Disaster-induced migration types and patterns, drivers, and impact: A union-level study in Bangladesh

Environmental shocks like disasters are reported to induce migration in different parts of the world. Bangladesh has been witnessing migration across the years, but the underlying mechanism of disaster-induced migration needs to be explored and understood with changing climate conditions. The main objective of this study is to evaluate disaster-induced migration types and patterns, the auxiliary drivers and the perceived impact of migration. A semi-structured questionnaire survey was carried out with 155 Union-level key persons from five districts of Bangladesh, and collected qualitative data were thematically analyzed using NVivo. Irrespective of the type of disaster, the major spatial-temporal pattern of migration was perceived to be temporary domestic migration from rural to urban areas. Comparing the auxiliary drivers of migration revealed some common economic drivers. The comparison diagram also identifies several other drivers which are disaster-specific. For e.g., social, demographic, and physical drivers are perceived to drive migration in cyclone-affected areas, while environmental drivers (land degradation, scarcity of safe drinking water, changes in soil condition, etc.) are the primary drivers behind migration in saline-affected areas. Regarding impacts, though household economic status is perceived to get better post-migration, loss of traditions and cultural value, loss of social ties, and loss of security are identified as some of the negative impacts of disaster-induced migration. The current study emphasizes that a migration policy as an umbrella policy may mask the local challenges and community requirements and argues for the need of a disaster-specific migration policy that addresses disaster-induced challenges encountered by local communities

The Effects of Internet on Rural-to-Urban Migrating Intentions of Young Villagers: Evidence from Rural Indonesia

Indonesian’s government attempts to build internet infrastructure covering all rural areas of which most internet users are young. Youths refer to a generation who intuitively able to operate internet device and are supposed to take an important decision about their future careers, occupations, and living places. This study aimed to identify effects of internet on rural-to-urban migrating intentions of rural youths. The Structural Equation Model-Partial Lease Square (SEM-PLS) approach was applied. This study involved 866 of 15 to 24 years villagers of Tumpukrenteng Village, Malang Regency. This village reflects an ordinary village which is characterized high rural-to-urban migration. A randomized of 213 respondents were taken but 193 respondents were analyzed due to internet users. The independent variables covered internet infrastructure, internet usage, collecting information on prospective destination activity, and the dependent variable covered migrating intention. The results demonstrated that internet accelerated young villagers’ rural migrating intention. Internet allowed their users to access information of prospective destination. This research suggested young villagers to apply internet into economic benefits activity, such as e-commerce and to reduce adverse impacts of internet usage and rural youth’s emigration

Association between the examination rate of treatment-resistant schizophrenia and the clozapine prescription rate in a nationwide dissemination and implementation study

Background: The decision to initiate clozapine treatment should be made on an individual basis and may be closely related to the early detection of treatment-resistant schizophrenia (TRS), although there is evidence that the early use of clozapine results in a better response to treatment. Therefore, we investigated the relationship between the examination rate of TRS and the prescription rate of clozapine. Methods: After attending a 1-day educational program on schizophrenia based on the "Guidelines for the Pharmacological Treatment of Schizophrenia," we asked the participating facilities to submit records of whether or not TRS was evaluated for each patient. We calculated the clozapine prescription rate from the schizophrenic patients prescribed clozapine and all of the schizophrenic patients. Forty-nine facilities in 2017 were included in the study. Results: There were dichotomous distributions in the examination rate of TRS and a non-normal distribution in the prescription rate of clozapine. There was a significant correlation between the prescription rate of clozapine and the examination rate of TRS (r s = 0.531, P = 1.032 × 10−4). A significant difference was found in the prescription rate of clozapine between the three groups of facilities according to the examination rate of TRS. Conclusion: As a preliminary problem for the use of clozapine, in Japan, the examination rate of TRS varies, and there are many facilities that typically do not consider the possibility of TRS; this trend leads to a low rate of clozapine use. Clearly, further clinician training is needed for the early detection and appropriate management of TRS that includes an explanation of TRS and how to introduce clozapine therapy to patients and their families

Improvements in the degree of understanding the treatment guidelines for schizophrenia and major depressive disorder in a nationwide dissemination and implementation study

Background: To implement clinical practice guidelines (CPGs), it is necessary for psychiatrists to deepen their understanding of the CPGs. The Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project is a nationwide dissemination and implementation study of two sets of CPGs for schizophrenia and major depressive disorder (MDD). Methods: A total of 413 psychiatrists (n = 212 in 2016; n = 201 in 2017) learned the two CPGs in the education program of the EGUIDE project, and clinical knowledge of these CPGs was evaluated at baseline and after the programs. To improve the correct answer rate for clinical knowledge after the programs, we revised the lecture materials associated with items that had a low correct answer rate in 2016 and used the revised lecture materials with the CPGs in 2017. The rates of correct answers after the programs between the 2016 and 2017 groups were compared. Results: The correct answer rate of one item on the schizophrenia CPG and one item on the MDD CPG tended to be improved (S-D5 and D-C6) and that of one on the MDD CPG was significantly improved (D-D3, P = 0.0008) in the 2017 group compared to those in the 2016 group. Conclusions: We reported improvements in clinical knowledge of CPGs after the EGUIDE program in the 2017 group following revision of the lecture materials based on results from the 2016 group. These attempts to improve the degree of understanding of CPGs may facilitate the successful dissemination and implementation of psychiatric guidelines in everyday practice

Clozapine and Antipsychotic Monotherapy

Background: Although clozapine is effective for treatment-resistant schizophrenia (TRS), the rate of clozapine prescription is still low. Whereas antipsychotic monotherapy is recommended in clinical practice guidelines, the rate of antipsychotic polypharmacy is still high. There is little evidence on whether a clozapine prescription influences changes in the rate of monotherapy and polypharmacy, including antipsychotics and other psychotropics. We therefore hypothesized that the rate of antipsychotic monotherapy in patients with TRS who were prescribed clozapine would be higher than that in patients with schizophrenia who were not prescribed clozapine. Methods: We assessed 8306 patients with schizophrenia nationwide from 178 institutions in Japan from 2016 to 2019. We analyzed the psychotropic prescription data at discharge in patients diagnosed with TRS and with no description of TRS (ND-TRS) based on the diagnosis listed in the discharge summary. Results: The rate of antipsychotic monotherapy in the TRS with clozapine group (91.3%) was significantly higher than that in the TRS without clozapine group (45.9%; P < 2.0 × 10−16) and the ND-TRS without clozapine group (54.7%; P < 2.0 × 10−16). The rate of antipsychotic monotherapy without any other concomitant psychotropics in the TRS with clozapine group (26.5%) was significantly higher than that in the TRS without clozapine group (12.6%; P = 1.1 × 10−6) and the ND-TRS without clozapine group (17.0%; P = 5.9 × 10−6). Conclusions: Clozapine prescription could be associated with a high rate of antipsychotic monotherapy. Patients will benefit from the correct diagnosis of TRS and thus from proper clozapine prescription

White matter microstructural alterations across four major psychiatric disorders : mega-analysis study in 2937 individuals

Identifying both the commonalities and differences in brain structures among psychiatric disorders is important for understanding the pathophysiology. Recently, the ENIGMA-Schizophrenia DTI Working Group performed a large-scale meta-analysis and reported widespread white matter microstructural alterations in schizophrenia; however, no similar cross-disorder study has been carried out to date. Here, we conducted mega-analyses comparing white matter microstructural differences between healthy comparison subjects (HCS; N = 1506) and patients with schizophrenia (N = 696), bipolar disorder (N = 211), autism spectrum disorder (N = 126), or major depressive disorder (N = 398; total N = 2937 from 12 sites). In comparison with HCS, we found that schizophrenia, bipolar disorder, and autism spectrum disorder share similar white matter microstructural differences in the body of the corpus callosum; schizophrenia and bipolar disorder featured comparable changes in the limbic system, such as the fornix and cingulum. By comparison, alterations in tracts connecting neocortical areas, such as the uncinate fasciculus, were observed only in schizophrenia. No significant difference was found in major depressive disorder. In a direct comparison between schizophrenia and bipolar disorder, there were no significant differences. Significant differences between schizophrenia/bipolar disorder and major depressive disorder were found in the limbic system, which were similar to the differences in schizophrenia and bipolar disorder relative to HCS. While schizophrenia and bipolar disorder may have similar pathological characteristics, the biological characteristics of major depressive disorder may be close to those of HCS. Our findings provide insights into nosology and encourage further investigations of shared and unique pathophysiology of psychiatric disorders

EGUIDE project and treatment guidelines

Background Clinical practice guidelines for schizophrenia and major depressive disorder have been published. However, these have not had sufficient penetration in clinical settings. We developed the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project as a dissemination and education programme for psychiatrists. Aims The aim of this study is to assess the effectiveness of the EGUIDE project on the subjective clinical behaviour of psychiatrists in accordance with clinical practice guidelines before and 1 and 2 years after participation in the programmes. Method A total of 607 psychiatrists participated in this study during October 2016 and March 2019. They attended both 1-day educational programmes based on the clinical practice guidelines for schizophrenia and major depressive disorder, and answered web questionnaires about their clinical behaviours before and 1 and 2 years after attending the programmes. We evaluated the changes in clinical behaviours in accordance with the clinical practice guidelines between before and 2 years after the programme. Results All of the scores for clinical behaviours in accordance with clinical practice guidelines were significantly improved after 1 and 2 years compared with before attending the programmes. There were no significant changes in any of the scores between 1 and 2 years after attending. Conclusions All clinical behaviours in accordance with clinical practice guidelines improved after attending the EGUIDE programme, and were maintained for at least 2 years. The EGUIDE project could contribute to improved guideline-based clinical behaviour among psychiatrists

How Social Media Can Foster Social Innovation in Disadvantaged Rural Communities

Social innovation has received widespread attention in the rural development field, especially its contribution to future rural sustainability. Social innovation revolves around social networks. Rural areas, however, can be relatively disadvantaged by their geographical peripherality. Social media, therefore, has strong potential to foster social innovation by enabling remote communication, but in rural areas, social media use may be low because of an aging and decreasing population. This study examined community-level adoption and use of social media in rural areas in Japan, with a focus on Facebook, for the purpose of sharing community information and facilitating networking with a variety of actors to promote rural social innovation. The study involved a comprehensive search and case studies targeting 139,063 rural communities and 10,922 rural joint-communities, all of which are legally designated agricultural communities throughout Japan. The search found that disadvantaged rural communities&#8217; adoption of Facebook was scarce, and most of the communities that had adopted Facebook did not expand their social networks. Furthermore, investigation into the communities that had adopted social networking to a larger extent revealed that external supporters or migrants had essential roles in successful networking. Based on the obtained findings, this study has provided insights for future policy design

Analyzing the association between disaster risk preparedness and environmental consciousness of small and medium-sized enterprises: The case of Sukagawa City, Fukushima Prefecture, Japan

This study aims to clarify the relation between preparedness status and the local natural resource conservation of small and medium-sized enterprises (SMEs). SMEs are key actors in sustainable development and local disaster risk reduction. To ensure the quick recovery of business, SMEs are expected to formulate a Business Continuity Plan (BCP). However, the rate of formulation has thus far not been very high among SMEs. This study conducted a questionnaire survey in 2017 targeting SMEs in Sukagawa, Fukushima. We analyzed the 240 responses collected through a Multiple Correspondence Analysis and used Cramer’s coefficient of association to determine the strength of association. Major findings are as follows: 1) Environment-related indices were associated with both BCP formulation and business size, and these associations indicate the possibility of connecting environmental actions or management to BCP formulation. 2) In the association between BCP formulation status and environmental actions, the environmental management system had a stronger association than business size (capital, number of employees). 3) The group interested in the conservation of regulating services related to local natural resources (reducing CO₂ emission, water quality, aquatic plants and animals) had a higher rate of BCP formulation. 4) This group considers mutual help more important than self-help or public help. 5) Capital and number of employees have a strong association with both BCP formulation status and their interest in participating in local natural resource conservation. Activities with local society and stakeholders may collectively increase SMEs’ awareness with neighbor enterprises or the local community. It would help both SMEs and local society to build a seamless attitude toward disaster risk reduction, which would contribute to local sustainability