Antipsychotics and Identity: The Adverse Effect No One is Talking About

People who take antipsychotics, and people who are prescribed antipsychotics without taking them, experience effects which are not frequently discussed: effects on their identity and sense of self. Qualitative research indicates the relationship between taking APs and identity is multilayered, and changeable. Taking APs can restore people to their earlier, pre-symptom sense of self. Being prescribed and taking APs can also, on the other hand, be experienced as damaging, erasing and dulling people's sense of who they are. This complexity deserves exploration in clinical practice, which we believe is currently not done routinely. More work is needed to understand whether, and how, the relationship between identity and APs is being addressed. We outline the importance of having discussions in a clinical space around identity, and a sense of agency, on the grounds that true recovery-oriented care, which enacts shared decision-making principles, demands it. Further, we argue that it will allow for better therapeutic alliance and trust to be forged between clinician and client, ultimately leading to better care.

What's on the horizon for community-based conservation? Emerging threats and opportunities

Community-based conservation can support livelihoods and biodiversity, while reinforcing local and Indigenous values, cultures, and institutions. Its delivery can help address cross-cutting global challenges, such as climate change, conservation, poverty, and food security. Therefore, understanding trends in community-based conservation is pertinent to setting and implementing global goals. We undertook a horizon scan to prioritize 15 emerging threats and opportunities expected to impact the future effectiveness of community-based conservation. Topics relate to global biodiversity policy; human rights; shifting human geography; inclusion, diversity, equity, and access; conservation finance and income; and economic reforms. Our findings offer guidance on strengthening community-based conservation to achieve global environmental and development goals.

Headspace, a youth integrated care model: The relation between users satisfaction, clinical and demographic characteristics and service utilization

Introduction

Youth integrated care services were developed to overcome common barriers to mental health treatment. Satisfaction is key for services utilization and engagement.

Objectives

To study users satisfaction with youth integrated care service, “Headspace”, throughout the course of treatment and its correlation with clinical and demographic characteristics and service utilization.

Methods

A sample of 112 participants ranging between ages 12-25 who attended the Headspace clinic between March 2016 and June 2018 were assessed in the middle (after 7 sessions) and end of treatment (n=71).

Results

Participants expressed high levels of satisfaction across all service aspects at the middle and end of treatment. The highest rate of satisfaction was with the centre’s staff and the lowest with personal outcomes. A repeated measures ANOVA analysis revealed that only satisfaction with personal outcomes improved significantly over time Length of wait to begin treatment and parental engagement y were negatively correlated with youth satisfaction.

Conclusions

Satisfaction rates of Headspace among youth are high from the start and with their outcomes increase over time. Youth satisfaction with the staff’s attitude and approach and satisfaction with accessibility suggest the service achievement in addressing barriers of help seeking in youth.

Disclosure

No significant relationships.

Bipolar Stigma in Jewish Communities in the United States

Introduction

This study investigated differences in mood disorder public stigma endorsed by Jewish adults. Specifically, it examined the association between public stigma and the symptomatology and gender of individuals with mood disorders and characteristics of respondents. The symptomatology investigated included major depressive disorder and bipolar disorder presenting with mania or depression. The public stigma factors measured for mood disorders were recovery, relationship disruption, hygiene, anxiety, and treatment/professional efficacy.

Objectives

Do symptomatology and gender predict stigma for mood disorders? For Jewish adults, do gender, age, religious characteristics, mental health history, and perceived stigma for mental illness predict their stigma toward individuals with mood disorders?

Methods

A convenience sample of 243 Jewish adults were randomly administered vignettes using a factorial design. MANCOVA was used for analysis. The Mental Illness Stigma Scale (Day et al., 2007) and the Devaluation of Consumer scale (Struening et al., 2001) were used to measure public and perceived stigma respectively.

Results

showed that recovery, relationship disruption, and hygiene stigmas were associated with vignette subject symptomatology, an interaction was found between respondent gender and age for treatability/professional efficacy stigma, and perceived stigma was correlated with public stigma factors. Consistent with previous research, the highest levels of stigma were found for individuals with bipolar disorder presenting with mania (Wolkenstein & Meyer, 2008).

Conclusions

These findings increase our knowledge of mood disorder stigma existing in the Jewish community and supports research showing that bipolar disorder presenting with mania is the most stigmatized type of mood disorder symptomatology (Wolkenstein & Meyer, 2008).

Disclosure

No significant relationships.

Promoting better mental health care for patients with psychosis by focusing on differences in causal beliefs between patients and clinicians

Introduction

Nonadherence to antipsychotic medications and disengagement from psychiatric services are frequent among people with psychosis. Research indicates how the beliefs of people with psychosis about the etiology of their symptoms, or their causal beliefs, affect treatment choice and outcomes. Yet, there is less research on causal beliefs of clinicians or on the impact of patient–clinician disagreements on treatment and adherence.

Objectives

This review aimed to explore the scope of the literature focusing on clinicians’ causal beliefs and to map the degree of patient–clinician concordance in causal beliefs.

Methods

A systematic literature search of PubMed, Embase, Scopus, PsycInfo, and ASSIA and a grey literature search of PsyArXiv and MedNar yielded 11,821 eligible references.

Results

Forty-two articles indicated that whereas clinicians endorse mainly biogenetic beliefs (9/15 articles, 60%), patients endorse mainly psychosocial causal beliefs (16/31, 52%) and other non-biogenetic causal beliefs (8/31, 26%). Most studies did not compare causal beliefs of people with psychosis and their treating clinicians.

Conclusions

While clinicians and people with psychosis often hold complex causal models, a gap in causal beliefs between these groups appears to exist, which may affect the therapeutic relationship and pose barriers to treatment adherence. Future studies should address this gap by developing interventions that facilitate open communication about causal beliefs to promote treatment alliance and an agreed-on treatment plan.

Disclosure

No significant relationships.

Prevalence of sustainable and unsustainable use of wild species inferred from the IUCN Red List of Threatened Species

Unsustainable exploitation of wild species represents a serious threat to biodiversity and to the livelihoods of local communities and Indigenous peoples. However, managed, sustainable use has the potential to forestall extinctions, aid recovery, and meet human needs. We analyzed species-level data for 30,923 species from 13 taxonomic groups on the International Union for Conservation of Nature Red List of Threatened Species to investigate patterns of intentional biological resource use. Forty percent of species (10,098 of 25,009 species from 10 data-sufficient taxonomic groups) were used. The main purposes of use were pets, display animals, horticulture, and human consumption. Intentional use is currently contributing to elevated extinction risk for 28-29% of threatened or near threatened (NT) species (2752-2848 of 9753 species). Intentional use also affected 16% of all species used (1597-1631 of 10,098). However, 72% of used species (7291 of 10,098) were least concern, of which nearly half (3469) also had stable or improving population trends. The remainder were not documented as threatened by biological resource use, including at least 172 threatened or NT species with stable or improving populations. About one-third of species that had use documented as a threat had no targeted species management actions to directly address this threat. To improve use-related red-list data, we suggest small amendments to the relevant classification schemes and required supporting documentation. Our findings on the prevalence of sustainable and unsustainable use, and variation across taxa, can inform international policy making, including the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services, the Convention on Biological Diversity, and the Convention on International Trade in Endangered Species.

Impacts of the COVID-19 pandemic on livelihoods and wild meat use in communities surrounding the Dja Faunal Reserve, South-East Cameroon

The COVID-19 outbreak has had considerable negative impacts on the livelihoods and living conditions of communities around the world. Although the source of COVID-19 is still unknown, a widely spread hypothesis is that the virus could be of animal origin. Wild meat is used by rural communities as a source of income and food, and it has been hypothesised that the pandemic might alter their perceptions and use of wild meat. McNamara et al. (2020) developed a causal model hypothesising how the impacts of the pandemic could lead to a change in local incentives for wild meat hunting in sub-Saharan African countries. From February 27 to March 19, 2021, we carried out a survey around the Dja Faunal Reserve, Southeast Cameroon, to test McNamara et al.'s model in practice, using semi-structured questionnaires to investigate the impacts of the COVID-19 outbreak on wild meat hunting and consumption. Our results generally agree with the causal pathways suggested by McNamara et al. However, our study highlights additional impact pathways not identified in the model. We provide revisions to McNamara's model to incorporate these pathways and inform strategies to mitigate the impacts of the pandemic.

Community-Based Approaches to Tackling Illegal Wildlife Trade—What Works and How Is It Measured?

The illegal wildlife trade (IWT) is a global issue that threatens the conservation of many species of fauna and flora and affects the livelihoods of people who are dependent upon wildlife. By far the most common approach to tackling IWT is to enhance law enforcement, including arming rangers and tougher penalties for perpetrators. Yet, critics of this approach argue that efforts to reduce IWT in source countries are likely to fail without the involvement of local people. However, little is known about the effectiveness of community-based approaches to tackling IWT or how this is being measured. We used information from the www.peoplenotpoaching.org learning platform to analyze over 100 case studies of community-based anti-IWT interventions to understand what proportion have been effective and how this has been measured. We present a typology of frequently reported outcomes, their indicators and means of verification. We show that effectiveness in community-based anti-IWT interventions is measured by a number of indicators and using a variety of verification means. Our findings suggest that conservation practitioners more frequently implement activities to measure conservation outcomes in comparison to livelihood outcomes, which has implications for how we consider if a community-based anti-IWT project has been effective. We recommend that future community-based anti-IWT projects build in more robust monitoring, evaluation and learning activities to measure how livelihood benefits impact local communities given their support is crucial to achieving long-term conservation success.

Longitudinal assessment of nonavalent vaccine HPV types in a sample of sexually active African American women from ten U.S. Cities

BACKGROUND

Chronic infection with high-risk human papillomavirus is a necessary cause for cervical carcinogenesis. This study examined prevalence of nonavalent vaccine preventable HPV types over four months among sexually active women in the United States.

METHODS

This sub-study obtained meta-data for 80 of the 1,365 women (18-25 years), enrolled in the BRAVO study, a randomized, open-label trial of home screening and treatment of asymptomatic bacterial vaginosis at high-risk for sexually transmitted infections conducted between 2008 and 2013. Participants were randomized to treatment or standard-of-care, and followed every 2-months for 12 months. Stored vaginal swabs from the first three visits were tested for the nine vaccine preventable HPV types using quantitative PCR. Prevalence and associated 95% confidence intervals for the HPV types were assessed using R (version 3.6.1).

RESULTS

The average age of the participants was 21.5 (SD ± 2.11) years, with 60% having ever been pregnant and all were African-American. Majority (71%) reported ≥ two sex partners in the prior year with 89% having unprotected vaginal sex and 45% having a new sex partner in the prior year. About 30% had ≥ one of the nine nonavalent vaccine HPV types at all three time points over a period of four months, 15% at two of any three visits, 19% at one of the three visits and 36% were negative for all nine vaccine HPV types at all time points. The most frequently detected HPV vaccine types were 52, 58, 16, and 18. The prevalence of any vaccine HPV types, and high-risk HPV types was 63.8% and 58.8%, respectively.

CONCLUSIONS

Our findings suggest that HPV vaccination which is currently recommended for all unvaccinated persons through age 26 years, is likely to be more beneficial than previously thought as nonavalent HPV vaccine was not available during the time these data were collected.

Think Before You Act: Improving the Conservation Outcomes of CITES Listing Decisions

The CITES treaty is the major international instrument designed to safeguard wild plants and animals from overexploitation by international trade. CITES is now approaching 50 years old, and we contend that it is showing its age. In stark contrast to most environmental policy arenas, CITES does not require, encourage, or even allow for, consideration of the impacts of its key decisions—those around listing species in the CITES Appendices. Decisions to list species in CITES are based on a simplistic set of biological and trade criteria that do not relate to the impact of the decision, and have little systematic evidentiary support. We explain the conservation failures that flow from this weakness and propose three key changes to the CITES listing process: (1) development of a formal mechanism for consideration by Parties of the likely consequences of species listing decisions; (2) broadening of the range of criteria used to make listing decisions; and (3) amplification of the input of local communities living alongside wildlife in the listing process. Embracing these changes will help to ensure CITES decisions more effectively respond to the needs of wildlife in today’s highly complex and dynamic conservation context.

The Sleep Side of Aging and Alzheimer's Disease

As we age, sleep patterns undergo significant modifications in micro and macrostructure, worsening cognition and quality of life. These are associated with remarkable brain changes, like deterioration in synaptic plasticity, gray and white matter, and significant modifications in hormone levels. Sleep alterations are also a core component of mild cognitive impairment (MCI) and Alzheimer's Disease (AD). AD night time is characterized by a gradual decrease in slow-wave activity and a substantial reduction of REM sleep. Sleep abnormalities can accelerate AD pathophysiology, promoting the accumulation of amyloid-β (Aβ) and phosphorylated tau. Thus, interventions that target sleep disturbances in elderly people and MCI patients have been suggested as a possible strategy to prevent or decelerate conversion to dementia. Although cognitive-behavioral therapy and pharmacological medications are still first-line treatments, despite being scarcely effective, new interventions have been proposed, such as sensory stimulation and Noninvasive Brain Stimulation (NiBS). The present review outlines the current state of the art of the relationship between sleep modifications in healthy aging and the neurobiological mechanisms underlying age-related changes. Furthermore, we provide a critical analysis showing how sleep abnormalities influence the prognosis of AD pathology by intensifying Aβ and tau protein accumulation. We discuss potential therapeutic strategies to target sleep disruptions and conclude that there is an urgent need for testing new therapeutic sleep interventions.

Beyond banning wildlife trade: COVID-19, conservation and development

One of the immediate responses to COVID-19 has been a call to ban wildlife trade given the suspected origin of the pandemic in a Chinese market selling and butchering wild animals. There is clearly an urgent need to tackle wildlife trade that is illegal, unsustainable or carries major risks to human health, biodiversity conservation or meeting acceptable animal welfare standards. However, some of the suggested actions in these calls go far beyond tackling these risks and have the potential to undermine human rights, damage conservation incentives and harm sustainable development. There are a number of reasons for this concerns. First calls for bans on wildlife markets often include calls for bans on wet markets, but the two are not the same thing, and wet markets can be a critical underpinning of informal food systems. Second, wildlife trade generates essential resources for the world's most vulnerable people, contributing to food security for millions of people, particularly in developing countries. Third, wildlife trade bans have conservation risks including driving trade underground, making it even harder to regulate, and encouraging further livestock production. Fourth, in many cases, sustainable wildlife trade can provide key incentives for local people to actively protect species and the habitat they depend on, leading to population recoveries. Most importantly, a singular focus on wildlife trade overlooks the key driver of the emergence of infectious diseases: habitat destruction, largely driven by agricultural expansion and deforestation, and industrial livestock production. We suggest that the COVID-19 crisis provides a unique opportunity for a paradigm shift both in our global food system and also in our approach to conservation. We make specific suggestions as to what this entails, but the overriding principle is that local people must be at the heart of such policy shifts.

Mapping the effectiveness of nature-based solutions for climate change adaptation

Nature-based solutions (NbS) to climate change currently have considerable political traction. However, national intentions to deploy NbS have yet to be fully translated into evidence-based targets and action on the ground. To enable NbS policy and practice to be better informed by science, we produced the first global systematic map of evidence on the effectiveness of nature-based interventions for addressing the impacts of climate change and hydrometeorological hazards on people. Most of the interventions in natural or semi-natural ecosystems were reported to have ameliorated adverse climate impacts. Conversely, interventions involving created ecosystems (e.g., afforestation) were associated with trade-offs; such studies primarily reported reduced soil erosion or increased vegetation cover but lower water availability, although this evidence was geographically restricted. Overall, studies reported more synergies than trade-offs between reduced climate impacts and broader ecological, social, and climate change mitigation outcomes. In addition, nature-based interventions were most often shown to be as effective or more so than alternative interventions for addressing climate impacts. However, there were substantial gaps in the evidence base. Notably, there were few studies of the cost-effectiveness of interventions compared to alternatives and few integrated assessments considering broader social and ecological outcomes. There was also a bias in evidence toward the Global North, despite communities in the Global South being generally more vulnerable to climate impacts. To build resilience to climate change worldwide, it is imperative that we protect and harness the benefits that nature can provide, which can only be done effectively if informed by a strengthened evidence base.

Local conditions and policy design determine whether ecological compensation can achieve No Net Loss goals

Many nations use ecological compensation policies to address negative impacts of development projects and achieve No Net Loss (NNL) of biodiversity and ecosystem services. Yet, failures are widely reported. We use spatial simulation models to quantify potential net impacts of alternative compensation policies on biodiversity (indicated by native vegetation) and two ecosystem services (carbon storage, sediment retention) across four case studies (in Australia, Brazil, Indonesia, Mozambique). No policy achieves NNL of biodiversity in any case study. Two factors limit their potential success: the land available for compensation (existing vegetation to protect or cleared land to restore), and expected counterfactual biodiversity losses (unregulated vegetation clearing). Compensation also fails to slow regional biodiversity declines because policies regulate only a subset of sectors, and expanding policy scope requires more land than is available for compensation activities. Avoidance of impacts remains essential in achieving NNL goals, particularly once opportunities for compensation are exhausted.

Countries are adopting ecological compensation policies aimed at achieving no net loss of biodiversity and ecosystem services. Here, Sonter and colleagues apply spatial simulation models to case studies in Australia, Brazil, Indonesia, and Mozambique to show that compensation alone is not sufficient to preserve biodiversity.

Understanding complex drivers of wildlife crime to design effective conservation interventions

In conservation understanding the drivers of behavior and developing robust interventions to promote behavioral change is challenging and requires a multifaceted approach. This is particularly true for efforts to address illegal wildlife use, where pervasive-and sometimes simplistic-narratives often obscure complex realities. We used an indirect questioning approach, the unmatched count technique, to investigate the drivers and prevalence of wildlife crime in communities surrounding 2 national parks in Uganda and combined scenario interviews and a choice experiment to predict the performance of potential interventions designed to tackle these crimes. Although poverty is often assumed to be a key driver of wildlife crime, we found that better-off households and those subject to human-wildlife conflict and those that do not receive any benefits from the parks' tourism revenue sharing were more likely to be involved in certain types of wildlife crime, especially illegal hunting. The interventions predicted to have the greatest impact on reducing local participation in wildlife crime were those that directly addressed the drivers including, mitigating damage caused by wildlife and generating financial benefits for park-adjacent households. Our triangulated approach provided insights into complex and hard-to-access behaviors and highlighted the importance of going beyond single-driver narratives.

Effect of Diindolylmethane on Estrogen-related Hormones, Metabolites and Tamoxifen Metabolism: Results of a Randomized, Placebo-controlled Trial

Dietary supplement use is high among breast cancer survivors. One compound natural to cruciferous vegetables, diindolylmethane (DIM), is among the supplements commonly used. This bioactive compound has significant experimental evidence for bioactivity in breast chemoprevention. Sparse evidence in the form of well-designed human clinical trials exist to test its efficacy or safety. Methods: In this double-blind placebo-controlled study women taking tamoxifen for breast cancer primary or tertiary prevention were randomly assigned to receive 150 mg DIM (BioResponse(BR)-DIM) twice daily or a placebo for a minimum period of 12 months. Primary outcome was change in urinary estrogen metabolites 2-hydroxyestrone and 16α-hydroxyestrone (baseline to 6 weeks, 6 and 12 months). Secondary endpoints included breast density by mammogram and fat:water ratio MRI (baseline to 12 months) and serum estrogens (baseline to 6, 12 months). Safety data were also evaluated, including tamoxifen metabolites. Results: Adherence to study pills was >91% by pill count and urinary DIM metabolite assessment. In participants assigned DIM there was a significant and sustained shift in urinary estrogen metabolism favoring a higher 2-OH:16α-OH ratio; sex hormone binding globulin (SHBG) was also increased. No change in breast density was demonstrated. Safety analysis showed no appreciable differences in adverse events by treatment arm; however, tamoxifen metabolism for the parent compound as well as endoxifen and 4-OH endoxifen were appreciably reduced in women assigned to the DIM arm. Conclusions In this first large study of DIM in the setting of breast cancer chemoprevention, a favorable shift in estrogen metabolism and SHBG was demonstrated. However, the reduction in tamoxifen metabolites raises concern regarding the potential interaction between DIM and tamoxifen, an area in need of continued research. Impact Given the widespread and generally unsupported use of dietary supplementation by breast cancer survivors, these data will help to inform the use of DIM as a dietary supplement for breast cancer patients receiving tamoxifen.

Developing a theory of change for a community-based response to illegal wildlife trade

The escalating illegal wildlife trade (IWT) is one of the most high-profile conservation challenges today. The crisis has attracted over US$350 million in donor and government funding in recent years, primarily directed at increased enforcement. There is growing recognition among practitioners and policy makers of the need to engage rural communities that neighbor or live with wildlife as key partners in tackling IWT. However, a framework to guide such community engagement is lacking. We developed a theory of change (ToC) to guide policy makers, donors, and practitioners in partnering with communities to combat IWT. We identified 4 pathways for community-level actions: strengthen disincentives for illegal behavior, increase incentives for wildlife stewardship, decrease costs of living with wildlife, and support livelihoods that are not related to wildlife. To succeed the pathways, all require strengthening of enabling conditions, including capacity building, and of governance. Our ToC serves to guide actions to tackle IWT and to inform the evaluation of policies. Moreover, it can be used to foster dialogue among IWT stakeholders, from local communities to governments and international donors, to develop a more effective, holistic, and sustainable community-based response to the IWT crisis.

Reframing the concept of alternative livelihoods

Alternative livelihood project (ALP) is a widely used term for interventions that aim to reduce the prevalence of activities deemed to be environmentally damaging by substituting them with lower impact livelihood activities that provide at least equivalent benefits. ALPs are widely implemented in conservation, but in 2012, an International Union for Conservation of Nature resolution called for a critical review of such projects based on concern that their effectiveness was unproven. We focused on the conceptual design of ALPs by considering their underlying assumptions. We placed ALPs within a broad category of livelihood-focused interventions to better understand their role in conservation and their intended impacts. We dissected 3 flawed assumptions about ALPs based on the notions of substitution, the homogenous community, and impact scalability. Interventions based on flawed assumptions about people's needs, aspirations, and the factors that influence livelihood choice are unlikely to achieve conservation objectives. We therefore recommend use of a sustainable livelihoods approach to understand the role and function of environmentally damaging behaviors within livelihood strategies; differentiate between households in a community that have the greatest environmental impact and those most vulnerable to resource access restrictions to improve intervention targeting; and learn more about the social-ecological system within which household livelihood strategies are embedded. Rather than using livelihood-focused interventions as a direct behavior-change tool, it may be more appropriate to focus on either enhancing the existing livelihood strategies of those most vulnerable to conservation-imposed resource access restrictions or on use of livelihood-focused interventions that establish a clear link to conservation as a means of building good community relations. However, we recommend that the term ALP be replaced by the broader term livelihood-focused intervention. This avoids the implicit assumption that alternatives can fully substitute for natural resource-based livelihood activities.