Understanding urbanicity: how interdisciplinary methods help to unravel the effects of the city on mental health

Twenty-first century urbanization poses increasing challenges for mental health. Epidemiological studies have shown that mental health problems often accumulate in urban areas, compared to rural areas, and suggested possible underlying causes associated with the social and physical urban environments. Emerging work indicates complex urban effects that depend on many individual and contextual factors at neighbourhood and country level and novel experimental work is starting to dissect potential underlying mechanisms. This review summarizes findings from epidemiology and population- based studies, neuroscience, experimental, and experience-based research and illustrates how a combined approach can move the field towards an increased understanding of the urbanicity-mental health nexus

A not so isolated fringe:Dutch later prehistoric (c. 2200 BCE-AD 0) bronze alloy networks from compositional analyses on metals and corrosion layers

Using a corpus of over 370 compositional analyses of Dutch Bronze Age and Iron Age (c. 2000 BCE AD 0) copper alloy artefacts, long-term patterns in the types of alloys used for specific bronze objects are identified. As the Low Countries are devoid of copper ores and alloying elements, a combination of typo(chrono) logical and compositional analysis is used to identify through which European contact networks (such as Atlantic, Central European or Nordic exchange networks) these alloys were obtained. We employ a methodology that (following Bray et al., 2015) defines alloy groups by presence of As, Sb, Ag and Ni over 0.1 %wt, but expanded this classification to include Pb and to track high-impurity (>1%wt) alloys. Due to interfering soil-derived iron hydroxides, and preferent dissolution of copper from the objects’ surface, the determination of tin is in most cases overestimated when using p-XRF, so Sn was not systematically reviewed. Objects were assigned a calendar age in years BCE to facilitate chronological sorting. Using this classification, we could show how different alloys (using different base ores) were used in different periods, and in different combinations. Moreover, particular alloys were used for different groups of functional types of objects. Also, we show diachronic differences in the influx of new (or less frequently mixed) alloys and chronological trends in the substitution of As by Sn as main alloying element in the Early Bronze Age as well as the rise of leaded alloys at the close of the Bronze Age. Combining information on the composition of the objects with their typological traits, allowed us to reconstruct the scales and geographic scopes of the European contact networks in which the copper alloys used throughout later prehistory were obtained

Trust and the city: Linking urban upbringing to neural mechanisms of trust in psychosis

Objective: Elevated prevalence of non-affective psychotic disorders is often found in densely populated areas. This functional magnetic resonance imaging study investigates if reduced trust, a component of impaired social functioning in patients with psychotic disorder, is associated with urban upbringing. Methods: In total, 39 patients (22 first episode and 17 clinical high risk) and 30 healthy controls, aged 16–29, performed two multi-round trust games, with a cooperative and unfair partner during functional magnetic resonance imaging scan-ning. Baseline trust was operationalized as the first investment made, and changes of trust as changes in investments made over the 20 trials during the games. Urban exposure during upbringing (0–15 years) was defined as higher urban (≥2500 inhabitants/km2) or lower urban (<2500 inhabitants/km2). Results: Patients displayed lower baseline trust (first investment) than controls, regardless of urbanicity exposure. During cooperative interactions, lower-urban patients showed increasing investments. In addition, during cooperative interactions, group-by-developmental urbanicity interactions were found in the right and left amygdalae, although for the latter only at trend level. Higher urbanicity was associated with decreased activation of the left amygdala in patients and controls during investments and with increased activation of the right and left amygdalae in patients only, during repayments. During unfair interactions, no associations of urbanicity with behavior or brain activation were found. Conclusion: Urban upbringing was unrelated to baseline trust. Associations with urbanicity were stronger for patients compared to controls, suggesting greater susceptibility to urbanicity effects during the developmental period. Higher-urban patients failed to compensate for the initial distrust specifically during repeated cooperative interactions. This finding highlights potential implications for social functioning. Urban upbringing was linked to dif-ferential amygdala activation, suggesting altered mechanisms of feedback learning, but this was not associated with trust game behavio

Delphi-research exploring essential components and preconditions for case management in people with dementia

<p>Abstract</p> <p>Background</p> <p>Case management programmes for home-dwelling people with dementia and their informal carers exist in multiple forms and shapes. The aim of this research was to identify the essential components of case management for people with dementia as well as the preconditions for an effective delivery of case management services.</p> <p>Method</p> <p>The method used to carry out the research was a modified four-phase Delphi design. First, a list of potentially essential components and preconditions for the provision of case management was drawn up on the basis of a literature review and a subsequent focus group interview. The list was then validated by experts in a first Delphi survey round, following which the researchers translated the list items into 75 statements. In the second Delphi survey, the experts rated the statements; in the third Delphi round, they rated 18 statements on which no consensus had been reached in the second round.</p> <p>Results</p> <p>The experts were able to build consensus on 61 of the 75 statements. Essential components of case management for people with dementia are: information, support and counselling, coordination of the care provided and, to a lesser extent, practical help. A patient-centred approach was found to be one of the key aspects of providing case management services. Essential preconditions are: vision, care relationship, structured methodology, integration of case management into the health care chain, and the case manager's level of training and expertise.</p> <p>Conclusions</p> <p>We recommend that, based on the essential components and preconditions referred to above, quality criteria be developed for the provision of case management for people with dementia. Furthermore, we suggest the conduct of additional research to assess the effectiveness of case management in people with dementia.</p

A complete characterization of plateaued Boolean functions in terms of their Cayley graphs

In this paper we find a complete characterization of plateaued Boolean functions in terms of the associated Cayley graphs. Precisely, we show that a Boolean function $f$ is $s$-plateaued (of weight $=2^{(n+s-2)/2}$) if and only if the associated Cayley graph is a complete bipartite graph between the support of $f$ and its complement (hence the graph is strongly regular of parameters $e=0,d=2^{(n+s-2)/2}$). Moreover, a Boolean function $f$ is $s$-plateaued (of weight $\neq 2^{(n+s-2)/2}$) if and only if the associated Cayley graph is strongly $3$-walk-regular (and also strongly $\ell$-walk-regular, for all odd $\ell\geq 3$) with some explicitly given parameters.Comment: 7 pages, 1 figure, Proceedings of Africacrypt 201

Biodiversiteit in Zundert : concrete maatregelen ter bevordering van de ecologische kwaliteit in de gemeente Zundert

Dit rapport beschrijft hoe de ecologische kwaliteit van de gemeente Zundert verbeterd kan worden. Ecologische kwaliteit is hier gedefinieerd als een combinatie van diversiteit, samenhang en duurzaamheid. Om de diversiteit te vergroten, zijn maatregelen ontworpen die de levensomstandigheden voor zorgvuldig geselecteerde ambassadeurssoorten optimaliseren. In het kielzog van de ambassadeurssoorten zullen ook andere soorten profiteren. Om de samenhang te vergroten, zijn maatregelen ontworpen die de ecologische verbindingen op landschapsschaal en op ecotoopschaal kunnen herstellen. Om de duurzaamheid van de maatregelen te borgen, wordt voor een aantal betrokken partijen een voorzet gedaan voor natuurplannen

The Role of Smoking Status in Making Risk-Informed Diagnostic Decisions in the Lung Cancer Pathway: A Qualitative Study of Health Care Professionals and Patients

BACKGROUND: Lung cancer clinical guidelines and risk tools often rely on smoking history as a significant risk factor. However, never-smokers make up 14% of the lung cancer population, and this proportion is rising. Consequently, they are often perceived as low-risk and may experience diagnostic delays. This study aimed to explore how clinicians make risk-informed diagnostic decisions for never-smokers. METHODS: Qualitative interviews were conducted with 10 lung cancer diagnosticians, supported by data from interviews with 20 never-smoker lung cancer patients. The data were analyzed using a framework analysis based on the Model of Pathways to Treatment framework and data-driven interpretations. RESULTS: Participants described 3 main strategies for making risk-informed decisions incorporating smoking status: guidelines, heuristics, and potential harms. Clinicians supplemented guidelines with their own heuristics for never-smokers, such as using higher thresholds for chest X-ray. Decisions were easier for patients with high-risk symptoms such as hemoptysis. Clinicians worried about overinvestigating never-smoker patients, particularly in terms of physical and psychological harms from invasive procedures or radiation. To minimize unnecessary anxiety about lung cancer risk, clinicians made efforts to downplay this. Conversely, some patients found that this caused process harms such as delays and miscommunications. CONCLUSION: Improved guidance and methods of risk differentiation for never-smokers are needed to avoid diagnostic delays, overreassurance, and clinical pessimism. This requires an improved evidence base and initiatives to increase awareness among clinicians of the incidence of lung cancer in never-smokers. As the proportion of never-smoker patients increases, this issue will become more urgent. HIGHLIGHTS: Smoking status is the most common risk factor used by clinicians to guide decision making, and guidelines often focus on this factor.Some clinicians also use their own heuristics for never-smokers, and this becomes particularly relevant for patients with lower risk symptoms.Clinicians are also concerned about the potential harms and risks associated with deploying resources on diagnostics for never-smokers.Some patients find it difficult to decide whether or not to go ahead with certain procedures due to efforts made by clinicians to downplay the risk of lung cancer.Overall, the study highlights the complex interplay between smoking history, clinical decision making, and patient anxiety in the context of lung cancer diagnosis and treatment

Vitamin D concentration and psychotic disorder:associations with disease status, clinical variables and urbanicity

Background The association between schizophrenia and decreased vitamin D levels is well documented. Low maternal and postnatal vitamin D levels suggest a possible etiological mechanism. Alternatively, vitamin D deficiency in patients with schizophrenia is presumably (also) the result of disease-related factors or demographic risk factors such as urbanicity. Methods In a study population of 347 patients with psychotic disorder and 282 controls, group differences in vitamin D concentration were examined. Within the patient group, associations between vitamin D, symptom levels and clinical variables were analyzed. Group x urbanicity interactions in the model of vitamin D concentration were examined. Both current urbanicity and urbanicity at birth were assessed. Results Vitamin D concentrations were significantly lower in patients (B= -8.05; 95% confidence interval (CI) -13.68 to -2.42;p= 0.005). In patients, higher vitamin D concentration was associated with lower positive (B= -0.02; 95% CI -0.04 to 0.00;p= 0.049) and negative symptom levels (B= -0.03; 95% CI -0.05 to -0.01;p= 0.008). Group differences were moderated by urbanicity at birth (chi(2)= 6.76 andp= 0.001), but not by current urbanicity (chi(2)= 1.50 andp= 0.224). Urbanicity at birth was negatively associated with vitamin D concentration in patients (B= -5.11; 95% CI -9.41 to -0.81;p= 0.020), but not in controls (B= 0.72; 95% CI -4.02 to 5.46;p= 0.765). Conclusions Lower vitamin D levels in patients with psychotic disorder may in part reflect the effect of psychosis risk mediated by early environmental adversity. The data also suggest that lower vitamin D and psychopathology may be related through direct or indirect mechanisms.</p

A Network of Psychopathological, Cognitive, and Motor Symptoms in Schizophrenia Spectrum Disorders

Schizophrenia spectrum disorders (SSDs) are complex syndromes involving psychopathological, cognitive, and also motor symptoms as core features. A better understanding of how these symptoms mutually impact each other could translate into diagnostic, prognostic, and, eventually, treatment advancements. The present study aimed to: (1) estimate a network model of psychopathological, cognitive, and motor symptoms in SSD; (2) detect communities and explore the connectivity and relative importance of variables within the network; and (3) explore differences in subsample networks according to remission status. A sample of 1007 patients from a multisite cohort study was included in the analysis. We estimated a network of 43 nodes, including all the items from the Positive and Negative Syndrome Scale, a cognitive assessment battery and clinical ratings of extrapyramidal symptoms. Methodologies specific to network analysis were employed to address the study’s aims. The estimated network for the total sample was densely interconnected and organized into 7 communities. Nodes related to insight, abstraction capacity, attention, and suspiciousness were the main bridges between network communities. The estimated network for the subgroup of patients in remission showed a sparser density and a different structure compared to the network of nonremitted patients. In conclusion, the present study conveys a detailed characterization of the interrelations between a set of core clinical elements of SSD. These results provide potential novel clues for clinical assessment and intervention