5-HT1A receptors within the intermediate lateral septum modulate stress vulnerability in male mice

Chronic stress is a major risk factor for psychiatric disorders. However, certain individuals may be at higher risk due to greater stress susceptibility. Elucidating the neurobiology of stress resilience and susceptibility may facilitate the development of novel strategies to prevent and treat stress-related disorders such as depression. Mounting evidence suggests that the serotonin (5-HT) system is a major regulator of stress sensitivity. In this study, we assessed the functions of 5-HT1A and 5-HT2A receptors within the lateral septum (LS) in regulating stress vulnerability. Among a group of male mice exposed to chronic social defeat stress (CSDS), 47.2% were classified as stress-susceptible, and these mice employed more passive coping strategies during the defeat and exhibited more severe anxiety- and depression-like behaviors during the following behavioral tests. These stress-susceptible mice also exhibited elevated neuronal activity in the LS as evidenced by greater c-Fos expression, greater activity of 5-HT neurons in both the dorsal and median raphe nucleus, and downregulated expression of the 5-HT1A receptor in the intermediate LS (LSi). Finally, we found the stress-induced social withdrawal symptoms could be rapidly relieved by LSi administration of 8-OH-DPAT, a 5-HT1A receptor agonist. These results indicate that 5-HT1A receptors within the LSi play an important role in stress vulnerability in mice. Therefore, modulation of stress vulnerable via 5-HT1A receptor activation in the LSi is a potential strategy to treat stress-related psychiatric disorders.

From erosion to epidemics: Understanding the overlapping vulnerability of hydrogeomorphic hotspots, malaria affliction, and poverty in Nigeria

Hydrogeomorphic changes, encompassing erosion, waterlogging, and siltation, disproportionately threaten impoverished rural communities. Yet, they are often marginalized in discussions of disasters. This oversight is especially concerning as vulnerable households with limited healthcare access are most susceptible to related diseases and displacement. However, our current understanding of how these risks intersect remains limited. We explore the complex relationships between hydrogeomorphic hazards, malaria incidence, and poverty in Nigeria. Through spatial analyses we expand traditional boundaries, incorporating factors such as healthcare access, migration patterns, dam locations, demographics, and wealth disparities into a unified framework. Our findings reveal a stark reality: most residents in hydrogeomorphic hotspots live in poverty (earnings per person ≤$1.25/day), face elevated malaria risks (80 % in malaria hotspots), reside near dams (59 %), and struggle with limited healthcare access. Moreover, exposure to hydrogeomorphic hotspots could double by 2080, affecting an estimated 5.8 million Nigerians. This forecast underscores the urgent need for increased support and targeted interventions to protect those living in poverty within these hazardous regions. In shedding light on these dynamics, we expose and emphasise the pressing urgency of the risks borne by the most vulnerable populations residing in these regions-communities often characterised by limited wealth and resilience.

Dynamic associations between frailty and cognition over 4 years: A population-based study on adults aged ≥50 from 12 European countries

PURPOSE

This study aimed (1) to investigate autoregressive and cross-lagged associations between frailty and cognition over 4 years in a large sample of European citizens aged ≥50 years, (2) to examine the 4-year temporal associations' differences between sex and between active and inactive physical behaviour, and (3) to explore in the years 2011, 2013, and 2015 associations between cognitive performance and the pre-frailty and frailty conditions.

MATERIALS AND METHODS

This longitudinal analysis was conducted with 20,857 individuals (11,540 women) from 12 countries aged ≥50 years who responded to waves 4, 5, and 6 of the SHARE project. The variables analysed were frailty (SHARE-FI) and a general cognition index (Cogindex) calculated for each wave from verbal fluency, immediate recall, and delayed recall.

RESULTS

A greater propensity for cognitive impairment was found in women, as well as in pre-frail and frail individuals. There were no significant differences between the sexes for the autoregressive effect of frailty and Cogindex over 4 years. On the other hand, sedentary and active individuals differed in frailty between Time 1-2. Cross-lagged analyses indicated a significant difference for the sexes between frailty and Cogindex Time 1-3 and between Cogindex and frailty of Time 2-3. Sedentary and active differed significantly in the path of frailty on Cogindex between Time 2-3.

CONCLUSION

Health policies should increase surveillance of frailty, cognition, and level of physical activity in the older European population, with a special focus on women.

A geospatial analysis of flood risk zones in Cyprus: insights from statistical and multi-criteria decision analysis methods

Over the past few decades, flood disasters have emerged as the predominant natural hazard in Cyprus, primarily driven by the escalating influence of climate change in the Mediterranean region. In view of this, the objective of this study is to develop a geospatial flood risk map for the island of Cyprus by considering 14 flood hazard factors and five flood vulnerability factors, utilizing geographic information systems (GIS) and remotely sensed datasets. A comparative assessment was conducted for hazard mapping, employing statistical methods of frequency ratio (FR) and FR Shannon's entropy (FR-SE), and multi-criteria decision analysis method of fuzzy analytic hierarchy process (F-AHP). The main findings indicated that the FR method exhibited the highest predictive capability, establishing it as the most suitable approach for flood hazard mapping. Additionally, vulnerability factors were aggregated using F-AHP to generate the vulnerability map. The resulting flood risk map, which is the product of flood hazard and flood vulnerability, revealed that 9% of the island was located within highly risky regions, while 13.2% was classified as moderate risk zones. Spatial analysis of these high-risk areas indicated their concentration in the primary city districts of the island. Therefore, to mitigate future risks within these cities, an analysis of potential expansion zones was conducted, identifying the best-suited zone exhibiting the lowest risk. The generated flood risk map can serve as a valuable resource for decision-makers on the island, facilitating the integration of flood risk analysis into urban management plans.

A review of social-ecological system vulnerability in desertified regions: Assessment, simulation, and sustainable management

Desertified regions face considerable vulnerability due to the combined effects of climate change and human activities, which threaten regional ecological security and societal development. It is therefore necessary to assess, simulate, and manage the vulnerability of desertified regions from the perspective of the social-ecological system, to support desertification control and sustainable development. This study is a systematic review of the vulnerability of the social-ecological system in desertified regions (SESDR) based on a bibliometric analysis, and a summary of the research progresses in vulnerability assessment, simulation, and sustainable management is provided. It was found that SESDR vulnerability research started relatively late, but has developed rapidly in recent years, with an emphasis on the coupling between natural systems and human activities, and multi-scale interactions and dynamics. Using various indicators at different scales, SESDR vulnerability could be assessed in terms of exposure, sensitivity, and adaptability. Modeling the complex interactions among natural and human factors across multiple scales is essential to simulate the vulnerability dynamics of the SESDR. The sustainable management of SESDR vulnerability focuses on rational spatial planning to achieve the maximum benefits, with the right measures in the right places. Four priority research directions were proposed to develop a better understanding of the mechanisms of vulnerability and smart restoration of desertified land. The findings of this study will enable researchers, land managers, and policymakers to develop a more comprehensive understanding of SESDR vulnerability, thereby enabling them to better address the challenges posed by complex resource and environmental issues.

Ecosystem service mismatches evidence inequalities in urban heat vulnerability

Exposure to heat poses a pressing challenge in cities, with uneven health and environmental impacts across the urban fabric. To assess disparities in heat vulnerability and its environmental justice implications, we model supply-demand mismatches for the ecosystem service (ES) urban temperature regulation. We integrated remote sensing, health, and socio-demographic data with Artificial Intelligence for Environment and Sustainability (ARIES) and geographical information system tools. We computed composite indicators at the census tract level for urban cooling supply, and vulnerability to heat as a measure of demand. We do so in the context of the mid-size city of Vitoria-Gasteiz, Basque Country (Europe). We mapped relative mismatches after identifying and analysed their relationship with socio-demographic and health factors. Our findings show disparities in heat vulnerability, with increased exposure observed among socio-economically disadvantaged communities, the elderly, and people with health issues. Areas associated with higher income levels show lower ES mismatches, indicating higher temperature regulation supply and reduced heat vulnerability. The results point at the need for nature-based heat mitigation interventions that especially focus on the more socio-economically disadvantaged communities.

Ethnobotanical study and vulnerability of medicinal plants used against the symptoms of COVID-19 in the Lomié subdivision, East Region of Cameroon

Science has advanced to the point that traditional medicine is now a useful instrument for treating a wide range of human ailments. Indigenous peoples and local communities (IPLCs) do not, however, have access to the contemporary healthcare system. As a result, they turn to biological resources, which are the only readily available and accessible means of treating diseases like COVID-19 and flu outbreaks. In response to worldwide illnesses, this study aligns with the perspectives of traditional knowledge of biological resources, particularly therapeutic plants. Therefore, this study was aimed to document the use of the potential of medicinal plants by IPLCs in the Lomié subdivision to manage COVID-19 symptoms. In four villages in the Lomié subdivision Ekom, Payo, Eschiambor, and Kongo, ethnobotanical surveys, including semi-structured interviews on traditional usage of plants against Covid-19 symptoms, were carried out with 80 participants in order to meet all of the study specific objectives. For every species, a vulnerability index was established in order to evaluate the species fragility. To analyze the data, both descriptive and inferential statistics were applied. The findings show that the respondents are well aware of the symptoms of the COVID-19 and that gave them the ability to provide timely and efficient responses. The survey identified 43 species from 39 genera grouped in 28 families were used to treat COVID-19 symptoms, with bark being the most commonly used plant part (43.8%). Decoction was the most frequently used method of preparation (50%), and oral administration was the main route of administration (56.3%). Most of the plant species were harvested from secondary forests (44.2%), of which trees formed 48.8%. A total of 30 species were recorded to be vulnerable, with Entandrophragma cylindricum (Sprague) Sprague, Milicia excelsa (Welw.) Benth, Myrianthus arboreus P. Beauv., and Trichoscypha aborea (A. Chev.) A. Chev being the most vulnerable, with vulnerability index of 2.4. The results showed a strong non-causal relationship between vulnerability and the continuous and discontinuous explanatory parameters. The susceptibility of medicinal plants used to treat COVID-19 symptoms and the explanatory parameters had a statistically significant causal association, according to the binomial logistic regression model. In light of novel diseases like COVID-19, this study finds that traditional knowledge of medicinal plants is still widely held, especially among the indigenous and local population. It can also be very beneficial in the development of new medications for a variety of illnesses.

Prioritizing resource allocation to reduce adverse effects of pesticide risk for endangered species

The use of pesticides promotes food security because of the multiple benefits it brings to agriculture, such as reduction in crop losses. However, the use of pesticides can be potentially harmful to non-target species. In the U.S., the Environmental Protection Agency regulates the use of pesticides to manage the risks associated with these agents and to protect species under the Endangered Species Act. As part of these regulations, pesticides must be registered and then reviewed every 15 years to ensure the use conditions are updated with the best available data. The registration and review process can invoke corrective measures to ensure protection of endangered species. However, the registration review process is highly resource and time consuming. There is currently a backlog of unreviewed pesticides, leaving a large quantity of pesticides without updated use conditions to protect species. Identifying ways to streamline this process is urgently needed. We develop a sequencing approach to address the risk assessment bottleneck in the pesticide registration and review process and identify species that would benefit most from detailed assessments. We then demonstrate the magnitude of potential efficiencies using this sequencing process for 61 terrestrial listed species in the state of California. Our results show a consistent ranking of listed species according to their relative benefits from assessment, with 90 % of the species being robustly classified across scenarios in the sensitivity analysis. We found that prioritizing the assessment of a small group of species could potentially result in high conservation benefits, and identify species in need of more detailed data for a robust sequencing. We examine how a sequencing approach can guide decisions about what species might benefit most from different levels of assessment. Our results demonstrate the conservation benefits of employing a sequencing approach to prioritize the allocation of limited resources for endangered species.

Assisted dying: principles, possibilities, and practicalities. An English physician's perspective

It seems probable that some form of medically-assisted dying will become legal in England and Wales in the foreseeable future. Assisted dying Bills are at various stages of preparation in surrounding jurisdictions (Scotland, Republic of Ireland, Isle of Man, Jersey), and activists campaign unceasingly for a change in the law in England and Wales. There is generally uncritical supportive media coverage, and individual autonomy is seen as the unassailable trump card: 'my life, my death'.However, devising a law which is 'fit for purpose' is not an easy matter. The challenge is to achieve an appropriate balance between compassion and patient autonomy on the one hand, and respect for human life generally and medical autonomy on the other. More people should benefit from a change in the law than be harmed. In relation to medically-assisted dying, this may not be possible. Protecting the vulnerable is a key issue. Likewise, not impacting negatively on societal attitudes towards the disabled and frail elderly, particularly those with dementia.This paper compares three existing models of physician-assisted suicide: Switzerland, Oregon (USA), and Victoria (Australia). Vulnerability and autonomy are discussed, and concern expressed about the biased nature of much of the advocacy for assisted dying, tantamount to disinformation. A 'hidden' danger of assisted dying is noted, namely, increased suffering as more patients decline referral to palliative-hospice care because they fear they will be 'drugged to death'.Finally, suggestions are made for a possible 'least worse' way forward. One solution would seem to be for physician-assisted suicide to be the responsibility of a stand-alone Department for Assisted Dying overseen by lawyers or judges and operated by technicians. Doctors would be required only to confirm a patient's medical eligibility. Palliative-hospice care should definitely not be involved, and healthcare professionals must have an inviolable right to opt out of involvement. There is also an urgent need to improve the provision of care for all terminally ill patients.

Assessing the vulnerability of food supply chains to climate change-induced disruptions

Climate change is one of the most significant challenges worldwide. There is strong evidence from research that climate change will impact several food chain-related elements such as agricultural output, incomes, prices, food access, food quality, and food safety. This scoping review seeks to outline the state of knowledge of the food supply chain's vulnerability to climate change and to identify existing literature that may guide future research, policy, and decision-making aimed at enhancing the resilience of the food supply chain. A total of 1526 publications were identified using the SCOPUS database, of which 67 were selected for the present study. The vulnerability assessment methods as well as the adaptation and resilience measures that have been employed to alleviate the impact of climate change in the food supply chain were discussed. The results revealed a growing number of publications providing evidence of the weakening of the food supply chain due to climate change and extreme weather events. Our assessment demonstrated the need to broaden research into the entire food supply chain and various forms of climatic variability because most studies have concentrated on the relationships between climatic fluctuations (especially extreme rainfall, temperatures, and drought) and production. A lack of knowledge about the effects of climate change on the food supply chain and the underlying socio-economic consequences could result in underperformance or failure of the food supply chain.

Genetic predisposition for negative affect predicts mental health burden during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic was accompanied by an increase in mental health challenges including depression, stress, loneliness, and anxiety. Common genetic variants can contribute to the risk for psychiatric disorders and may present a risk factor in times of crises. However, it is unclear to what extent polygenic risk played a role in the mental health response to the COVID-19 pandemic. In this study, we investigate whether polygenic scores (PGSs) for mental health-related traits can distinguish between four resilience-vulnerability trajectories identified during the COVID-19 pandemic and associated lockdowns in 2020/21. We used multinomial regression in a genotyped subsample (n = 1316) of the CovSocial project. The most resilient trajectory characterized by the lowest mental health burden and the highest recovery rates served as the reference group. Compared to this most resilient trajectory, a higher value on the PGS for the well-being spectrum decreased the odds for individuals to be in one of the more vulnerable trajectories (adjusted R-square = 0.3%). Conversely, a higher value on the PGS for neuroticism increased the odds for individuals to be in one of the more vulnerable trajectories (adjusted R-square = 0.2%). Latent change in mental health burden extracted from the resilience-vulnerability trajectories was not associated with any PGS. Although our findings support an influence of PGS on mental health during COVID-19, the small added explained variance suggests limited utility of such genetic markers for the identification of vulnerable individuals in the general population.

Effects of Highly Palatable Diet on motivation for food and resistance to punishment in rats: Role of sex and age of exposure

Exposure to highly palatable food is believed to induce behavioral and neurobiological changes that may produce addiction-like behavior and increase the risks of obesity and overweight. Studies in rodents have led to conflicting results suggesting that several factors such as sex and age of exposure contribute to the development of maladaptive behaviors towards food. In addition, it is not clear whether effects of exposure to highly palatable diets (HPD) persist after their discontinuation, which would indicate long-term risks to develop addiction-like behavior. In this study, we investigated the persistent effects of an intermittent 8-week exposure to HPD in male and female rats as a function of age of exposure (adult and adolescent). We found that intermittent exposure to HPD did not alter body weight, but it affected consumption of standard food during the time of exposure in all groups. In addition, in adults, HPD produced a decrease in the initial baseline responding in FR1 schedules, an effect that persisted for 4 weeks in males but not in female rats. However, we found that exposure to HPD did not affect resistance to punishment measured by progressive shock strength break points or motivation for food as measured by progressive-ratio break points regardless of sex or age of exposure. Altogether, these results do not provide support for the hypothesis that intermittent exposure to HPD produce persistent increases in the vulnerability to develop addiction-like behaviors towards palatable food.

Assessing tropical cyclone risk for improving mitigation strategies in Coastal Odisha, India

Tropical cyclone causes large-scale devastation and destruction in the coastal plains of India, particularly in Odisha, which is the most cyclone-affected state in the country. Tropical cyclones are projected to be more powerful and widespread due to changing climate. Hence, the risk assessment of tropical cyclone is necessary to identify cyclone-risk areas in coastal Odisha which may help in the mitigation of the damages caused by cyclones. Therefore, this study utilizes geospatial techniques to produce a comprehensive risk map posed by tropical cyclones and to estimate the degree of risk for coastal districts of Odisha. For this, we evaluated the district-level cyclone risk for coastal Odisha using multi-criteria decision-making (MCDM) technique by considering 21 parameters for each of the four components of risk, i.e., exposure, hazard, vulnerability, as well as mitigation capacity. For each criterion, thematic raster map layers were created and weighted using a fuzzy analytical hierarchy process (FAHP). We prepared individual risk component maps using weighted overlay techniques and finally integrated all indices to create the risk map. The study shows that 13% area of the study area comes under a very high-risk zone whereas, 25% area comes under a high-risk zone. The central (Cuttack, northern parts of Khordha, and south-western parts of Jajpur district) and the eastern part (most of the parts of Jagatsinghpur, Kendrapara, and northern parts of Puri district) of the study area come under high to very high tropical cyclone impact zone. Almost 67% of the total area is highly vulnerable to tropical cyclones and mainly concentrated near the shoreline. The applied approach and results can assist the local authorities in identifying vulnerable and hazardous locations and developing workable solutions for the mitigation of revised cyclone threats in the coastal districts of Odisha.

Childhood growth during recovery from acute illness in Africa and South Asia: a secondary analysis of the childhood acute illness and nutrition (CHAIN) prospective cohort

Background

Growth faltering is well-recognized during acute childhood illness and growth acceleration during convalescence, with or without nutritional therapy, may occur. However, there are limited recent data on growth after hospitalization in low- and middle-income countries.

Methods

We evaluated growth following hospitalization among children aged 2-23 months in sub-Saharan Africa and South Asia. Between November 2016 and January 2019, children were recruited at hospital admission and classified as: not-wasted (NW), moderately-wasted (MW), severely-wasted (SW), or having nutritional oedema (NO). We describe earlier (discharge to 45-days) and later (45- to 180-days) changes in length-for-age [LAZ], weight-for-age [WAZ], mid-upper arm circumference [MUACZ], weight-for-length [WLZ] z-scores, and clinical, nutritional, and socioeconomic correlates.

Findings

We included 2472 children who survived to 180-days post-discharge: NW, 960 (39%); MW, 572 (23%); SW, 682 (28%); and NO, 258 (10%). During 180-days, LAZ decreased in NW (-0.27 [-0.36, -0.19]) and MW (-0.23 [-0.34, -0.11]). However, all groups increased WAZ (NW, 0.21 [95% CI: 0.11, 0.32]; MW, 0.57 [0.44, 0.71]; SW, 1.0 [0.88, 1.1] and NO, 1.3 [1.1, 1.5]) with greatest gains in the first 45-days. Of children underweight (<-2 WAZ) at discharge, 66% remained underweight at 180-days. Lower WAZ post-discharge was associated with age-inappropriate nutrition, adverse caregiver characteristics, small size at birth, severe or moderate anaemia, and chronic conditions, while lower LAZ was additionally associated with household-level exposures but not with chronic medical conditions.

Interpretation

Underweight and poor linear growth mostly persisted after an acute illness. Beyond short-term nutritional supplementation, improving linear growth post-discharge may require broader individual and family support.

Funding

Bill & Melinda Gates FoundationOPP1131320; National Institute for Health ResearchNIHR201813.

Cross-national analysis of the prevalence of prolonged grief disorder

BACKGROUND

Prolonged grief disorder (PGD) is now included as a diagnosis in international classification systems. Most research on PGD is based on Western populations, but first data from non-Western countries have recently become available. Little is still known about country-related effects on PGD's prevalence.

OBJECTIVE

Determining possible causes of variations in the prevalence of PGD as defined by DSM-5-TR and ICD-11 within and between countries.

METHODS

We retrieved data from 24 prevalence studies, the World Bank and the 2022 World Risk Report. Negative binomial regressions were used to explore methodological, loss-related and country context characteristics as predictors of PGD. The average rate of PGD was calculated using random effects models.

RESULTS

The included studies comprised 34 samples from 16 countries (20,347 participants). Non-probability sampling and older mean age of the sample as well as lower country vulnerability were associated with higher PGD rates. The average PGD prevalence was 13 % (95 % CI [11, 22]), varying from 5 % (95 % CI [3, 11]) in probability to 16 % (95 % CI [13, 25]) in non-probability samples.

LIMITATIONS

Samples from Europe and North America were overrepresented. For about half of the countries, data were available from only one sample.

CONCLUSIONS

While confirming the importance of studies' methodological quality, the results show that PGD is of public health relevance around the world, but especially common in less vulnerabled countries with better access to daily necessities and healthcare services, highlighting sociocultural impacts on grief processing. Further investigations of cross-national differences are needed.

Vulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives

What are the major vulnerabilities in people with social anxiety? What are the most promising directions for translational research pertaining to this condition? The present paper provides an integrative summary of basic and applied translational research on social anxiety, emphasizing vulnerability factors. It is divided into two subsections: intrapersonal and interpersonal. The intrapersonal section synthesizes research relating to (a) self-representations and self-referential processes; (b) emotions and their regulation; and (c) cognitive biases: attention, interpretation and judgment, and memory. The interpersonal section summarizes findings regarding the systems of (a) approach and avoidance, (b) affiliation and social rank, and their implications for interpersonal impairments. Our review suggests that the science of social anxiety and, more generally, psychopathology may be advanced by examining processes and their underlying content within broad psychological systems. Increased interaction between basic and applied researchers to diversify and elaborate different perspectives on social anxiety is necessary for progress.

Efficiency evaluation of low impact development practices on urban flood risk

Urban flood risk assessment delivers invaluable information regarding flood management as well as preventing the associated risks in urban areas. The present study prepares a flood risk map and evaluate the practices of low-impact development (LID) intended to decrease the flood risk in Shiraz Municipal District 4, Fars province, Iran. So, this study investigate flood vulnerability using MCDM models and some indices, including population density, building age, socio-economic conditions, floor area ratio, literacy, the elderly population, and the number of building floors to. Then, the map of thematic layers affecting the urban flood hazard, including annual mean rainfall, land use, elevation, slope percentage, curve number, distance from channel, depth of groundwater, and channel density, was prepared in GIS. After conducting a multicollinearity test, data mining models were used to create the urban flood hazard map, and the urban flood risk map was produced using ArcGIS 10.8. The evaluation of vulnerability models was shown through the use of Boolean logic that TOPSIS and VIKOR models were effective in identifying urban flooding vulnerable areas. Data mining models were also evaluated using ROC and precision-recall curves, indicating the accuracy of the RF model. The importance of input variables was measured using Shapley value, which showed that curve number, land use, and elevation were more important in flood hazard modeling. According to the results, 37.8 percent of the area falls into high and very high categories in terms of flooding risk. The study used a stormwater management model (SWMM) to simulate node flooding and provide management scenarios for rainfall events with a return period ranging from 2 to 50 years and five rainstorm events. The use of LID practices in flood management was found to be effective for rainfall events with a return period of less than 10 years, particularly for two-year events. However, the effectiveness of LID practices decreases with an increase in the return period. By applying a combined approach to a region covering approximately 10 percent of the total area of Shiraz Municipal District 4, a reduction of 2-22.8 percent in node flooding was achieved. The analysis of data mining and MCDM models with a physical model revealed that more than 60% of flooded nodes were classified as "high" and "very high" risk categories in the RF-VIKOR and RF-TOPSIS risk models.

Patients Lost to Follow-up After Injury: Who are They and What are Their Long-Term Outcomes?

INTRODUCTION

Trauma patients are at high risk for loss to follow-up (LTFU) after hospital discharge. We sought to identify risk factors for LTFU and investigate associations between LTFU and long-term health outcomes in the trauma population.

METHODS

Trauma patients with an Injury Severity Score ≥9 admitted to one of three Level-I trauma centers, 2015-2020, were surveyed via telephone 6 mo after injury. Univariate and multivariate analyses were performed to assess factors associated with LTFU and several long-term outcomes.

RESULTS

Of 3609 patients analyzed, 808 (22.4%) were LTFU. Patients LTFU were more likely to be male (71% versus 61%, P = 0.001), Black (22% versus 14%, P = 0.003), have high school or lower education (50% versus 42%, P = 0.003), be publicly insured (23% versus 13%, P < 0.001), have a penetrating injury (13% versus 8%, P = 0.006), have a shorter length of stay (3.64 d ± 4.09 versus 5.06 ± 5.99, P < 0.001), and be discharged home without assistance (79% versus 50%, P < 0.001). In multivariate analyses, patients who followed up were more likely to require assistance at home (6% versus 11%; odds ratio [OR] 2.23, 1.26-3.92, P = 0.005), have new functional limitations (11% versus 26%; OR 2.91, 1.97-4.31, P = < 0.001), have daily pain (30% versus 48%; OR 2.11, 1.54-2.88, P = < 0.001), and have more injury-related emergency department visits (7% versus 10%; OR 1.93, 1.15-3.22, P = 0.012).

CONCLUSIONS

Vulnerable populations are more likely to be LTFU after injury. Clinicians should be aware of potential racial and socioeconomic disparities in follow-up care after traumatic injury. Future studies investigating improvement strategies in follow-up care should be considered.

Exploring the vulnerability of the coastal wetlands of India to the changing climate and their adaptation strategies

Changing climate exerts significant pressure on coastal wetland fishery, ecosystems and livelihood at the eco-regional level. In the present study, an indicator and scoring-based vulnerability assessment framework was developed to assess climate change-induced potential impacts and vulnerability of the coastal wetlands through stakeholder perception and primary data collection on ecology and fisheries. The study was conducted in 12 coastal wetlands in the Gangetic estuarine regions of eastern India. Analysis of rainfall, temperature and extreme climatic events was also carried out. The climate variability in the region was analysed and discussed in the context of ecosystem health and sustainability indicators. The results indicated that anthropogenic stress has a greater influence on ecosystem services than climatic stress. However, the nature and degree of vulnerability of fishers to climate change vary with their capacity to adapt to such changes and alternate sources of livelihood. Altogether, 34 fish species were documented, belonging to 11 taxonomic orders, and categorized as per intensity of resilience using selected criteria. Perception-based climate-resilient adaptation strategies have also been discussed. Developing appropriate adaptation policies and implementing climate-resilient practices and management can minimize vulnerability and increase the adaptive capacity of fishers ensuring sustainable livelihood options.

Comparative study for coastal aquifer vulnerability assessment using deep learning and metaheuristic algorithms

Coastal aquifer vulnerability assessment (CAVA) studies are essential for mitigating the effects of seawater intrusion (SWI) worldwide. In this research, the vulnerability of the coastal aquifer in the Lahijan region of northwest Iran was investigated. A vulnerability map (VM) was created applying hydrogeological parameters derived from the original GALDIT model (OGM). The significance of OGM parameters was assessed using the mean decrease accuracy (MDA) method, with the current state of SWI emerging as the most crucial factor for evaluating vulnerability. To optimize GALDIT weights, we introduced the biogeography-based optimization (BBO) and gray wolf optimization (GWO) techniques to obtain to hybrid OGM-BBO and OGM-GWO models, respectively. Despite considerable research focused on enhancing CAVA models, efforts to modify the weights and rates of OGM parameters by incorporating deep learning algorithms remain scarce. Hence, a convolutional neural network (CNN) algorithm was applied to produce the VM. The area under the receiver-operating characteristic curves for OGM-BBO, OGM-GWO, and VMCNN were 0.794, 0.835, and 0.982, respectively. According to the CNN-based VM, 41% of the aquifer displayed very high and high vulnerability to SWI, concentrated primarily along the coastline. Additionally, 32% of the aquifer exhibited very low and low vulnerability to SWI, predominantly in the southern and southwestern regions. The proposed model can be extended to evaluate the vulnerability of various coastal aquifers to SWI, thereby assisting land use planers and policymakers in identifying at-risk areas. Moreover, deep-learning-based approaches can help clarify the associations between aquifer vulnerability and contamination resulting from SWI.

Impact of natural disasters on student enrollment in higher education programs: A systematic review

This study aims to evaluate how natural disasters affect student enrollment in higher education programs, considering both immediate and long-term consequences. The PRISMA guidelines were adhered to in conducting this review. Multiple databases, such as Web of Science and Scopus, including those with articles from January 2000 to February 2023, were thoroughly searched. Articles focusing on how natural disasters affect students' enrollment in higher education programs met the inclusion requirements. A total of 22 studies were deemed eligible for inclusion and detailed analysis. The findings suggest that natural disasters have a negative influence on higher education enrollment, with the most severe effects being felt by disadvantaged populations. This study reveals that natural disasters impact various aspects of the enrollment process, such as application, acceptance, registration, attendance, retention, and graduation, in higher education due to infrastructural and psychological impacts. Key variables linking natural disasters to enrollment changes include damage to institutional infrastructure, economic and psychological strain, resource limitations, loss of social support networks, and disruptions to academic programs. Enhancing resilience involves adopting online learning, providing financial support, flexible enrollment policies, mental health services, disaster preparedness training, resilient infrastructure development, and collaborative institutional programs. The study highlights the need for comprehensive, context-specific disaster management strategies that address both immediate and long-term educational needs. It identifies potential solutions, including online learning platforms, financial aid, flexible enrollment policies, mental health support, disaster preparedness training, infrastructure resilience, and collaborative programs with other institutions. Context-specific programs are essential to support impacted students by rebuilding educational infrastructure and providing financial and emotional support, thereby ensuring their continued access to higher education. This study offers valuable insights for disaster management, educational policy, and future research on this critical issue.

Neurological patients confronting climate change: A potential role for the glymphatic system and sleep

Interest in the health consequences of climate change (global warming, heatwaves) has increased in the neurological community. This review addresses the impact of elevated ambient temperatures and heatwaves on patients with neurological and mental health disorders, including multiple sclerosis, synucleinopathies, dementia, epilepsies, mental health, and stroke. Patients with such conditions are highly vulnerable during heatwaves because of functional disorders affecting sleep, thermoregulation, autonomic system reactivity, mood, and cognitive ability. Several medications may also increase the risk of heatstroke. Special attention is devoted to the involvement of common underlying mechanisms, such as sleep and the glymphatic system. Disease prevention and patient care during heatwaves are major issues for caregivers. Beyond the usual recommendations for individuals, we favor artificially induced acclimation to heat, which provides preventive benefits with proven efficacy for healthy adults.

Access to child developmental assessment services in culturally and linguistically diverse metropolitan Sydney: a retrospective cohort analysis

BACKGROUND

Despite the increasing prevalence of neurodevelopmental disorders (NDD), data regarding access to child development services have remained limited globally. Long wait times are a major barrier to developmental assessments, impacting on care and outcomes. The aim is to retrospectively analyse the demographic profile and prioritisation of patients seen at a child developmental assessment service (CDAS) in a vulnerable region of Sydney, and explore factors affecting wait times.

METHODS

Data was collated and analysed for 2354 patients from 2018 to 2022. Socio-Economic Indexes for Areas (SEIFA) were collated from the Australian Bureau of Statistics. Descriptive statistics were used for demographic data and various statistical methods were used to analyse the relationships and impact of factors likely to affect wait lists.

RESULTS

The median age was 51 months (IQR41-61) and males comprised 73.7% of the cohort. 64% of children were from culturally and linguistically diverse backgrounds (CALD) and 47% lived in the most disadvantaged suburbs. The median wait time was 302.5 days (IQR175-379) and 70% of children were seen within 12 months. CALD patients and children over 5-years had shorter wait times. Most children with Global Developmental Delay (GDD) were from the lowest four SEIFA deciles and waited longer for an appointment. 42.6% were seen within the priority allocated time or sooner. Children with ASD and/or severe GDD were prioritised to be seen earlier. Overall, the study could not demonstrate any difference in the wait times according to the prioritisation groups.

CONCLUSION

This study provides insights into the profile, prioritisation processes and wait lists of children seen by CDAS in South Western Sydney with high rates of social vulnerability and presents an argument to discuss benchmarking targets with service providers. It identifies the need to prioritise children living in suburbs with socioeconomic disadvantage and refine prioritisation and data collection processes to improve wait times.

InSAR and machine learning reveal new understanding of coastal subsidence risk in the Yellow River Delta, China

Coastal subsidence is a geological disaster that has devastating consequences. However, an accurate understanding of its risks involves more than simply assessing the amount or rate of land subsidence. The existing methods used to evaluate geological disaster risks depend on extensive data collection, entail substantial workloads, suffer from error estimation challenges, and lack regional adaptability. These limitations prevent us from fully understanding coastal subsidence risks in estuarine deltas. Therefore, in this study, we propose a new subsidence risk assessment method that addresses the challenges of traditional geological risk assessments in terms of spatial coverage, spatiotemporal resolution, and data collection difficulty. First, Sentinel-1 multitemporal interferometric synthetic aperture radar (MT-InSAR) and cluster analysis were used to estimate the subsidence hazards. Subsequently, Landsat-8 imagery and a random forest (RF) classifier were used to obtain land use and land cover (LULC), and the analytic hierarchy process (AHP) was used to obtain settlement vulnerability. Thereafter, subsidence susceptibility was derived from the sediment layer thickness. By combining subsidence hazard, vulnerability, and susceptibility, the first subsidence risk map with a 30 m resolution was generated. The results showed that 4.54 % of the Yellow River Delta (YRD) area was high-risk, 8.75 % was medium-risk, and 10.14 % was low-risk. Notably, the risk map shows a clear overlap between high-risk and saltwater mining areas in the YRD. The proposed method is expected to improve our understanding of the coastal subsidence risk in estuarine deltas. Considering that the risk in high-value economic areas in the YRD is increasing, whereas the risk in low-value economic areas may change owing to human activity, early preventive measures are required.

Spatial congruency or discrepancy? Exploring the spatiotemporal dynamics of built-up expansion patterns and flood risk

Most coastal cities have been experiencing unprecedented urbanization-induced flood risk, climatic events, and haphazard anthropogenic activities, jeopardizing residents' lives and building environments. Despite mounting flood-related studies, analyzing the correlation between the spatiotemporal dynamics of Built-up Expansion patterns (BE) and flood risk remains unknown and holds divergent perspectives. In this context, the coastal city of Alexandria, Egypt, characterized by multiple urban patterns and experiencing heavy rainfall annually, was selected as a testbed. Our method defined the spatiotemporal rates of BE from 1995 to 2023, quantified flood risk spatially, and finally investigated the correlation between BE and flood risk through spatial and statistical analysis. Our results show the built-up area occupied 30.32 % of the total city area till 2023, and the infilling pattern dominated the BE growth by 45.21 % of the total built-up area, followed by leapfrogging and edge expansion by 33.25 % and 21.55 %, respectively. The unplanned-infilling pattern is predominantly highly correlated with the flood-vulnerable peaks (correlation coefficient (rk) = 0.975, p-value < 0.05) and lowers dramatically towards planned-infilling regions with flood protections. Meanwhile, a spatial mismatch exists between high-risk peaks and leapfrogging and edge expansion (rk = 0.118 and 0.662, respectively, with a p-value < 0.01), indicating that controlling the built-up amount is inadequate for mitigating flood risk. Porosity-based urban configuration and spatial distribution of built-up patches in harmony with nature-based solutions are recommended for shaping flood-resilient and effective urban planning.

A balancing act: navigating the nuances of co-production in mental health research

BACKGROUND

In the context of mental health research, co-production involves people with lived expertise, those with professional or academic expertise, and people with both of these perspectives collaborating to design and actualize research initiatives. In the literature, two dominant perspectives on co-production emerge. The first is in support of co-production, pointing to the transformative value of co-production for those involved, the quality of services developed through this process, as well as to broader system-level impacts (e.g. influencing changes in health system decision making, care practices, government policies, etc.). The second stance expresses scepticism about the capacity of co-production to engender genuine collaboration given the deeply ingrained power imbalances in the systems in which we operate. While some scholars have explored the intersections of these two perspectives, this body of literature remains limited.

MAIN TEXT

This paper contributes to the literature base by exploring the nuances of co-production in health research. Using our mental health participatory action research project as a case example, we explore the nuances of co-production through four key values that we embraced: 1. Navigating power relations together 2. Multi-directional learning 3. Slow and steady wins the race 4. Connecting through vulnerability CONCLUSIONS: By sharing these values and associated principles and practices, we invite readers to consider the complexities of co-production and explore how our experiences may inform their practice of co-production. Despite the inherent complexity of co-production, we contend that pursuing authentic and equitable collaborations is integral to shaping a more just and inclusive future in mental health research and the mental health system at large.

Climate Change Adaptation Methods for Public Health Prevention in Australia: an Integrative Review

PURPOSE OF REVIEW

Climate change poses a serious threat to human health and well-being. Australia is not immune to the public health impacts and continues to be underprepared, putting the population health at risk. However, there is a dearth in knowledge about how the Australian public health system will address the impacts of climate change.

RECENT FINDINGS

This integrative review synthesises tools, frameworks, and guidance material suitable for climate change adaptation from a preventive public health perspective. The literature search was conducted in electronic databases MEDLINE, PubMed, CINAHL, and Web of Science. Of 4507 articles identified, 19 articles met the inclusion criteria that focused on operational methods in public health and excluded the clinical context and reactive disaster response approaches. This review revealed that Australia is ill-prepared to manage climate change adverse health impacts due to ineffective adaptation strategies. The review highlights that Australia urgently requires effective adaptation strategies such as undertaking a National Adaptation Plan process and an improved understanding in managing complex health risks. Taking this action will strengthen the public health system and build health resilience especially for vulnerable populations. These findings will help understand and develop of the necessary adaptive strategies in Australia.

Care-ethical considerations of technology-care-assemblages

Technology plays a major role in care. Against the background of demographic ageing, the use of assistive technologies to support and relieve carers in their work is becoming more and more important. One sector that is increasingly coming into focus is home care by family caregivers. Here, the use of assistive technologies takes place under specific conditions. The article proposes a care-ethical perspective to understand these conditions. It critically discusses issues of power and participation in the negotiation of care that can be associated with the use of technology and outlines a care-ethical perspective on technocare.

Analysis of genetic diversity in patients with major psychiatric disorders versus healthy controls: A molecular-genetic study of 1698 subjects genotyped for 100 candidate genes (549 SNPs)

BACKGROUND

This study analyzed the extent to which irregularities in genetic diversity separate psychiatric patients from healthy controls.

METHODS

Genetic diversity was quantified through multidimensional "gene vectors" assembled from 4 to 8 polymorphic SNPs located within each of 100 candidate genes. The number of different genotypic patterns observed per gene was called the gene's "diversity index".

RESULTS

The diversity indices were found to be only weakly correlated with their constituent number of SNPs (20.5 % explained variance), thus suggesting that genetic diversity is an intrinsic gene property that has evolved over the course of evolution. Significant deviations from "normal" diversity values were found for (1) major depression; (2) Alzheimer's disease; and (3) schizoaffective disorders. Almost one third of the genes were correlated with each other, with correlations ranging from 0.0303 to 0.7245. The central finding of this study was the discovery of "singular genes" characterized by distinctive genotypic patterns that appeared exclusively in patients but not in healthy controls. Neural Nets yielded nonlinear classifiers that correctly identified up to 90 % of patients. Overlaps between diagnostic subgroups on the genotype level suggested that (1) diagnoses-crossing vulnerabilities are likely involved in the pathogenesis of major psychiatric disorders; (2) clinically defined diagnoses may not constitute etiological entities.

CONCLUSION

Detailed analyses of the variation of genotypic patterns in genes along with the correlation between genes lead to nonlinear classifiers that enable very robust separation between psychiatric patients and healthy controls on the genotype level.

Who is more vulnerable to effects of long-term exposure to air pollution on COVID-19 hospitalisation?

OBJECTIVE

Factors that shape individuals' vulnerability to the effects of air pollution on COVID-19 severity remain poorly understood. We evaluated whether the association between long-term exposure to ambient NO2, PM2.5, and PM10 and COVID-19 hospitalisation differs by age, sex, individual income, area-level socioeconomic status, arterial hypertension, diabetes mellitus, and chronic obstructive pulmonary disease.

METHODS

We analysed a population-based cohort of 4,639,184 adults in Catalonia, Spain, during 2020. We fitted Cox proportional hazard models adjusted for several potential confounding factors and evaluated the interaction effect between vulnerability indicators and the 2019 annual average of NO2, PM2.5, and PM10. We evaluated interaction on both additive and multiplicative scales.

RESULTS

Overall, the association was additive between air pollution and the vulnerable groups. Air pollution and vulnerability indicators had a synergistic (greater than additive) effect for males and individuals with low income or living in the most deprived neighbourhoods. The Relative Excess Risk due to Interaction (RERI) was 0.21, 95 % CI, 0.15 to 0.27 for NO2 and 0.16, 95 % CI, 0.11 to 0.22 for PM2.5 for males; 0.13, 95 % CI, 0.09 to 0.18 for NO2 and 0.10, 95 % CI, 0.05 to 0.14 for PM2.5 for lower individual income and 0.17, 95 % CI, 0.12 to 0.22 for NO2 and 0.09, 95 % CI, 0.05 to 0.14 for PM2.5 for lower area-level socioeconomic status. Results for PM10 were similar to PM2.5. Results on multiplicative scale were inconsistent.

CONCLUSIONS

Long-term exposure to air pollution had a larger synergistic effect on COVID-19 hospitalisation for males and those with lower individual- and area-level socioeconomic status.

Association between electrocardiographic abnormalities and flood exposure among middle-aged and elderly people: A national longitudinal study in China

BACKGROUND

Flooding has become more frequent and intensive due to climate change, particularly in Asian countries. However, evidence on the long-term health effects of floods from large-scale studies on the vulnerable aged population in China is insufficient. This study analyzed the long-term effects of exposure to flood on electrocardiographic (ECG) abnormalities, a commonly used indicator of cardiovascular disease (CVD) screening, in middle-aged and elderly people.

METHOD

We evaluated the Chinese National Stroke Screening Survey data of 80,711 follow-up records from 38,375 participants aged > 40 years with two or more visits between 2013 and 2018 in this longitudinal study. Flood exposure was assessed as the presence of a satellite-detected flooded area within 500 m of the residence within 5 years before the survey date. The association between ECG abnormalities and flood exposure was analyzed using a random effects model with multiple adjustments. As age is an important CVD risk factor, a varying-coefficient function was derived to estimate the nonlinear modifying effect of age on the association between ECG abnormalities and flood exposure. The strata-specific associations between ECG abnormalities and flood exposure were applied to characterize vulnerability to flood.

RESULTS

The fully adjusted model suggested that flood exposure was associated with an increased risk for ECG abnormalities among the middle-aged and elderly population (odds ratio [OR] 1.74, 95 % confidence interval [CI] 1.49, 2.03). The ORs of flood exposure for ECG suggesting atrial fibrillation, ST depression, and left ventricular hypertrophy were 1.85 (95 % CI 1.16, 2.94), 6.92 (95 % CI 5.23, 9.16), and 1.55 (95 % CI 0.66, 3.65), respectively. These associations were generally robust in various subpopulations, while a sublinear curve for the negative modifying effect of age was observed on the population vulnerability to flood.

CONCLUSION

Flood exposure was associated with an increased long-term risk for an ECG abnormality. The need for effective measures to mitigate vulnerability to flood is not negligible in China.

Common and distinct neural correlates of emotional processing in individuals at familial risk for major depressive disorder and bipolar disorder: A comparative meta-analysis

Individuals at familial risk for mood disorders exhibit deficits in emotional processing and associated brain dysfunction prior to illness onset. However, such brain-behavior abnormalities related to familial predisposition remain poorly understood. To investigate robust abnormal functional activation patterns during emotional processing in unaffected at-risk relatives of patients with major depressive disorder (UAR-MDD) and bipolar disorder (UAR-BD), we performed a meta-analysis of task-based functional magnetic resonance imaging studies using Seed-based d Mapping (SDM) toolbox. Common and distinct patterns of abnormal functional activation between UAR-MDD and UAR-BD were detected via conjunction and differential analyses. A total of 17 studies comparing 481 UAR and 670 healthy controls (HC) were included. Compared with HC, UAR-MDD exhibited hyperactivation in the parahippocampal gyrus, amygdala and cerebellum, while UAR-BD exhibited parahippocampal hyperactivation and hypoactivation in the striatum and middle occipital gyrus (MOG). Conjunction analysis revealed shared hyperactivated PHG in both groups. Differential analysis indicated that the activation patterns of amygdala and MOG significantly differed between UAR-MDD and UAR-BD. These findings provide novel insights into common and distinct neural phenotypes for familial risk and associated risk mechanisms in MDD and BD, which may have implications in guiding precise prevention strategies tailored to the family context.

Local sources of vulnerability to climate change and armed conflicts in East Africa

While socioeconomic and institutional factors are crucial in explaining the onset and evolution of conflicts, recent research suggests that climate change is a further indirect driver acting as a "threat multiplier". This paper focuses on the concept of vulnerability to both climate change and conflicts to explain why some locations are more likely to engage in armed conflicts than others in the presence of a similar level of exposure to climatic changes. In particular, by means of a Spatial Autoregressive Model, we identify a set of local-specific vulnerability factors that increase conflict risk in East Africa. We employ a georeferenced database with a resolution of 25 × 25 km, covering the period 1997-2016. Results from our analysis provide some interesting insights: first, climate change does not increase conflict risk per se, but only in the presence of pre-existing vulnerabilities. Second, resource access and socioeconomic factors play a key role in driving the climate-conflict nexus especially in urban areas. In particular, vulnerability is increased whenever power is not distributed in such a way as to ensure an equitable distribution of resources. Overall, our findings suggest that, by addressing vulnerability factors that prevent adaptive capacity and an equitable distribution of resources, societies may benefit in terms of both diminished conflict risk and alleviation of climate change impacts.

When Space and Time Matter in Environmental Injustice: A Bayesian Analysis of the Association between Socio-economic Disadvantage and Air Pollution in Greater Mexico City

Environmental injustice refers to the unequal burden of pollutants on groups with lower socioeconomic status. An increasing number of studies have identified associations between high levels of pollution and socioeconomic disadvantage. However, few studies have controlled adequately for spatio-temporal variations in pollution. This study uses a Bayesian approach to explore the association between socioeconomic disadvantage and pollution in Mexico City Metropolitan Area. We quantify the association of socioeconomic disadvantage with PM10 and ozone and evaluate the impact of accounting for spatio-temporal structure of the pollution data. We find a significant positive association between socio-economic disadvantage and pollution for levels of PM10, but not ozone. The inclusion of the spatio-temporal element in the modeling results in improved weaker estimates of this association but this does not alter results substantially. These findings confirm the robustness of previous studies that found signs of environmental injustice where spatio-temporal variations have not been explicitly considered, confirming that targeted policies to reduce pollution in socio-economically disadvantaged areas are required.

A bioethical perspective on the meanings behind a wish to hasten death: a meta-ethnographic review

BACKGROUND

The expressions of a "wish to hasten death" or "wish to die" raise ethical concerns and challenges. These expressions are related to ethical principles intertwined within the field of medical ethics, particularly in end-of-life care. Although some reviews were conducted about this topic, none of them provides an in-depth analysis of the meanings behind the "wish to hasten death/die" based specifically on the ethical principles of autonomy, dignity, and vulnerability. The aim of this review is to understand if and how the meanings behind the "wish to hasten death/die" relate to and are interpreted in light of ethical principles in palliative care.

METHODS

We conducted a meta-ethnographic review according to the PRISMA guidelines and aligned with Noblit and Hare's framework. Searches were performed in three databases, Web of Science, PubMed, CINAHL, with no time restrictions. Original qualitative studies exploring the meanings given by patients, family caregivers and healthcare professionals in any context of palliative and end-of-life care were included. A narrative synthesis was undertaken. PROSPERO registration CRD42023360330.

RESULTS

Out of 893 retrieved articles, 26 were included in the analysis, accounting for the meanings of a total of 2,398 participants. Several factors and meanings associated with the "wish to hasten death" and/or "wish to die" were identified and are mainly of a psychosocial and spiritual nature. The ethical principles of autonomy and dignity were the ones mostly associated with the "wish to hasten death". Ethical principles were essentially inferred from the content of included articles, although not explicitly stated as bioethical principles.

CONCLUSIONS

This meta-ethnographic review shows a reduced number of qualitative studies on the "wish to hasten death" and/or "wish to die" explicitly stating ethical principles. This suggests a lack of bioethical reflection and reasoning in the empirical end-of-life literature and a lack of embedded ethics in clinical practice. There is a need for healthcare professionals to address these topics compassionately and ethically, taking into account the unique perspectives of patients and family members. More qualitative studies on the meanings behind a wish to hasten death, their ethical contours, ethical reasoning, and implications for clinical practice are needed.

The threaten of typhoons to the health of residents in inland areas: a study on the vulnerability of residents to death risk during typhoon "Lekima" : In Jinan, China

BACKGROUND

Studies had suggested increased risk of death of residents was associated with typhoons, particularly coastal regions. However, these findings ignored the impact of inland typhoons on the health of residents, especially the indirect death risk caused by typhoons. This study aimed to investigate the acute death risk of residents during inland typhoon Lekima in Jinan, further identify vulnerable populations and areas.

METHODS

We selected the daily death from 11 to 27th August 2019 in Jinan as case period, and conducted a time-stratified case-crossover design to match the contemporaneous data from 2016 to 2018 as control period. We used the generalized linear Poisson models to estimate the related effects of death risk during typhoon Lekima and lag days.

RESULTS

During the Lekima typhoon month, there were 3,366 deaths occurred in Jinan. Compared to unexposed periods, the acute death risk of non-accidental diseases (especially circulatory diseases), female and the older adults increased significantly in the second week after the typhoon. The maximum significant effect of circulatory disease deaths, female and older adult deaths were appeared on lag9, lag9, and lag13 respectively. And the typhoon-associated RR were 1.19 (95%CI:1.05,1.34), 1.28 (95%CI:1.08,1.52), and 1.22 (95%CI:1.06,1.42) respectively. The acute death risk of residents living in TQ and CQ increased significantly on Lag2 and Lag6 after the typhoon, respectively, while those living in LX, LC, HY, JY, and SH occurred from Lag 8 to Lag 13 after the typhoon. LC lasted the longest days.

CONCLUSIONS

Typhoons would increase the vulnerability of residents living in Jinan which mainly occurred from the seventh day after the typhoon. Residents suffering from non-accidental diseases (circulatory diseases), female and the older adults were more vulnerable. The vulnerability of TQ and CQ occurred on Lag2 and Lag6 after typhoon Lekima, respectively, and the other areas except ZQ and PY occurred from Lag 8 to Lag 13. LC lasted the longest duration. Our findings emphasized the importance of the emergency response, which would help policymakers to identify vulnerable regions and populations accurately during typhoons and formulate the emergency response plan.

Limited incremental predictive value of the frailty index and other vulnerability measures from routine care data for mortality risk prediction in older patients with COVID-19 in primary care

BACKGROUND

During the COVID-19 pandemic, older patients in primary care were triaged based on their frailty or assumed vulnerability for poor outcomes, while evidence on the prognostic value of vulnerability measures in COVID-19 patients in primary care was lacking. Still, knowledge on the role of vulnerability is pivotal in understanding the resilience of older people during acute illness, and hence important for future pandemic preparedness. Therefore, we assessed the predictive value of different routine care-based vulnerability measures in addition to age and sex for 28-day mortality in an older primary care population of patients with COVID-19.

METHODS

From primary care medical records using three routinely collected Dutch primary care databases, we included all patients aged 70 years or older with a COVID-19 diagnosis registration in 2020 and 2021. All-cause mortality was predicted using logistic regression based on age and sex only (basic model), and separately adding six vulnerability measures: renal function, cognitive impairment, number of chronic drugs, Charlson Comorbidity Index, Chronic Comorbidity Score, and a Frailty Index. Predictive performance of the basic model and the six vulnerability models was compared in terms of area under the receiver operator characteristic curve (AUC), index of prediction accuracy and the distribution of predicted risks.

RESULTS

Of the 4,065 included patients, 9% died within 28 days after COVID-19 diagnosis. Predicted mortality risk ranged between 7-26% for the basic model including age and sex, changing to 4-41% by addition of comorbidity-based vulnerability measures (Charlson Comorbidity Index, Chronic Comorbidity Score), more reflecting impaired organ functioning. Similarly, the AUC of the basic model slightly increased from 0.69 (95%CI 0.66 - 0.72) to 0.74 (95%CI 0.71 - 0.76) by addition of either of these comorbidity scores. Addition of a Frailty Index, renal function, the number of chronic drugs or cognitive impairment yielded no substantial change in predictions.

CONCLUSION

In our dataset of older COVID-19 patients in primary care, the 28-day mortality fraction was substantial at 9%. Six different vulnerability measures had little incremental predictive value in addition to age and sex in predicting short-term mortality.

"I think they should give primary health care a little more priority". The primary health care in Caribbean SIDS: what can be said about adaptation to the changing climate? The case of Dominica- a qualitative study

BACKGROUND

Adaptation to climate change (CC) is a priority for Small Island Developing States (SIDS) in the Caribbean, as these countries and territories are particularly vulnerable to climate-related events. Primary health care (PHC) is an important contributor to CC adaptation. However, knowledge on how PHC is prepared for CC in Caribbean SIDS is very limited. The aim of this paper is to discuss health system adaptation to climate change, with a focus on PHC.

METHODS

We explored the perspectives of PHC professionals in Dominica on PHC adaptation to climate change. Focus group discussions (FGDs) were conducted in each of the seven health districts in Dominica, a Caribbean SIDS, between November 2021 and January 2022. The semi-structured interview guide was based on the Essential Public Health Functions: assessment, access to health care services, policy development and resource allocation. Data coding was organized accordingly.

RESULTS

Findings suggest that health care providers perceive climate change as contributing to an increase in NCDs and mental health problems. Climate-related events create barriers to care and exacerbate the chronic deficiencies within the health system, especially in the absence of high-level policy support. Healthcare providers need to take a holistic view of health and act accordingly in terms of disease prevention and health promotion, epidemiological surveillance, and ensuring the widest possible access to healthcare, with a particular focus on the environmental and social determinants of vulnerability.

CONCLUSION

The primary health care system is a key stakeholder in the design and operationalization of adaptation and transformative resilience. The Essential Public Health Functions should integrate social and climate and other environmental determinants of health to guide primary care activities to protect the health of communities. This study highlights the need for improved research on the linkages between climate events and health outcomes, surveillance, and development of plans informed by contextual knowledge in the SIDS.

"Superheroes? No, thanks." Accepting vulnerability in healthcare professionals

In this commentary, we develop a conceptual proposal aimed to explain why a discourse of praise and admiration for healthcare professionals´ limitless dedication can trigger a general indifference to the burnout and suffering they experience. Ultimately, this can lead to the justification of the lack of resources dedicated to preventing these problems. We first start by pointing out the stigmatisation of healthcare professionals suffering from burnout and showing their vulnerability, highlighting the complex interactions that occur in the healthcare context and that increase the risk of perpetuating their suffering. Then, we appeal to the recognition of one's own vulnerability as a key element towards the creation of a culture more focused on the duty of care for those who care for others. We conclude with several proposals for action to cope with burnout-related stigma, trying to change the superhuman image of health personnel and incorporating the vulnerability inherent to human beings.

Beyond flood hazard. Mapping the loss probability of pedestrians to improve risk estimation and communication

The effective communication of flood hazard and risk is a necessary step to foster preparedness and resilience, hence reducing the detrimental impacts of flooding events. Classical flood maps, which show flow depth and velocity, have often proved to be incomprehensible to the majority of people. Some recent studies used color maps to convey the spatial distribution of diverse hazard indexes that, accounting for both water depth and velocity, are intended to communicate the hazard degree in a more intelligible way. It is first shown that these hazard indexes have some inherent limitations, as for example the implicit assumption of a linear relationship between flood hazard and flow velocity. As an alternative, we propose to map the loss probability (LP) of pedestrians exposed to floodwaters, which is a physics-based and data-consistent risk index accounting for both hazard and vulnerability. LP can be easily computed and allows for a sounder estimation and a more effective communication of flood risk to the general public.

Layered vulnerability and researchers' responsibilities: learning from research involving Kenyan adolescents living with perinatal HIV infection

BACKGROUND

Carefully planned research is critical to developing policies and interventions that counter physical, psychological and social challenges faced by young people living with HIV/AIDS, without increasing burdens. Such studies, however, must navigate a 'vulnerability paradox', since including potentially vulnerable groups also risks unintentionally worsening their situation. Through embedded social science research, linked to a cohort study involving Adolescents Living with HIV/AIDS (ALH) in Kenya, we develop an account of researchers' responsibilities towards young people, incorporating concepts of vulnerability, resilience, and agency as 'interacting layers'.

METHODS

Using a qualitative, iterative approach across three linked data collection phases including interviews, group discussions, observations and a participatory workshop, we explored stakeholders' perspectives on vulnerability and resilience of young people living with HIV/AIDS, in relation to home and community, school, health care and health research participation. A total of 62 policy, provider, research, and community-based stakeholders were involved, including 27 ALH participating in a longitudinal cohort study. Data analysis drew on a Framework Analysis approach; ethical analysis adapts Luna's layered account of vulnerability.

RESULTS

ALH experienced forms of vulnerability and resilience in their daily lives in which socioeconomic context, institutional policies, organisational systems and interpersonal relations were key, interrelated influences. Anticipated and experienced forms of stigma and discrimination in schools, health clinics and communities were linked to actions undermining ART adherence, worsening physical and mental health, and poor educational outcomes, indicating cascading forms of vulnerability, resulting in worsened vulnerabilities. Positive inputs within and across sectors could build resilience, improve outcomes, and support positive research experiences.

CONCLUSIONS

The most serious forms of vulnerability faced by ALH in the cohort study were related to structural, inter-sectoral influences, unrelated to study participation and underscored by constraints to their agency. Vulnerabilities, including cascading forms, were potentially responsive to policy-based and interpersonal actions. Stakeholder engagement supported cohort design and implementation, building privacy, stakeholder understanding, interpersonal relations and ancillary care policies. Structural forms of vulnerability underscore researchers' responsibilities to work within multi-sectoral partnerships to plan and implement studies involving ALH, share findings in a timely way and contribute to policies addressing known causes of vulnerabilities.

Riverbank erosion vulnerability assessment and coping strategies: A case study of the riparian communities in the Mekong River Basin in Cambodia

Riverbank erosion is a major hazard for riparian communities in the Mekong River Basin. This study aims to (1) assess the livelihood vulnerability of two communities residing along the Mekong River, namely, Kaoh Soutin (KS) and Ruessei Srok (RS), by using the livelihood vulnerability index framed within the Intergovernmental Panel on Climate Change vulnerability framework (LVI-IPCC) and (2) identify the coping strategies of the communities based on semi-structured interviews. The results show that KS is slightly more vulnerable to riverbank erosion than RS, as indicated by LVI-IPCC values of 0.49 and 0.46 for KS and RS, respectively. RS exhibits high adaptive capacity and low sensitivity, but its exposure level is relatively high. Majority of the respondents in KS (62 %) and RS (93 %) were affected by riverbank erosion. In KS, approximately 48 % of the respondents experienced displacement, and 39 % of them relocated once. Meanwhile, in RS, 81 % of the respondents experienced displacement, with 46 % displaced at least three times. The affected households have coped with riverbank erosion by reducing expenses, diversifying their income sources, seeking support from others, and receiving assistance from local authorities, NGOs, and government interventions. Despite such efforts to mitigate the effects of riverbank erosion, the high level of exposure and external factors, such as high living costs and low profits from agriculture, have weakened the ability of the people in both communities to cope with disasters. Moreover, the social ties among households, especially in KS, have declined, thereby making low-income households highly vulnerable to riverbank erosion.

The sensitivities and adaptive capacity of public lands visitors

Lands and waters administered by governing entities for public use (i.e., "public lands") are subject to changing social and ecological conditions (e.g., overcrowding, drought). Public lands managers are often tasked with addressing these changes while balancing conservation goals and public use mandates, and their decisions can significantly and inequitably impact visitor sensitivities to different types of exposures. To gain insights into visitor sensitivities and their adaptive capacity to mitigate the impacts of exposures, we draw upon a comprehensive monitoring effort conducted in collaboration with the U.S. Fish and Wildlife Service (Service) to understand visitor experiences on national wildlife refuges (refuges). We collected data from 10,556 visitors to 68 refuges during 2018-2019, then segmented respondents into unique visitor types based on their frequency of visiting "this refuge" where they were contacted, their participation across different activities at that refuge, and visits to other public lands for purposes of their primary activity, all during the 12 months prior to being contacted. We then explored differences among the resulting visitor types in their (a) purpose of visit, (b) satisfaction with opportunities during their visit, and (c) demographic characteristics. Finally, we used external data sources to explore the sensitivities and adaptive capacity of visitors' home communities. Our approach identified eight types of visitors with distinct sensitivities and adaptive capacities. For example, the type categorized as "most sensitive" due to activity specialization and site dependency was more likely to engage in activities (e.g., fishing, hunting) that may be subsistence uses of public lands and more often lived in communities with reduced adaptive capacity. Our assessment supports public lands decision-making by helping to understand and address social inequities that may arise or be exacerbated by rapidly changing conditions.

Behavioural characteristics and sex differences of a treatment-resistant depression model: Chronic mild stress in the Wistar-Kyoto rat

Depression affects 20% of the general population and is a leading cause of disability worldwide, with a strong female prevalence. Current pharmacotherapies have significant limitations, and one third of patients are unresponsive. Male Wistar-Kyoto rats exposed to chronic mild stress (CMS) were recently proposed as a model to study antidepressant resistance. However, sex differences and interindividual vulnerability to stress are yet unexplored in this model. We aimed to investigate these in the context of the behavioural impact of CMS in the sucrose preference test, elevated plus maze (EPM), forced swim test (FST), open field test and daily locomotor activity rhythms, in male and female WKY rats exposed or not to a 4-week CMS protocol. CMS-exposed animals were clustered through K-means into subgroups based on the EPM and FST results. In both sexes, one subgroup behaved similarly to non-stressed animals and was labelled stress-non vulnerable; the second exhibited less open arms exploration in the EPM and higher immobility in the FST and was named stress-vulnerable. Vulnerable males presented phase delay in daily locomotor activity following CMS, but no significant rhythm could be determined in females. CMS-exposed males of both groups showed hyperlocomotion in reaction to novelty and slower weight gain through the course of CMS, while CMS-exposed females showed smaller sucrose intake. Unexpectedly, CMS did not affect sucrose preference. Our findings strengthen the view that in models of psychiatric pathologies based on stress exposure it is important to consider the effect of sex and to differentiate the non vulnerable and vulnerable subpopulations.

External vulnerability, local resilience, and urban-rural heterogeneity in the Marshall Islands

Popular media often positions the Marshall Islands as especially vulnerable to environmental shocks and shifts. This framing overlooks sources of vulnerability, local resilience, and within country differences. To better understand relationships between social, economic, and cultural shifts and vulnerability and resilience in the Marshall Islands, this study draws on interviews with internal migrants and members of government and civil society to investigate perceptions of vulnerability and resilience in outer islands and Majuro. Findings reveal sharp perceived differences. Participants largely tied vulnerability on outer islands to increasingly variable environmental conditions affecting natural resource-dependent livelihoods and vulnerability on Majuro to the cash economy. In both urban core and rural outer islands, participants linked vulnerability to interdependencies far beyond the Marshall Islands. By evaluating historical and external influences and spatial heterogeneity, this study supports a nuanced understanding of vulnerability and resilience within archipelagic countries critical to policy development.

Acquisition of cocaine reinforcement using fixed-ratio and concurrent choice schedules in socially housed female and male monkeys

RATIONALE

Previous studies in socially housed monkeys examining acquisition of cocaine self-administration under fixed-ratio (FR) schedules of reinforcement found that subordinate males and dominant females were more vulnerable than their counterparts.

OBJECTIVES

The present studies extended these findings in two ways: (1) to replicate the earlier study, in which female monkeys were studied after a relatively short period of social housing (~ 3 months) using cocaine-naïve female monkeys (n = 9; 4 dominant and 5 subordinate) living in well-established social groups (~ 18 months); and (2) in male monkeys (n = 3/social rank), we studied cocaine acquisition under a concurrent schedule, with an alternative, non-drug reinforcer available.

RESULTS

In contrast to earlier findings, subordinate female monkeys acquired cocaine reinforcement (i.e., > saline reinforcement) at significantly lower cocaine doses compared with dominant monkeys. In the socially housed males, no dominant monkey acquired a cocaine preference (i.e., > 80% cocaine choice) over food, while two of three subordinate monkeys acquired cocaine reinforcement. In monkeys that did not acquire, the conditions were changed to an FR schedule with only cocaine available and after acquisition, returned to the concurrent schedule. In all monkeys, high doses of cocaine were chosen over food reinforcement.

CONCLUSIONS

The behavioral data in females suggests that duration of social enrichment and stress can differentially impact vulnerability to cocaine reinforcement. The findings in socially housed male monkeys, using concurrent food vs. cocaine choice schedules of reinforcement, confirmed earlier social-rank differences using an FR schedule and showed that vulnerability could be modified by exposure to cocaine.

A framework for modeling an agronomic system's vulnerability to climate change with reflections from the Caspian coastal agro-ecological zone of Iran

Assessing the vulnerability of different sectors to climate change has great importance in determining the appropriate adaptation measures to deal with climate change impacts on a river basin scale. In this research, using a framework for modeling the agronomic system vulnerability to climate change, vulnerability assessment under different scenarios was conducted for the Gorganrud River Basin located in the agro-ecological zone of the Caspian coastal plain of Iran. Considering exposure, susceptibility, and lack of resilience components, 12 indicators were chosen and quantified for both agronomic-environmental and socio-economic aspects. The SSM-iCrop2 model was used to simulate crop yield under current and climate change scenarios across the basin. The analysis indicates that in the current condition, the vulnerability level is different across the watersheds of the Gorganrud River Basin. By applying the climate change scenarios, agronomic system vulnerability would increase in the basin to some extent, particularly in Madarsu and Tilabad watersheds attributed with high vulnerability (0.63 and 0.61, respectively). This justifies the need to implement adaptation plans for encountering water shortage in the future. The analysis also suggests that the vulnerability of the agronomic system for adaptation scenarios characterized by less water consumption under climate change conditions is going to be slightly different from the vulnerability under the climate change scenarios. Due to an increase in agronomic system vulnerability under climate change scenarios, coupled with the fact that most watersheds (except Chehelchai, Nardin, and Narmab) are moderately vulnerable even under current conditions, policymakers and planners should promote crop and livelihood diversification programs aiming to prevent an increase in agronomic vulnerability.

Impact of short-term exposure to air pollution on natural mortality and vulnerable populations: a multi-city case-crossover analysis in Belgium

BACKGROUND

The adverse effect of air pollution on mortality is well documented worldwide but the identification of more vulnerable populations at higher risk of death is still limited. The aim of this study was to evaluate the association between natural mortality (overall and cause-specific) and short-term exposure to five air pollutants (PM2.5, PM10, NO2, O3 and black carbon) and identify potential vulnerable populations in Belgium.

METHODS

We used a time-stratified case-crossover design with conditional logistic regressions to assess the relationship between mortality and air pollution in the nine largest Belgian agglomerations. Then, we performed a random-effect meta-analysis of the pooled results and described the global air pollution-mortality association. We carried out stratified analyses by individual characteristics (sex, age, employment, hospitalization days and chronic preexisting health conditions), living environment (levels of population density, built-up areas) and season of death to identify effect modifiers of the association.

RESULTS

The study included 304,754 natural deaths registered between 2010 and 2015. We found percentage increases for overall natural mortality associated with 10 μg/m3 increases of air pollution levels of 0.6% (95% CI: 0.2%, 1.0%) for PM2.5, 0.4% (0.1%, 0.8%) for PM10, 0.5% (-0.2%, 1.1%) for O3, 1.0% (0.3%, 1.7%) for NO2 and 7.1% (-0.1%, 14.8%) for black carbon. There was also evidence for increases of cardiovascular and respiratory mortality. We did not find effect modification by individual characteristics (sex, age, employment, hospitalization days). However, this study suggested differences in risk of death for people with preexisting conditions (thrombosis, cardiovascular diseases, asthma, diabetes and thyroid affections), season of death (May-September vs October-April) and levels of built-up area in the neighborhood (for NO2).

CONCLUSIONS

This work provided evidence for the adverse health effects of air pollution and contributed to the identification of specific population groups. These findings can help to better define public-health interventions and prevention strategies.

'There's a will, but not a way': Norwegian GPs' experiences of collaboration with child welfare services - a grounded theory study

BACKGROUND

Adverse childhood experiences can have immediate effects on a child's wellbeing and health and may also result in disorders and illness in adult life. General practitioners are in a good position to identify and support vulnerable children and parents and to collaborate with other agencies such as child welfare services. There is a need for better integration of relevant services. The aim of this study is to explore GPs' experiences of the collaboration process with child welfare services.

METHOD

This is a qualitative grounded theory study, with data consisting of ten semi-structured interviews with general practitioners across Norway.

RESULTS

The doctors' main concern was: 'There's a will, but not a way'. Three subordinate stages of the collaboration process were identified: (I) Familiar territory, with a whole-person approach to care by the doctor. (II) Unfamiliar territory, when child welfare becomes involved. Here, a one-way window of information and a closed door to dialogue perpetuate the doctors' lack of knowledge about child welfare services and uncertainty about what is happening to their patients. (III) Fragmented territory, where doctors experience lost opportunities to help and missing pieces in the patient's history.

CONCLUSION

General practitioners are willing to contribute to a collaborative process with child welfare, but this is hampered by factors such as poor information flow and opportunities for dialogue, and limited knowledge of the partner. This implies lost opportunities for doctors to help families and contribute their knowledge and potential actions to a child welfare case. It can also impede whole-person care and lead to fragmentation of patient pathways. To counteract this, electronic two-way communication could enable a collaborative process and relationships that enhance coordination between the parties. Making space for all parties and their individual roles was considered important to create a positive collaborative environment.

Continuous cropping disorders of eggplants (Solanum melongena L.) and tomatoes (Solanum lycopersicum L.) in suburban agriculture: Microbial structure and assembly processes

Deciphering the intricate relationships between microorganisms and plants remains a formidable challenge in plant microbial ecology, an area that holds promise for optimizing microbial interventions to enhance stress resilience and agricultural yields. In our investigation, we procured samples during 2019 and 2022 from a suburban agricultural greenhouse. Our study delineated the composition of bacterial and fungal communities across various ecological niches-namely, the rhizosphere soil, bulk soil, and phyllosphere of healthy, Ralstonia solanacearum-infected, and dead eggplants and tomatoes. The structure and composition of both fungal and bacterial communities change significantly under the influence of the host genotype across all samples. In the tomato or eggplant groups, bacterial wilt exerts a more pronounced impact on the bacterial community than on the fungal community. We speculate that the rhizosphere of healthy eggplants and tomatoes harbored more antibiotic-producing (e.g., Amycolatopsis and Penicillium) and biocontrol (e.g., Bacillus) strains, which can lead to have lower absolute abundance of R. solanacearum. In the context of R. solanacearum invasion, deterministic processes were responsible for shaping 70.67 % and 80.63 % of the bacterial community assembly in the rhizosphere of eggplants and tomatoes, respectively. Deterministic processes dominated the assembly of fungal communities in the rhizosphere of R. solanacearum-infected eggplants, whereas the opposite was true in the tomatoes. Homogeneous selection emerged as the predominant force governing the bacterial community assembly in the rhizospheres of R. solanacearum-infected eggplants and tomatoes. The bacterial co-occurrence networks in healthy rhizosphere soil were characterized by reduced vulnerability and enhanced stability (i.e., robustness index) and complexity (i.e., cohesion index), compared to their infected counterparts. In summary, complex microbial networks in rhizosphere soils are more resistant to invasion by soil-borne pathogens. The dynamics of bacterial interactions and community assembly processes are pivotal for effective microbiome management and offer predictive insights into the ecological ramifications of R. solanacearum invasions.