Climate Change and Intrastate Conflict in Africa

Africa has the dubious distinction of being the continent most likely to experience the worst climate change has to offer while having the population most vulnerable to its effects. Many of the continent\u27s sub regions and countries also have recent histories of violence or are currently mired in conflict. Africa\u27s proneness to conflict and its vulnerability to climate change provide the best model for showing how climate change, by the way it interacts with other, better understood drivers of conflict, will likely become an important source of conflict within the region and around the world over the rest of this century. This paper\u27s aim was to identify some possible causal pathways by which the effects of climate change might be linked to the outbreak of conflict. To achieve this, this paper sought to answer five main questions: 1) why do conflicts occur when and where they do? 2) How might climate change impact human societies in Africa? 3) Can those impacts lead directly to conflict occurrence, or 4) might they instead act indirectly, through other, more central drivers of conflict? 5) Should there be a climate-conflict relationship, can we build a model to identify potential future conflict `hotspots\u27 in Africa or around the world? By providing some answers to these questions, we were able to identify several possible climate-conflict pathways. We found that the economic impacts of climate change, particularly on a country\u27s agricultural sector and economy through direct disaster related damage do provide a realistic pathway to conflict in vulnerable countries as peoples\u27 livelihoods are negatively impacted, the impacts are not equally shared among all ethnic groups, and the state itself may not be able to correct such imbalances. The economic impact of climate change coupled with its negative impact on food and water security may also drive increased levels of migration, and with the movement of large numbers of people comes a greater probability of conflict. The impacts of climate change may also weaken states to the point that they can no longer provide basic services demanding by its population, leading to a loss of legitimacy and potentially the rise of rebellion. The pace of climate change can also affect the likelihood of conflict occurrence with more rapid pace developments and disasters being more likely to cause conflict due to less possibility of successful adaptation. In each pathway, climate change acts as a threat multiplier, acting through other sociopolitical, economic, democratic, security and systemic drivers to increase the likelihood of conflict, rather than driving conflict outright

Understanding the relation between attachment and depression in adolescence

Previous research has established a link between insecure attachment and depression in adolescence. However, little is known about the mechanisms that may mediate this relation or the contexts in which this association occurs. One objective of this study was to examine whether adolescents who were more anxious or avoidant in their attachment orientation were more sensitive to interpersonal versus achievement-related stress, made negative attributions and used a ruminative coping strategy in response to stress, and as such, reported more depressive symptoms. Given that the nature of close relationships changes during adolescence, the second objective was to investigate (1) the relative importance of working models of specific attachment figures (i.e., mother, father, best friend, and romantic partner) in the prediction of depression; and (2) the existence of target-specific pathways to depression following relational stress. It was expected that the paths to depression would differ depending on the type of stress and attachment figure under consideration. A total of 134 adolescents ( n = 88 girls; M age = 16.95 years; SD = .74) completed attachment questionnaires, a depression inventory, and a computer task consisting of hypothetical interpersonal and achievement-related vignettes and questions. Tests of the first objective revealed that adolescents' appraisals of the stressfulness of interpersonal and achievement-related situations varied as a function of attachment orientation. Adolescents high on anxiety interpreted all stresses in terms of interpersonal rejection. Adolescents high on avoidance interpreted achievement problems as a reflection of shortcomings of the self, but perceived interpersonal stresses similarly to their anxious counterparts. Insecure attachment relationships with romantic partner and mother, for girls, were uniquely predictive of depression. Adolescents' tendency to make negative attributions in response to stresses fully explained the relation between attachment to these persons and depression. Adolescents were found to ruminate when confronted with stresses involving romantic partner, which was also associated with depression. Results support cognitive models of depression and underscore the role of negative attributions in depression. Furthermore, the pathways to depression were found to be complex and to depend on the types of stress, who is involved in the stress, and the quality of the attachment relationship

Case Series of Fertility Treatment in HIV-Discordant Couples (Male Positive, Female Negative): The Ontario Experience

The success of combination antiretroviral therapies for the treatment of human immunodeficiency virus (HIV) has resulted in prolonged life expectancy (over 40 years from diagnosis) and an improved quality of life for people living with HIV. The risk of vertical HIV transmission during pregnancy has been reduced to less than 1%. As a result of these breakthroughs and as many of these individuals are of reproductive age, fertility issues are becoming increasingly important for this population. One population in which conception planning and reduction of horizontal HIV transmission warrants further research is HIV-discordant couples where the male partner is HIV-positive and the female partner is HIV-negative. Sperm washing is a technique carried out in a fertility clinic that separates HIV from the seminal fluid. Although sperm washing followed by intrauterine insemination significantly reduces the risk of horizontal HIV transmission, there has been limited access to the procedure in North America. Furthermore, little is known about the conception decision-making experiences of HIV-discordant couples who might benefit from sperm washing. Chart reviews and semi-structured interviews were completed with 12 HIV-discordant couples in Ontario, Canada. Couples were recruited through HIV clinics and one fertility clinic that offered sperm washing. Participants identified a number of factors that affected their decision-making around pregnancy planning. Access to sperm washing and other fertility services was an issue (cost, travel and few clinics). Participants identified a lack of information on the procedure (availability, safety). Sources of support (social networks, healthcare providers) were unevenly distributed, especially among those who did not disclose their HIV status to friends and family. Finally, the stigmatisation of HIV continues to have a negative affect on HIV-discordant couples and their intentions to conceive. Access to sperm washing and fertility service is significantly limited for this population and is accompanied with a number of challenges

Benefit of low-dose tamoxifen in a large observational cohort of high risk ER positive breast DCIS

Lega Italiana per la Lotta contro i Tumori Gruppo Bancario Credito Valtellinese Ministero della Salute Cancer Research UK Associazione Italiana per la Ricerca sul Cancr

NMDA receptor genotypes associated with the vulnerability to develop dyskinesia

Dyskinesias are involuntary muscle movements that occur spontaneously in Huntington's disease (HD) and after long-term treatments for Parkinson's disease (levodopa-induced dyskinesia; LID) or for schizophrenia (tardive dyskinesia, TD). Previous studies suggested that dyskinesias in these three conditions originate from different neuronal pathways that converge on overstimulation of the motor cortex. We hypothesized that the same variants of the N-methyl--aspartate receptor gene that were previously associated with the age of dyskinesia onset in HD were also associated with the vulnerability for TD and not LID. Genotyping patients with LID and TD revealed, however, that these two variants were dose-dependently associated with susceptibility to LID, but not TD. This suggested that LID, TD and HD might arise from the same neuronal pathways, but TD results from a different mechanism

Risky use of alcohol, drugs and cigarettes in a psychosis unit: a 1 1/2 year follow-up of stability and changes after initial screening

<p>Abstract</p> <p>Background</p> <p>Co-morbidity with substance use disorders negatively influences overall functioning in patients with psychosis. However, frequencies and courses of risky use of alcohol, drugs and cigarettes are rarely investigated in patients at psychosis units.</p> <p>The purpose of this study is to describe the use of alcohol, drugs and cigarettes in patients at a psychosis unit over a 1 1/2 year period after them having taken part in a screening investigation including a feed-back of the results to personnel. Relationships with sex and age are also described.</p> <p>Methods</p> <p>The patients' use of the substances was examined at baseline and at follow-up using three self-reporting instruments: Alcohol Use Disorders Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT) and Fagerstrom Test for Nicotine Dependence (FTND).</p> <p>Results</p> <p>One hundred and eighty-six patients out of 238 at baseline (78 percent) took part in the follow-up. Total AUDIT score decreased in women. Older men more often developed a risky alcohol use. Older women tended to reduce their risky drug habits. On a group level the habits mostly were stable, but 11 percent changed their alcohol habits and 15 percent changed their smoking habits from risky to no/low risky use, or vice versa. Nine percent changed their drug habits, predominantly from risky to no/low risky use.</p> <p>Conclusion</p> <p>A more active approach towards alcohol, drug and smoking habits in psychosis units would probably be beneficial.</p

Evaluating the Clinical Feasibility of an Artificial Intelligence-Powered, Web-Based Clinical Decision Support System for the Treatment of Depression in Adults: Longitudinal Feasibility Study.

BACKGROUND: Approximately two-thirds of patients with major depressive disorder do not achieve remission during their first treatment. There has been increasing interest in the use of digital, artificial intelligence-powered clinical decision support systems (CDSSs) to assist physicians in their treatment selection and management, improving the personalization and use of best practices such as measurement-based care. Previous literature shows that for digital mental health tools to be successful, the tool must be easy for patients and physicians to use and feasible within existing clinical workflows. OBJECTIVE: This study aims to examine the feasibility of an artificial intelligence-powered CDSS, which combines the operationalized 2016 Canadian Network for Mood and Anxiety Treatments guidelines with a neural network-based individualized treatment remission prediction. METHODS: Owing to the COVID-19 pandemic, the study was adapted to be completed entirely remotely. A total of 7 physicians recruited outpatients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Patients completed a minimum of one visit without the CDSS (baseline) and 2 subsequent visits where the CDSS was used by the physician (visits 1 and 2). The primary outcome of interest was change in appointment length after the introduction of the CDSS as a proxy for feasibility. Feasibility and acceptability data were collected through self-report questionnaires and semistructured interviews. RESULTS: Data were collected between January and November 2020. A total of 17 patients were enrolled in the study; of the 17 patients, 14 (82%) completed the study. There was no significant difference in appointment length between visits (introduction of the tool did not increase appointment length; F2,24=0.805; mean squared error 58.08; P=.46). In total, 92% (12/13) of patients and 71% (5/7) of physicians felt that the tool was easy to use; 62% (8/13) of patients and 71% (5/7) of physicians rated that they trusted the CDSS. Of the 13 patients, 6 (46%) felt that the patient-clinician relationship significantly or somewhat improved, whereas 7 (54%) felt that it did not change. CONCLUSIONS: Our findings confirm that the integration of the tool does not significantly increase appointment length and suggest that the CDSS is easy to use and may have positive effects on the patient-physician relationship for some patients. The CDSS is feasible and ready for effectiveness studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT04061642; http://clinicaltrials.gov/ct2/show/NCT04061642

The impact of substance use on brain structure in people at high risk of developing schizophrenia

Ventricular enlargement and reduced prefrontal volume are consistent findings in schizophrenia. Both are present in first episode subjects and may be detectable before the onset of clinical disorder. Substance misuse is more common in people with schizophrenia and is associated with similar brain abnormalities. We employ a prospective cohort study with nested case control comparison design to investigate the association between substance misuse, brain abnormality, and subsequent schizophrenia. Substance misuse history, imaging data, and clinical information were collected on 147 subjects at high risk of schizophrenia and 36 controls. Regions exhibiting a significant relationship between level of use of alcohol, cannabis or tobacco, and structure volume were identified. Multivariate regression then elucidated the relationship between level of substance use and structure volumes while accounting for correlations between these variables and correcting for potential confounders. Finally, we established whether substance misuse was associated with later risk of schizophrenia. Increased ventricular volume was associated with alcohol and cannabis use in a dose-dependent manner. Alcohol consumption was associated with reduced frontal lobe volume. Multiple regression analyses found both alcohol and cannabis were significant predictors of these abnormalities when simultaneously entered into the statistical model. Alcohol and cannabis misuse were associated with an increased subsequent risk of schizophrenia. We provide prospective evidence that use of cannabis or alcohol by people at high genetic risk of schizophrenia is associated with brain abnormalities and later risk of psychosis. A family history of schizophrenia may render the brain particularly sensitive to the risk-modifying effects of these substances