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Multi-dimensional well-being associated with economic dependence on ecosystem services in deltaic social-ecological systems of Bangladesh
No full textWhile the benefits humans gain from ecosystem functions and processes are critical in natural resource-dependent societies with persistent poverty, ecosystem services as a pathway out of poverty remains an elusive goal, contingent on the ecosystem and mediated by social processes. Here we investigate three emerging dimensions of the ecosystem services-poverty relationship: economic contribution of provisioning ecosystem services to the household livelihood mix; social-ecological systems producing different bundles of ecosystem services; and material wealth versus reported life satisfaction. We analyse these relationships in Bangladesh, using data from a bespoke 1586-household survey, stratified by seven social-ecological systems in the delta coastal region. We create poverty lines to ensure comparability with traditional poverty measures that overlook environmental factors and subjective measurements of well-being. We find that any contribution of ecosystem services-based income to the livelihood mix decreases the likelihood of the incidence of poverty, and of individuals reporting dissatisfaction. We find no relationship between the incidence of material poverty and the specific social-ecological systems, from agriculture to fisheries-dominated systems. However, the probability of the household head being dissatisfied was significantly associated with social-ecological system. Individuals living in areas dominated by export-oriented shrimp aquaculture reported lower levels of life satisfaction as an element of their perceived well-being. These results highlight the need for social policy on poverty that accounts for the diversity of outcomes across social-ecological systems, including subjective as well as material dimensions of well-being. National poverty reduction that degrades ecosystem services can have negative implications for the subjective well-being of local populations
Functional Neurological Disorders: Current Concepts in Diagnosis and Treatment
No full textImportance: Functional neurological disorders (FND) are common sources ofdisability in medicine. Patients have often been misdiagnosed for years, correctlydiagnosed late, and subject to poorly delivered diagnoses that prevent diagnosticunderstanding and lead to inappropriate treatments, iatrogenic harm, unnecessary and costly evaluations, and poor outcomes.Observations: “Functional Neurological Symptom Disorder/Conversion Disorder” was adopted by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), replacing psychogenic with functional in the diagnostic labeling and removing the former criterion of psychological stress as prerequisite for FND. A diagnosis can now be made in an inclusionary manner by identifying neurological signs that are specific to FND, without reliance on presence or absence ofpsychological stressors or “suggestive” historical clues. The new model of FND highlights a wider range of past sensitizing events such as physical trauma, medical illness, or (psycho)physiological events. In this model, strong ideas and expectations about these events correlate with abnormal predictions of sensory data and body- focused attention. Neurobiological abnormalities include hypoactivation of thesupplementary motor area and relative disconnection with areas that select/inhibit movements and are associated with a sense of agency. Promising evidence has accumulated for the benefit of specific physical rehabilitation and psychological interventions alone or in combination, but controlled trial evidence remains limited. Conclusions and Relevance: FND are a neglected but potentially reversible source of disability. Further research is needed to determine the dose and duration of various interventions, the value of combination treatments and multidisciplinary therapy, and the patients best suited for each therapeutic modality. <br/
Genome-wide transcriptome analysis identifies novel dysregulated genes implicated in Alzheimer’s pathology
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Post-Traumatic Growth amongst UK Armed Forces personnel who deployed to Afghanistan and the role of combat injury, mental health and pain: The ADVANCE cohort study
No full textBackground: Post-Traumatic Growth (PTG) is a positive psychological consequence of trauma. The aims of this study were to investigate whether combat injury was associated with deployment-related PTG in a cohort of UK military personnel who deployed to Afghanistan, and whether Post-Traumatic Stress Disorder (PTSD), depression and pain mediate this relationship.Methods: 521 physically injured (n=138 amputation; n=383 non-amputation injury) and 514 frequency-matched uninjured personnel completed questionnaires including the deployment-related Post-Traumatic Growth Inventory (DPTGI). DPTGI scores were categorised into tertiles of: no/ low (score 0-20), moderate (score 21-34) or a large (35-63) degree of deployment-related PTG. Analysis was completed using generalised structural equation modelling.Results: A large degree of PTG was reported by 28.0% (n=140) of the uninjured group, 36.9% (n=196) of the overall injured group, 45.4% (n=62) of amputee and 34.1% (n=134) of the non-amputee injured subgroups. Combat injury had a direct effect on reporting a large degree of PTG (Relative Risk Ratio (RRR) 1.59 (95% Confidence Interval (CI) 1.17, 2.17)) compared to sustaining no injury. Amputation injuries also had a significant direct effect (RRR 2.18 (95% CI 1.24, 3.75)), but non-amputation injuries did not (RRR 1.35 (95% CI 0.92, 1.93)). PTSD, depression and pain partially mediate this relationship, though mediation differed depending on injury subtype. PTSD had a curvilinear relationship with PTG, whilst depression had a negative association and pain had a positive association.Conclusions: Combat injury, in particular injury resulting in traumatic amputation, is associated with reporting a large degree of PTG. <br/
The Challenge of Managing Multimorbid Atrial Fibrillation: a pan-European EHRA member survey of current management practices and clinical priorities:EHRA PATH survey
No full textAims: As part of the EHRS-PATHS study examining comorbidities in Atrial Fibrillation across Europe, the aim was (i) to evaluate how multimorbidity is currently addressed by clinicians during AF treatment to characterize the treatment structure and (ii) to assess how the interdisciplinary management of multimorbid AF is currently conducted.Methods: An online survey was distributed amongst EHRA members in Europe that included 21 questions and free-text option for comments on detection, assessment and management of AF-related comorbidities. Results: A total of 451 responses were received with 339 responses eligible for inclusion. Of these, 221 were male (66%), 300 (91.5%) were physicians and 196 (57.8%) were working in academic university teaching hospitals. Half of the respondents managed between 20 to 50 patients per month with multimorbid AF. Varying rates of specialist services and referral to these services were available at each location (e.g. heart failure and diabetes), with a greater number of specialist services available at academic university teaching hospitals compared to non-teaching hospitals(e.g. anticoagulation 92 (47%) vs 50 (35%), p<0.03). Barriers to referring to specialist services for AF comorbidities included lack of integrated care model (n=174, 51%), organisational or institutional issues (n=145, 43%) and issues with patient adherence (n=126, 37%) highlighting the need for organisational restructuring and developing an integrated collaborative evidenced-based approach to multimorbid AF care. Conclusion: The survey and analyses of free-text comments demonstrated the need for systematic, integrated management of AF-related comorbidities and these results will inform the next phases of the EHRA-PATHS study. <br/
The Role of Low Subcortical Iron, White Matter Myelin, and Oligodendrocytes in Schizophrenia:A Quantitative Susceptibility Mapping and Diffusion Tensor Imaging Study
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