“But can chatbots understand sex?” Attitudes towards artificial intelligence chatbots amongst sexual and reproductive health professionals: An exploratory mixed-methods study

Background Artificial Intelligence (AI)-enabled chatbots can offer anonymous education about sexual and reproductive health (SRH). Understanding chatbot acceptability and feasibility allows the identification of barriers to the design and implementation. Methods In 2020, we conducted an online survey and qualitative interviews with SRH professionals recruited online to explore the views on AI, automation and chatbots. Qualitative data were analysed thematically. Results Amongst 150 respondents (48% specialist doctor/consultant), only 22% perceived chatbots as effective and 24% saw them as ineffective for SRH advice [Mean = 2.91, SD = 0.98, range: 1–5]. Overall, there were mixed attitudes towards SRH chatbots [Mean = 4.03, SD = 0.87, range: 1–7]. Chatbots were most acceptable for appointment booking, general sexual health advice and signposting, but not acceptable for safeguarding, virtual diagnosis, and emotional support. Three themes were identified: “Moving towards a ‘digital’ age’“, “AI improving access and service efficacy”, and “Hesitancy towards AI”. Conclusions Half of SRH professionals were hesitant about the use of chatbots in SRH services, attributed to concerns about patient safety, and lack of familiarity with this technology. Future studies should explore the role of AI chatbots as supplementary tools for SRH promotion. Chatbot designers need to address the concerns of health professionals to increase acceptability and engagement with AI-enabled services

Exploring young people's perspectives on mental health support: A qualitative study across three geographical areas in England, UK

Improving young people's (YP) mental health and well-being is a global public health priority. Despite continued commitment within the UK policy agenda to improve the mental health and well-being of YP, the incidence of mental health issues continues to rise. This has been further compounded by the outbreak of COVID-19 which has disproportionately affected YP in the most socioeconomically disadvantaged areas. Understanding YP's perspectives on what supports their mental health is important to develop policies that meet their needs. We conducted focus groups (n = 18 with 42 YP aged 13–21) in three geographical areas with high levels of deprivation in England, UK. Recruited through six local youth organisations, each group of YP took part in three interlinked focus groups designed to explore their perceptions of what impacts their health in their local area, and their understandings of health inequalities through participatory methods. Throughout their discussions, YP foregrounded the significance of mental health and mental health support structures. YP perceived challenges to accessing mental health provision and an unmet need for support within their local communities. Alongside this, YP consistently highlighted the importance of youth groups for promoting good mental health and mitigating challenges to poor mental health. However, ongoing cuts to the voluntary sector and universal services continue to impact areas and individuals in the greatest need. In the face of deficits in formal mental health support, our findings highlight the pressing need for increased investment in services focused on prevention (such as youth groups) in areas of high deprivation

Why does early childhood deprivation increase the risk for depression and anxiety in adulthood? A developmental cascade model

Abstract Background: Using data from the English & Romanian Adoptees (ERA) study we recently reported that early time-lmited exposure to severe institutional deprivation is associated with early onset and persistent neurodevelopmental problems and later onset emotional problems. Here we examine possible reasons for the late emergence of emotional problems in this cohort. Our main focus is on testing a developmental cascade mediated via the functional impact of early-appearing neurodevelopmental problems on late adolescent functioning. We also explore a second putative pathway via sensitization to stress. Methods: The ERA study includes 165 Romanian individuals who spent their early lives in grossly depriving institutions and were subsequently adopted into UK families, along with 52 UK adoptees with no history of deprivation. Age six years symptoms of neurodevelopmental problems and age 15 anxiety/depression symptoms were assessed via parental reports. Young adult symptoms of depression and anxiety were assessed by both parent and self-reports; young adults also completed measures of stress reactivity , exposure to adverse life events and functioning in work and interpersonal relationships. Results: The path between early institutional deprivation and adult emotional problems was mediated via the impact of early neurodevelopmental problems on unemployment and poor friendship functioning during the transition to adulthood. The findings with regard to early deprivation, later life stress reactivity and emotional problems were inconclusive. Conclusions: Our analysis suggests that the risk for adult depression and anxiety following extreme institutional deprivation is explained through the effects of early neurodevelopmental problems on later social and vocational functioning. Future research should more fully examine the role of stress susceptibility in this model

Common, low-frequency, rare, and ultra-rare coding variants contribute to COVID-19 severity

The combined impact of common and rare exonic variants in COVID-19 host genetics is currently insufficiently understood. Here, common and rare variants from whole-exome sequencing data of about 4000 SARS-CoV-2-positive individuals were used to define an interpretable machine-learning model for predicting COVID-19 severity. First, variants were converted into separate sets of Boolean features, depending on the absence or the presence of variants in each gene. An ensemble of LASSO logistic regression models was used to identify the most informative Boolean features with respect to the genetic bases of severity. The Boolean features selected by these logistic models were combined into an Integrated PolyGenic Score that offers a synthetic and interpretable index for describing the contribution of host genetics in COVID-19 severity, as demonstrated through testing in several independent cohorts. Selected features belong to ultra-rare, rare, low-frequency, and common variants, including those in linkage disequilibrium with known GWAS loci. Noteworthily, around one quarter of the selected genes are sex-specific. Pathway analysis of the selected genes associated with COVID-19 severity reflected the multi-organ nature of the disease. The proposed model might provide useful information for developing diagnostics and therapeutics, while also being able to guide bedside disease management. © 2021, The Author(s)

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

A Multicenter, Randomized, Placebo‐Controlled Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Patients With Rheumatoid Arthritis

Objective: Rheumatoid arthritis (RA) is associated with increased cardiovascular event (CVE) risk. The impact of statins in RA is not established. We assessed whether atorvastatin is superior to placebo for the primary prevention of CVEs in RA patients. Methods: A randomized, double‐blind, placebo‐controlled trial was designed to detect a 32% CVE risk reduction based on an estimated 1.6% per annum event rate with 80% power at P 50 years or with a disease duration of >10 years who did not have clinical atherosclerosis, diabetes, or myopathy received atorvastatin 40 mg daily or matching placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, transient ischemic attack, or any arterial revascularization. Secondary and tertiary end points included plasma lipids and safety. Results: A total of 3,002 patients (mean age 61 years; 74% female) were followed up for a median of 2.51 years (interquartile range [IQR] 1.90, 3.49 years) (7,827 patient‐years). The study was terminated early due to a lower than expected event rate (0.70% per annum). Of the 1,504 patients receiving atorvastatin, 24 (1.6%) experienced a primary end point, compared with 36 (2.4%) of the 1,498 receiving placebo (hazard ratio [HR] 0.66 [95% confidence interval (95% CI) 0.39, 1.11]; P = 0.115 and adjusted HR 0.60 [95% CI 0.32, 1.15]; P = 0.127). At trial end, patients receiving atorvastatin had a mean ± SD low‐density lipoprotein (LDL) cholesterol level 0.77 ± 0.04 mmoles/liter lower than those receiving placebo (P < 0.0001). C‐reactive protein level was also significantly lower in the atorvastatin group than the placebo group (median 2.59 mg/liter [IQR 0.94, 6.08] versus 3.60 mg/liter [IQR 1.47, 7.49]; P < 0.0001). CVE risk reduction per mmole/liter reduction in LDL cholesterol was 42% (95% CI −14%, 70%). The rates of adverse events in the atorvastatin group (n = 298 [19.8%]) and placebo group (n = 292 [19.5%]) were similar. Conclusion: Atorvastatin 40 mg daily is safe and results in a significantly greater reduction of LDL cholesterol level than placebo in patients with RA. The 34% CVE risk reduction is consistent with the Cholesterol Treatment Trialists’ Collaboration meta‐analysis of statin effects in other populations

Evaluating an Intensive Recovery Programme for Adolescents Who Have Been Bullied: a Mixed Methods Study

Bullying is a serious problem for many adolescents, and one that can have detrimental effects on normal developmental processes, as chronic and severe bullying can obstruct the fulfilment of essential psychological needs. However, there are currently few targeted interventions available for chronic and severe bullying cases. The purpose of this study was to evaluate the effectiveness of the Red Balloon Learner Centres (RBLC) which are a full time personal and academic recovery programme for bullied adolescents. A mixed-methodology was utilised, and quantitative outcome measures included: depression, anxiety and trauma symptoms, self-esteem and academic engagement and self-concept. The study was non equivalent groups design (NEGD) and incorporated a comparison group of bullied adolescents from Hertfordshire local authority (LA). The aim was to compare the recovery process between groups over time by taking an initial baseline measure, and conducting follow-up assessments every three months. Both groups demonstrated significant improvements in outcome variables over time, but there were no significant differences between groups at six month follow-up on any outcome variable. Both groups reported similar recovery themes that related to need fulfilment in the areas of safety and security, control, belonging and self-esteem. Recovery is not just the absence of internalising symptomology, but constructive fulfilment of needs. Social needs were felt to be most affected by chronic and severe bullying and most difficult to fulfil constructively. It is recommended that interventions for chronically and severely bullied adolescents should enable constructive need fulfilment, which may involve changes to the ethos and culture of schools, collaborative therapeutic intervention and targeted skill building

Evaluating an intensive recovery programme for adolescents who have been bullied : a mixed methods study

Bullying is a serious problem for many adolescents, and one that can have detrimental effects on normal developmental processes, as chronic and severe bullying can obstruct the fulfilment of essential psychological needs. However, there are currently few targeted interventions available for chronic and severe bullying cases. The purpose of this study was to evaluate the effectiveness of the Red Balloon Learner Centres (RBLC) which are a full time personal and academic recovery programme for bullied adolescents. A mixed-methodology was utilised, and quantitative outcome measures included: depression, anxiety and trauma symptoms, self-esteem and academic engagement and self-concept. The study was non equivalent groups design (NEGD) and incorporated a comparison group of bullied adolescents from Hertfordshire local authority (LA). The aim was to compare the recovery process between groups over time by taking an initial baseline measure, and conducting follow-up assessments every three months. Both groups demonstrated significant improvements in outcome variables over time, but there were no significant differences between groups at six month follow-up on any outcome variable. Both groups reported similar recovery themes that related to need fulfilment in the areas of safety and security, control, belonging and self-esteem. Recovery is not just the absence of internalising symptomology, but constructive fulfilment of needs. Social needs were felt to be most affected by chronic and severe bullying and most difficult to fulfil constructively. It is recommended that interventions for chronically and severely bullied adolescents should enable constructive need fulfilment, which may involve changes to the ethos and culture of schools, collaborative therapeutic intervention and targeted skill building.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

HPA axis dysregulation in adult adoptees twenty years after severe institutional deprivation in childhood

Hypothalamic–pituitary–adrenal (HPA) axis function is disrupted in institutionally-deprived children – reduced morning cortisol, flattened diurnal slope and blunted reactivity persist even after successful adoption into positive family environments. Here we test whether such effects persist into adulthood. Cortisol release across the day (sampled at awakening, 30 and 45min later, and at four points across the day) was investigated in young adult adoptees who had lived in severe deprivation for up to 43 months in early childhood in Ceaușescu’s Romanian orphanages and a comparison group of non-deprived UK adoptees (Total N=57; mean age=24±0.9years). The mediating role of cortisol levels on adult mental health was examined using data from standardized clinical assessments. Cortisol profiles were disrupted in the Romanian adoptees who experienced more than 6 months deprivation marked by a striking absence of the cortisol awakening response (CAR) and a significantly flatter cortisol curve until 1h 15min after awakening. Whereas institutional deprivation was associated with both cortisol secretion and emergence of emotional problems in young adulthood, path analysis revealed no evidence for a mediating role of CAR disruption in the sub-sample studied here. The results are in line with findings of HPA axis hypo-functionality following early adverse experience and provide strong evidence for long-term programming effects of HPA axis function through experience of institutional deprivation

Psychological consequences of early global deprivation: an overview of findings from the English &amp; Romanian Adoptees Study

The English &amp; Romanian Adoptees (ERA) study follows children who spent their first years of life in extremely depriving Romanian institutions before they were adopted by families in the UK. The ERA study constitutes a “natural experiment” that allows the examination of the effects of radical environmental change from a profoundly depriving institution environment to an adoptive family home. The cohort has been assessed at ages 4, 6, 11 and 15 years, and has provided seminal insights into the effect of early global deprivation. The current paper focuses on the long-term psychological sequelae associated with deprivation experiences. These deprivation specific problems (DSP) constitute a striking pattern of behavioural impairments, in its core characterized by deficits in social cognition and behaviour, as well as quasi-autistic features, often accompanied by cognitive impairment and symptoms of ADHD. Possible moderating influences, including variations in family environment, pre-adoption characteristics, and genetic variation, will be discussed to answer the question why some individuals have prospered while others have struggled. Apart from findings on the moderating effect of variation in genes associated with serotonergic and dopaminergic signalling involving specific phenotypes, heterogeneity in outcome is largely unexplained. The review will conclude with an outlook on currently ongoing and future research of the ERA study cohort, which involves the investigation of neurobiological and epigenetic mechanisms as possible mediators of the long-term effects of institutional deprivatio