bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alcohol Use and Associated Risk Factors Among Female Sex Workers in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
Authors: Beksinska Alicja , Karlsen Oda , Gafos Mitzy , Beattie Tara 
Published: July 2023

AimsDue to its widespread use in the sex work industry, female sex workers (FSWs) in low- and middle-income countries (LMICs) are at high risk of harmful alcohol use and associated adverse health outcomes. This systematic review and meta-analysis aims to provide an estimate of the prevalence of harmful alcohol use among FSWs in LMICs and to examine associations with common health and social concerns.MethodsThe review protocol was registered with PROSPERO, number CRD42021237438. We searched three electronic databases for peer-reviewed, quantitative studies from inception to 24th February 2021.Inclusion criteria:
•Any measure of prevalence or incidence of alcohol use among FSWs aged 18 years or older.•Countries defined as LMIC in accordance with the World Bank income groups 2019.•Study designs: cross-sectional survey, case–control study, cohort study, case series analysis, or experimental study with baseline measures for alcohol use.Pooled prevalence estimates were calculated for:
1.Any hazardous/harmful/dependent alcohol use2.Harmful/dependent alcohol use only, both overall and by region3.Daily alcohol use.4.Meta-analyses examined associations between harmful alcohol use and violence, condom use, HIV/STIs, mental health problems and other drug use.ResultsIn total, 435 papers were identified. After screening, 99 papers reporting on 87 unique studies with 51,904 participants from 32 LMICs met the inclusion criteria. Study designs included cross-sectional (n = 89), cohort (n = 6) and experimental (n = 4). Overall, 5 scored as high quality, 79 studies scored as moderate and 15 scored as weak quality. Twenty-nine papers reporting on 22 unique studies used validated alcohol use tools including AUDIT, CAGE and WHO CIDI. The pooled prevalence of any hazardous/harmful/dependent alcohol use was 41% (95% CI: 31–51%), and of daily alcohol use was 26% (95% CI: 17–36%). There was variation in harmful alcohol use by global region (Sub-Saharan Africa: 38%; South Asia/Central Asia/ East Asia and Pacific: 47% and Latin America and the Caribbean:44%). Harmful alcohol use was significantly associated with inconsistent condom use (pooled unadjusted RR: 1.65; 95% CI: 1.01–2.67), STIs (pooled unadjusted OR: 1.29; 95% CI 1.15–1.46); and other drug use (pooled unadjusted OR of 2.44; 95% CI 1.24–4.80), but not with HIV, violence or mental health problems.ConclusionWe found a high burden of problem alcohol use and daily alcohol use among FSWs in LMICs. Harmful drinking was associated with HIV risk factors such as inconsistent condom use, STIs and other drug use. There is an urgent need for tailored interventions for FSWs in LMICs that address alcohol use as well as the associated sex work risk environment
Using Evidence-Based Measures to Assess the Effectiveness of Residential Mental Health Rehabilitation for Adults With Dual Disabilities
Authors: Charles Rock , Bhandarkar Ritesh , Fulgoni Catherine 
Published: July 2023

AimsThe Transitional Support Unit (TSU) is a unique 10-bed state-wide service and currently operates as one of two community-based long-term mental health services in Victoria. TSU is geared towards adults with complex mental health disorders in addition to a co-occuring intellectual disability or acquired brain injury--also referred to as a dual disability (DD). The aim of this project is to identify the benefits of this service to participants in order to improve the current structure and also to encourage development and expansion of similar services in Australia or globally.MethodsThe project was performed at the TSU. Participants included all previous and current residents of the TSU program (N = 24). Data were collected from three different evidence-based measures; the Health of the Nation Outcome Scales (HoNoS), Lifestar, and the Life Skills Profile (LSP). Each participant had these scales performed on admission, at time of discharge, and at 91 day intervals throughout their stay at TSU. The change in the measures were used to determine what clinical benefit, if any, resulted from undergoing engagement with the TSU program. Inclusion criteria was broad and encompassed any adult who had a DD and was admitted into TSU. Exclusion criteria was defined as any TSU resident with no completed discharge scales for comparison.ResultsOn review, it was found that on average, there was an overall decrease in HoNoS scores from admission to discharge of 4 points. For the LSP, there was an average decrease of 10 points in TSU participants and the Lifestar was found to have an average increase of 20 points. Within Lifestar specifically, participants were found to have an average improvement between 1.64 and 2.94 in each individual category assessed. No TSU participants were observed to suffer from any decline or step back in categories related to how they spent their time, feeling good about themselves, or the people they knew.ConclusionTSU does appear to have notable benefit for adults with DD, particularly in improving overall mood, social interaction, and development of a routine as well as activities throughout the day. The least improvement was found in categories such as physical health and communication. The data were limited by participants who have not yet been discharged from TSU, therefore any discharge scales were unavailable for comparison.
Effect of Accelerated TMS vs Daily Sessions on Clinical Outcomes in Depression
Authors: Kennedy Eoin , Madan Rio , Neal Leigh 
Published: July 2023

AimsThis study investigated the impact of accelerated Transcranial Magnetic Stimulation (aTMS) compared to daily sessions on outcomes in depression patients. While traditional TMS protocols involved daily sessions 4/5 times per week, this can be inconvenient for patients, particularly those travelling long distances to a TMS clinic. Recent well-designed studies have demonstrated that multiple sessions per day (aTMS) can be as effective as daily TMS. It was expected that these findings would be replicated in a clinical setting and that aTMS would be just as effective at reducing symptoms of depression as daily TMS.MethodsA retrospective chart review of 240 patients (126 males, mean age = 42.36, range = 16–86) was analysed using multiple regression. Patients were treated for unipolar depression over the left Dorsolateral Prefrontal Cortex (LDLPFC) using TMS protocols that have been shown to deliver equivalent outcomes (Blumberger et al, 2018).The aTMS intensity variable (aTMSiv) was calculated by dividing total number of TMS sessions by number of days between the first and last session (minimum of five days for inclusion). Therefore, a patient who had 30 sessions over 15 days would have an aTMSiv of 2. The mean number of sessions delivered was 24.46 (SD = 8.01, Range = 7–45) and the mean days between first and last treatment was 35 (SD = 20.21 Range = 6–105).The main outcome variable was percentage reduction of PHQ-9 scores from baseline (mean = 17.89) to treatment completion (mean = 10.76). The mean reduction in PHQ-9 was 40%. The independent variables (IVs) included: aTMSiv, PHQ-9 baseline score, number of sessions, age and sex.ResultsCollectively the IVs predicted PHQ-9 reduction at a statistically significant level (F (5,234) =7.91, p = 6.70E-07, R2 = 0.14). Individual analysis of predictors revealed that aTMSiv did not significantly predict PHQ-9 reduction (F (1,238) = 0.05, p = 0.82, R2 = 0.0002). Only number of sessions significantly predicted PHQ-9 reduction in this model (t = 6.04, p = 5.88E-09).ConclusionAs the aTMSiv did not predict the change in PHQ-9, this suggests the frequency at which TMS is delivered does not affect the outcome when treating depression. Thus, either daily sessions or aTMS can be utilised to best fit the schedule and lifestyle of the patient.
Stifled Screams: Experiences of Sexual Harassment Survivors at First Generation Universities in Southwest Nigeria
Authors: Mapayi Boladale , Oloniniyi Ibidun , Oginni Olakunle , Ukpong Morenike , Harrison Abigail 
Published: July 2023

AimsSexual Harassment (SH) in colleges and universities in Nigeria is often shrouded in secrecy. Survivors rarely report the SH experience. This is often because of unequal power relations, fear of loss of status, marks, or job as retaliation, and the attendant stigma. The sexual harassment policy, implementation, and campus climate also have huge roles to play in reportage. This study aimed to investigate the experience of SH by men and women in heterosexual and same-sex situations in first-generation universities in South West Nigeria.MethodsStudents and staff who had survived SH were targeted for IDIs focused on the experience of SH from the perspective of the survivor including the consequences, reportage, outcomes, and whether justice had been served. A purposive approach was adopted in identifying respondents and a snowballing method guided the process across the three universities. The sensitivity of the topic and the stigma attached called for a recruitment strategy that ensured privacy, confidentiality, and freedom to share experiences without reservation. About four IDIs were conducted in each university. Interviews were held on several (face-to-face via telephone or Whatsapp calls) platforms. Analysis commenced with verbatim transcription of the audio recordings. The accuracy, integrity, and completeness of all transcriptions were verified. A thematic analysis was conducted and all transcripts were coded by three experts which were organized into categories. The most prominent and salient thematic findings were brought forward by merging codes while maintaining the integrity of the individual categories. A cluster analysis of code associations was also performed to facilitate pattern recognition in the data. NVivo Pro v.12 was used to facilitate the analysis. Themes were categorized into four distinct areas: experience of SH, consequences, reportage, and outcome.ResultsThe experience of SH ranged from sexual assault to unsolicited physical touch and verbal harassment. In terms of consequences, survivors experienced low self-esteem, had problems in their relationships with others, became less trusting, and increased risk-taking behaviour. Most survivors were not aware of anti-SH policies in their institutions. None reported to law enforcement agents due to stigma, lack of financial means, and lack of trust in the system.ConclusionInstitutions need to do more than develop adequate antisexual harassment policies. There is a need to interrogate the culture around implementation and training to improve prevention and raise awareness.
Staff Perspectives of Emergency Department Pathways for People Attending in Suicidal Crisis: A Qualitative Study
Authors: McCarthy Molly , Nathan Rajan , McIntyre Jason , Ashworth Emma , Saini Pooja 
Published: July 2023

AimsBackground: The number of suicide-related presentations to emergency departments (EDs) has significantly increased over recent years; thus, making staff often the first point of contact for people in suicidal crisis. Despite this, staff receive minimal psychiatric training and few opportunities for education on the treatment and management of people presenting in suicidal emergencies. Understanding the needs of those who work within EDs is key to maximising the opportunity to reduce suicidal behaviour. Aims: To examine staff perspectives and experiences of working with people presenting to emergency departments in suicidal crisis.MethodsQualitative study guided by thematic analysis of semi-structured interviews with ED administrative, medical and mental health staff.ResultsTwenty-three staff participated. Three key themes were identified: (1) factors influencing staff decision-making; (2) quality of care for both staff and patients; (3) staff burnout, mental health and well-being. Staff described an overall lack of confidence and training related to asking patients about suicidal thoughts, which resulted in defensive practice and risk adverse decision-making. Quality of care for both patients and staff were discussed in relation to availability of resources, staffing pressures and team collegiality.ConclusionStaff felt inadequately equipped to deal with suicide-related presentations. Organisational support is lacking with increased staffing pressures, poor service availability and lack of beds. Negative staff attitudes often reflected an inherent unintentional use of language. Changing ED culture from top-down is imperative to address negative language and behaviours towards suicidal crisis and improve patient pathways and experience. Mandatory and ongoing training is needed to improve staff confidence, knowledge and attitudes.
Measuring the Permeability of the Blood-Brain Barrier in Alzheimer's Disease Using Dynamic Contrast Enhanced MRI
Authors: McCausland Beth , Huneke Nathan , Varatharaj Aravinthan , Gee Claire , Kunicki Amy , Darekar Angela , Teeling Jessica , Zetterberg Henrik , Holmes Clive , Galea Ian , Amin Jay 
Published: July 2023

Aims1) To compare blood brain barrier (BBB) permeability between AD and controls. 2) To examine the relationship between BBB permeability and cognitive decline in AD. 3) To examine the relationship between BBB permeability and peripheral markers of inflammation.MethodsThis pilot study combines the use whole brain DCE-MRI, with measures of peripheral inflammation in serum and urine. This is a clinical cohort study with longitudinal and cross-sectional arms, involving n = 15 AD and n = 17 age and gender matched controls. BBB permeability is measured using DCE-MRI and inflammation is measured by comparing serum cytokine and urine neopterin concentrations. AD participants attend three study visits over 12 months; control participants attend two over one week. Urinary neopterin analysis is being conducted in February 2023.The 12 month follow up visits complete in May 2023. Both neopterin and longitudinal cognitive assessment data will be included in the poster presentation in July.ResultsAD and control groups were well matched with no significant differences in demographics and multi-morbidity. We measured blood cytokine profiles for IL-6, IL-8, IL-2, IL-4, IL-1b, IL-10, IL13, IL-12p70-, TNF-alpha and INF-gamma. Only INF-Gamma was significantly different; higher in AD vs Controls (mean ± SD; 28.758 ± 90.226 AD, 3.773 ± 2.256 Control, P = 0.03). There were no significant differences in markers of neurodegeneration NfL and pTau-181, or vascular markers VCAM1, ICAM1, CRP and SAA between the groups. Ki is being calculated for overall whole brain, white matter, grey matter and hippocampus regions; an interim analysis showed no significant differences between the tissue categories, but analysis is ongoing.ConclusionThere are currently no prognostic biomarkers that accurately predict decline in AD. We believe this pilot study will add to the literature about the utility and feasibility of DCE-MRI to measure BBB permeability. We hope that combining DCE-MRI with blood and urine biomarkers will further our knowledge of the pathophysiology of AD and help to develop minimally invasive biomarkers for identifying patients with AD, including those who are at risk of faster progression.
Effectiveness of rTMS on Suicidal Thoughts in Patients With Depression
Authors: Bapakunhi Dilshana Nafisa , Pillay Parvathy 
Published: July 2023

AimsrTMS (Repetitive transcranial magnetic stimulation) as a brain stimulation modality is approved to treat treatment-resistant depression. Its efficacy in depression and anxiety is well supported in several studies. However, its direct effect on suicidality is still unclear, unlike electroconvulsive therapy. This study aims to evaluate the effectiveness of rTMS on pessimistic and suicidal thoughts. We hypothesized that rTMS reduces pessimistic and suicidal thoughts, alongside other symptoms, in patients experiencing depression and anxiety as the therapy progresses over six weeks.MethodsThe study is a retrospective observational study. The study was conducted in the rTMS Clinic, Brentwood. All of the patients undergoing treatment at the rTMS Clinic were assessed with subjective and objective scales for depression. One of the scales was MADRS (Montgomery Asperger's Depression Rating Scale); this was used to study the response of therapy. I looked into the pessimistic and suicidal thoughts component in MADRS, the baseline score was recorded, and its progression on weekly monitoring for six weeks was noted.63 patients attended the rTMS clinic from January 2019 to October 2022. 21 patients were excluded for reasons that included dropping out before completion of treatment, MADRS weekly scores not being available, and some of them still undergoing treatment. A total of 42 patients, 21 male and 21 female, who successfully finished rTMS therapy at the Neuromodulation clinic were included in the study.ResultsThe study showed that rTMS was effective and well-tolerated in reducing pessimistic and suicidal thoughts in the majority of patients. Average baseline scores and their average weekly progressions for pessimistic and suicidal thoughts over six week's period were recorded. The average score of baseline pessimistic thoughts was 3.925, and baseline suicidal thoughts was 3, in the severity scale of 0–6. There was a gradual reduction in scores of pessimistic and suicidal thoughts from baseline to the end of intensive six-week treatment. Scores measured at the end of every week showed a reduction in scores from the previous week of treatment. Average scores at the end of six weeks showed 2.375 and 1.65 in the pessimistic and suicidal thought domains respectively in the MADRS scale.ConclusionrTMS is being used for symptoms of depression and anxiety and evidence is encouraging in treating symptoms including pessimistic and suicidal thoughts. rTMS therapy over six weeks showed a gradual reduction in the severity of pessimistic and suicidal thoughts, demonstrated by decreases in average MADRS weekly score.
Integrating Cultural Awareness to Improve Mental Health Services in the Multi-Ethnic Community: A Systematic Literature Review
Authors: Olotu Sarah 
Published: July 2023

AimsThe challenges in providing mental healthcare in an ethnically diverse society exist within the limited frameworks of psychopathologies. Ethnocultural communities suggest relative syndrome of beliefs and practices so that experiences of mental illness differ and may not fit into the concept of colonial psychiatry. This review examines the necessity to recognise these trends as social determinants in the effectiveness and accessibility of healthcare and in preventing disparities.MethodsAccording to the Centre for Reviews and Dissemination (CRD), this abstract adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Standards using a search strategy of major online databases. The published studies selected were based on inclusion and exclusion criteria surrounding cultural competency in clinical practice in the context of global mental health. The studies were analysed and synthesised with quality appraisal tools and reported in a narrative approach.ResultsThe outcome from the pool of studies revealed the following common themes.Culturally informed clinical practice/transcultural psychiatry: Integrating the perspectives of the client's explanatory model with the clinician lens in a shared narrative through ethnographic principles. The cultural consultation service (CCS) recommendations increased knowledge of the specific issues of the patient's background and improved empathy and communication.The improvement of therapeutic alliance: A focus on the aspects of religiosity/spirituality on human life experiences and the implication in healing and psychotherapy for better positive clinical outcomes.The impact of psychosocial stressors: The clinician highlights the significant contributing factor to the mental distress of the patient, which may include cultural stressors, to provide tailored care and solutions within a multidisciplinary team.ConclusionThe research on cultural competency in the mental health setting is multifaceted. The ongoing discussion on transcultural psychiatry, integrating biomedical and traditional practices and specialised clinical formulations, can improve mental health service delivery in a global society.
Assessing Prevalence of Post- Traumatic Stress Disorder Symptoms Following the 2015 Earthquake in Langtang ,Nepal
Authors: Sharma Rajasee , Tamang Ngawang Dorje , Bhattarai Gaurav 
Published: July 2023

AimsAmong the consequences of natural disasters, post-traumatic stress disorder (PTSD) has been one of the most prevalent mental health issue. Nepal has been categorized as a region prone to natural disasters including earthquakes and avalanches. However, mental health implications of such disasters have been rarely explored in Nepal especially in remote regions like Langtang.In this research, we have estimated the prevalence of post-traumatic stress disorders (PTSD) among the survivors 7 years after the mega earthquake and avalanche in 2015 in rural mountainous region of Langtang in Nepal. We also explored the association between sociodemographic parameters and PTSD scores.MethodsA Cross sectional quantitative observational study was carried out in 2022. Study population included the residents of Langtang who are the survivors of 2015 earthquake. Simple random sampling was done and participants aged 18 years and above who consented to the study were included. Sociodemographic details were assessed using a predesigned structured questionnaire and PTSD symptoms were measured using the Nepali version of PTSD Symptom Checklist 5 (PCL 5). PCL-5 scores of >31 was used as cutoff for presence of PTSD. Data were analysed using SPSS software.ResultsA total of 124 participants were included in the study. PTSD symptoms score were above the cut off in 7.3% . Most respondents were males (60.5%), young adults aged 18–30 years (36.3%), with no formal education (53.2%), with at least loss of one family member (66.1), and majority rescued after a week(42.7%). Sociodemographic variables such as age group, education, occupation, location during the incident, rescue time and substance use were significantly associated with the PTSD scores. Middle aged respondents were observed to have significantly high PTSD scores followed by older age group(p = 0.04). Similarly, PTSD scores were significantly higher among the respondents with no formal education and who had agriculture/tourism as their main occupation(p = 0.02). Likewise, respondents who were in Langtang during the incident were found to have significantly higher scores(p < 0.001). Interestingly, PTSD scores were found higher among those respondents who were rescued within a week from the time of incident as compared to individuals who were rescued after a week(p < 0.001). Also, PTSD scores were higher among the respondents who consumed any type of substance(p = 0.002).ConclusionPTSD was prevalent even 7 years after the incident in the Langtang community. Certain sociodemographic parameters were identified to be associated with increased PTSD symptoms.