Incarcerated peers play a critical role in the provision of care for incarcerated older adults. Peer counsel is part of the culture in carceral settings and official and unofficial caregiving is a necessity for visually, mobility, and cognitively impaired residents of these institutions. Due to their experiences of exploitation by the prison system and research institutions, most older incarcerated people are reluctant to trust community partners or correctional staff members who conduct research in correctional settings. Many older residents who are offered participation in research do not believe any real systemic changes will occur with the publication of findings. This presentation will draw on autoethnographic experiences of a peer health worker in the palliative care setting. We will describe the role that peer health workers play in guiding patients in decision-making around research and interrogate a model of partnering with peer health workers to engage incarcerated older adults in research.


Voluntary dropouts before completion of inpatient psychiatric treatment are common in patients with dual disorders. However, the socioeconomic profile and family structure of patients who undergo a therapeutic program may correlate with their motivation and participation in the treatment received, as well as with their subsequent recovery.To evaluate the family typology of patients with dual diagnosis according to the degree of intrafamily cohesion and adaptability correlated with the prediction of therapeutic success and the risk of voluntary abandonment of hospital detoxification treatment.A total of 211 patients admitted to an inpatient psychiatric unit with substance use disorders were studied. Data were obtained from two sources: (1) interview of participants, (2) review of participants’ medical records using the Maudsley Addiction Profile (MAP) and the Family Cohesion and Adaptability Assessment Scale (FACES III).The 127 subjects who completed the hospital detoxification program had significantly lower MAP and FACES III scores at baseline than the 84 subjects who did not complete the study. Those who did not complete the admission reported greater addictive severity and poorer family functioning. Family cohesion and adaptability measured with FACES III and addictive severity assessed with MAP positively correlated with successful compliance with the hospital treatment program for dual diagnosis patients.These findings reveal the association of psychosocial and family determinants and addictive severity with treatment completion and subsequent prognostic evolution. Recognizing these predictive characteristics may allow early identification of patients at higher risk of early dropout and prevent it by increasing the intensity of treatment.


The retraction has been agreed because none of the listed authors ‐ Mohsen Shoja, Ali Jafarpour and Shahin Aghamiri ‐ fulfil the journal's criteria for authorship for the research published in the article. The article was submitted for publication by Mohsen Shoja without the consent of the legitimate authors or attribution to the legitimate authors.The above article, published online on 19 August 2019 in Wiley Online Library ( The retraction has been agreed because none of the listed authors ‐ Mohsen Shoja, Ali Jafarpour and Shahin Aghamiri ‐ fulfil the journal's criteria for authorship for the research published in the article. The article was submitted for publication by Mohsen Shoja without the consent of the legitimate authors or attribution to the legitimate authors.The above article, published online on 19 August 2019 in Wiley Online Library (


The authors regret that there was an error in the author list in the original article. Thomas Shean Yaw Choong should have been listed as a corresponding author. The amended author list and contact details are shown above.The Royal Society of Chemistry apologises for these errors and any consequent inconvenience to authors and readers.


This paper describes the creation of a comprehensive, linked Australian population spine including name and address history. This spine was developed using four national datasets and linked to multiple State and Territory datasets. This enabled the creation of linkage maps which could then be used to produce de-identified linked datasets.Initially the spine was created using identifiers from Medicare Consumer Directory (MCD), Social Services data (DOMINO) and National Death Index (NDI). The COVID-19 vaccination program covering almost the entire Australian population provided the opportunity to add the Australian Immunisation Registry (AIR).Probabilistic linkage was used to link MCD and DOMINO with linkage rates of 97.3%. MCD and NDI data were also linked probabilistically. Most AIR identifiers shared IDs with MCD and were linked deterministically with the remainder linked probabilistically.Based on the linkage results, unique identifiers were created for everyone appearing in at least one of the four datasets. Only unlinked records with very incomplete information in NDI and AIR were excluded. All unique combinations of names and addresses for each individual were added to the combined spine. This allowed us to cover the data gaps of each dataset and create a comprehensive history not possible when using a single data source.Linkage maps were created between all contributing data sources. State and Territory datasets were also linked to the spine using probabilistic linkage. These linkages were then reused for multiple projects.Linkage to the combined spine increased linkage efficiency  as well as increased linkage accuracy and a reduction in the transfer of personal information to provide a better service to the Australian research community.


Today the maternal death of black women is four times than the maternal death of white women. A lot has been written about the physical health of black women during pregnancy and childbirth however the perinatal mental health of this group of women is less well researched. I wanted to investigate if black and ethnic minority women in the UK had the same access to perinatal mental health services.To explore how the access to perinatal mental health services vary between white British and non-white British women.A literature review was conducted. Papers were selected based on their focus on perinatal mental health service access and differences in access based on ethnicities. Most research focused on the perinatal mental health service access of white British and non-white British groups of women.The literature review revealed that black African, Asian and minority white women had significantly lower access to community perinatal mental health services when compared to white British women. It was also found that that black African, Asian and minority White women had a higher percentage of involuntary admissions to psychiatric hospitals when compared to white British women.The literature would suggest that there is less access to perinatal mental health for non-white British women. This suggested that the disparities that exist within perinatal physical health extend into perinatal maternal health.No significant relationships.


The case for perinatal psychiatry as a subspecialty is strong. In the context of perinatal mental illness consideration has to be given to; differences in presentation, the need to account for mother and baby and the risks associated with inadequate treatment. Specialist services improve outcomes, reduce risks and save money. Despite the government's agenda of preventative healthcare, service provision has been inequitable across the UK. Here we detail the journey towards the development of new Community Perinatal Mental Health Services in Northern Ireland (NI).In NI the first embers of a perinatal service were ignited by Dr Janine Lynch approximately 15 years ago when she established a small community perinatal team in Belfast Health and Social Care Trust (BHSCT). Her commitment and foresight regarding training inspired others, resulting in high levels of interest among trainees. From this grew a dedicated group of consultants committed to supporting service development across NI.A multidisciplinary regional perinatal mental health forum was formed leading the development of a Northern Ireland Care Pathway in 2012. In partnership with women with lived experience, this forum led the bid for perinatal service development across the province.Following years of campaigning the need for services was recognised in both the Bamford Review (2012) and RQIA Perinatal Review (2017). A commitment for funding for specialist teams, across all five health and social care trusts, was outlined in the Mental Health Action Plan in May 2020. Funding was finally approved in January 2021.Significant work has gone into training to ensure there is a workforce ready to deliver services with focus on upskilling all professionals who deliver care to mums during the perinatal period. A competency framework has been developed to compliment this.It is important to recognise the support and commitment of many members of the college Perinatal Faculty throughout this journey.Community perinatal mental health services are at an exciting juncture in NI. Each of the trusts have made a commitment to the development of services under the co-ordination of the Public Health Agency. Several have progressed to recruitment of key staff with the aspiration for services to go live before the end of the year. There will be an overarching, integrated approach, co-ordinated by the new Regional Perinatal Network.As newly recruited consultants we look forward to working in partnership to address this long-standing health inequality and improve the outcome for women and their babies in NI.


Although the primary goal of self-directed programs providing long term services and supports (LTSS) is to maximize choice and control for service recipients, such programs may also benefit family caregivers by compensating them for providing supportive services. This study draws on qualitative data from research supporting the RAISE Family Caregiver Advisory Council, finding that family caregivers themselves see the expansion of self-directed programs as a policy priority due to their need for financial security. The request for compensation was the strongest finding, with respondents highlighting the incompatibility of work with caregiving and their inability to rely on the existing paid workforce due to supply and quality issues; the consequences of this loss of earned income were reported as severe. Ultimately, respondents saw payment for providing care as an issue of fairness. This evidence supports the policy case for expanding access to self-directed programs that permit the employment of family caregivers.


Stark geographic variation in later-life health outcomes suggests that local built and social environments are critical in shaping disease and disability, physical and cognitive function, and engagement in everyday life among older adults. This paper presents a community-engaged mapping project aiming to depict the uneven distribution of hazards and amenities relevant to cognitive aging across the United States. Living in neighborhoods with opportunities for social interaction , intellectual stimulation  and physical activity  may slow rates of cognitive decline and reduce risk for Alzheimer’s disease. We assembled a community advisory board to translate research findings into a pilot website and interactive map that assesses neighborhoods for cognitive aging resources and amenities. The objective is to increase public awareness and inform public health and policy efforts to ameliorate community barriers and create more equitable opportunities to promote healthy aging in place.


Young people who are care experienced are overrepresented in the criminal justice system and in general have worse outcomes in education than their non-looked after peers . Recent evidence has reported that children who have a social worker (classified as child in need or those with a child protection plan), but who do not enter the care system, can have worse outcomes in education than those children who are looked after . There remains little research evidence about the extent to which children with a social worker become involved with criminal justice services or how the age, duration and nature of formal social care service involvement may impact on education and offending outcomes. Researchers have been challenged by the lack of a sufficiently sized quantitative data, that crossed social care, education and offending domains. In work funded by ADR-UK, the present research project uses the newly linked DfE-MoJ administrative dataset to explore how different forms of formal social care services involvement impacts on education and criminal justice outcomes. Multi-level models will explore the role of formal child social care services amongst other multi-systemic risk and protective factors for education and offending. The presentation of his work will include preliminary statistics and insights into the challenges and potential further use of the linked dataset for researchers.


The harmful use of alcohol is an important risk factor for the health of the population around the world. The incidence of alcohol dependence in women is increasing and both its consumption pattern and its consequences have unique characteristics.To present a literature review focused on alcohol use disorder with a gender perspective.Literature review.- Women use to start using alcohol sooner than men and this seems to be a risk factor to become addicted. - Due to physiological and psychological factors women experience more negative health effects from excessive alcohol use than men and it occurs at lower levels of use. - Psychiatric comorbidity associated with alcohol abuse such as anxiety and depression is more common in women and this in turn worsens the alcohol use disorder. - Alcohol consumption increases the vulnerability of women on several levels, including an increased risk of physical abuse.Alcohol abuse among women deserves special attention and a specific intervention focused on the gender perspective.No significant relationships.


Affective Disorders are on a clinical continuum in which temperaments and other coexisting or emerging mental conditions may cover the role of risk factors or determinants of specific dimensional aspects of Bipolar Disorder. Overall, it is important to better characterize the psychopathological conditions associated to the clinical picture of an affective disorder in order to perform more personalized and integrated approach for the assessment, diagnosis and treatment of individuals with dual disorder.No significant relationships.


Disruptive medical events such as pneumonia and hip fracture occur more frequently among older adults with dementia than those without dementia. It is not well-understood whether these events increase the risk of mortality to a greater extent for people with dementia (PWD) compared to people without dementia (PWoD). Using data from the Health and Retirement Study linked to Medicare claims, we estimated the impact of hip fracture and pneumonia on risk of mortality among 700 PWD and 12,438 PWoD using a Cox proportional hazards model. PWD had a higher risk of mortality both in the case of hip fracture  and pneumonia  compared to PWoD who experienced those events. This study provides evidence that dementia may increase mortality after a disruptive medical event and suggests that the clinical course of dementia may not always be slow and gradual.


Psychiatry is facing major challenges during times of a pandemic as illustrated by the current COVID-19 pandemic. The challenges involve its actual and perceived role within the medical system, in particular how psychiatric hospitals can maintain their core mission of attending to the mentally ill while at the same time providing relief to general medicine. Since psychiatric disorders are the top leading causes of global burden of disease, we need to strengthen mental health care in the wake of the massive onslaught of the pandemic. While nobody can deny the need to act decisively and swiftly and ramp up intensive care readiness, we believe that the immediate availability of psychiatric care is just as important. In order to provide the best possible treatment conditions for people suffering from mental illness but as well for those suffering from the immediate pandemic’s consequences such as isolation, reduced social interaction etc. instant and comprehensive provision is inevitable.No significant relationships.


The current social distancing directives have heightened the need for older adults to seek remote healthcare solutions. Telehealth robots could support home health by carrying out on-demand tasks for diagnosis and treatment at the user’s home through remote teleoperation by the healthcare provider. Acceptability of such telehealth robots by older adults is critical to their successful deployment. The overall goal of this research was to investigate older adults’ perceptions and attitudes towards a telehealth robot supporting health checkups at home. Specific objectives were to explore potential healthcare use cases for the robot; identify facilitators and barriers to its use; and elicit design requirements for use in healthcare contexts. We interviewed 5 men and 5 women (ages 66–73) after they viewed a series of videos demonstrating the potential uses of the telehealth robot. The older adults had positive first impressions towards the telehealth robot and were generally open to the idea of using it for telehealth tasks. They conveyed a high level of trust with the robot, especially if it were controlled by a healthcare provider, yet expressed concerns with privacy and security of health information that would need to be addressed in the design of security protocols. They described added value of the robot’s healthcare support while suggesting potential improvements to the robot. This research provided insights into older adults’ perceptions and attitudes towards a telehealth robot as well as identified potential healthcare use cases that would inform the design requirements for telehealth robots in different home healthcare contexts.


There is a significant global lack of policy action on consumption of sustainable diets. Application of political science theories such as theories of the policy process can help in understanding policy inaction. Applying these theories could provide a more in-depth understanding of how various influences on the policy process shape decision making for consumption of sustainable diet policy.A systematic review to examine application of eight key political science theories of the policy process to research on consumption of sustainable diets was conducted.The review identified no papers applying a theory of the policy process although 17 papers did mention or discuss influences on the policy process that are common elements within theories of the policy process. Most notably these elements were the influence of coalitions/networks, evidence use, narratives and framing, institutional and political system factors, and the importance of value and belief systems and socio-cultural norms. However, in most papers these influences were not examined in a detailed or in-depth way and often presented as suggestions for lack of policy action without the support of empirical data or application of any theory.Most research discussing policy inaction on the consumption of sustainable diets fails to utilise political science theories of the policy process, although a small number of papers include mention of or discussion of influences on the policy process. Application of political science theories could provide a more in-depth understanding of how different determinants might shape decision making at various points in the policy process. This could help identify key reasons for policy inaction on the consumption of sustainable diets and suggest possible ways to increase attention and action on the issue from policy decision makers.The online version contains supplementary material available at 10.1186/s12889-022-13717-5. A systematic review of the environmental and health impacts of dietary change in high-income countries concludes there are clear environmental benefits to modifying current dietary practices towards more sustainable choices, and that environmental benefits are largely proportional to the extent by which meat and dairy consumption can be reduced . HoweverA number of possible reasons for this policy resistance have been put forward, with studies citing the complexities related to contemporary food production and consumption as being the major challenge for policy makers in taking action . The difAlongside these suggestions there have also been some recent attempts in the literature to examine the processes occurring around the creation and implementation of policies in support of consumption of sustainable diets. These studies have largely focused on describing the competing interests involved in the governance of sustainable diets such as between government, civil society, consumers, and private sector stakeholders , 14–19. how these determinants might shape decision making at various points in the policy process. For example the powerful influence of food and agricultural industry lobbying on policy makers has often been cited as a key reason for a lack of policy action, and the production and use of evidence highlighted as a significant factor in shaping policy decisions. Yet there is no research which examines critical questions such as how and on whom do policy actors exert influence in the policy process? And, how do policy actors form successful coalitions to influence policy decisions, and how are policies on consumption of sustainable diets informed by evidence?While studies which elucidate potential policy determinants have a role to play in contributing to knowledge about why there has been so little policy action on consumption of sustainable diets, they do not provide any in-depth understanding of The questions outlined above are not isolated to the area of sustainable diets and indeed in areas such as public health and environmental policy there has been increasing attention on the need to utilise theories from other disciplines, particularly political science, to help conceptualise and make sense of the many interactions and variables involved in complex policy areas –31. As BDistinct from the “what have we done” and “what should we do” questions of policy evaluation and analysis, policy process research asks questions about the why and how of policy making. For example policy process scholars seek to find out why certain policy issues capture the attention of governments, how coalitions or groups influence policy making, and how different institutional arrangements and history shape policy. As Breton and de Leeuw  identifyMeet the criteria of a theory .Is indicative of an active research program via recent theoretical development and empirical applications.Has a relatively broad scope that seeks to explain a substantial portion of the policy processDe Leeuw et al.  describeFor the purpose of this review ‘Theories of the policy process’ will refer to the eight key theories identified by Sabatier as meeting the minimal set of conditions. These will be the theories that are used to guide the systematic review and analyse the current gaps and limitations of current research into consumption of sustainable diets policy.Given the large body of literature espousing the need for policies to increase consumption of sustainable diets for both health and environmental reasons, there is a clear need to understand why there has been such a significant lack of policy action on this issue at a global scale. Increasing sustainable diet scholars’ knowledge of how policy works could help make their work more relevant and targeted towards addressing policy barriers which could assist with uptake of sustainable diet policies. One way this knowledge could be increased is through the use of theories of the policy process that examine reasons for policy inaction. This study thus aimed to systematically review the literature on consumption of sustainable diets to determine if any research uses policy process theories from political science to explain the lack of policy action and if so what are these explanations?The systematic review was undertaken to broadly align with the guidelines laid out in the PRISMA  statement . These gThis systematic review examines the literature on consumption of sustainable diets to ask the question: Do sustainable diet consumption studies draw on or apply any political science theories of the policy process to help explain policy inaction? A systematic electronic search was conducted in June 2021 to identify relevant publications from the following databases: CINAHL, ScienceDirect, Scopus, Web of Science, ProQuest, PubMed, PLoS and JSTOR. The reference lists for included papers were also searched for relevant studies. Search terms for all databases included the following: (climate change OR greenhouse gas OR sustain*) AND (food OR diet* OR nutrition* OR meat) AND (policy OR policies OR govern*). These search terms were chosen to help include papers that linked diets to sustainability and included some mention of policy. The searched fields were keyword, title and abstract where available. Searches were limited to English language studies published until July 2021.Titles (and then abstracts where available) were screened for relevance to consumption of sustainable diets policy. Citations were categorized into two groups: i) possibly relevant studies; and ii) excluded studies. The full text of all candidate studies  was obtained, using a low threshold for inclusion if there was any doubt. These publications were then screened against the inclusion criteria (see Table N = 0).Applies a theory of the policy process to analyse sustainable diet consumption policy to help explain policy inaction (N = 17).Includes mention of or discussion of influences on the policy process consistent with elements from theories of the policy process to help explain policy inaction but does not directly apply a theory of the policy process  . One theA number of papers made mention of dominant economic or neoliberal political ideology acting as a barrier to policies to encourage consumption of sustainable diets. This often has interactions with other influences on the policy process. For example in their examination of how livestock industry practices influence sustainable diet policy in the US Rose et al.  discusseThere is a large literature demonstrating the gap between production of evidence and a policy making response , 56, 57 Theories of the policy process recognise the importance of the public mood, and the values and beliefs of stakeholders in the way the policy process operates. Almost all theories of the policy process include these elements with some such as the Social Construction Framework and Narrative Policy Framework more specifically focusing on these influences. A number of papers in this review commented on the way meat consumption is associated with socio-cultural norms and beliefs. Beverland  argued tThis systematic review found no papers that applied a key political science theory of the policy process to help explain policy inaction on consumption of sustainable diet policy. However, a small number of papers did discuss or mention some influences on the policy process that are regularly included as elements within theories of the policy process. Most commonly mentioned was the influence of coalitions or networks on the way sustainable diet consumption policy is being made, with a focus on power imbalances between stakeholders’ ability to influence policy. The power of the food industry and/or farming lobby groups in exerting political influence was mentioned in a number of papers  argue, recognising that policy makers have a tendency to base judgements on their well-established value and belief systems and make decision making shortcuts based on emotions and familiarity with information is a key understanding required for stakeholders advocating policy change. Without a focus on the way policy makers understand and react to problems those seeking to create policy change will find it much harder to exert any influence, and instead find themselves only responding to sudden demands from policy makers for evidence-based solutions to pre-defined problems . Greaterhow they can best influence future policy making and the best strategies for different political and socio-cultural contexts. Given the ample evidence on the need for a global shift to public consumption of more sustainable diets to help mitigate climate change and other environmental impacts, future research that applies political science theories of the policy process to help understand policy inaction is urgently needed.Given that food consumption is a complex and interconnected policy area that encompasses a vast literature including food security and production issues, a limitation of this review is that it may have missed studies which have used policy theories to examine other food sustainability policy issues. Never the less this review highlights that in the area of consumption of sustainable diets there is the need for greater use of political science theories of the policy process to help analyse the lack of meaningful policy action from governments across the world. This could provide greater clarity on how policy decision making is being made in this area, where there may be increased opportunities for policy advocacy efforts and to identify where barriers to policy adoption lie. Without application of such theories studies may be more limited in their ability to explain a lack of policy action and elucidate which policy options would be most likely to gain the attention of decision makers. Further, a greater understanding of how the policy process is operating for consumption of sustainable diet policy could help inform policy actors on This review examined the application of theories of the policy process to research on consumption of sustainable diets to help explain policy inaction. No papers were found that directly applied a theory of the policy process although a small number of papers were identified that did include some discussion of key influences on policy making that are commonly included elements within theories of the policy process. However, these were often only examined in a rudimentary way and most papers lacked empirical evidence to support suggestions for policy inaction. A lack of application of theories of the policy process means studies are more limited in their ability to explain the absence of policy action or to recommend strategies and leverage points which would help achieve future policy change. Given the urgent need to shift consumers towards more sustainable diets to help mitigate climate change and other environmental impacts we recommend more research utilising theories of the policy process to help explain this lack of policy action and provide greater insight into how to achieve increased attention and policy implementation by decision makers.Additional file 1: Appendix A. Summary of key themes of policy influence extracted from the data.


The context of infodemic and necessity of preventive behavior  demands for studies of the role of news in compliance including health priming . Especially important is a topic the effect of news about traditional and alternative medicine  their impact on subjective compliance.The aim was to study the relationship to medicine and subjective compliance in people with hypochondriac beliefs after priming by negative news about traditional and alternative medicine.122 healthy adults  were randomized to conditions ; then they read and appraised four news ; filled changes in emotions after reading , Cognitions About Body and Health Questionnaire , checklist of relationship to medicine and compliance.Moderation analysis indicates that in people with higher hypochondriac beliefs negative news about alternative medicine lead to lower readiness to use these methods but also to comply with any medical recommendations (p<.01). In people with higher hypochondriac beliefs negative news about traditional medicine decrease readiness to use it but not alternative medicine (p<.01).Negative news about formal medicine situationally decrease readiness to use it while negative news about alternative medicine situationally decrease any readiness for treatment. Research is supported by the Russian Foundation for Basic Research, project No. 20-013-00799.


The citizen’ awareness about environmental health risks has been identified as an important determinant of citizens’ choices for the adoption of pro-environmental behaviors, but for its study simple measures to be applied in population studies are still lacking. The Environmental Health Literacy (EHL), is a recent sub-cathegory of health literacy, including functional, critical and interactive dimensions, that can be applied in surveys on environmental health risk perception and behaviors. The aim of our study was to elaborate and validate an EHL Index (ELHI) using data from a large multicenter survey carried out among 4778 students of different disciplines in 15 Italian Universities, with a self-administered anonymous questionnaire investigating risk perceptions, attitudes and behaviors towards environmental health risks and including a simple Functional Health Literacy test (FHL). From the original questionnaire of 56 items three sets of questions were selected to represent the three dimensions of health literacy  and their outcomes were compared with the answers about FHL test and pro-environmental behaviors. The Principal Component Analysis was used to select the most representative questions that were then grouped in the EHLI. The index was significantly associated with both FHL test and behaviors questions. The ROC curve indicated a satisfying accuracy and was used to identify the best cut-off for ELHI. In conclusion the constructed ELHI can be considered reliable and useful for further population surveys in similar target people to plan communication interventions about environmental health risks and their prevention through individual choices.An Environmental Health Literacy Index is proposed as simple measure to be used in population surveys.This measure resulted associated with behaviors and can be considered accurate and reliable.


Two rapid communications in this issue report on attempts to gauge the extent of the recently reported increase in acute hepatitis cases among children in several countries in Europe and on other continents. They show that at the start of a possible outbreak with a yet unknown aetiology but features suggestive of an infectious cause, it is challenging to establish a sound evidence-base and to measure increase against a baseline of a syndrome or disease which is not under systematic surveillance and governed by standard case definitions. The short communications by van Beek et al.  and de KVan Beek et al. set out to establish the incidence for acute hepatitis of unknown aetiology in children over the previous 5 years (2017─21) as comparison baseline to assess the increase and included data from the United Kingdom (UK). They further investigate geographical distribution of cases up to 26 April 2022. This year, of 24 countries with experts responding, five of 17 identified an increase in probable cases of unexplained acute hepatitis in European countries and in one of seven non-European countries. An increase in severe cases was noted in five European countries.De Kleine et al. establish estimates of paediatric acute liver failure (pALF) registered by specialised liver centres within the European Reference Network on Hepatological Diseases over 3 previous years (2019─21) that fulfil the definition of the Paediatric Acute Liver Failure Study Group [The results from these surveys show that the condition remains rare also in 2022. They do not provide a uniform picture but indicate that while in some countries or centres there are signals for an increase in cases, this is not evident in others. As examples of the former, Marsh et al. described the clear signal seen in Scotland and the initial investigation and clinical details of the first Scottish cases on 14 April .Despite acknowledged limitations, the two Rapid communications in this issue provide some useful information in the form of ‘best available evidence’ at this moment in time. International collaboration is needed to support robust and timely epidemiological and clinical investigations to establish if there is an excess of cases of severe hepatitis of unknown origin that demands targeted studies to determine the aetiological agent. Over the coming weeks we hope to see more data and results from ongoing investigations that should help to fill the present gaps.


In the published article, there was an error in the Funding statement. This work was not supported by the Humanities and Social Sciences youth project of Liaoning Provincial Department of Education (WQ2020012). The correct Funding statement appears below.


The relationship between behavioral changes and the menstrual cycle in women at a reproductive age has been investigated in several studies; women during every menstrual cycle experience noticeable changes in levels of sex hormones which are consequently reflected on their mood and behavior. The relationship between the menstrual cycle and the emotion recognition processing has been also studied.The aim of this study was to examine if differences exist between women with Premenstrual Dysphonic Disorder (PMDD) and women without PMDD in Emotion recognition processing across menstrual cycle.We examined 26 women with a PMDD and 30 women without PMDD, who have both visited the Mental Health Centre . Women were clinically interviewed (DSM-V); also the Emotion Recognition Task (ERT) was administered in the luteal and the follicular phase.Women with PMDD showed significant differences in emotion recognition depending on the the luteal and the follicular phase (according to estradiol and progesterone level) whereas women without PMDD did not present significantly different responses to the emotional stimuli.Our findings suggest that there is an effect of PMDD on emotional facial recognition across the two phases of the menstrual cycle. Thus, the importance of incorporating ERT in the formal clinical examination of PMDD is highlighted.No significant relationships.


Family care partners face increased and more complex caregiving demands at the time of hospital discharge for persons living with dementia. This study examined family care partners’ needs for preparation and factors associated with the degree of preparation for caregiving. Care partners who were younger , demonstrated anxiety  and depression , and were caring for a person in pain  had lower scores on the Preparation for Caregiving Scale. Care partners described the least preparation to care for the patients’ emotional needs  and deal with the stress of caregiving . Content analysis of nurses’ transitional care notes converged with these findings, while also describing a lack of preparation to advocate for information from medical providers. Findings suggest the need to attend to the psychological and informational needs of care partners, while considering patient well-being and comfort.


A feeling of restrictiveness is often associated with coercive practices, such as seclusion or restraint. In addition to these obvious procedures more subtle practices can also feel restrictive. Its registration and monitoring is of special importance in forensic mental health care since feelings of restrictiveness can lead to adverse events like increased aggression and suicidal intentions.To enable the registration of the experience of restrictiveness in forensic mental health settings in Germany, the Forensic Restrictiveness Questionnaire was translated from English into German.Method: We used the TRAPD approach presented by Harkness (2003). This approach combined the expertise of professional translators and clinical experts and enabled adaptation at an early stage. The developed version underwent a cognitive pretest with a small patient sample to check for comprehensibility and interpretation of the questions in line with the original authors intention.A preliminary translation of the FRQ was developed. Translators combined their expertise from linguistic and clinical practice as well as their knowledge about English and German culture to produce a translation as close as possible to the original questionnaire with necessary adaptations. Remaining uncertainties, e.g., regarding comprehensibility of long phrases or uniform interpretation of certain wordings or questions, were addressed in the cognitive pretest with patients. The version produced can be used for validation.Conclusion: The TRAPD approach produced a comprehensible and well adapted German translation of the FRQ. This version underwent a cognitive pretest by a small patient sample and is now ready for validation.No significant relationships.


Physical inactivity accounts for as many as 5 million deaths per year globally but has yet to be addressed effectively by most governments or the World Health Organization (WHO).Reasonable evidence for effective strategies exist, and several countries have implemented consistent public health policies and programs that have increased population prevalence of regular physical activity. In 2018 WHO launched a Global Action Plan for Physical Activity (GAPPA). However, most countries do not have effective public health policies in place for physical activity. Evaluating the history of national and global policies to understand how some countries have developed sound public health programs for physical activity while most have not requires monitoring and evaluating policy, programmatic, and perhaps even research indicators for physical activity. Only recently have there been systematic efforts to do so.Several key questions about physical activity policy, starting with an examination of the evolution of public health physical activity policy and policy research from when it was first explicitly identified in the 1990s to the present will be addressed. Key recommendations, global statements, research reviews and action plans will be summarized to provide a clear picture of the evolution of this important aspect of public health. Evidence on the implementation of policy at national and global levels will also be reviewed. We will examine whether it feasible to track physical activity policy at the global and country levels, if the existence of ?good? physical activity policy is associated with less physical inactivity, how policy indicators may be used for advocacy and guidance.Physical activity policy for public health is a relatively new concept that has evolved significantly in the last three decades with formal national and global policy statements, research, and evaluation efforts all increasing markedly since 1990.Despite notable growth in policy research and the development of sophisticated national and global policies and action plans, implementation of effective national and global policies and programs for physical activity remains limited.


The traditional ‘one size fits all’ model within secondary care mental health (MH) settings of regular appointments scheduled by a clinician at defined intervals isn't always responsive to an individual's changing needs. Previous reviews have shown significant levels of patient and clinician satisfaction with Patient initiated models of review in a variety of healthcare settings but its use within secondary care MH settings has been relatively limited. We describe the development and implementation of a Patient initiated follow-up (PIFU) pathway within MH services in NHS Greater Glasgow and Clyde (GG&C).The pathway was developed by a small working group of clinicians with input from local management and eHealth colleagues with an emphasis on the principles of Realistic Medicine. There was input from peer support workers and the Mental Health network, a local service user organisation, into the development of the pathway. The pathway underwent a ‘test of implementation’ within three adult CMHT's with support from the development group. Feedback from the test sites was used to modify the pathway and ultimately support the wider rollout of the model across all seventeen CMHTs within NHS GG&C over the course of 2021. Formal evaluation of the pathway, including patient and clinician satisfaction, service utilisation as well as safety measures, is due to be undertaken at 12 months after full implementation.The tests of implementation identified a range of factors that needed to be considered as part of the introduction of a PIFU model into MH settings.Patient choice and shared decision making along with other clinical factors such as level of insight, availability of other supports, shared risk assessments and current clinical need were identified as relevant patient related factors. Clinician related factors included concerns about applicability within MH settings, perception of risk, increase in workload and appropriate identification of suitable patients. Regular meetings between the clinicians in the test sites and members of the development group as part of the implementation process helped address clinicians concerns and ultimately supported uptake of the model.Our experience highlighted the potential for a personalised approach to care planning in empowering patients have a more active role in the way they access services as part of their recovery journey. It also highlighted patient and clinician related factors that need to be considered for a successful adoption of the model.


This clinical guideline is intended for use by orthopedic surgeons andphysicians who care for patients with possible or documented septicarthritis of a native joint (SANJO). It includes evidence and opinion-basedrecommendations for the diagnosis and management of patients with SANJO.


This presentation provides an overview of factors that can cause symptom exaggeration and/or fabrication in chronic pain. It will explore how symptom and performance validity tests can be applied to chronic pain in the context of a malingering framework and the problems of implementing this in the UK through a case example.No significant relationships.


A quality improvement project was undertaken to counteract obesity in patients with mental health morbidity. The exponential trend of increased antidepressant prescribing  has created a trend towards weight gain in patients. An audit of the Serious Mental Illness (SMI) register and depression registers was conducted in a population of 591 patients. Those patients identified as obese were offered referral to the local authority weight management services.Patients have a body weight and BMI calculation with their twice yearly mental health and medication review and those whose BMI met the obesity criteria were offered referral to the local authority for 12 weeks weight management services.Of the SMI and depression register 189 (32%) patients met the criteria for referral to the weight management program. Of these 154 (81%) patients accepted the local NHS weight management program, 35 (18%) of patients declined the NHS weight management program.Weight gain is a known side effect of antidepressant medication SSRI and SNRIs and Anti psychotic medication resulting in increased risk of obesity and cardiovascular and metabolic disease. The QI program was undertaken to counteract these changes with referral to weight management services to address the weight gain the patients were experiencing.This quality improvement service was done to help patients across three surgeries lose weight in an effective and educational manner. We found a high rate of acceptability of referral to weight management services when offered as patients themselves were aware of the weight gain. A review of positive changes in the BMI after referral to the weight management program will be undertaken at 6 and 12 months to evaluate its acceptability and effectiveness. We advocate sensitive counselling of the risks of weight gain and regular monitoring of body weight throughout the span of the prescribing of these weight gaining agents.


Teaching Point: Infected urachal cysts are a rare cause of abdominal complaints and can be accurately diagnosed by abdominal ultrasound and computed tomography (CT). An abdominal ultrasound revealed a thick-walled heterogeneous cystic mass surrounded by fat stranding anteriorly in the midline on top of the bladder. The bladder dome was thickened, and the lesion was focally invading the left rectus abdominis muscle . The primary imaging modality for urachal cysts is ultrasound revealing a cystic mass in the midline anteriorly between the bladder dome and umbilicus. CT or MRI may be subsequently employed to help reach a definite diagnosis. Infection represents the most common complication of urachal anomalies and may present with nonspecific symptoms. Imaging findings that should prompt consideration of infection in the setting of an acute clinical presentation include the presence of a urachal remnant with complex echogenicity at ultrasound and heterogeneous attenuation of the content and contrast enhancement of the thick wall on CT. As in this case, it can be challenging to distinguish an infected urachal remnant from a malignant urachal neoplasm. Treatment consists of antibiotic therapy followed by complete excision to mitigate the 30% risk of infection recurrence and potential malignant degeneration [


The impact of racism on health and the quality of health care services for racialized patients have been the object of prior research. The experiences of racialized medical students and physicians, who operate in a field of tension between natural sciences and practical application and between a ‘medical habitus’ and exclusionary discrimination, have hardly been examined to date. The education of (future) physicians is an especially fruitful research area in the context of the study of institutional racism in the health care system, as informal everyday experiences come together with formal knowledge and normative learning.Based on expert consultations and preliminary interviews with civic stakeholders, teaching and learning materials in German medical studies were randomly sampled and used as a starting point for qualitative guided interviews with physicians and medical students in Germany who are themselves affected by racism. The first steps of the thematic analysis of these interviews are reflected upon and further developed in focus group discussions with the interviewees.The study is particularly concerned with the question of how certain dimensions of racism in the health care sector are related, and how racist normativity appears in this context. This is concretized in the relationship between formal and informal medical curricula as well as in the interweaving of everyday experiences and teaching materials.There are different dimensions of relation between a hegemonic normativity in the medical curriculum and the everyday experiences of racialized medical students and physicians in Germany. Politics, faculties, publishers, and civic society may be the target of several recommendations for action regarding those diverse dimensions, e.g. the line between omission and stereotyping of several patient groups.• Hegemonic normativity in German medical education is an important and challenging issue. There are several institutional levels of medical knowledge reproducing racism in the health care sector.• Both racialized physicians and racialized patients are affected by symbolic and material forms of racism in the German health care system, which are interweaving and crucial on diverse levels.


The Global Council on Brain Health (GCBH) convened experts from around the world to examine the impact of cardiovascular risk factors on brain health. GCBH issue experts carefully considered how high blood pressure, diabetes and stroke, as well as lifestyle choices such as diet and exercise, influence brain health in adults age 50 and over. The GCBH concluded that the best evidence to date shows us “what’s good for the heart is good for the brain.” Their consensus puts powerful tools in the hands of adults wanting to protect their brain as they age. The GCBH adopted 10 recommendations for individuals to incorporate into their lives to keep heart and blood vessels healthy and reduce the risk for cognitive decline and dementia. These recommendations and 16 practical tips are provided in the final report. Liaisons from numerous civic and nonprofit organizations with expertise in heart and brain health helped develop these recommendations for adults 50+ and their health care providers.


Building upon the Scottish Safe Haven Network’s (SSHN) collaborative experience to develop an exemplar dataset on Scottish national level laboratory tests within the SSHN. To test the feasibility of a federated safe haven network in Scotland for clinical laboratory data using existing federation solutions.Considerations were given to the clinical tests that are being commonly used across Scotland. An investigation of laboratory data structure was conducted using SQL with the assistance of White Rabbit which captures the metadata information from each safe haven. Data heterogeneity or commonalities were investigated in detail in R. We examined the inter-relationships among clinical laboratories from different regions of NHS Scotland. A common data structure was proposed to facilitate the sharing of clinical test results. We investigated multiple existing federation solutions to streamline access to data across the SSHN.A dataset of all laboratory tests for patients registered with the Scottish Health Research Register and Biobank (SHARE) from laboratory data sources within the network  were developed. An open-source toolkit that includes SQL scripts to harmonise laboratory data from multiple safe haven and R scripts to conduct heterogeneity investigation to streamline the sharing and the analysis was created. We have shown a working model for federation within Scotland for the first time with the view to expand into more routine projects. The project has developed a systematic concept mapping of data available across the SSHN to aid cohort discovery.The exemplar national level laboratory data together with the toolkit will help provide researchers with information such as which data are available to access. It will also support and improve national-level research studies at a faster pace. The work has demonstrated the feasibility of a common process for federated data discovery and sharing across the SSHN.


Establishing broad spectrum of new mental health services in whole Bosnia and Herzegovina (BH) existing mental health laws in both entities needed to be upgrade according positive results of the mental health reform in the country. Previous laws were exclusivelly oriented on protection of rights of the people with mental health disorders in (mainly) psychiatric institutions and were progressive and new in the period of their implementation (2001-2004).Since 2010 main reform processes had direction to community mental health care and developed positive movement with implementing new services oriented to patients and their needs/continuity of care. For example case management and occupational therapy are part of daily work in whole country and standards established trough accreditation process lead to uniform approach in community work in the area of mental health.Comparative analysis of laws in BH concerning mental health.Carefuly and good preparation for pronounce of new Mental Health Law both in Republic of Srpska and Federation of BH were supported from both entities  and they are formaly supported in both entities parliaments in 2020 (prolonged since COVID-19 situation). In both laws is more emphasised role of commnity services, prevention, and post-hospital rehabilitation as continuity of care. Book of rules that follow the laws will be establish no longer than the end of 2020.New mental health laws in BH are path to better protection of mental health of all population in BH and rights of our patients’ recovery.


The youth and adult criminal justice systems in England and Wales disproportionately draw in individuals from ethnic minority backgrounds  and those who have been in care as children . While evidence suggests that there is likely to be considerable overlap between these two groups , there was previously little in the way of quantitative data to explore this. The newly linked MoJ/DfE datasets have provided a unique opportunity to investigate the intersections between ethnicity, care experience and justice systems involvement for the first time. This paper will draw on findings from an ADR UK (Administrative Data Research UK) Fellowship utilising the newly linked datasets. It will outline to what extent ethnic minority care-experienced people are over-represented in justice systems. It will also explore the nature of this involvement including offence type, frequency, and disposals. The findings will be contextualised within the wider literature on racialisation  and criminalisation in care  to enable a broader understanding of the issues. The paper will outline the challenges of conducting interdisciplinary research using linked data from across government departments as well as the possibilities for future research.


Comparatively little is known about the ability of physical activity to improve or maintain cognitive function in older adults. Our Midwest Roybal Center uses social/behavioral theory to promote engagement in physical activity in order to improve this outcome. In 2019, we received funding to establish a Multimodal Connectomics Core that enabled investigators to examine concurrent changes in cognitive function and brain connectivity by providing access to fMRI imaging. The Connectomics Core enabled investigators for the first time to examine cognitive function and changes in brain connectivity simultaneously by providing access to fMRI imaging as well as MRI data storage and data analysis. It enabled measuring of standardized participant outcomes selected from the NIH toolbox. This Symposium describes findings from the first three completed pilots and discusses their implications for the field. The first pilot by Bronas examined effect of a 6-month home-based walking program in people chronic kidney disease on cognitive function and intervention induced neuroplasticity compared to usual care. The second pilot by Marquez adapted the Fit & Strong! program to test the combined impact of physical activity and interactive health education for managing mood on cognitive function among older adults with depression. The third pilot by Bhatt examined the effectiveness of 4 weeks of exergaming combined explicit cognitive training on behavioral measures of fall-risk  and their associations with brain integrity measures. The discussant will initiate discussion based on outcomes of these pilots and future directions for developing them into larger studies or clinical translation.


The project aimed to test an alternative method to estimate the number of duplicate responses in the 2021 England and Wales Census. The method utilises information from all census records instead of relying on samples. It requires less clerical review than the original inverse sampling method used for overcount estimation.We used the Splink implementation of Fellegi-Sunter to match the 2021 Census to itself. The resulting linked dataset was filtered to retain only the top scoring record pair for each unique census record, giving a final dataset of around 71.5 million record pairs. These pairs were divided by score into 13 homogeneous buckets. Random samples of 1000 pairs per bucket were clerically reviewed to determine whether each pair was a true duplicate or not. The clerical results were used to assign an estimated probability of being a duplicate to each bucket and hence to every census record within the bucket.A dashboard was created which contained percentages of duplicates by region and ‘overcount group’ for the original and alternative methods. This enabled us to view the data side by side and create visualisations to aid analysis. The alternative method had higher average duplicate percentages in overcount groups for communal establishments and was also higher for 9 out of 10 regions in the armed forces overcount group. We found that both the original and alternative methods of overcount estimation followed the same pattern in terms of minimum and maximum duplicate percentages except for those in communal establishments where minimum and maximums were both higher than the original method. Additionally, the minimum was marginally higher for the student and armed forces overcount groups for the alternative method.On initial comparison, estimated rates of duplication resulting from the different methods are comparable. We plan to conduct further analysis on the similarities and differences of the two methods, and research whether the new method could be applied to estimate the duplication rate in other large datasets including administrative data.


Digital home assistants  hold great potential for supporting older adults in completing a wide range of daily living activities and improving their overall quality of life. As these devices can wirelessly connect with other smart technologies to increase their capabilities , digital assistance technologies may benefit older adults who need support within their home such as those living with mobility disabilities. However, research is needed to better understand the facilitators and barriers of using these technologies by these individuals, as well as the resources that best support their onboarding and continued use. To assess the potential efficacy of integrating smart and connected technologies into the homes of older adults with mobility disability, we are conducting a field trial to understand how best to introduce these devices and support their use. Design considerations and initial findings are discussed.


Few studies have explored the Central Nervous System (CNS) infection illness trajectory among older persons with dementia in sub-Saharan African (SSA) settings. This study explored the Caregiver’s perspectives on the Central Nervous System infection illness trajectory among the older persons with dementia in Northern Uganda.This was a qualitative study conducted in Lira District northern Uganda in March 2022 amongst purposively selected 20 caregivers of the older persons aged 50 + years with a positive history of CNS infection and later life dementia. Data were collected using an in-depth interview guide. Audio recordings and field notes of the interviews were undertaken. The interviews generated data on the CNS infection illness trajectory from onset to the current demented state of the older persons. The audio-recorded interviews were transcribed verbatim before manual reflective thematic analysis.Older persons with a positive history of CNS infection illness and later life dementia in rural northern Uganda presented with symptoms of early life CNS infection illness ranging from neck pain, back pain, chronic headache, and fatigue. There were also manifestations of comorbidities particularly road traffic accidents involving traumatic injury to the head, neck, and spine, high blood pressure, chronic headache, and or their medications in the older person’s trajectory to later life dementia. A plurality of healthcare which included both formal and informal healthcare medicines was sought and utilized for the treatment and care of the CNS infection illness and dementia by the older persons amidst improper diagnosis and mismanagement.Older persons with early-life CNS infections illness and later-life dementia were reported to present with symptoms including neck pain, back pain, chronic headache, high blood pressure, and fatigue. The reported symptoms of CNS infection illness may be intertwined with co-morbidities particularly traumatic injury involving the head, neck, and spine, high blood pressure, and chronic headache. Healthcare professionals should integrate routine screening of older persons for the history of CNS infections, chronic headache, high blood pressure, trauma to the head, neck, and spine, and dementia and early treatment. Dementia is a syndrome in which there is deterioration in cognitive function beyond what might be expected from the usual consequences of biological aging . More thCentral Nervous System (CNS) infections have for decades been epidemiologically and sometimes mechanistically associated with dementia among older persons globally –11. InfeThe CNS infection may be spread from blood-borne infections, infections at sites adjacent or contiguous to the CNS such as the mastoid, sinuses or middle ear or from primary infections at more remote anatomic sites such as lungs, and heart, skin, gastrointestinal tract, or the kidneys , 12. CliTowards a Dementia Plan – A WHO guide, guidelines on risk reduction of cognitive decline and dementia, mdementia handbook, WHO mental health gap action program (mhGAP) and Towards a dementia-inclusive society – WHO toolkit for dementia friendly initiatives have insufficiently addressed CNS infection’s considerations in dementia risk reduction, prevention and care.In Uganda, there is an increasing population of older persons , 19 who Worse still, fewer previous studies investigated the CNS infection illness trajectory among older persons with probable or possible, dementia especially from sub-Saharan African (SSA) context. The few available previous studies in the SSA focused on the prevalence and risk factors for HIV-associated neurocognitive disorders including HIV-associated dementia , 21–23.An CNS infection illness trajectory is defined as the occurrence of factors, events, signs, and or symptoms with or without causative—outcome roles in the past and present life history of the older persons with possible or probable dementia. Investigations into CNS infection illness trajectory among older persons with probable or possible dementia are critical in risk reduction and prevention of severe forms of dementia through early screening, and diagnosis of persons with signs and symptoms of CNS infection illness.Lira district located in northern Uganda has an increasing population of older persons . HoweverThis study therefore explored CNS infection illness symptoms among older persons aged ≥ 50 years in Lira District northern Uganda with positive history of CNS infection illness who screened positive for probable or possible dementia with the BCSD. Notably, the definition of older persons from a seemingly early age of 50 years was used in a sister quantitative study upon which this qualitative study was piggybacked meant for screening possible or probably dementia including early onset cases as early as 50 years.This qualitative inquiry was prompted by a preceding quantitative survey which found a significant association between possible or probable dementia and positive history of CNS infection illness among older persons aged 50 + years in northern Uganda. We conducted a descriptive qualitative study . The desThe study was conducted among the key informants who were the caregivers of the older persons aged ≥ 50 years with probable or possible dementia [from the Brief Cognitive Score for Dementia scale (BCSD) screening] and a positive history of CNS infection illness. Caregivers are defined as the spouse or relative providing general home-based care for the older persons with dementia by providing support in form of house cleaning, cooking, bathing, washing, shopping, grooming, walking support and or accompaniment to the healthcare facilities among other activities of daily living. We used the maximum variation purposive sampling method to recruited 20 participants who lived the experience of being caregivers of the older persons with the phenomena under scrutiny (i.e. CNS infection illness symptoms trajectory among their relatives or partners with probable or possible dementia). This being a qualitative key informant study the variations considered during the purposive sampling of the key informants were the caregiver’s age, sex, educational level, and relationship with the older person with possible or probable dementia under their care rather than the CNS infection illness characteristics among the older persons with dementia Table . Only onThis qualitative study was piggybacked on the quantitative household survey which investigated for the association between CNS infection illness and dementia among older persons in the study setting and helped to identify participants with both positive history of CNS infection illness using a CNS infection questionnaire and probable or possible dementia using a Brief Cognitive Score for Dementia scale. From the preceding quantitative survey analysis, a total 49 older persons met the criteria of having possible or probable dementia and positive history of CNS infection illness and it provided the sampling frame for the selection of key informants for the qualitative research. The preceding quantitative household survey of older persons in northern Uganda for prevalence of dementia and its association with CNS infection illness was conducted in March 2022. It involved a sample of 434 older persons aged 50 + years in Lira district northern Uganda. The quantitative household survey found a high prevalence of possible or probable dementia (23%) among older persons aged 50 + years in northern Uganda. It also found a significant association between possible or probable dementia and positive history of CNS infection illness among older persons aged 50 + years in northern Uganda at both bivariate and multi-multivariate analysis. The quantitative survey paper is under peer review for journal publication.The selection of the study setting for this descriptive qualitative study was informed by a preceding quantitative household survey of older persons in the aforementioned 20 villages in Lira district northern Uganda for dementia among older persons and its association with CNS infection ilness. Older persons who were found to have a positive history of the CNS infection illness and dementia from the quantitative household survey were eligible for this qualitative study. The Community health extension workers (CHEWs) also known as Village Health Teams (VHTs) who enlisted the households with older persons aged ≥ 50 years for the quantitative household survey also helped to identify and locate the residential addresses of the older persons with positive history of the CNS infection illness and later life dementia.The VHTs are community health volunteers who maintain registers of all residents including older persons in their respective villages . The VHTWe conducted the face-to-face in-depth interview using an interview guide. The interview guide comprised of open-ended questions to elicit the participants account of the CNS infection illness trajectory among older persons with probable or possible dementia who were their care receivers. The interview guide was developed by the research team members informed by literature. The items in the guide were pre-tested among caregivers of the older persons who were not included in the study and improvements were made accordingly. The interview guide had three sections. The first section comprised of the socio-demographic characteristics of the study participants. The second section comprised of items for confirming the prior CNS infection illness diagnosis or the history of CNS infection illness, the characteristics and hence the types of the CNS infection illness and dementia among the older persons. The third and last section of the guide comprised of items on the CNS infection illness trajectory from onset to the current demented state of the older persons. The Research Assistants with nursing and midwifery educational background who were trained on the research protocol asked the questions in an open-ended format to elicit responses and conversations for each section of the interview guide. The interviews were conducted in the local language Luo. Interviews were conducted in private spaces within the participants’ homes. The interviews lasted for 30 to 60 min. Interviews were audio recorded. Field notes were also taken by the Research Assistants on the body language and unique circumstances around the participant at the time of data collection.The audio recorded data were transcribed verbatim by the Data Clerk. The transcripts were verified against the source audio recordings by a research team member to clarify any unclear data before permitting the Data Clerk to conduct the next transcription. Verbatim transcripts in the local language (Luo) were translated to English language before analysis. Two research team members independently coded the data and discrepancies in codes were reconciled through consultation with other research team members. We conducted a manual reflexive thematic analysis of data as they manifest from the participants in accordance with the six steps described by Braun and Clarke . FindingThe four principles of credibility, dependability, confirmability, and transferability of qualitative research were upheld to assure and maintain rigor and trustworthiness in the study. Credibility was assured by restating and summarizing points during the interviews and also by taking field notes from the interviews in addition to the audio recording . DependaWe approached the 20 purposively selected caregivers of the older persons aged ≥ 50 years to provide informed consent and all of them consented and participated in the in-depth interviews. The response rate was therefore 100%.The socio-demographic characteristics of the 20 caregivers of the older persons aged ≥ 50 years with a positive history of CNS infection illness and later life dementia in Lira District northern Uganda who participated in the study is shown in Table Some symptoms of the CNS infection illnesses surfaced at an earlier time or age of the demented person’s life. These early symptoms in terms of their earlier time of manifestation in the demented person’s life are therefore put together under the theme of presenting early symptoms of the CNS infection illness although they varied considerably in terms of the actual time of manifestations in the demented person’s life ranging from childhood, adolescence, youthful age, middle age though a few years or months ago.“The problem she had especially now that you have come to make a follow up, her main problem she used to complain of pain. This complain went on until a point that it become worse to the extent that she started forgetting a lot of things. Her major complaint was that the pain would start from the lower limbs, radiates to the waist region then to the back through her spinal cord” We explored the initially presenting symptoms of CNS infection illness among the older persons prior to being screened positive for probable or possible dementia. Many of the key informants (who were caregivers) narrated that the older persons with probable or possible dementia were always complaining of pain around the neck and the back. From these, it slowly progressed to memory loss and inability to carry on with daily activity. The experiences of neck and back pain was typified by a response from one of the study participants described below.“it all started one day as she was here on the compound winnowing sorghum when she realized her energy was getting low and she decided to go and take some rest, when I went inside to check on her after sometime I found she was struggling with breath, I tried calling her she could not respond to me I then ran to my elder brother who came and picked her and she was taken to the hospital. And another thing I know is she subjects herself into too much worry” Some key informants reported that the older persons with probable or possible dementia also complained of fatigue. This would also interfere with their ability to carry on daily activities and raised the suspicion that something was not right with their health. Some key informants went on to say that the feeling fatigue increased stress levels among the older persons. They thought the fatigue was the part of the reason as to why their relative with probable or possible dementia suffered from memory loss. One of the participants had the below to say.My relative always complained of having too much headache and sudden feeling of being very tired, it was then at that point we took her to the hospital and she was confirmed to be having illness which was said had started to affect her brain” “Some key informants pointed out chronic headaches as one of the complaints that were always raised by the older persons who were screened positive for probable or possible dementia. Chronic headache typically is due to the inflammation of the immune system secondary to the CNS infection. This continuous headache without concise remedy could have led to development of the dementia among the older persons. This was described by one participant below.The study also investigated prior conditions amongst the older persons with a positive history of CNS infection and dementia. These prior disease conditions or illnesses that co-existed in the demented persons with positive history of CNS infection illnesses were defined under the theme of manifesting co-morbidities and or their medications. The findings are presented below.“Her condition started after she had suffered an accident and hit her head on the ground. suffered two accidents in a row and after the accidents, hit her head on the ground, she started experiencing memory loss, back and body pain, victim of Goiter, shock, suffered a stroke. Half of her body was completely paralyzed for some time, and she kept suffering from the brain infection which made her forget a lot of things. Keeps getting malaria infections” Some of the key informants revealed that the older persons have been victims of road traffic accidents that led to shock and paralysis for some time. And from the accident they started experiencing signs of forgetfulness and memory loss. Traumatic tissue injury from road traffic accidents are often entry point for some of the pathogenic microbes that infect the central nervous system as many of the participants also reported that from the time their relative were involved in two rows of the accidents they started suffering from episode of CNS infection illness. This was typified by one of participants below.“What I can tell you according to my understanding about how this problem begun is she was taken to the hospital and was diagnosed with pressure and she was given medication to help control the condition, it was then when she started on medication when we realized she started having episodes of forgetfulness but this was not happening before she was put on medication. And so people started telling us it could be the side effects of the medication that she is taking to control pressure which is causing her to be acting that way” Other key informants reported that their relatives (the older persons) started experiencing episodes of forgetfulness following treatment for high blood pressure. They related the forgetfulness to the side effects of the medications they gave their relatives (the older persons) as treatment for high blood pressure. The thiazide diuretic and a calcium channel blocker (nifedipine) the two widely available and commonly prescribed antihypertensive drugs in Ugandan public health facilities were implicated by the key informants. This was exemplified by one of the key informant’s comment below.My relative always complained of having too much headache and sudden feeling of being very tired, it was then at that point we took her to the hospital and she was confirmed to be having illness which was said had started to affect her brain” “Some key informants also pointed out chronic headache as one of the complaints that were always raised by these older persons indicated for probable dementia. This could be due to the inflammatory response of the immune system to the CNS infection that triggered the headache. This continuous experiencing of headache with no concise remedy for the infection-related CNS illness could have led to development of signs dementia among the older persons aged ≥ 50 years. This is quoted by one participant.“She looks young though already aged than I am, my sister was once diagnosed with an underlying condition of high blood pressure, which I hope has made her weak and very vulnerable to CNS infections and forgetting things” Many of the key informants reported of their relatives (the older persons) being ever diagnosed with high blood pressure in addition to the diagnosis of CNS infection and dementia. The participants believed having hypertension weakened their immune system and made them vulnerable to CNS infections and developed dementia. This was exemplified by a narrative from one of the study participants below.The study explored the diagnosis, treatment and care sought and given to the older persons when experiencing the signs and symptoms of illness before the diagnosis of CNS infections and the positive screening test for dementia. Therefore, this theme of seeking and receiving of series of treatment and care without thorough checkup for CNS illnesses consolidates all the missed diagnosis, unsuccessful treatment and care sought and received by the demented persons.When the pain first started she kept visiting the hospital time and again to get medical help, she was given drugs without any thorough checkup to find the origin of the illness” “Most of the key informants reported of ever taking the older persons for medical professional care at nearby health facilities. They further narrated that during the time no clear diagnosis was done on their patients (the older persons) as the health workers provided treatment for the prevailing signs and symptoms. The delay in definitive treatment could have given time for the infections to disseminate further to CNS region and cause further pathology including dementia. The narrative was typified by a participant by the saying below.She was discharged from the hospital after spending about three weeks, and advised to continue with her treatment from home. “The doctor said that my mother was much better but needed to continue taking some medication, and as said by the doctor, to-date my mother mostly suffers only from the effect on the brain, which causes her to lose memory quite often and fail to talk or make sense out of what people are saying, this is all that she is still going through once in a while” “Some key informants narrated that their patients would get admitted in the hospitals but could not stay longer because of the treatment expenses they could not sustain admitted in the hospitals to receive the desired treatment and so gets discharged to receive further treatment from home. This prompted discharge of patients before full recovery from hospitals and receive the rest of care while at home without follow up from the health workers to assess improvements in the conditions of the patient.“The only treatment she received was local herbs that was given to her from the village and prayers that the church pastor came home and prayed when we told him of what was happening to her. We could not raise the money to pay for the drugs the doctors had prescribed for her” Some key informants also reported of their relatives (the older persons) sometimes used local herbs to treat themselves. They related this to the high financial constraints that their families could not raise to meet the cost of biomedical care. They also attached the condition of CNS infection and dementia to spirituality that did not require biomedical care and thus opted for spiritual care. This was exemplified by a narrative from a participant below.“She had only used the painkillers and antibiotics which helped her to reduce the pain. These drugs used to help her reduce the pain but was unfortunately just helping her temporarily and after sometime the pain gets triggered again and kept on increasing overtime” Some key informants reported that their patients the older persons were being treated mostly with pain killers and antibiotics. Such presumptive treatment without specificity on the type of infection the medicines are targeted at instead escalated the condition. Participants reported that the presumptive treatment would palliate temporarily and then the patient’s condition reoccurs. This was exemplified by a narrative of a participant below.We explored the challenges faced by the caregivers or family of the older persons with a positive history of CNS and probable or possible dementia while seeking the desired health care. This theme of Facing a Multitude of challenges to optimal diagnosis, treatment and care therefore consolidates all the diagnosis, treatment and care related challenges or difficulties encountered by the demented persons, their caregivers or family. The findings are described below.“She faced financial constraints and couldn’t start medication. She spent a lot of money in the tests and because of this, purchasing the prescribed medication became a little challenging for her” Many of the participants expressed the lack of money was the main reason for the failure of their patients the older persons to receive the desired care. The lack of money for care could probably be due to limited the financial support for the elderly persons in the community. The lack of money hindered them from receiving quality care from quality health facilities which offered specialized care for CNS infections. The above narrative was typified by a participant in the saying below.When the pain first started she kept visiting the hospital time and again to get medical help, she was given drugs without any thorough checkup to find the origin of the illness” “Some key informants also reported that the older persons lacked proper diagnosis in the initial stages of the infection. The inadequate or lack of diagnostic equipment’s in health facilities led to treatment of the presenting signs and symptoms without definitive understanding of the causative agents of the infection. This led to reoccurrence of the infection and long stays in hospitals. One participant narrated it as below.Old age is one problem I can say is affecting her memory because at this time she needs special attention they used to get but now they are not getting. The need someone to keep around and do for him most of the work, you can see he is even weak” “Some key informants also reported that because of the forgetful nature of these patients, if not helped and reminded to take their drugs they end up missing taking the drugs in the right time. Therefore, their patients need a full time person to take care of them, since even their treatment take longer durations. One participant had the description below to narrate.Our study explored the Central Nervous System (CNS) infection illness trajectory to dementia among the older persons with positive history of CNS infection illness and later life dementia in northern Uganda. The themes that emerged were four and they were the presentation of early symptoms of illnesses, manifestations of co-morbidities and or their medications, seeking and receiving of series of improper diagnosis, treatment and care and facing of a multitude of challenges to optimal diagnosis, treatment and care.The early symptoms of CNS infection illness among older persons with dementia that emerged from interviews of key informants included chronic headache, neck pain, back pain and fatigue. These findings concur with the findings from a previous study conducted in the United States (US) where elderly patients with CNS infection illness presented with headache, fever, neck stiffness and altered mental status . The impInterestingly, our study found the existence of comorbidities of high blood pressure, CNS infection illness and dementia among older persons with positive history of CNS infection illness and later life dementia. There is limited literature on the comorbidity of high blood pressure, CNS infection illness and dementia. Whereas previous studies have shown separate associations between CNS infection illness and high blood pressure, high blood pressure and dementia, CNS infection illness and dementia , 14, theOur study also found that some of the older persons with positive history of CNS infections and later life dementia were once victims of road traffic accidents involving traumatic injury to the head, neck or spine  developed CNS infections later in life. The road traffic accidents involving traumatic injury to the head, neck, or spine have the potential to cause breakage in surface barriers such as the skin and bones allowing pathogens from the external environment to gain entry into the CNS and cause CNS infections. These findings agree with a previous study conducted in the US where CNS infection was also found to result from trauma and fractures involving the CNS . These fThe treatment and care modalities received by the older persons with positive history of CNS infections and later life dementia in this study included a mix of biomedical care, home-based care, and local herbs. This finding concurs with findings from previous studies conducted in southwestern Uganda where caregivers or families of older persons with dementia were found to be seeking healthcare for their patient with dementia from both formal and informal care providers . The simOur study also found that pain killer was among the treatment for pain management among the older persons with probable or possible and positive history of CNS infections. This could be as a result of pain being reported to be among the symptom of CNS infection the older persons with possible or probable dementia experience. This finding is in conformity with previous studies were analgesic were also reported among the medication for pain management among older patients with dementia , 17. TheOur study in northern Uganda further found that older persons with history of CNS infection and dementia in later life used local herbs as one of the treatment and care modality for the neurological conditions. These results is in conformity with the previous studies were plant-based medicines were found to be the most frequently sought and used mode of treatment for a number of CNS disorders , 19. TheOur study found that poverty was one of the challenges hindering the older persons from obtaining timely and optimal health care for both the early CNS infections and the dementia in later life. As many of the caregivers made mention of their family’s inability to raise funds for carrying out diagnostic tests and procuring the drugs as prescribed by the healthcare professionals. This result concurs with the previous study conducted in South Africa where poverty and financial stress were highlighted as the most common barrier to providing care for older persons with dementia –22. ThesOur study in northern Uganda also revealed that patients with positive history of CNS infections and later life dementia encounter a series of missed diagnosis and mismanagements of their neurological conditions. This was probably due to the lack of equipped medical laboratories in most of the healthcare settings in northern Uganda being a post armed conflict area. These results conforms with findings in previous studies, were late diagnosis and syndromic approaches are used to treat CNS illness among older persons . The finLastly, our study in northern Uganda unearthed the need for government and partners to consider policies and mechanisms of care for older persons including those with the positive history of CNS infections and later life dementia to address their long course of treatment and care needs. The long time for treatment and care needs of the older persons with a positive history of CNS infections and later life dementia put their families not only in financial distress but also in emotional discomfort. Our findings conform to the findings of previous studies where caregivers were faced with similar challenges of a long course of treatment and extended hours of caring for the persons with dementia , 23. TheThe current study in northern Uganda did not conduct laboratory investigations on the participants to confirm the positive history of the CNS infection illness. This was however addressed by obtaining additional data on the CNS infection illness from the past medical discharge forms of the participants. The natures of the CNS infection illnesses were written in the medical records as laboratory results or medical diagnosis for example ‘Cryptococcal meningitis’ although some of them were based on clinical history and physical examinations. Also, control for potential confounders for the association between CNS infection illness and dementia such as traumatic injuries were not possible in the qualitative research design but are well controlled for in the preceding quantitative study in the same setting which investigated the prevalence of CNS infections among older persons and its association with dementia among older persons in northern Uganda. Additionally, key informants who were caregivers of the index participants were the ones involved to provide data about the CNS infection trajectory to dementia of the index participants. The concurrent manifestations of multiplicity of symptoms in older persons made it not possible to examine what symptoms or comorbid conditions led to which type of treatment seeking. The reflexive thematic analysis of data as they manifest from participants resulted in multiple symptoms and factors with or without proven causative relations to possible or probable dementia.Older persons with the positive history of CNS infection illness and later life dementia in rural northern Uganda were reported to present with symptoms of early life CNS infection illness ranging from neck pain, back pain, chronic headache, and fatigue. There were also reports of comorbidities particularly road traffic accidents involving traumatic injury to the head, neck, and spine, high blood pressure, chronic headache, and or their medications in the older person’s trajectory to later life dementia. A plurality of healthcare which included both formal and informal healthcare medicines were reported to be sought and utilized for the treatment and care of the CNS infection illness and the dementia without thorough checkup for the CNS infection illness. Sticking out were the reported challenges of poverty, and long course of treatment and care for the older persons with positive history of CNS infection illness and dementia which requires government interventions in the form of policies and mechanisms for funding of institutions or agencies to facilitate care for the older persons. Health professionals should conduct routine screening of older patients for history of CNS infection illness, chronic headache, high blood pressure, history of traumatic injuries to the head, neck and spine and their proper management to reduce the likelihood of dementia in later life. Further research with case–control or retrospective cohort design is recommended to characterize the trajectory of CNS infection illness to dementia including the time, duration and comorbidities among others.


In 2020, Afghanistan supplied around 85% of the world's heroin. The recent Taliban takeover and political upheaval seems highly likely to impact the supply chain, but how? This literature review aims to explore the background of heroin production and possible consequences of the recent conflict, both for suppliers and for end users.In addition to recent mainstream media news articles on the Afghanistan conflict, PubMed search terms “heroin adulteration” were used to find 202 results. Only results published from the year 2000 onwards were examined for relevance, leaving 160 results. These were reviewed for relevance and led to suggestions of similar PubMed articles to arrive at the final 23 sources used.Studies of previous heroin shortages in Australia and the UK are discussed to gain insight into the potential effects of a future shortage. A reduction in heroin exports from Afghanistan would cut down the supply to most nations excluding North and South America. Sources of evidence for our current understanding of the supply chain are examined. Specific US and UK policy failure which led to the current situation is also provided for context.Methods of production in Afghanistan and smuggling routes are also examined to help predict impending changes.Given the number of factors involved it is difficult to anticipate with much certainty how the Taliban takeover of Afghanistan will affect the global heroin trade, but based on the available literature it seems more likely that this will cause shortages rather than an increased supply.Clinicians should be aware that in line with previous shortages, this may cause a shift towards increased rates of polysubstance use in regular heroin users. We may also see a rise in incidents of harm from heroin adulteration with substances other than the currently widespread paracetamol and caffeine.


The authors regret that the title shown in the original article was incorrect. The correct title should read as follows:Preparation of superhydrophobic surfaces with micro/nano hierarchical structures by nanoimprinting using anodic porous alumina molds.The Royal Society of Chemistry apologises for these errors and any consequent inconvenience to authors and readers.