bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on the construction of intangible cultural heritage corridors in the Yellow River Basin based on geographic information system (GIS) technology and the minimum cumulative resistance (MCR) model
Authors: Li Xiaobin , Zhu Rong , Shi Chengyong , Yang Xueke , Chen Jizhou , Wei Kexin
Published: August 2024

Objectively and accurately identifying the spatial structure and protection scope of intangible cultural heritage and constructing intangible cultural heritage corridors are crucial for the comprehensive systematic protection of intangible cultural heritage and the synergistic development of the region. However, the current research on intangible cultural heritage is limited to the protection and development of intangible cultural heritage in specific locations or specific areas. Thus, systematic and holistic research perspectives are relatively limited. Therefore, this study employs geographic information system spatial analysis and the minimum cumulative resistance model to construct an intangible cultural heritage corridor in the Yellow River Basin. This study aims to establish a systematic protection method and framework for intangible cultural heritage. The results show the following: (1) The intangible cultural heritage in the Yellow River Basin has a large-scale centralized distribution and small-scale scattered distribution, which provides an important spatial basis for the construction of intangible cultural heritage corridors. (2) Overall, intangible cultural heritage corridors can be more effectively constructed in the eastern region of the Yellow River Basin than in the western region, with 84.6% of the area being suitable and 15.4% being unsuitable. (3) Based on the suitability analysis, the "18 + N" corridor system of intangible cultural heritage in the Yellow River Basin, distributed across the eastern, central and southern regions, is constructed. The major corridor has a suitable width of 60–100 km, a total length of 11,935 km, and an area of 625,976 km2–919,942 km2, and can connect 634–711 intangible cultural heritage sites in series. On this basis, this study proposes a multilevel construction system for intangible cultural heritage corridors in the Yellow River Basin that integrates the "network structure–spatial scope" and "element–axis–region" levels. This approach culminates in a pattern of intangible cultural heritage protection and development in the Yellow River Basin characterized by "connecting points into lines, distributing in groups, and linking regions." This study reveals that combining geographic information system spatial analysis tools with a minimum cumulative resistance model effectively identifies potential heritage corridor networks and clarifies the hierarchical relationships of heritage element protection in the study area. This approach provides a reference model for the comprehensive protection and systematic development of intangible cultural heritage in the Yellow River Basin. Furthermore, the effectiveness and universality of this framework make it applicable to the protection and development of other similar international heritage areas.
Upcycling of melon seed (Cucumis melo L.) oil processing by-product: evaluation of functional properties and nutritional components as novel ingredient
Authors: Zhang Guoqiang , Li Ziqian , Charalampopoulos Dimitris
Published: August 2024

Background

Defatted melon seed, a major by-product from melon oil processing chain, is scarcely utilsed. However, it has high potential value and can be used as novel ingredient in food products production. In line with zero waste policy and food sustainability, exploring and utilisation of this oil processing by-product can reduce food waste, and is key to moving towards a more sustainable food system. Therefore, this study aimed to assess the nutritional profile and functional properties of three varieties of defatted melon seeds (Galia, Cantaloupe, and Honeydew), and then compare them with defatted pumpkin seeds (as control group).

Results

In this study, three varieties of melon seeds (Galia, Cantaloupe, and Honeydew) and pumpkin seeds (as control group) were defatted using Soxhlet extraction with petroleum ether; subsequently, their functional properties and nutritional components were assessed. The defatted melon seeds contained high level of protein (51.1–54.2%, w/w), dietary fibre (29.4–33.2%, w/w), potassium (1181.0–2373.1 mg/100 g), and GABA (γ-aminobutyric acid, 1.4–4.3 mmol/kg), whereas in terms of anti-nutritional compounds, they contained a relatively high amount of phytic acid (5.0%—5.8%, w/w). They also exhibited good in water/oil absorption capacity and emulsifying capacity. The phenolics were mainly free phenolics (FP) fraction (75%–77%), followed by the conjugated phenolics (CP) fraction (15%–16%), and the bound phenolics (BP) fraction (about 8%); the antioxidant capacity of each fraction followed the same sequence (FP > CP > BP).

Conclusion

Considering the nutritional composition, functional properties, and the presence of potentially bioactive compounds, defatted melon seeds have considerable potential to be used as a functional food ingredient for the reformulation of foods.

Graphical Abstract
A probabilistic approach for the valuation of variance swaps under stochastic volatility with jump clustering and regime switching
Authors: He Xin-Jiang , Lin Sha
Published: August 2024

The effects of stochastic volatility, jump clustering, and regime switching are considered when pricing variance swaps. This study established a two-stage procedure that simplifies the derivation by first isolating the regime switching from other stochastic sources. Based on this, a novel probabilistic approach was employed, leading to pricing formulas with time-dependent and regime-switching parameters. The formulated solutions were easy to implement and differed from most existing results of variance swap pricing, where Fourier inversion or fast Fourier transform must be performed to obtain the final results, since they are completely analytical without involving integrations. The numerical results indicate that jump clustering and regime switching have a significant influence on variance swap prices.
Blood pressure control in diabetic kidney disease: a post-hoc analysis of the FANTASTIC trial
Authors: Park Cheol Ho , Hong Soon Jun , Kim Sung Gyun , Shin Seok Joon , Kim Dong Ki , Lee Jung Pyo , Han Sang Youb , Lee Sangho , Won Jong Chul , Kang Young Sun , Park Jongha , Han Byoung-Geun , Na Ki-Ryang , Hur Kyu Yeon , Kim Yong-Jin , Park Sungha , Yoo Tae-Hyun
Published: August 2024

Background

The target blood pressure (BP) value is unclear for diabetic kidney disease (DKD). Therefore, we aimed to evaluate the effect of strict BP control or ‘on treatment’ BP on clinical outcomes in patients with DKD.

Methods

A post-hoc analysis of the prespecified secondary outcomes of the FimAsartaN proTeinuriA SusTaIned reduCtion in comparison with losartan in diabetic chronic kidney disease (FANTASTIC) trial, a randomized multicenter double-blind phase III trial. Eligible patients were aged ≥ 19 years with DKD. We assigned 341 participants with DKD to BP control strategy (standard-systolic BP [SBP] < 140 mmHg versus strict-SBP < 130 mmHg). The outcome was the occurrence of cardiovascular events and renal events. Separate analyses were performed to compared the risk of outcome according to achieved average BP levels.

Results

A total of 341 participants were included in the analysis. Over a median follow-up of 2.8 years, cardiovascular/renal events were observed in 25 (7.3%) participants. Mean (SD) SBPs in the standard and strict BP control group were 140.2 (11.6) and 140.2 (11.9) mmHg, respectively. The strict BP control group did not show significantly reduced risk of cardiovascular/renal events (HR 1.32; 95% CI 0.60–2.92]). In the post-hoc analyses using achieved BP, achieved average SBP of 130–139 mmHg resulted in reduced risk of cardiovascular/renal events (HR 0.15; 95% CI 0.03–0.67) compared to achieved average SBP ≥ 140 mmHg, whereas further reduction in achieved average SBP < 130 mmHg did not impart additional benefits.

Conclusion

In patients with DKD, targeting a SBP of less than 130 mmHg, as compared with less than 140 mmHg, did not reduce the rate of a composite of cardiovascular and renal events. Achieved SBP of 130–139 mmHg was associated with a decreased risk for the primary outcome in patients with DKD.

Trial registration

ClinicalTirals.gov Identifier: NCT02620306, registered December 3, 2015.

(https://clinicaltrials.gov/study/NCT02620306).
Perforator-based local flaps for cutaneous facial reconstruction
Authors: Azeem Khaled Mohamed Abdel , Abdelaal Sarah Mohamed Abdelghany , Maguid Mohamed Fathi Abdel , Awad Philobater Bahgat Adly , Hassan Basma Hussein Abdelaziz , Shaer Wael Mohamed El , Ahmed Mostafa Fathy Ibrahim
Published: August 2024

Background

Despite the advancement of reconstructive surgical techniques, facial defect reconstruction has been always very challenging, aesthetic satisfaction has often been difficult to achieve due to the unique characteristics and complexity of the facial tissue. There have been various options regarding reconstruction and compensation of soft tissue loss all over the body rather than the face. Regardless of whether skin grafts, local flaps, and free flaps were used in the reconstruction process, each of them has its limitations. Beginning with skin grafts results could not always be satisfactory due to contracture, color, and lack of texture Additionally, local flaps have limitations due to mobility and the availability of overlapping skin and tissue, as well as the bulkiness of the pedicle which may need a second staged surgery and lately the difficulty of the free flaps and being a major surgery.

Results

Patients ages ranged between 23 and 77 years old, with a mean age of 58.33 ± 12.47. As regards the patients’ sex, 63.3% of our patients were males and 36.7% were females. Co-morbidities were found in 60% of cases (DM 23.3%, HTN 20%, HCV 3.3%, cardiac 3.3%).

Most flaps were facial artery perforator flaps 53.3%, then transverse facial artery 26.7%, superficial temporal artery 10%, angular artery 6.7%, and supra-trochlear artery 3.3%.

Twenty-ix cases representing 86.7% of cases went uneventful, while complications showed in 4 cases representing 13.3% of cases, 1 case (3.3%) showed venous congestion that was relieved within 24 h after 2 suture releases, another case (3.3%) showed wound dehiscence that was improved after 2 days with regular dressings, the third patient (3.3%) had recurrence after 4 months that was treated by excision and grafting, while last patient (3.3%) had inadequate excision that was treated by radiotherapy. No bleeding or infection occurred. Also, we observed no correlation between flap length and complications. As regards the functional point of view, all patients showed no functional impairment at the donor site, and only one case showed functional impairment at the recipient site.

As regards patient satisfaction, all 30 patients achieved positive satisfaction scores using the Likert scale, 18 cases were satisfied, and 12 cases were very satisfied.

Conclusion

The use of perforator-based flaps can provide a more effective and aesthetically pleasing solution for the reconstruction of small to moderate facial defects, provided that a reliable Perforator is accurately identified and executed by an experienced surgeon.
Primary hepatic diffuse large B- cell lymphoma mimicking cholangiocarcinoma
Authors: Yadav Taruna , Datta Deepanksha , Elhence Poonam , Varshney Vaibhav , Kumar Rajesh
Published: August 2024

Primary lymphoma of liver is a rare malignancy with non-specific clinical features and tumor markers. The presentation and imaging features may be indistinguishable from other hepatic malignant lesions. Pathological diagnosis is the gold standard, and early detection is essential to choose the treatment modality. Here, we share an interesting case of Primary Diffuse Large B cell lymphoma of liver and its imaging findings on Computed tomography (CT), Magnetic Resonance Imaging (MRI) and F-18 FDG PET/CT.
The Network for Emergent Socio-Scientific Thinking (NESST): collaboration for a shared transformative future through STEM Education
Authors: O’Donnell Carol , Blanchard Katherine Pedersen , Strom Kathryn J. , D’Amico Amy , Mogck Alexa , Alcazar Rachel , Brennan Victoria , Elsayed Ayman , Fitzgerald Ange , Greenbaum Eliana , Osman Enja , Sepiurka Mariana
Published: August 2024

Impact networks are formed to address complex social or environmental issues and are often needed to maximize human and financial resources, impact, and scale of individual organizations, including those serving students in Kindergarten through college (K-16). However, contrary to existing network models described by the literature, networks designed to address complex emergent socio-scientific issues such as climate change and biodiversity loss should themselves be emergent. This paper uses a critical analysis to outline our theory of change for one type of impact network—the emergent network—whose structure, function, and purpose are based on the emerging needs of its members and the needs of a changing world; and, whose members work across borders, disciplines, and generations to educate for a shared transformative future. We apply our theory to a case study called the Network for Emergent Socio-Scientific Thinking (NESST), which brings together people with a commitment to think differently about educating youth for the future outlined in the United Nations Sustainable Development Goals (SDGs). Together, through the lens of complexity theory and emergence, we reimagine the future of K-16 Science, Technology, Engineering, and Mathematics (STEM) Education for Sustainable Development (STEM4SD) and demonstrate what collaborative STEM education within the context of SDG 17 and SDG 4.7 can look like.
Rawon: the black soup delicacy from East Java
Authors: Murtini Erni Sofia , Murdianti Befrika S.
Published: August 2024

Rawon is a meat-based soup from the east of Java characterized by its black color due to the use of keluak seeds. Rawon is prepared through the boiling of meat with sautéed spices. The use of various spices resulted in a unique Rawon flavor liked by many. Rawon has existed for over a thousand years and is still very popular today. The delicious flavor of Rawon is not only loved by the local people of East Java but is also nationally recognized as one of Indonesia's traditional culinary icons and is internationally recognized as one of the best meat-based soups in the world. Rawon is usually served with rice, side dishes such as salted egg, and tempe, and various condiments such as mung bean sprouts, sambal, and kerupuk. Thus, Rawon not only satiates hunger but is also highly nutritious. Nasi Rawon or Rawon rice can be consumed for breakfast, lunch, or dinner. Rawon originated as a royal dish; however, presently it can be found anywhere and is sold in many food stalls and restaurants. It manifests a philosophy that although the Indonesian archipelago consists of many different ethnic groups, a harmonious life can be attained when they unite and coexist. Furthermore, this dish contains the philosophy of “sugeng rawuh” as a greeting to guests; therefore, Rawon rice is commonly served at weddings and community events or activities. This paper discusses in more detail the history of Rawon (including its origin and philosophy), the nutritional aspects, the ingredients, the process of making Rawon, and the chemical reactions that take place in creating the delicious flavor of the dish. The discussion also addresses presentation and on what occasions Rawon is served.
Bioactive poly(ethylene glycol)-chondroitin sulfate-triple helical recombinant collagen hydrogel for enhanced cranial defect repair
Authors: Wang Lili , Zhang Shanshan , Yang Fan , Chen Xian , He Huixia , Liu Zaiman , Xiao Jianxi
Published: August 2024

The reconstruction of critical-size calvarial defects remains a fundamental challenge. Recombinant collagen has gained significant attention in bone tissue engineering owing to its remarkable bioactivity and non-immunogenicity. Herein, we have for the first time developed a bioactive poly(ethylene glycol)-chondroitin sulfate-triple helical recombinant collagen (PEG-ChS-THRC) hydrogel for enhanced bone regeneration in cranial defects. A simple and mild crosslinking reaction of two-arm polyethylene glycol active ester (NHS-PEG-NHS), adipic dihydrazide modified chondroitin sulfate (ChS-ADH) and triple helical recombinant collagen (THRC) leads to the formation of the PEG-ChS-THRC hydrogel. The hydrogel demonstrates interconnected porous structures, enhanced mechanical strength, diminished swelling ratios and adjustable biodegradability. It possesses exceptional biocompatibility and bioactivity, significantly facilitating cell proliferation, adhesion, migration, and osteogenic differentiation of BMSCs. Micro-computed tomography (micro-CT), magnetic resonance imaging (MRI) and histological characterization of rat models with critical-size cranial defects have consistently demonstrated that the PEG-ChS-THRC hydrogel significantly promotes bone tissues regeneration. The innovative bioactive scaffold provides a remarkably improved remedy for critical-size cranial defects, holding greatly promising applications in the fields of bone tissue regeneration.

Graphical Abstract
Effects of natural and mechanical drying processes on unsaturated fatty acids, vitamin E, estradiol, and physicochemical properties of Rana chensinensis ovum
Authors: Xu Xinxin , Wang Yongsheng , Zhou Yue , Xu Yang , Zhang Meiru , Zhang Changli , Wang Shihan , Yao Bin , Chen Junting , Wang Zhihan
Published: August 2024

Although Rana chensinensis Ovum (RCO) is enriched with high nutritional value, its quality varies due to the different drying methods used by farmers. This study aims to explore the impact of natural and mechanical drying methods on the nutritional compositions and physicochemical properties of RCO. Five different drying methods were studied, including blast drying (BD), mild breeze light drying (MBLD), natural air drying (NAD), vacuum heat drying (VHD), and vacuum freeze drying (VFD). The quality assessment was based on unsaturated fatty acid (UFA) content, iodine value, estradiol, vitamin E, saponification value, thiobarbituric acid value (TBA), acid value, and antioxidant properties. The results showed that VFD had higher UFA content and lower acid value (139.950 ± 0.397 mg · g−1) and TBA value (0.097 ± 0.003) than others. VFD and NAD had higher iodine values (147.166 ± 1.475 and 146.803 ± 1.209, respectively) than others. There were no significant differences in estradiol, vitamin E, peroxide value and the clearance rates of ABTS+ free radicals and DPPH• free radicals with different drying methods. The findings will provide valuable insights into the industrialization of RCO.

Graphical Abstract
Microfinance Institutions and Corporate Social Responsibility. A scientometric study
Authors: López-Penabad Mª Celia , Maside-Sanfiz José Manuel , Agha Yousif , Iglesias-Casal Ana
Published: August 2024

This study investigates the integration of Corporate Social Responsibility (CSR) within Microfinance Institutions (MFIs) in relation to Sustainable Development Goals. Through a Systematic Literature Review (SLR) and bibliometric analysis of 281 Scopus-indexed articles from January 1999 to November 2023, we delineate seven essential thematic clusters that define the CSR paradigm in MFIs: performance dimensions, balanced social and financial goals, improved social performance, qualitative perspectives, mission drift determinants, environmental sustainability, and funding sources and lending techniques. The study uncovers emerging research areas including the impact of digital-fintech innovations, climate change adaptations, the rise of Islamic microfinance, and explores significant gaps such as internationalization, corporate governance, gender diversity, and alternative funding mechanisms. These insights are pivotal for framing future research and offer critical guidance for policymakers and practitioners aiming to maximize the societal impacts of MFIs. Our analysis not only maps the current landscape but also sets a comprehensive agenda for enhancing CSR’s role in achieving sustainable development, thus providing a strategic framework for ongoing empirical and theoretical advancements.
Prevalence and predictors of fibromyalgia among Egyptian physicians: a cross-sectional study
Authors: Abdulazim Dina O. , Lacerda Yasmim , Mendes Amanda , Souza Bianca , Salem Amany A. , Al-Shaarawy Arwa , Eissa Basma M.
Published: August 2024

Background

Fibromyalgia is a chronic, disabling disorder of widespread musculoskeletal pain. It is generally considered a stress-related syndrome. Healthcare workers are prone to mental and physical stress due to due to excessive work burdens, long working hours, and a lack of balance between work and social life.

Objective

The aim of this study was to examine the prevalence of fibromyalgia and its predictors among Egyptian physicians.

Methods

Six hundred and ninety-one Egyptian physicians completed an online survey which included a self-reported fibromyalgia rapid screening tool (FiRST) as well as demographic (sex and age), health-related (chronic illnesses if any), and employment data (workday length, specialty, and employer). Logistic regression was performed to explore possible predictors of fibromyalgia.

Results

Fibromyalgia was observed in 13.2% of participants, with a female to male ratio of 3.8:1. Predictors of FM in this cohort included the following: female sex (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.2–3.9, p = 0.014), age 41–50 years (OR 3.8, 95% CI 1.5–9.6, p = 0.005), concomitant chronic illness: endocrinopathies (other than diabetes mellitus) (OR 2.69, 95% CI 1.09–6.64, p = 0.035), musculoskeletal disorders (OR 5.60, 95% CI 2.96–10.6, p < 0.001), autoimmune disorders (OR 3.61, 95% CI 1.69–7.73, p = 0.002), employment at a Ministry of Health Healthcare Facility (OR 1.8, 95% CI 1.1–3.1, p = 0.013), and a workday length of ≥ 13 h (OR 2.4, 95% CI 1.1–5.3, p = 0.038). Physicians in surgical specialties were less likely to suffer from FM (OR 0.47, 95% CI 0.24–0.94, p = 0.033).

Conclusion

Egyptian physicians have higher fibromyalgia prevalence than the general population. Demographic, health-related, and professional predictors of FM were identified in this cohort.
Integrating building information modelling (BIM) and extended reality (XR) in the transportation infrastructure industry
Authors: Alhady Ahmed , Alanany Mohamed , Khodair Yasser , Salem Shady , El Maghraby Yosra
Published: August 2024

Although building information modelling (BIM) has been widely used in the building industry, its usage in infrastructure projects such as bridges has been very challenging. Extended Reality (XR) that simulates a construction project is still considered a new technology in the Architecture, Engineering, and Construction (AEC) industry. This paper investigates the viability of integrating both BIM and XR technologies into transportation infrastructure projects. A fully integrated workflow for introducing different XR, Augmented Reality (AR), and Virtual Reality (VR), and BIM technologies using different software for a case study of El-Merghani bridge, a reinforced concrete girder type bridge, was developed. The models for the bridge included GIS integration and geometric road design according to AASHTO, documentation, shop drawings and quantification were developed for the bridge. A hypothetical time schedule was generated in Oracle Primavera P6 elevating the BIM model to 4-D and developing VR and AR virtual experiences with the capability to investigate, visualize, and present the model in a virtual environment, at a high level of immersion. Additionally, the associated risk reduction for the considered XR technology was assessed using Monte Carlo simulation. The workflow and the detailed 3D models developed for the bridge along with the highly immersive VR and AR experiences have provided an interactive platform for engineers and different stakeholders to monitor the project during the design and construction phases. The risk analysis showed that significant cost savings can be achieved with the utilization of VR and AR technology in bridges construction.
Implementation of a population mental health and wellness text-message service: a mixed-methods study
Authors: Risling Tracie , Kassam Iman , Shin Hwayeon Danielle , Carlberg Courtney , Moss Tyler , Chen Sheng , Ma Clement , Strudwick Gillian
Published: August 2024

Background

Despite the growing adoption of digital health tools as a means to support mental health, many individuals remain unaware of the variety of mental health resources available to them through this format. To address this knowledge gap, this study advanced the design, development, and implementation of a text-based service called SaskWell to raise awareness of evidence based mental health resources and create more immediate connections to these tools. The two primary objectives of the study were to assess and evaluate the adoption of SaskWell by focusing on user acceptance, satisfaction, and perceived benefit, and to identify factors which contributed to user engagement with the SaskWell text-based service. Both quantitative and qualitative data contributed to the final study results.

Results

This study utilized a co-designed text-messaging service to provide residents of Saskatchewan an important connection to digital mental health and wellness resources during the height of the COVID-19 pandemic. Using the RE-AIM framework as an implementation guide, four distinct cycles of SaskWell were delivered with modifications to the service in each subsequent cycle based on user engagement, feedback, and the direction of a community advisory group. Quantitative data was collected through user engagement text message response data, along with enrollment and exit surveys, while semi-structured interviews served as the primary means of qualitative data collection. In addition to the quantitative user data, these user interviews resulted in themes exploring motivation to sign-up for the service, perceptions of texting as a mechanism to deliver mental health resources, the impact of SaskWell on mental health and well-being, and beliefs on the future potential of text-based mental health supports.

Conclusions

Both the user engagement survey and the qualitative data supported the worth of ongoing efforts to refine and extend the use of text messaging as a means to engage citizens around the awareness and use of digital mental health and wellness resources. As the pandemic has receded into the background in many peoples’ daily lives, for healthcare providers, and others who continue to be impacted more heavily by the persistent challenges of this global event, this type of service may continue to be timely.
Pharmacological management of personality disorders: from evidence to practice
Authors: Völlm Birgit , Cerci Deniz
Published: August 2024

Clinical guidelines recommend avoiding the use of medications to manage personality disorder. In clinical practice, however, substantial amounts of medication are used. In this article, we summarise the recommendations of guidelines published in various countries in the past 15 years. We review the evidence from randomised controlled trials and recent reviews, discuss the discordance between guidance and clinical practice and give recommendations on what a clinician should consider if they choose to prescribe in cases of severe disturbances in mood or behaviour despite the lack of evidence.
Navigating ADHD in Higher Education: Evaluating Psychosocial Interventions for Student Self-Esteem, Well-Being, and Quality of Life
Authors: Ali Aminah , Collier Karen , Mayomi Tosin
Published: August 2024

Aims

Several studies have shown that individuals diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) have difficulties in maintaining their psychological well-being and are at risk of negative impacts on their psychological health during higher education. Consequently, it is crucial to introduce targeted interventions to promote self-esteem, quality of life, and overall well-being to minimise potential adverse outcomes. For this reason, the main objective of this systematic literature review was to identify and evaluate studies on the target population that explored the effects of psychosocial interventions on dimensions of psychological well-being, such as self-esteem, well-being, or quality of life.

Methods

A systematic literature review was conducted following the PICO approach and PRISMA guidelines. The electronic databases – MEDLINE, PsycINFO, Web of Science, PubMed, COCHRANE Central and Education Research Complete were searched for English-language studies published between 2013–2023 on interventions conducted in university-level ADHD students that impacted their psychological well-being. Exclusion criteria encompassed studies focusing on comorbid clinical diagnoses such as anxiety or depression outcomes and pharmacological interventions. Nine studies that met the inclusion criteria were identified.

Results

Cognitive-behavioural therapy (CBT), interpersonal group therapy, and coaching emerged as interventions with the strongest evidence base for improving psychological well-being in university students with ADHD. The ACCESS (Accessing Campus Connections and Empowering Student Success) intervention, a CBT and mentoring programme, demonstrated increased well-being over time (p = 0.001, d = 0.45). Interpersonal group therapy yielded significant improvements in global self-esteem (p = 0.001, η2 = 0.12), with a significant difference from the control group (p = 0.01, η2 = 0.07), while the coaching intervention revealed significantly higher well-being scores in participants compared with the control (p = 0.05, R2 = 0.11).

Conclusion

This systematic review found psychosocial interventions focussing on CBT, interpersonal group therapy, and coaching were effective in improving the psychological well-being of university students with ADHD. Future intervention studies should establish a specific ADHD-focused CBT approach and have more extended follow-up periods to understand long-term effectiveness. This review also identifies priority areas for additional research.
From At-Risk Mental State to Psychosis: Demographic Characteristics and Clinical Corelates of Individuals Who Transitioned to Psychosis
Authors: Khoso Ameer , Bamford Jordan , Qureshi Inti , Chaudhry Imran , Husain Nusrat
Published: August 2024

Aims

The at-risk mental state (ARMS) describes individuals at high risk of developing schizophrenia or psychosis. This study aimed at exploring the demographic characteristics of individuals who transitioned to psychosis from a large multicenter factorial design trial.

Methods

This was a secondary analysis of large multicenter randomised controlled trial of minocycline and/or omega-3 fatty acids added to treatment as usual for at-risk mental states. Participants (n = 326) were randomised to minocycline, omega-3, combined minocycline and omega-3 or to double placebo for 6 months. The primary outcome was transition to psychosis at 12 months.

Results

Forty-five (13.8%) participants transitioned to psychosis. The mean age of participants was 23.31 (5.31 SD) and 15.6% no formal education, 8.9% primary, 48.9% matriculation, 8.9% intermediate and 15.6% graduation and above. Majority 66% of participants were male and 71.1% single, 66.7% living in a joint family, 44.4% were employed, 24% students, 17.8% household/housewife and 3% unemployed. Interestingly 36.8% participants had a family history of psychosis, followed by 21.0% any unknown mental illnesses, 15.8% bipolar disorder, 15.8% depression, 5.3% anxiety and 5.3% intellectual disability. The mean total score for the Prodromal Questionnaire was 8.93, with a standard deviation of 1.67. The mean score on the Comprehensive Assessment for At Risk Mental State (CAARMS) unusual thoughts was 3.98 (SD = 0.84), Non-Bizarre Ideas 3.64 (SD = 0.77), Perceptual Abnormalities 3.76 (SD = 0.71) and disorganized speech 2.49 (SD = 1.12). Participants had mean Social and Occupational Functioning (SOFAS) score of 66.67 which suggests moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

Conclusion

Transition to psychosis appears to have different demographic and clinical correlates which may have the causal relationship to transition. The cross-comparative studies are warranted to understand differences and similarities between the groups.
Substance Use Among Female Sex Workers in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
Authors: Beattie Tara , Beksinska Alicja , Fitzgerald Molly , Karlsen Oda , Abramsky Tanya
Published: August 2024

Aims

This systematic review aimed to quantify the prevalence of substance use among female sex workers (FSWs) in low- and middle-income countries (LMICs).

Methods

Design: The review protocol was registered with PROSPERO (CRD42021242048). We searched Ovid, PubMed and Web of Science databases for peer-reviewed, quantitative studies from inception to 6th March 2023. Study designs included: cross-sectional, case–control, cohort study, case series analysis, or experimental studies. Study quality was assessed using the Centre for Evidence-Based Management (CEBM) Critical Appraisal Tool.

Setting: FSWs in LMICs.

Participants/Inclusion criteria: any measure of prevalence or incidence of substance use (not alcohol or tobacco) among FSWs aged 18+ years.

Measurements: A narrative synthesis was conducted across all studies meeting the inclusion criteria. Pooled prevalence estimates for ‘ever’ and ‘recent’ drug use were calculated using a random effects model.

Results

3135 papers were identified; 161 papers reporting on 102 studies with 167,333 FSWs from 39 LMICs met the inclusion criteria. 26 studies scored high, 61 scored moderate, and 15 scored in the lower quality range. Only 4/102 studies used a validated measurement tool to assess levels of substance use dependence. The mean age of study participants was 28.9 years (SD 7.7). The pooled prevalence for recent (past month to past year) substance use among FSWs in LMICs is: illicit drug use 29% (95% CI: 14–34%), cannabis 20% (95% CI: 8–30%), cocaine 21% (95% CI: 9–32%), amphetamine type stimulants 19% (95% CI: 12–26%), opioids 8% (95% CI: 4–12%), sedatives and sleeping pills 6% (95% CI: 0–12%), inhalants 4% (95% CI: –4–12%), hallucinogens 0% (95% CI: 0–0%), and recent drug use during sex work 42% (95% CI: 15%–68%). Only 5/102 studies reported a substance use intervention. Key study limitations include the lack of a validated measurement tool by most studies (96%) meaning it was not possible to distinguish between any drug use vs. harmful drug use. The criminalisation of drug use may have led to under-reporting and an underestimate of true substance use prevalences.

Conclusion

FSWs in LMICs report a high prevalence of recent drug use – including during sex work – with cannabis, cocaine and amphetamine type stimulants the most commonly used. There is an urgent need for effective low-cost substance use interventions. Future studies should use validated substance-use measurement tools to assess the burden of substance use disorders.
Culturally Adapted Problem-Solving Intervention for Women Experiencing Suicidal Ideation During Postnatal Period
Authors: Sattar Rabia , Husain Nusrat , Kiran Tayyeba , Eylem Ozlem , Chaudhry Nasim
Published: August 2024

Aims

Suicide is a global public health concern, affecting not only the individuals but also families. It is the leading cause of maternal death during pregnancy and up to one year after birth and commonly occurs after a period of suicidal ideation (SI). It is imperative to have interventions to help with SI and behaviors. We therefore aimed to adapt and test the feasibility and acceptability of a culturally adapted intervention for SI in women during postnatal period in Pakistan.

Methods

This is a two phase, mixed method Randomized Controlled Trial (RCT). First phase included adaptation of an existing Culturally Adapted Manual-Assisted Problem-Solving intervention (CMAP) for women experiencing SI. Adaptation process included two focus group discussion (FGDs), one with lived experience experts (women who experienced suicidal ideation during postnatal period), the other with health professionals (n = 8 in each group). Second phase involves a feasibility RCT with aim to recruit and randomize a total of 90 postnatal women experiencing suicidal ideation (screened using the Beck Scale for Suicidal Ideation), randomize into either of two study arms: CMAP (n = 45) or Treatment as usual (n = 45). Potential participants are being recruited from hospitals, communities, and self-referrals from 5 major cities in Pakistan. Culturally adapted CMAP is a brief problem-solving therapy of 6 individually delivered sessions, lasting about 50 minutes. The primary outcome is to assess the feasibility of CMAP through semi-structured qualitative interviews. Secondary outcomes include measuring SI, self-harm, depression, social support, and quality of life. Assessments will be conducted at baseline and 3rd month post randomization.

Results

Analysis of qualitative data from FGD with lived experience experts highlighted importance of incorporating additional techniques of trust building, modifying thinking behavior, mindfulness, distraction exercises including religious practices as a preventive measure of self-harm, child safety measures, and involvement of partner in intervention. Analysis of FGD with healthcare professionals emphasized addition of visualized content, re-assessing depression and suicidal ideation in-between the sessions to monitor relapse, involving family, and capacity building of health professionals to improve their understanding about perinatal mental health problems.

Conclusion

Women in postnatal period are at high risk of SI, specifically those women from low- and middle-income countries, due to limited resources and mental healthcare provision. The earlier detection of SI, early intervention for suicide risk by delivery of culturally sensitive interventions can help reduce maternal mortality rates.
The Association Between Outdoor Ambient Temperature and Depression and Mania: An Ecological Momentary Assessment Study
Authors: Clery Pip , Osborn David , Hayes Joseph , Jeffery Annie , Dykxhoorn Jen
Published: August 2024

Aims

Heat exposure can negatively impact mental health. Evidence for the effect of temperature on mood disorders is inconsistent. Current studies exploring the link between temperature and mood disorders are limited by poor temporal and geographical resolution. We aimed to use ecological momentary assessment (EMA) to investigate the effect of real-time temperature on depressive and manic symptoms. We hypothesised higher temperatures would be associated with increased depressive and manic symptoms.

Methods

We used EMA data from the digital platform and smartphone app juli to investigate the effect of real-time mean and maximum ambient temperature on depressive and manic symptoms in adults with depression and bipolar disorder. Depressive and manic symptoms were assessed using the Patient Health Questionnaire-8 and the Altman Self Rating Mania score, respectively. Time- and location-specific temperature data were collected from participants’ smartphone geolocation on a 5-by-5 km resolution grid. We analysed data using negative binomial mixed-effects regression models, controlled for demographic and weather variables, and stratified by season.

Results

We analysed data from 4,000 participants with depressive symptoms and 2,132 with manic symptoms, between July 2021 and March 2023. We found that each 1°C increase in mean daily temperature in the preceding two weeks was associated with a 0.2% reduction in depressive symptom scores (IRR 0.998, 95%CI 0.997–0.999). This association was most pronounced in the spring (IRR 0.995, 95%CI 0.992–0.999). For manic symptoms, we found that each 1°C increase in mean temperature in the preceding two weeks was associated with a 0.4% increase in manic symptom scores (IRR 1.004, 95%CI 1.001–1.007), with the strongest association observed in the autumn (IRR 1.011, 95%CI 1.002–1.020). Associations between maximum temperature and depressive and manic symptoms followed a similar pattern.

Conclusion

We found evidence that higher temperatures were associated with decreased depressive symptoms and increased manic symptoms, indicating a complex relationship between temperature and mood disorder symptoms. With globally rising temperatures due to climate change, there is a need to understand the impact of heat on mental health symptoms to provide targeted support. This study demonstrates the potential for using novel data sources and EMA methods to inform our understanding of the link between climate and mental health, although there is a need for improved data collection to realise the potential of these methods. Clinically, our findings highlight opportunities for risk stratification and targeted interventions based on local temperature patterns.
Prevalence of Depression Amongst Adult Hemophilia Patients Registered With Hemophilia Foundation of Zambia
Authors: Darji Dhruv
Published: August 2024

Aims

Main Objective

To assess the prevalence of depression (major depression) amongst adult hemophilia patients in Zambia.

Specific Objectives

1.

To assess the prevalence of depression amongst adult hemophilia patients in Zambia using the Patient Health Questionnaire 9 (PHQ9) tool to screen for/diagnose depression.

2.

To determine risk factors, amongst hemophilia patients, to developing depression.

3.

To ascertain factors that significantly associate with depression amongst adult patients with hemophilia in Zambia.

Methods

This was a quantitative cross-sectional study, conducted by administering the study questionnaire to collect data on demographic characteristics, clinical characteristics and the Patient Health Questionnaire – 9. A total of 59 adult patients with Hemophilia in Zambia, registered under the Hemophilia Foundation of Zambia were interviewed through the questionnaire. The data were analyzed using STATA 14. Descriptive analyses were done on the data, responses on PHQ-9 were totaled to assess for the prevalence of depression. Depression was defined as PHQ-9 ≥ 5; Major Depression as PHQ-9 ≥ 10. Pearson Chi-2 test was done to assess for associations and a logistic regression model was created to show the relationship between significant risk factors (independent variables) and depression.

Results

59 participants were interviewed in this study. They were all male with an average age of 24.77 years from various parts of Zambia. 91.53% of the patients reported to have Hemophilia A, while 8.47% had Hemophilia B, there were no patients with Hemophilia C. The average PHQ-9 score was 8.66. 83.04% of participants had depressive symptoms (PHQ > 5); 44.06% having major depression and only 16.96% of the participants reported no depression. Number of painful bleeding episodes (OR = 2.063; P = 0.048) and difficulty in performing daily activity (OR = 4.311; P = 0.008) were significantly associated with a higher risk for major depression.

Conclusion

There was a high prevalence of major depression (44.06%) amongst adult patients with hemophilia registered under the Hemophilia Foundation of Zambia. Hence there is need for addition of mental health care to the multidisciplinary management of adults with hemophilia for improved health outcomes due to the high prevalence of depression amongst this group. Additionally, patients who suffer many painful bleeding episodes must be prioritized candidates for mental health care.
Exploring Pathways to Autism Spectrum Diagnosis in Adulthood
Authors: Dufour Isabelle , Brodeur Sébastien , Chiu Yohann , Dubé Émilie , Couture Mélanie
Published: August 2024

Aims

Autism spectrum is a neurodevelopmental condition usually diagnosed in early childhood. The broadened diagnostic criteria of the DSM–5 (2013) have led to an increasing number of autism spectrum diagnoses of individuals requiring lower levels of support. Barriers to diagnosis, especially in adults, include the complexity of differential diagnosis with co-occurring psychiatric disorders. This study explored the various pathways of psychiatric diagnosis preceding an autism spectrum diagnosis in adulthood.

Methods

This retrospective cohort study was extracted from health-administrative data from Quebec (Canada) and included all adults with a first recorded autism spectrum diagnosis between 2010 and 2017 (index date). A Trajectory of psychiatric Diagnoses (TDx) was defined as a succession of categorical states, each corresponding to a medical record of a psychiatric diagnosis. These TDx were analysed from 2002 to 2017, using a state sequence analysis with trimester as time units. For each trimester, we defined the following diagnoses in order of priority: 1) autism spectrum, 2) intellectual disability (ID), 3) schizophrenia, 4) bipolar disorder (BP), 5) depressive disorder (DD), 6) anxiety disorder (AD), 7) attention-deficit/hyperactivity disorder (ADHD), and 8) other psychiatric disorders. The simple Hamming metric was used to measure the dissimilarity between TDx, followed by a hierarchical cluster analysis to categorise similar trajectories.

Results

The study cohort included 2799 adults diagnosed with autism spectrum between 2010 and 2017. Several psychiatric disorders were recorded during the study period, including AD (77.5%), DD (58.0%), schizophrenia (49.4%), BP (48.3%) and ID (33.2%). Results revealed 5 distinct types of TDx. Types 1 and 2, shared by 63.8% and 17.6% of the cohort respectively, represented individuals in younger age groups with similar characteristics, but with very different sequences of psychiatric diagnoses. Slight or sharp increases in diagnoses were observed around 2010, predominantly associated to autism spectrum in Type 1, and to schizophrenia and AD in Type 2. Individuals in Type 4 (6%) were little different from Types 1 and 2, but the TDx showed high prevalence of diagnoses of ID, DD, AD and ADHD, decreasing progressively around the diagnosis of autism. Types 3 and 5 (9.0% and 3.6%), representing middle-aged/older groups, displayed distinctive trajectories of high healthcare use, almost entirely associated with schizophrenia (Type 3), and BD (Type 5).

Conclusion

This study proposes a complementary examination of the multiple pathways to diagnosis experienced by autistic adults, highlighting the need for further investigation into co-occurring psychiatric disorders.