Life-course neighbourhood deprivation and brain structure in older adults: the Lothian Birth Cohort 1936.

Neighbourhood disadvantage may be associated with brain health but the importance of exposure at different stages of the life course is poorly understood. Utilising the Lothian Birth Cohort 1936, we explored the relationship between residential neighbourhood deprivation from birth to late adulthood, and global and local neuroimaging measures at age 73. A total of 689 participants had at least one valid brain measures (53% male); to maximise the sample size structural equation models with full information maximum likelihood were conducted. Residing in disadvantaged neighbourhoods in mid- to late adulthood was associated with smaller total brain (ß = -0.06; SE = 0.02; sample size[N] = 658; number of pairwise complete observations[n]=390), grey matter (ß = -0.11; SE = 0.03; N = 658; n = 390), and normal-appearing white matter volumes (ß = -0.07; SE = 0.03; N = 658; n = 390), thinner cortex (ß = -0.14; SE = 0.06; N = 636; n = 379), and lower general white matter fractional anisotropy (ß = -0.19; SE = 0.06; N = 665; n = 388). We also found some evidence on the accumulating impact of neighbourhood deprivation from birth to late adulthood on age 73 total brain (ß = -0.06; SE = 0.02; N = 658; n = 276) and grey matter volumes (ß = -0.10; SE = 0.04; N = 658; n = 276). Local analysis identified affected focal cortical areas and specific white matter tracts. Among individuals belonging to lower social classes, the brain-neighbourhood associations were particularly strong, with the impact of neighbourhood deprivation on total brain and grey matter volumes, and general white matter fractional anisotropy accumulating across the life course. Our findings suggest that living in deprived neighbourhoods across the life course, but especially in mid- to late adulthood, is associated with adverse brain morphologies, with lower social class amplifying the vulnerability.

Supporting conservationists' mental health through better working conditions.

Biodiversity conservation work can be challenging but rewarding, and both aspects have potential consequences for conservationists' mental health. Yet, little is known about patterns of mental health among conservationists and its associated workplace protective and risk factors. A better understanding might help improve working conditions, supporting conservationists' job satisfaction, productivity, and engagement, while reducing costs from staff turnover, absenteeism, and presenteeism. We surveyed 2311 conservation professionals working in 122 countries through an internet survey shared via mailing lists, social media, and other channels. We asked them about experiences of psychological distress, working conditions, and personal characteristics. Over half were from and worked in Europe and North America, and most had a university-level education, were in desk-based academic and practitioner roles, and responded in English. Heavy workload, job demands, and organizational instability were linked to higher distress, but job stability and satisfaction with one's contributions to conservation were associated with lower distress. Respondents with low dispositional and conservation-specific optimism, poor physical health, and limited social support, women, and early-career professionals were most at risk of distress in our sample. Our results flag important risk factors that employers could consider, although further research is needed among groups underrepresented in our sample. Drawing on evidence-based occupational health interventions, we suggest measures that could promote better working conditions and thus may improve conservationists' mental health and abilities to protect nature.

Mejores condiciones de trabajo para apoyar la salud mental de los conservacionistas Resumen La conservación de la biodiversidad puede ser difícil pero gratificante y ambos aspectos pueden tener consecuencias en la salud mental de los conservacionistas. Sin embargo, sabemos poco sobre la salud mental de los conservacionistas, sus patrones y los factores de protección y riesgo asociados al lugar de trabajo. Un mayor conocimiento ayudaría a mejorar las condiciones de trabajo, pues impulsaría la satisfacción laboral, la productividad y el compromiso de los conservacionistas, mientras se reducen los costos derivados de la rotación de personal, el ausentismo y el presentismo. Encuestamos a 2,311 profesionales de la conservación de 122 países con una encuesta virtual compartida por listas de correo, redes sociales y otros medios. Les preguntamos a los profesionales sobre sus experiencias de estrés psicológico, condiciones de trabajo y características personales. Más de la mitad trabajaban y procedían de Europa y Norteamérica; la mayoría respondió en inglés, contaba con estudios universitarios y actualmente desempeña funciones académicas y profesionales. La carga de trabajo excesiva, las exigencias laborales y la inestabilidad organizacional se relacionaron con un mayor estrés, mientras la estabilidad laboral y la satisfacción con la contribución propia a la conservación se asociaron con un menor estrés. En nuestra muestra, los encuestados con baja disposición y un optimismo específico hacia la conservación, mala salud física, apoyo social limitado, las mujeres y los profesionales que inician su carrera son los que corren un mayor riesgo de sufrir estrés. Nuestros resultados señalan importantes factores de riesgo que los empresarios podrían considerar, aunque es necesario seguir investigando entre los grupos menos representados en nuestra muestra. Con base en las intervenciones de salud laboral respaldadas con pruebas, sugerimos medidas que podrían promover mejores condiciones de trabajo y, así mejorar la salud mental de los conservacionistas y su capacidad para proteger la naturaleza.

Universal, selective and indicated interventions for supporting mental health at the workplace: an umbrella review of meta-analyses.

The current umbrella review aimed to assess and summarise evidence on universal, selective and indicated interventions for mental health at the workplace. This umbrella review forms one of the evidence reviews which were commissioned by the WHO to develop global guidelines on mental health at work. We conducted systematic searches in five bibliographic databases (PubMed, Embase, PsycINFO, Cochrane and Global Medicus Index) and included meta-analyses of randomised trials examining psychosocial, physical activity and lifestyle interventions delivered to all general workers (universal interventions), at-risk workers (selective interventions) and workers already experiencing symptoms of mental disorders (indicated interventions). We included outcomes from seven domains: symptoms of mental health conditions, positive mental health, quality of life, work-related outcomes, substance use, suicide-related outcomes and potential adverse effects. We identified 16 meta-analyses producing 66 pooled effect sizes of the examined interventions, mostly on symptoms of mental health conditions (n=43 pooled effect sizes) (eg, burnout, insomnia, stress) and positive mental health (n=15) (eg, well-being). Most of the evidence on universal, selective and indicated interventions was focused on psychosocial interventions, showing small to moderate effects across the various outcomes. Certainty levels according to GRADE (Grading of Recommendations Assessment, Development and Evaluation) were low to very low in almost all of the examined outcomes. The results of existing meta-analyses are promising for the use of preventative and early treatment interventions in the workplace. However, the quality and certainty of the evidence were very modest, and further research on the effectiveness of these interventions is warranted.

Early life PM2.5 exposure, childhood cognitive ability and mortality between age 11 and 86: A record-linkage life-course study from Scotland.

BACKGROUND: Living in areas with high air pollution concentrations is associated with all-cause and cause-specific mortality. Exposure in sensitive developmental periods might be long-lasting but studies with very long follow-up are rare, and mediating pathways between early life exposure and life-course mortality are not fully understood. METHODS: Data were drawn from the Scottish Longitudinal Study Birth Cohort of 1936, a representative record-linkage study comprising 5% of the Scottish population born in 1936. Participants had valid age 11 cognitive ability test scores along with linked mortality data until age 86. Fine particle (PM2.5) concentrations estimated with the EMEP4UK atmospheric chemistry transport model were linked to participants' residential address derived from the National Identity Register in 1939 (age 3). Confounder-adjusted Cox regression estimated associations between PM2.5 and mortality; regression-based causal mediation analysis explored mediation through childhood cognitive ability. RESULTS: The final sample consisted of 2734 individuals with 1608 deaths registered during the 1,833,517 person-months at risk follow-up time. Higher early life PM2.5 exposure increased the risk of all-cause mortality (HR = 1.03, 95% CI: 1.01-1.04 per 10 µg m-3 increment), associations were stronger for mortality between age 65 and 86. PM2.5 increased the risk of cancer-related mortality (HR = 1.05, 95% CI: 1.02-1.08), especially for lung cancer among females (HR = 1.11, 95% CI: 1.02-1.21), but not for cardiovascular and respiratory diseases. Higher PM2.5 in early life (≥50 µg m-3) was associated with lower childhood cognitive ability, which, in turn, increased the risk of all-cause mortality and mediated 25% of the total associations. CONCLUSIONS: In our life-course study with 75-year of continuous mortality records, we found that exposure to air pollution in early life was associated with higher mortality in late adulthood, and that childhood cognitive ability partly mediated this relationship. Findings suggest that past air pollution concentrations will likely impact health and longevity for decades to come.

Neighbourhood deprivation across eight decades and late-life cognitive function in the Lothian Birth Cohort 1936: a life-course study.

INTRODUCTION: although neighbourhood may predict late-life cognitive function, studies mostly rely on measurements at a single time point, with few investigations applying a life-course approach. Furthermore, it is unclear whether the associations between neighbourhood and cognitive test scores relate to specific cognitive domains or general ability. This study explored how neighbourhood deprivation across eight decades contributed to late-life cognitive function. METHODS: data were drawn from the Lothian Birth Cohort 1936 (n = 1,091) with cognitive function measured through 10 tests at ages 70, 73, 76, 79 and 82. Participants' residential history was gathered with 'lifegrid' questionnaires and linked to neighbourhood deprivation in childhood, young adulthood and mid-to-late adulthood. Associations were tested with latent growth curve models for levels and slopes of general (g) and domain-specific abilities (visuospatial ability, memory and processing speed), and life-course associations were explored with path analysis. RESULTS: higher mid-to-late adulthood neighbourhood deprivation was associated with lower age 70 levels (ß = -0.113, 95% confidence intervals [CI]: -0.205, -0.021) and faster decline of g over 12 years (ß = -0.160, 95%CI: -0.290, -0.031). Initially apparent findings with domain-specific cognitive functions (e.g. processing speed) were due to their shared variance with g. Path analyses suggested that childhood neighbourhood disadvantage is indirectly linked to late-life cognitive function through lower education and selective residential mobility. CONCLUSIONS: to our knowledge, we provide the most comprehensive assessment of the life-course neighbourhood deprivation and cognitive ageing relationship. Living in advantaged areas in mid-to-late adulthood may directly contribute to better cognitive function and slower decline, whereas an advantaged childhood neighbourhood likely affects functioning through cognitive reserves.

Association of Life-Course Neighborhood Deprivation With Frailty and Frailty Progression From Ages 70 to 82 Years in the Lothian Birth Cohort 1936.

Neighborhood features have been postulated to be key predictors of frailty. However, evidence is mainly limited to cross-sectional studies without indication of long-term impact. We explored how neighborhood social deprivation (NSD) across the life course is associated with frailty and frailty progression among older Scottish adults. Participants (n = 323) were persons selected from the Lothian Birth Cohort 1936 with historical measures of NSD in childhood (1936-1955), young adulthood (1956-1975), and mid- to late adulthood (1976-2014). Frailty was measured 5 times between the ages of 70 and 82 years using the Frailty Index. Confounder-adjusted life-course models were assessed using a structured modeling approach; associations were estimated for frailty at baseline using linear regression and for frailty progression using linear mixed-effects models. Accumulation was the most appropriate life-course model for males; greater accumulated NSD was associated with higher frailty at baseline (b = 0.017, 95% confidence interval: 0.005, 0.029). Among females, the mid- to late adulthood sensitive period was the best-fitting life-course model, and higher NSD in this period was associated with widening frailty trajectories (b = 0.005, 95% confidence interval: 0.0004, 0.009). To our knowledge, this is the first investigation of the life-course impact of NSD on frailty in a cohort of older adults. Policies designed to address deprivation and inequalities across the full life course may support healthy aging.

Lower social participation partly explains the association between perceived neighbourhood crime and depressive symptoms in European adults aged 50 years or older: A longitudinal mediation analysis.

Neighbourhood crime likely increases the risk of developing depression among older adults. However, little is known about the underlying behavioural and social pathways. We examined the association between perceived neighbourhood crime and depressive symptoms and whether this relationship was mediated by health behaviours (physical activity, smoking, and alcohol consumption) and social participation. Furthermore, we explored differential vulnerability across age, gender, education and household wealth. Data were drawn from six waves of longitudinal data (from 2004/2005 to 2017) of approximately 15,000 adults aged 50 years and older, derived from the multi-national Survey of Health, Ageing and Retirement in Europe. Perceived neighbourhood crime and covariates were measured at baseline, time-variant mediators and depressive symptoms across all waves. Confounder-adjusted mediator and outcome models were fitted with mixed-effects models. Total association was decomposed into direct and indirect pathways applying causal mediation analyses with Monte-Carlo simulations. Perceived crime was associated with higher risk of depressive symptoms; 4.6% of the effect was mediated via lower engagement in social activities (b = 0.005; 95% CI: 0.001-0.009). No mediation was detected through physical activity, smoking or alcohol consumption. Exploratory analyses revealed that the mediating role of social participation was more pronounced among participants with low household wealth (b = 0.012; 95% CI: 0.004-0.023; 7.3% mediated). Lower engagement in social activities partly explained the association between perceived neighbourhood crime and depressive symptoms in adults aged 50 years or older. Policies targeting disadvantaged communities to prevent crime and support social participation might be beneficial for population mental health, especially among financially vulnerable older residents.

Balancing making a difference with making a living in the conservation sector.

Goals play important roles in people's lives because they focus attention, mobilize effort, and sustain motivation. Understanding conservationists' satisfaction with goal progress may provide insights into real-world environmental trends and flag risks to their well-being and motivation. We asked 2694 conservationists working globally how satisfied they were with progress toward goals important to them. We then explored how this satisfaction varied among groups, including demographic and occupational. Finally, we looked at respondents' experiences associated with goal-progress satisfaction. Many (94.0%) indicated that making a meaningful contribution to conservation was an important goal for them, and over half were satisfied or very satisfied in this area (52.5%). However, respondents were generally dissatisfied with progress on collective conservation goals (e.g., stopping species loss). Some groups were more likely to report dissatisfaction than others. For instance, those in conservation for longer tended to be less satisfied with collective goal progress (log odds -0.21, 95% credibility interval [CI] -0.32 to -0.10), but practitioners reported greater satisfaction (log odds 0.38, 95% CI 0.15-0.60). Likewise, those who were more optimistic in life (log odds 0.24, 95% CI 0.17-0.32), male (log odds 0.25, 95% CI 0.10-0.41), and working in conservation practice (log odds 0.25, 95% CI 0.08-0.43) reported greater satisfaction with individual goal progress. Free-text responses suggested widespread dissatisfaction with livelihood goals, particularly related to job security and adequate compensation. Although contributing to conservation appeared to be a source of satisfaction, slow goal progress in other areas--particularly around making a living--looked to be a source of distress and demotivation. Employers, funders, professional societies, and others should consider ways to help those in the sector make a difference while making a satisfactory living by, for example, prioritizing conservationists' well-being when allocating funding. This support could include avoiding exploitative practices, fostering supportive work environments, and celebrating positive outcomes.

El Balance entre Hacer una Diferencia y Ganarse la Vida en el Sector de la Conservación 21-323 Resumen Los objetivos juegan un papel importante en la vida de las personas porque enfocan la atención, movilizan esfuerzos y mantienen la motivación. El entendimiento de la satisfacción de los conservacionistas con el progreso de sus objetivos podría proporcionar información sobre las tendencias ambientales del mundo real y marcar los riesgos para su bienestar y motivaciones. Les preguntamos a 2694 conservacionistas trabajando alrededor del mundo cuán satisfechos están con el progreso hacia los objetivos que consideran más importantes. Después exploramos cómo esta satisfacción varió entre grupos, incluyendo grupos demográficos y laborales. Finalmente, observamos las experiencias de los respondientes asociadas con la satisfacción con el progreso de los objetivos. Muchos (94%) indicaron que contribuir significativamente a la conservación es un objetivo importante para ellos, y más de la mitad estuvieron satisfechos o muy satisfechos en este campo (52.5%). Sin embargo, los respondientes también mostraron una inconformidad generalizada con el progreso de los objetivos colectivos de conservación (p. ej.: detener la pérdida de especies). Algunos grupos tuvieron una mayor probabilidad de reportar inconformidades que otros grupos. Por ejemplo, aquellos con mayor tiempo en la conservación tendieron a estar menos satisfechos con el progreso de los objetivos colectivos (probabilidad log -0.21, 95% intervalo de credibilidad [IC] -0.32 a -0.10), pero los practicantes reportaron una mayor satisfacción (probabilidad log 0.38, 95% IC 0.15-0.60). De igual manera, quienes cuentan con mayor optimismo cotidiano (probabilidad log 0.24, 95% IC 0.17-0.32), son de sexo masculino (probabilidad log 0.25, 95% IC 0.10-0.41) y trabajan en la práctica de la conservación (probabilidad log 0.25, 95% IC 0.08-0.43) reportaron una mayor satisfacción con el progreso de los objetivos individuales. Las respuestas de texto libre sugirieron una inconformidad generalizada con los objetivos de sustento, particularmente los relacionados con la seguridad laboral y las compensaciones adecuadas. Aunque contribuir a la conservación parece ser una fuente de satisfacción, el progreso lento de los objetivos en otras áreas - particularmente las relacionadas con ganarse la vida - indicaba ser una fuente de angustia y desmotivación. Los empleadores, financiadores, las sociedades profesionales y demás deberían considerar maneras para ayudar a aquellos en el sector de la conservación a lograr una diferencia a la vez que se ganan la vida satisfactoriamente, por ejemplo, mediante la priorización del bienestar de los conservacionistas al momento de asignar financiamientos. Este apoyo podría incluir evitar prácticas explotadoras, fomentar ambientes de trabajo solidarios y celebrar los resultados positivos.

A data linkage study of the effects of the Great Recession and austerity on antidepressant prescription usage.

BACKGROUND: International literature shows unemployment and income loss during the Great Recession worsened population mental health. This individual-level longitudinal study examines how regional economic trends and austerity related to depression using administrative prescription data for a large and representative population sample. METHODS: Records from a sample of the Scottish Longitudinal Study (N=86 500) were linked to monthly primary care antidepressant prescriptions (2009-15). Regional economic trends were characterized by annual full-time employment data (2004-14). Economic impact of austerity was measured via annual income lost per working age adult due to welfare reforms (2010-15). Sequence analysis identified new cases of antidepressant use, and group-based trajectory modelling classified regions into similar economic trajectories. Multi-level logistic regression examined relationships between regional economic trends and new antidepressant prescriptions. Structural equation mediation analysis assessed the contributory role of welfare reforms. RESULTS: Employed individuals living in regions not recovering post-recession had the highest risk of beginning a new course of antidepressants (AOR 1.23; 95% CI 1.08-1.38). Individuals living in areas with better recovery trajectories had the lowest risk. Mediation analyses showed that 50% (95% CI 7-61%) of this association was explained by the impact of welfare benefit reforms on average incomes. CONCLUSIONS: Following the Great Recession, local labour market decline and austerity measures were associated with growing antidepressant usage, increasing regional inequalities in mental health. The study evidences the impact of austerity on health inequalities and suggests that economic conditions and welfare policies impact on population health. Reducing the burden of mental ill-health primarily requires action on the social determinants.

The Longitudinal Associations of Perceived Neighborhood Disorder and Lack of Social Cohesion With Depression Among Adults Aged 50 Years or Older: An Individual-Participant-Data Meta-Analysis From 16 High-Income Countries.

Although residential environment might be an important predictor of depression among older adults, systematic reviews point to a lack of longitudinal investigations, and the generalizability of the findings is limited to a few countries. We used longitudinal data collected between 2012 and 2017 in 3 surveys including 15 European countries and the United States and comprising 32,531 adults aged 50 years or older. The risk of depression according to perceived neighborhood disorder and lack of social cohesion was estimated using 2-stage individual-participant-data meta-analysis; country-specific parameters were analyzed by meta-regression. We conducted additional analyses on retired individuals. Neighborhood disorder (odds ratio (OR) = 1.25) and lack of social cohesion (OR = 1.76) were significantly associated with depression in the fully adjusted models. In retirement, the risk of depression was even higher (neighborhood disorder: OR = 1.35; lack of social cohesion: OR = 1.93). Heterogeneity across countries was low and was significantly reduced by the addition of country-level data on income inequality and population density. Perceived neighborhood problems increased the overall risk of depression among adults aged 50 years or older. Policies, especially in countries with stronger links between neighborhood and depression, should focus on improving the physical environment and supporting social ties in communities, which can reduce depression and contribute to healthy aging.

Use of sequence analysis for classifying individual antidepressant trajectories to monitor population mental health.

BACKGROUND: Over the past decade, antidepressant prescriptions have increased in European countries and the United States, partly due to an increase in the number of new cases of mental illness. This paper demonstrates an innovative approach to the classification of population level change in mental health status, using administrative data for a large sample of the Scottish population. We aimed to identify groups of individuals with similar patterns of change in pattern of prescribing, validate these groups by comparison with other indicators of mental illness, and characterise the population most at risk of increasing mental ill health. METHODS: National Health Service (NHS) prescription data were linked to the Scottish Longitudinal Study (SLS), a 5.3% sample of the Scottish population (N = 151,418). Antidepressant prescription status over the previous 6 months was recorded for every month for which data were available (January 2009-December 2014), and sequence dissimilarity was computed by optimal matching. Hierarchical clustering was used to create groups of participants who had similar patterns of change, with multi-level logistic regression used to understand group membership. RESULTS: Five distinct prescription pattern groups were observed, indicating: no prescriptions (76%), occasional prescriptions (10%), continuation of prior use of prescriptions (8%), a new course of prescriptions started (4%) or ceased taking prescriptions (3%). Young, white, female participants, of low social grade, residing in socially deprived neighbourhoods, living alone, being separated/divorced or out of the labour force, were more likely to be in the group that started a new course of antidepressant prescriptions. CONCLUSIONS: The use of sequence analysis for classifying individual antidepressant trajectories offers a novel approach for capturing population-level changes in mental health risk. By classifying individuals into groups based on their anti-depressant medication use we can better identify how over time, mental health is associated with individual risk factors and contextual factors at the local level and the macro political and economic scale.

A longitudinal study of neighbourhood conditions and depression in ageing European adults: Do the associations vary by exposure to childhood stressors?

Emerging literature emphasises the association between neighbourhood conditions and late life depression. Childhood experiences, crucial for life course development of mental health, may modify how neighbourhood affects subsequent depression. This study assessed the longitudinal associations of access to services and neighbourhood nuisance with depression among older adults, and tested whether these associations varied by exposure to childhood stressors. Data were drawn from the cross-national Survey of Health, Ageing and Retirement in Europe, a prospective cohort study between 2004/2005 and 2015, representative for European adults over the age of 50. Individual perceptions of neighbourhood were measured at baseline; childhood stressors, defined as socioeconomic conditions, adverse experiences and health problems, were collected retrospectively. Multilevel logistic regression estimated the risk of depression (n = 10,328). Access to services were negatively (OR = 0.78, 95% CI 0.68-0.90) and neighbourhood nuisance positively (OR = 1.36, 95% CI 1.18-1.56) associated with the probability of depression during follow-up. We found interactions between neighbourhood and childhood socioeconomic conditions, but not with adverse experiences and health problems. While older adults who grew up in better childhood socioeconomic conditions benefited more from living in a residential area with good access to services, they were at higher risk of developing depression when residing in areas with more neighbourhood nuisances. Older adults' mental health can benefit from better access to public transportation and neighbourhood amenities, while physical and social problems in the local area increase the risk of depression. Importantly, socioeconomic circumstances in early life may influence vulnerability to neighbourhood effects in older age.

Cognitive resources moderate the adverse impact of poor perceived neighborhood conditions on self-reported physical activity of older adults.

Poor neighborhood conditions are associated with lower levels of physical activity for older adults but socio-ecological models posit that physical activity depends on both environmental and individual factors. Older adults' ability to overcome environmental barriers to physical activity may partially rely on cognitive resources. However, evidence on the moderating role of these cognitive resources in the associations between environmental barriers and physical activity is still lacking. We analyzed cross-national and longitudinal data on 28,393 adults aged 50 to 96 years as part of the SHARE. Lack of access to services and neighborhood nuisances were used as indicators of poor neighborhood conditions. Delayed recall and verbal fluency were used as indicators of cognitive resources. Confounder-adjusted generalized estimation equations were conducted to test associations between neighborhood conditions and self-reported moderate physical activity, as well as the moderating role of cognitive resources. Results showed that poor neighborhood conditions reduced the odds of engagement in physical activity. Cognitive resources robustly reduced the adverse influence of poor neighborhood conditions on physical activity. Participants with lower cognitive resource scores showed lower odds of engaging in physical activity when neighborhood conditions were poorer, whereas these conditions were not related to this engagement for participants with higher cognitive resource scores. These findings suggest that cognitive resources can temper the detrimental effect of poor neighborhood conditions on physical activity. Public policies should target both individual and environmental factors to tackle the current pandemic of physical inactivity more comprehensively.

Substance Use During Imprisonment in Low- and Middle-Income Countries.

Substance use disorders are among the most common health problems of people involved with the criminal justice system. Scaling up addiction services in prisons is a global public health and human rights challenge, especially in poorly resourced countries. We systematically reviewed the prevalence of substance use in prison populations in low- and middle-income countries. We searched for studies reporting prevalence rates of nicotine, alcohol, illicit drug, and injection drug use during imprisonment in unselected samples of imprisoned people in low- and middle-income countries. Data meta-analysis was conducted and sources of heterogeneity were examined by meta-regression. Prevalence of nicotine use during imprisonment ranged from 5% to 87%, with a random-effects pooled estimate of 56% (95% confidence interval (CI): 45, 66) with significant geographical heterogeneity. Alcohol use varied from 1% to 76% (pooled prevalence, 16%, 95% CI: 9, 25). Approximately one-quarter of people (25%; 95% CI: 17, 33; range, 0-78) used illicit drugs during imprisonment. The prevalence of injection drug use varied from 0% to 26% (pooled estimate, 1.6%, 95% CI: 0.8, 3.0). Lifetime substance use was investigated in secondary analyses. The high prevalence of smoking in prison suggests that policies regarding smoking need careful review. Furthermore, the findings underscore the importance of timely, scalable, and available treatments for alcohol and illegal drug use by people involved with the criminal justice system.

Prevalence of Posttraumatic Stress Disorder in Prisoners.

People involved with criminal justice frequently are exposed to violence and traumatic experiences. This may lead to posttraumatic stress disorder (PTSD); however, no review, to our knowledge, has synthetized findings in this setting. We conducted a systematic review and meta-analysis to estimate prevalence rates of PTSD in prison populations. Original studies in which prevalence rates of PTSD in unselected samples of incarcerated people were reported were systematically searched between 1980 and June 2017. Data were pooled using random-effects meta-analysis, and sources of heterogeneity for prespecified characteristics were assessed by meta-regression. We identified 56 samples comprising 21,099 imprisoned men and women from 20 countries. Point prevalence of PTSD ranged from 0.1% to 27% for male, and from 12% to 38% for female prisoner populations. The random-effects pooled point prevalence was 6.2% (95% confidence interval: 3.9, 9.0) in male prisoners and 21.1% (95% confidence interval: 16.9, 25.6) in female prisoners. The heterogeneity between the included studies was very high. Higher prevalence was reported in samples of female prisoners, smaller studies (n ≤ 200), and for investigations based in high-income countries. Existing evidence shows high levels of PTSD among imprisoned people, especially women. Psychosocial interventions to prevent violence, especially against children and women, and to mitigate its consequences in marginalized communities must be improved. Trauma-informed approaches for correctional programs and scalable PTSD treatments in prisons require further consideration.

Metabolites of Aliphatic Alcohols Detected in Alcoholic Beverages Inhibit Phagocytosis.

AIMS: The aim of our study was to measure granulocyte and monocyte phagocytosis following treatment of cells with some metabolites of aliphatic alcohols alone and in combination with acetaldehyde. METHODS: The cells were separated from human peripheral blood prior to determination of phagocytosis of opsonized zymosan particles by granulocytes and monocytes treated individually with metabolites of aliphatic alcohols including formaldehyde, 1-propanal, acetone, 1-butanal, and 2-butanone and in combination with acetaldehyde. RESULTS: The findings revealed that metabolites of aliphatic alcohols inhibited phagocytosis by granulocytes and monocytes in a concentration-dependent manner and when combined with acetaldehyde, they caused a further decrease in phagocytic activity. CONCLUSION: Due to their additive effects, it is possible that, in combination with acetaldehyde, metabolites of aliphatic alcohols may inhibit phagocytosis at physiologically realistic concentrations in episodic heavy drinkers, thereby contributing to their increased susceptibility to infectious diseases.

Aliphatic alcohols in spirits inhibit phagocytosis by human monocytes.

A large volume of alcoholic beverages containing aliphatic alcohols is consumed worldwide. Previous studies have confirmed the presence of ethanol-induced immunosuppression in heavy drinkers, thereby increasing susceptibility to infectious diseases. However, the aliphatic alcohols contained in alcoholic beverages might also impair immune cell function, thereby contributing to a further decrease in microbicidal activity. Previous research has shown that aliphatic alcohols inhibit phagocytosis by granulocytes but their effect on human monocytes has not been studied. This is important as they play a crucial role in engulfment and killing of pathogenic microorganisms and a decrease in their phagocytic activity could lead to impaired antimicrobial defence in heavy drinkers. The aim of this study was to measure monocyte phagocytosis following their treatment with those aliphatic alcohols detected in alcoholic beverages. Monocytes were separated from human peripheral blood and phagocytosis of opsonized zymosan particles by monocytes treated with ethanol and aliphatic alcohols individually and in combination was determined. It was shown that these alcohols could suppress the phagocytic activity of monocytes in a concentration-dependent manner and when combined with ethanol, they caused a further decrease in phagocytosis. Due to their additive effects, it is possible that they may inhibit phagocytosis in a clinically meaningful way in alcoholics and episodic heavy drinkers thereby contribute to their increased susceptibility to infectious diseases. However, further research is needed to address this question.

Higher air pollution exposure in early life is associated with worse health among older adults: A 72-year follow-up study from Scotland.

Air pollution increases the risk of mortality and morbidity. However, limited evidence exists on the very long-term associations between early life air pollution exposure and health, as well as on potential pathways. This study explored the relationship between fine particle (PM2.5) exposure at age 3 and limiting long-term illness (LLTI) at ages 55, 65 and 75 using data from the Scottish Longitudinal Study Birth Cohort 1936, a representative administrative cohort study. We found that early life PM2.5 exposure was associated with higher odds of LLTI in mid-to-late adulthood (OR = 1.10, 95% CI: 1.06, 1.14 per 10 µg m-3 increment) among the 2085 participants, with stronger associations among those growing up in disadvantaged families. Path analyses suggested that 15-21% of the association between early life PM2.5 concentrations and LLTI at age 65 (n = 1406) was mediated through childhood cognitive ability, educational qualifications, and adult social position. Future research should capitalise on linked administrative and health data, and explore causal mechanisms between environment and specific health conditions across the life course.

Worldwide incidence of suicides in prison: a systematic review with meta-regression analyses.

BACKGROUND: Suicide is a leading cause of death during imprisonment. This systematic review aimed to synthesise available evidence of prison suicide incidence worldwide. METHODS: We systematically searched the scientific literature, data repositories, and prison system reports, supplemented by correspondence with prison administrations. We included reports on people living in prison but excluded studies in preselected groups (by age or offence type). Absolute numbers and incidence rates of suicide mortality per 100 000 person-years by sex and country were extracted from 2000 to 2021. IQRs were used to describe the suicide incidence in different world regions. Incidence rate ratios comparing suicides of people living in prison with age-standardised general populations were calculated. We conducted meta-regression analyses on national-level and prison-level factors to examine heterogeneity. The study protocol was pre-registered with PROSPERO, CRD42021296819. FINDINGS: We included three scientific studies, 124 official reports, and 11 datasets from email correspondence. Between 2000 and 2021, there were 29 711 reported suicides during 91·2 million person-years of imprisonment in 82 jurisdictions worldwide (sex-specific data available for 13 289 individuals: 12 544 [94·4%] male and 745 [5·6%] female individuals). There were large variations between countries, with most studies reporting suicide rates in the range of 24-89 per 100 000 person-years in both sexes (22-86 in male individuals and 25-107 in female individuals). In meta-regression analyses, Europe (vs other regions), high-income countries (vs low-income and middle-income countries), and countries with lower incarceration rates (vs those with higher incarceration rates) had higher suicide rates. Incidence rate ratios between people who are incarcerated and age-standardised general populations in the same jurisdictions were typically in the range of 1·9-6·0 in male and 10·4-32·4 in female individuals. INTERPRETATION: Prison services worldwide, and particularly in Europe, should prioritise suicide prevention. Assessment and management of suicide risk in female individuals living in prison need particular attention due to excess mortality relative to community-based populations. Interpretation of synthesised data needs to be done with caution due to high heterogeneity between jurisdictions. FUNDING: Agencia Nacional de Investigación y Desarrollo, Economic and Social Research Council, and Wellcome Trust.