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Barriers to 12-month treatment of common anxiety, mood, and substance use disorders in the World Mental Health (WMH) surveys
Get PDFBackground: High unmet need for treatment of mental disorders exists throughout the world. An understanding of barriers to treatment is needed to develop effective programs to address this problem. Methods: Data on barriers were obtained from face-to-face interviews in 22 community surveys across 19 countries (n = 102,812 respondents aged ≥ 18 years, 57.7% female, median age [interquartile range]: 43 [31–57] years; 68.5% weighted average response rate) in the World Mental Health (WMH) surveys. We focus on the n = 5,136 respondents with 12-month DSM-IV anxiety, mood, or substance use disorders with perceived need for treatment. The n = 2,444 such respondents who did not receive treatment were asked about barriers to receiving treatment, whereas the n = 926 respondents who received treatment with a delay were asked about barriers leading to delays. Consistent with previous research, we distinguished five broad classes of barriers: low perceived disorder severity, two types of barriers in the domain of predisposing factors (beliefs/attitudes about treatment ineffectiveness and stigma) and two types in the domain of enabling factors (financial and nonfinancial). Baseline predictors of receiving treatment found in a prior report (i.e., comparing the n = 2,692 respondents who received treatment with the n = 2,444 who did not) were examined as predictors of barriers, while barriers were examined as mediators of associations between these predictors and treatment. Results: Most respondents reported multiple barriers. Barriers among respondents who did not receive treatment included low perceived severity (52.9%), perceived treatment ineffectiveness (44.8%), nonfinancial (40.2%) and financial (32.9%) barriers in the domain of enabling factors, and stigma (20.6%). Barriers causing delays in treatment had a similar rank-order but were reported by higher proportions of respondents (X 2 1 = 3.8–199.8, p = 0.050− < 0.001). Barriers were predicted by low education, disorder type, age, employment status, and financial obstacles. Predictors varied as a function of barrier type. Conclusions: A wide range of barriers to treatment exist among people with mental disorders even after a need for treatment is acknowledged. Most such individuals have multiple barriers. These results have important implications for the design of programs to decrease unmet need for treatment of mental disorders.</p
Associations of Prenatal Mercury Exposure and PUFA with Telomere Length and mtDNA Copy Number in 7-Year-Old Children in the Seychelles Child Development Nutrition Cohort 2
Get PDFTelomere length (TL) and mitochondrial DNA copy number (mtDNAcn) variations are linked to age-related diseases and are associated with environmental exposure and nutritional status. Limited data, however, exist on the associations with mercury exposure, particularly early in life. We examined the association between prenatal mercury (Hg) exposure and TL and mtDNAcn in 1,145 Seychelles children, characterized by a fish-rich diet. Total mercury (THg) was determined in maternal hair at delivery and cord blood. TL and mtDNAcn were determined relative to a single-copy hemoglobin beta gene in the saliva of 7-y-old children. Linear regression models assessed associations between THg and relative TL (rTL) and relative mtDNAcn (rmtDNAcn) while controlling for maternal and cord serum polyunsaturated fatty acid (PUFA) status and sociodemographic factors. Interactions between THg and child sex, PUFA, and telomerase genotypes were evaluated for rTL and rmtDNAcn. Higher THg concentrations in maternal hair and cord blood were associated with longer rTL [ ; 95% confidence interval (CI): 0.002, 0.016 and ; 95% CI: 0.001, 0.003, respectively], irrespective of sex, PUFA, or telomerase genotypes. Maternal serum n-6 PUFA and n-6/n-3 ratio were associated with shorter [ ; 95% CI: , and ; 95% CI: , , respectively] and PUFA with longer ( ; 95% CI: 0.032, 0.65) rTL. Cord blood n-6 PUFA was associated with longer ( ; 95% CI: 0.050, 0.26) rTL. Further analyses revealed linoleic acid in maternal blood and arachidonic acid in cord blood as the main drivers of the n-6 PUFA associations. No associations were observed for THg and PUFA with rmtDNAcn. Our results indicate that prenatal THg exposure and PUFA status are associated with rTL later in childhood, although not consistently aligned with our initial hypothesis. Subsequent research is needed to confirm this finding, further evaluate the potential confounding of fish intake, and investigate the underlying molecular mechanisms to verify the use of rTL as a true biomarker of THg exposure. https://doi.org/10.1289/EHP14776
Sugar Reduction Strategies in Sponge Cake: Impact on Sensory Properties and Consumer Perceptions
Get PDFReducing sugar in food products for food manufacturers causes many challenges. However, food product reformulation must have minimal changes in sensory attributes to ensure consumer acceptability. One product of focus within the “sugar reduction strategy” is cakes. This study aims to (1) determine sensory evaluation comparison of control (31% sugar), reduced sugar (25% sugar) and sugar-replaced cake samples (18% sugar) and (2) identify consumers’ perceptions of acceptability of cake portions. Cakes were prepared using eggs, self-raising flour, cake margarine, water, baking powder, caster sugar and sugar replacer (where applicable). The cake batter was portioned into bun cases 20–25 g, then baked in an oven at 180°C for 8–10 min, cooled and frozen before sensory evaluation. Participants were recruited via email, word of mouth and social media platforms whereby, they were invited to take part to taste cakes containing sugar alternatives and offer opinions on cake consumption and portion sizes. Participants, aged 18+ years were recruited from Loughry Campus (n = 58) and Ulster University (n = 32) and presented with four blinded samples (1: control, 2: reduced sugar, 3: inulin sweetener, and 4: carbohydrate blend sweetener-replaced cakes, with 31, 25 and 18% sugar, respectively) in randomised order. Participants were asked to evaluate the samples on a hedonic scale of 1 to 9 (1: dislike extremely to 9: like extremely) for appearance, aroma, taste, texture, sweetness, and overall acceptability. The texture of the cake samples (n = 9) was analysed through a texture analyser (TA; XT plus 100C). The sensory evaluation showed the most preferred cake sample was the control (35.2%) with the carbohydrate blend sugar-replaced sample being the least (15.4%). A significant difference was found within the attributes of appearance, texture, sweetness, and overall acceptability between the cake samples. The highest-ranked cake sample for the attributes was the control sample, except for appearance whereby the reduced sugar sample was higher, but not significantly different. The overall acceptability had no significant difference between control, reduced sugar, and inulin, but the carbohydrate blend sample was significantly different (P = 0.025). The texture attribute for the control cake had the highest likability (6.44) and was significantly different to the carbohydrate blend sugar-replaced cake sample (P = 0.026) but had no difference from the other cake samples. There was no difference between the texture analyser results between the cake samples. A significant difference was found in portion control visuals presented to participants of three different portion weights of cake, 55, 100, and 150 g, and the most selected for acceptability was 55g (67.8%)
Idiopathic pulmonary fibrosis in the UK: findings from the British Thoracic Society UK Idiopathic Pulmonary Fibrosis Registry
Get PDFObjectives Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease (ILD) and the most common idiopathic interstitial pneumonia. The UK IPF Registry was established in 2013 to collect data pertaining to clinical features, therapeutic approaches and outcomes. From February 2023, the Registry expanded to include any ILD with evidence of fibrosis.Design The UK IPF Registry is a national, multicentre observational registry, including both prospective and retrospective data of patients with IPF in secondary or tertiary care. Cases eligible for inclusion were those with a diagnosis of IPF, presenting at participating centres from January 2013.Results Between January 2013 and February 2023, 5052 IPF cases were registered from 64 participating centres. There was a male preponderance (77.8%) with mean±SD age of 74±8.1 years, 66% were ex-smokers and 76% had at least one comorbidity. Over a third (36.7%) experienced symptoms for more than 24 months prior to their first clinic visit. The majority of cases were discussed at a multidisciplinary team (MDT) meeting and the most common radiological patterns at presentation were probable (54.6%) and definite (42.7%) usual interstitial pneumonia. There was a reduction in surgical lung biopsies from 14% in 2013 to 5.5% in 2022. Antifibrotic therapy prescription rose from 36.0% in 2013 to 55.9% in 2023. The use of nintedanib (approved by National Institute of Clinical Excellence in January 2016) rose from 6.7% in 2013 to 31.5% in 2022 and pirfenidone (approved in April 2013) was initially used in around a third of cases before dropping to between 16.8% and 24.9% after nintedanib was approved.Conclusion These data reflect clinical practice across the UK and it is intended the data will have a role in informing the future of IPF care and providing a model for benchmarking, ultimately increasing knowledge and improving clinical care for this devastating disease
Revolutionising Digital Marketing Education with Generative Artificial Intelligence Integration: An Asynchronous Approach †
Get PDFThe discipline of marketing has seen a significant shift toward the use of AI over the past 10 years, with generative AI such as ChatGPT exponentially accelerating the impact of this technology due to its accessibility and relevance in helping meet organisational and practitioners’ objectives. The objective of this project was to innovatively incorporate generative pretrained transformers (GPTs) into digital marketing education as a means of asynchronously exposing learners to advances in this domain but also provide insights into managing AI use in this field more effectively. This pilot study focused on supporting tourism enterprises in less developed countries (LDCs), specifically Botswana, Uganda, and Zambia.<br/
Artificial Intelligence and evidence for social work: Will a robot steal your job?
Get PDFArtificial intelligence (AI) is widely used to support decision making and interventions, arguably saving time, reducing bias and improving decision accuracy. The profession must urgently appraise the potential and pitfalls of this rapidly developing technology. This challenge was addressed at the 2024 European Social Work Research Association conference in Vilnius, at which the Evidence into Practice Special Interest Group focused on three contemporary AI developments: (1) large language models (LLMs); (2) AI- and robot-supported interventions; and (3) predictive risk modelling (PRM). This short ‘Reflection, exchange and dialogue’ article outlines the presentations, issues discussed and further reflections. Although LLMs have an impressive ability to manipulate language, essential case detail and analysis remain human tasks. There are robot technologies already helping people in the domains of disability and eldercare, and AI ‘language robots’ are being used favourably in low-risk mental health contexts, providing a non-judgemental (non-human) and ever-available ‘listener’ and ‘advisor’. PRMs raise many conflicting views. The ‘black box’ of AI may ‘hide’ systemic bias, though proponents argue that humans are biased too, so perfection is not an appropriate comparator. Our conclusion is that a priority is to examine, shape and regulate the interface between humans and computer algorithms
Snippet-based result merging in federated search
Get PDFIn federated search, the central broker simultaneously forwards the search query to multiple resources. The returned results from those resources are then merged into a single ranked list. An autonomous resource in a federated search system usually does not provide scores for the retrieved documents; even if some of them do, scores from different resources are incomparable due to the heterogeneity in many aspects of those resource involved such as retrieval models and corpus statistics. Many results merging approaches have been proposed in the literature to deal with this problem. However, to the best of our knowledge, none of them has utilised snippets. This article proposes a snippet-based weighting scheme for the query terms involved. It quantifies the importance of each query term from two angles: the frequency of the term and the part in which the term occurs inside a snippet. Three parts – which are URL, title, and description – are given different weights. Experiments are conducted with the TREC 2013 FedWeb data set. The results show that the proposed methods consistently outperform several baseline models. We also find in many instances, a further small slight performance improvement is achievable by an extra measure of weighting each of the resources involved, which can be done in the phase of resource selection.</p
Living on the edge: how do perceptions of coastal erosion risk affect residential mobility decisions?
Get PDFThis paper explores the experiences of households affected by coastal erosion. In England alone 82,000 properties are predicted to be at risk by 2100. The paper advances the understanding of the effects of coastal erosion upon residential mobility decision-making, via interviews with residents living in areas of coastal risk along the Holderness Coast in the UK, the fastest eroding coastline in Europe. The research illustrates that whilst moves into the areas at risk are seemingly irrational, they are in fact the result of upon intuitive and individual judgments of perception of risks and benefits. Participants report the negative impacts of erosion in the study area (e.g. loss of physical infrastructure), yet it was also clear they derived many benefits from living within the study area, including the appreciation of the seascape and access to natural amenities. There was also a strong emotional connection associated with the Holderness Coast meaning that many participants were unwilling to move away. For some, the negative impact upon house prices meant some household’s financial resources could not support a move away from risk, for others the benefit of a discounted home served to encourage a move into the area, despite the presence of risk. The evidence has several implications for the management of coastal erosion. Whilst outright compensation is not advocated in this paper, there is a clear need for additional support for relocation, which should include financial support for roll-back and provision of appropriate and suitability located alternative accommodation, particularly for lower-income households.HighlightsAmenity benefits and attachment to coastal areas can outweigh perceptions of the risk of coastal erosion.Low house prices due to coastal erosion can attract individuals to move to areas at risk.Lack of financial and practical support as well as place attachment can prevent or discourage households to move away from risk.Physical decline and perceptions of unfairness regarding coastal management can foster mistrust between local institutions and residents
Theranostics for Neuroblastoma: Making Molecular Radiotherapy Work Better
Get PDFDespite improvements in neuroblastoma treatment, survival figures lag behind those of many other childhood malignancies. New treatments, and better use of existing treatments, are essential to reduce mortality. Neuroblastoma expresses several molecular targets for radionuclide imaging and therapy, of which the most widely exploited is the norepinephrine transporter. [ 123I]metaiodobenzylguanidine (MIBG) imaging and [ 131I]MIBG treatment, which target this physiologic pathway, have been in clinical practice for 40 y. Although therapy outcomes have been favorable, [ 131I]MIBG use has not yet been optimized. Somatostatin receptors and the disialoganglioside are alternative targets, but their use remains experimental. The charity Children's Cancer Research Fund organized a workshop bringing together a broad range of scientists including radiochemists, radiobiologists, radiation physicists, clinical researchers including pediatric oncologists and nuclear medicine physicians, and patient advocates from the United Kingdom, United States, and continental Europe to share their experiences with molecular imaging and radiotherapy of neuroblastoma and discuss potential ways of improving treatment outcomes and access. These include development of alternative vectors targeting somatostatin receptors and disialoganglioside, isotopes such as α-particle and Auger electron emitters with different radiation characteristics, and combinations with external-beam radiotherapy, immunotherapy, and DNA damage repair inhibitors. Barriers to progress discussed included the unpredictable radioisotope supply, production of novel radiopharmaceuticals, lack of data regarding which are the best combination therapies, and insufficient clinical facilities. The aim was to stimulate the development and assessment of more effective treatments. </p
