions. Three items with low factor loadings (<0.30) were excluded, and the final version included 27 items with a total explained variance of 57.3%. CFA confirmed good model fit, and internal consistency was strong (CA = 0.700 to 0.924). Test–retest reliability was also high (ICC = 0.787 to 0.896). In conclusion, the Turkish version of the FWBQ is a valid and reliable tool for assessing a wide range of food wasting behaviours. The emergence of a sixth factor highlights the importance of cultural context in shaping food management routines and has implications for cross-cultural comparisons and future adaptations.
In the introduction for their recent state-of-the-art volume on English at the grassroots, Meierkord and Schneider (2021) point out the recurrent problem of Creolistic study not being fully incorporated into the World Englishes paradigm, arguing, like Mufwene (1997; 2001) and others, that English-based Creoles are best viewed as varieties of English ‘and, as such, require their integration into existing models and theories, too’ (11). Further work which seeks to overtly integrate Creole varieties within studies of English at the grassroots – the ‘new player in the World Englishes paradigm’ (Buschfeld 2001, 25) – has not been quickly forthcoming, though, with most of the work in the field focusing on ‘typical’ multilingual settings. In an attempt to remedy this, the current paper discusses the language situation in Trinidad, the last island in the Caribbean’s Lesser Antilles. In Trinidad, Trinidadian English Creole (TEC) and Trinidadian English (TE) interact in a complex where English might be best viewed as a second dialect (ESD), rather than in one of the prototypical ENL, ESL, or EFL situations of acquisition or use (cf. Deuber 2014). After an exploration of the limited research that has been done on language use and social class in Trinidad, this paper compares those previous findings on morphosyntactic features with new data from short semi-structured interviews conducted with speakers who can be described as grassroots.
The COVID-19 pandemic has posed a significant health threat to people in corrections facilities due to communal living, inability to social distance, and high rates of comorbidity among incarcerated populations. Combined with the First Step Act of 2018, which granted incarcerated individuals seeking compassionate release access to the courts, the pandemic increased the number of people in federal prisons petitioning for early release due to health risk. Analysis of federal compassionate release case law throughout the pandemic reveals inconsistent judicial reasoning related to COVID-19-based requests. Inconsistently interpreted compassionate release factors include vaccination status, COVID-19 reinfection, and the “degree” of extraordinary circumstances considered. Varied application among federal districts produced inequitable access to compassionate release. Therefore, this analysis provides insight into how an unclear policy can create disparate public health outcomes and considerations for compassionate release determinations in future times of uncertainty, such as a pandemic.
During the COVID-19 pandemic, pandemic-driven nationalism surged in China, exemplified by widespread mockery and disparagement of India’s handling of the crisis in Chinese cyberspace. Adopting a linguistically grounded approach, this study scrutinizes how India is discursively constructed as an inferior Other amid COVID-19. It conducts a linguistically informed discourse analysis of a highly viewed text on Zhihu (China’s largest online Q&A platform). Drawing mainly on Halliday’s transitivity theory, this study unpacks the linguistic features in the chosen text, which, within a discourse of modern medicine, depicts the Indian people as trapped between hopelessly passive and absurdly overactive in the face of the pandemic. The text also casts the Indian government as an impotent foil to the Chinese government, a representation situated within a discourse of strong-state pandemic governance. By interrogating the non-official social media text through a linguistic lens, this study contributes to understanding China’s representational politics of Othering the non-West within the intertextual nexus between official and non-official spheres. It also contributes to making sense of the multidimensionality and ambivalence underlying Chinese national identity-making as well as “Orientalism within the ‘Orient’” in the Chinese context.
Existing portfolio combination rules that optimize the out-of-sample performance under parameter uncertainty assume multivariate normally distributed returns. However, we show that this assumption is not innocuous because fat tails in returns lead to poorer out-of-sample performance of the sample mean–variance and sample global minimum-variance (GMV) portfolios relative to normality. Consequently, when returns are fat-tailed, portfolio combination rules should allocate less to the sample mean–variance and sample GMV portfolios, and more to the risk-free asset, than the normality assumption prescribes. Empirical evidence shows that accounting for fat tails in the construction of optimal portfolio combination rules significantly improves their out-of-sample performance.
The following documents are part of a collection of ephemeral materials published by nationalist movements of Portuguese Africa. During the past five years I have been gathering these materials in order to have them microfilmed and placed on deposit in the library of the Hoover Institution on War, Peace, and Revolution, Stanford University, where they will be available for use by interested scholars. A related objective is to translate to English the most important of these documents, edit them, and add relevant notes along with a full bibliography on each Portuguese African territory; this project is nearing completion and should be published in book form in 1967. I am grateful to the many African specialists who have assisted me on the documents collection, and it is my hope that other specialists who have documents not included in the listings below will send me photocopies or duplicates, for which I can pay expenses incurred.
Universal free school meals represent a powerful public health tool to promote healthy eating among all children. Yet, in Catalonia, school lunches are not guaranteed for all, leaving the most vulnerable children at risk of nutrient inadequacy. Although grants that subsidize school lunches are available, this assistance only reaches 12.44% of at-risk-of-poverty students (1). Moreover, for those who do receive the support, the economic relief is tied to the number of monthly school days.
Therefore, the aim of this study is to estimate the economic relief that subsidized school meals offered in Catalonia constitute for the recipient families, assessing its fluctuation throughout the twelve months of the year.
The economic relief provided by subsidized school lunches has been assessed by estimating the monetary savings that families achieve by not having to cover these food costs. To do so, an economic value is assigned to hypothetic school meals designed based on the recommendations of the regional School Menu Review Program (PReME, for its acronym in Spanish) (2). The resulting cost is then deducted from the overall month expense for each age profile, as estimated by the reference budgets approach.
The daily cost of meals in the canteen ranges from €1.09 for children aged 1-3, and €1.91 for teenagers, with the cost of the menu for children aged 4-6 and 7-11 years of €1.38 and €1.72, respectively. As for the monthly cost, it fluctuates depending on the school days of each month. Therefore, July and August offer the least financial relief for families, as no school lunches are provided during the summer holidays, leaving parents to cover the full cost of meals. December follows as the third month with the lowest relief, offering only 11 school days. The estimated savings for these days are: €11.97 for ages 1-3, €15.17 for ages 4-6, €18.94 for ages 7-11, and €21.04 for ages 12-18. November and April, with 21 school days, are the months that represent the highest economic relief (1-3 years: €22.85; 4-6 years: 28 €96; 7-11 years: €36.15; 12-18 years: €40.16).
Our findings underscore the crucial role of subsidized school meals in alleviating the economic burden on families. However, the potential instability of such assistance poses challenges to maintaining food security and adequate nutrition. Additionally, the study emphasizes age-specific variations in the capacity of subsidized meal programs to allow economic relief. In view of the alarming rate of child poverty in Spain, which rose to 28.9% in 2023, and even higher in Catalonia, affecting 32.5% of children (3). These findings underscore the urgent need for effective targeted interventions to ensure equitable access to nutritious meals for children and adolescents.
Microbiome composition may differ according to menopause status, which may be partially mediated by diet (1). Peri- and post-menopausal symptom burden is associated with diet quality (2), however, knowledge on the association between menopause symptoms and gut microbiome composition is limited (3). This study investigates the associations between gut microbiome composition and menopause symptoms.
Data was analysed from 70,399 peri- (N = 27,926) and post-menopausal women (N = 42,473) from the PREDICT 3 cohort (NCT04735835), examining the gut microbiome composition (using metagenomic sequencing) and diet quality using Healthy Eating Index (HEI) scores derived from the PREDICT Food Frequency Questionnaire. Data was also collected on menopause symptoms, grouped into vasomotor, sexual, psychological and somatic domains. A Menopause Symptom Tracker Score (MSTS) (0-100) was used to capture symptom prevalence (out of 20 symptoms) and impact on quality of life (0-not at all, 1-a little, 3-quite a bit and 5-extremely), with higher score values reflecting greater symptom burden (4).
Using random forest machine learning (ML) models, we found that microbiome composition was predictive of the MSTS (AUCall = 0.70; AUCperi = 0.66; AUCpost = 0.65), as well as physical (e.g., fatigue, weight gain and slowed metabolism, thinning hair) and psychological (e.g., low mood or depression, anxiety and mood changes) domain scores (AUCall = 0.70; AUCperi = 0.66; AUCpost = 0.68 and AUCall = 0.70; AUCperi = 0.65; AUCpost = 0.66 respectively). Microbiome was also predictive of diet quality (HEI; AUCall = 0.77; AUCperi = 0.77; AUCpost = 0.75). Subsequently, we compared the top 50 species predictive for the HEI and MSTS respectively, and identified 32 common predictive species. Notably, the top predictive species for both HEI and MSTS was the not-yet-characterised Lachnospiraceae species-level genome bin SGB4964.
To the best of our knowledge, this is the first time associations between menopause symptoms and the gut microbiome have been identified. Further work is needed to unravel diet-microbiome-symptom interrelationships and investigate a potential causal role of microbiome in menopause symptom burden. This knowledge could ultimately lead to novel, microbiome-based strategies for improving the quality of life for women during and after the menopausal transition.
The appointment in March 1966 of Kwame Nkrumah as honorary president of Guinea was ostensibly made on the basis of an agreement signed by Nkrumah and Sékou Touré in 1958 which founded the Union of Independent African States (UIAS, Ghana-Guinea, 1958-1960). The UIAS, subsequently the Union of African States (UAS, Ghana-Guinea-Mali, 1960-1963), has not been of great importance in the development of Pan-Africanism. Nkrumah's recent appointment probably caused more publicity for the UIAS-UAS than any other event in its history, with the exception of its founding in 1958. Because of the quiet functioning of this organization, declared as no longer in existence by Touré in 1963, very little has been written about it. Thus a student of Africa is reduced to dependence upon short newspaper accounts of the various meetings of the leaders of the states involved, to brief references in more general works on African unity, and to conjecture.
Yet there are several bibliographic sources which are useful. Among these is Peter Duignan, “Pan-Africanism: A Bibliographic Essay,” African Forum, I, No. 1 (Summer 1965), 105-107, a brief survey of the most important works on Pan-Africanism. The subject is divided into three phases--the American reaction to racism, the drive for African independence, and the dream of continental unity. For materials concerning Ghana, the best reference is Albert F. Johnson, A Bibliography of Ghana, 1930-1961 (Evanston, Ill., Published for the Ghana Library Board by the Northwestern University Press, 1964). Of a more general nature are W. J. Hanna and J. L. Hanna, Politics in Black Africa (East Lansing, African Studies Center, Michigan State University, 1964); the annual United States and Canadian Publications on Africa, for years from 1960 (Washington, Library of Congress, 1962; Stanford, Calif., Hoover Institution, 1963-), an excellent source for references to periodical materials; and International Committee for Social Sciences Documentation, The International Bibliography of Political Science (Chicago, Aldine Publishing Co., 1952-).
This article reflects on a collaborative drawing group in a mother and baby unit, exploring the clinical value of arts-based interventions in perinatal psychiatry. Grounded in an evolutionary and biopsychosocial theory, it highlights how creative practice can reduce hierarchy, support emotion regulation and foster relational safety. A practical group model is described, encouraging clinicians to draw on their own creative skills to enrich care, build connection and hold space for meaning beyond symptom management.