Damian Sendler: THC, one of the psychoactive compounds in cannabis, has been linked to a variety of long-term psychopathological outcomes when it is exposed to developing brains. As a result of this increased risk come an increased incidence of mental illnesses such as schizophrenia and other mood and anxiety disorders, in addition to possible cognitive declines. THC-related psychotic risk vulnerability may be explained by a variety of neuropathophysiological sequelae and mechanisms being studied in clinical and preclinical settings, particularly in adolescents who have had cannabis exposure. THC’s ability to induce long-term adaptations in the mesocorticolimbic system that resemble pathological endophenotypes associated with these disorders is common in these studies.

Damian Jacob Sendler: In terms of both recreational and medicinal use, cannabis is one of the most commonly used psychoactive substances. The growing acceptance of marijuana as a recreational drug around the world heightens the urgency of furthering clinical and preclinical research into the drug’s potentially harmful effects, particularly on the developing brain. Drug experimentation is common during the adolescent years as a result of the profound neurodevelopmental vulnerability during this time period. One-third of adolescents in Europe between the ages of 12 and 17 smoke cannabis, and 1.2 percent of them do so on a regular basis [1]. In the United States, however, the percentage of high school students who use cannabis has steadily increased from 14 percent to 44 percent. As a result of COVID-19, 31% of people aged 16 to 19 and 20 to 24 reported an increase in their cannabis consumption [3]. A decline in participants’ belief that daily cannabis smoke increases their risk of mental health disorders (from 76% in 2020 to 66 percent in 2019) coincided with these findings [3]. A wide range of cannabis-related pathophenotypes have been linked to factors such as the age at which exposure began, frequency, and duration. However, prolonged exposure to the main psychoactive marijuana phytochemical THC induces overstimulation of cannabinoid receptor type 1 (CB1Rs). This may profoundly affect the endocannabinoid system development and the endocannabinoid system’s physiological development (ECS). Anandamide (AEA) and other CB1R endogenous agonists are subject to metabolic control mechanisms, but THC escapes these neuroregulatory control mechanisms, leading to more long-lasting and unregulated neurophysiological effects [4].

Dr. Sendler: Chronic cannabis use in adolescents has been linked to a wide range of long-term health problems, according to both clinical and preclinical research. When it comes to the mesocorticolimbic system, developmental exposure to THC has been linked to numerous cognitive deficits and increased susceptibility to neurological disorders [5,6,7]. These findings are also accompanied by neuroanatomical abnormalities and maladaptations in the region.

The relative potency of THC appears to play an important role in the pathology of cannabis, as well. The concentration of THC in cannabis has steadily increased over the last few decades, while the concentration of cannabidiol (CBD), the main non-psychoactive constituent of cannabis, has not changed [8,9]. High-THC cannabis strains (e.g., sinsemilla) use in young people has been linked to an increased risk of anxiety and cannabis use disorder [13], as well as psychiatric-like symptoms [14,15] and relapses more frequently [16].

As a result, adolescence is a time when the brain is particularly vulnerable to the effects of external insults, which can lead to pathological phenotypes later in life. As a result of chronic cannabinoid exposure during adolescence in humans and animals, long-term behavioral and brain development abnormalities have been documented. As a result of our research, we’ve identified potential pharmacotherapeutic targets for treating these side effects of cannabis use.

Numerous epidemiological studies have found a link between adolescent cannabis use and an increased risk of developing various neuropsychiatric disorders in adulthood. According to Andréasson and colleagues in 1987, heavy cannabis users were six times more likely than non-users to develop schizophrenia in adulthood. There is a strong correlation between the onset of cannabis use and the development of psychopathological symptoms. Subjects who used cannabis for the first time before the age of 16 showed both positive and negative aspects of psychosis [18]. A higher risk of depression phenotypes and anxiety, as well as changes in cognition, have been linked to early cannabis use [19,20,21]. Long-term neurocognitive deficits in IQ, working memory, executive functioning, decision-making, impulsivity and attention, and scholastic performance have been linked to chronic cannabis use before the age of 17. During Jacobus and colleagues’ prospective studies, they found a correlation between cognitive impairments and neurostructural maladaptations. Researchers found that cannabis users had worse attention and memory, as well as reduced white and gray matter integrity and thicker frontal and temporal cortexes in the brain [25]. [25] Prefrontal, limbic, parietal and cerebellar tracts of young marijuana users showed reduced white matter integrity [26,27], and an opposite pattern in cortical thickness was associated with the onset of use, which highlighted thicker cortices in early- vs. late-onset users [27]. The right superior temporal, right inferior parietal, and left paracentral regions of the brain had increased thickness after heavy marijuana use, while the right caudal middle frontal, bilateral insula, and bilateral superior frontal cortices had decreased [28].

Other studies have shown that marijuana exposure may influence the development of the brain’s structure during neurodevelopmental periods. For example, a study of brain volume measurements found that marijuana users who began using before the age of 17 had smaller gray matter and larger white matter volumes in their brains [29]. There have been findings of morphological changes and profound impairments in connectivity in the corpus callosum and right fimbria of hippocampus in cannabis-related pathology [30–31,32–33]. These findings may explain the long-term cognitive impairments observed in cannabis-related pathology.

Cannabis-related symptoms may be caused by imbalances in the excitatory and inhibitory pathways in the brain, according to neurochemical studies. Repetition of CB1R stimulation during brain maturation may, in fact, interfere with normal neurodevelopmental processes, particularly in the frontal cortex, hippocampus, and striatum, where CB1Rs expression gradually increases until adulthood [35].. GABAergic and glutamatergic abnormalities in young chronic smokers and cannabis users in the early stages of psychosis were observed following adolescent cannabis exposure, but no clinical studies to our knowledge have reported long-lasting effects on these systems. It’s not unusual to see such anomalies in patients with neuropsychiatric disorders. A decrease in cortical glutamate decarboxylase (GAD-67) levels was found in schizophrenic patients’ post-mortem analyses [38]. This enzyme is involved in the synthesis and release of GABA. In addition, it has been shown that GAT-1 and GABAA receptor subunit levels have decreased [39,40,41]. Patients with major depression had similar changes in GAD-67 and GABAA receptors [42,43,44].

In addition, both clinical and pre-clinical studies have examined the effects of adolescent marijuana use on dopaminergic system function. As an example, studies have shown that long-term cannabis use is associated with decreased striatal dopamine (DA) release [45,46]. In addition, the COMT and Akt genes have been investigated because of their role in regulating DA and causing psychosis. Cannabis use during adolescence has been linked to an increased risk of developing psychotic symptoms in adulthood, according to Caspi and colleagues [47]. A genetic variation in the Akt gene [48] was found to be the mediating factor in the absence of this effect following acute consumption in young smokers. Cannabis-related psychopathology has been linked to the same polymorphism of the Akt gene [49]. [48, 49] Studies on the BDNF gene, a neurotrophin involved in the growth, differentiation, and survival of neurones, have shown that frequent cannabis use in adolescence deregulated BDNF production [50]. The onset of psychosis has also been linked to cannabis use at a young age and variations in BDNF [51].

New therapeutic approaches to prevent and/or reverse pathophysiological sequelae induced by chronic marijuana use during adolescence could be developed by examining the role of neuronal and genetic markers in the association between early cannabis consumption and vulnerability to neuropsychiatric disorders, as this evidence suggests. Correlational studies in humans, on the other hand, make it difficult to distinguish between causal and correlative measures, whether in terms of time or function. The role of cannabinoid biomarkers linked to adolescent brain development in pre-clinical studies using rodent models of adolescent brain development has been extremely important. Many pre-clinical studies and reported clinical effects are now beginning to align, allowing for greater opportunities to identify therapeutic interventions aimed at reversing the pathophysiological effects of cannabinoid exposure in adolescents.

To model cannabinoid-related endophenotypes similar to those reported in schizophrenia and other neuropsychiatric diseases, pre-clinical studies on adolescent neurodevelopmental cannabis exposure have been critical. Identifying cannabinoid-induced neuroadaptations, while precisely controlling drug concentration and the age window of exposure, as well as allowing mechanistic approaches to prevent or revert observed psychopathological phenotypes, are advantages of animal studies. Adolescence in rodents can be divided into three distinct phases, beginning at postnatal days (PNDs) 21, 34, and 46, in order to better translate these models into human health outcomes [52]. These three distinct stages are known as “early, middle, and late adolescence.”

Many behavioral paradigms with high validity have been used to investigate schizophrenia-like features following adolescent cannabinoid exposure, although schizophrenia is unquestionably an exclusively human disease. Prepulse inhibition (PPI) is one of the most commonly used assays to investigate sensory filtering impairments in a variety of neuropsychiatric disorders, including schizophrenia and autism. In fact, one of the hallmark symptoms of schizophrenia is an inability to discriminate between relevant and unimportant stimuli [53]. Sensorimotor gating has been shown to be significantly disrupted in adult rodents after chronic THC exposure during middle adolescence (PND 35–45) [54,55]. However, this effect was not observed when THC was administered to adult rats (PND 65–75) directly after adolescent THC exposure [55].

Damian Sendler

Schizophrenia is characterized by impairments in social cognition and memory [56]. Animal studies have shown that adolescent exposure to neurodevelopmental THC causes deficits in cognition similar to those seen in schizophrenia [57,58]. THC-treated adolescent rats, for example, showed significant long-term abnormalities in social interaction memory [54,59]. Additionally, both males and females were affected by specific tasks (e.g. novel and spatial object recognition; radial arm maze; T maze; Morris water maze) when they were tested. The memory-enhancing effects of THC have not been consistently reported across studies [64,65,66,67]. Disparities in THC administration methods and dosing regimens, as well as differences in behavioral paradigm techniques, may be to blame for these inconsistencies. The paired-associates learning task, which assesses for associative learning and visual memory deficits, also yielded relevant long-lasting deficits. Adult THC-exposed rats needed more trials than controls to meet a criterion of 80% at adulthood [55].

Anxiety and depression-like symptoms have been linked to long-term cannabinoid exposure during adolescence in rodents, according to extensive research. THC-exposed adolescent rats, on the other hand, were more likely to become immobilized in a water cylinder during the Porsolt Forced Swim Test (FST) if they were placed in an inescapable water cylinder. Females are more likely to engage in these behaviors, which are seen as indicators of despair and resignation [69,70]. Adolescent THC exposure has been shown to induce anhedonia-like behaviors, as demonstrated by decreased interest in rewarding stimuli measured by sucrose and palatable food preference tests [68,70,71]. Moreover Furthermore, these findings support the role of cannabis use during adolescence in the development of mood disorders in adulthood, which is consistent with the remarkable gender differences in depression observed.

Damian Jacob Markiewicz Sendler: Adolescent THC exposure has been linked to a variety of anxiety disorders, but the evidence is inconsistent. It was found that chronic THC treatment in adolescents resulted in long-lasting anxiety in the light-dark box test [54], which is an experimental paradigm built on rodents’ natural aversion to bright light. Adolescent THC has been found to induce either no changes, anxiety- or anxiolytic-like effects when other assays are used. Adult rats given low doses of THC from PND 30 to 50 during the Elevated Plus Maze test spent less time and made fewer entries into the open arms [68]. THC-exposed males and females [71,72] as well as C57Bl/6J and DBA/2J male mice [63,65] showed no long-term differences. The strain-specific anxiolytic effects of THC were also found in Lewis rats, which spent more time open arms compared to their vehicle counterpart and THC-exposed Fischer344 rats [73]. THC-induced maladaptations might have been influenced by genetic differences and differences in vulnerability. In fact, one study found that chronic adolescent THC exposure had no effect on adult Long-Evans rats in terms of affective dysregulation [74]. According to the Open Field test, there have been conflicting results on whether or not tigmotaxis occurs. As a result of their natural instinct to avoid predators, rodents prefer to stay close to the walls of an enclosed test environment rather than venture out into the open arena. This anxiety index is based on this preference. Adolescent THC exposure was found to either increase [60] or maintain [68,71] the thigmotaxis index in adulthood using this assay. This suggests a complex interaction between a person’s genetic background and their relative vulnerability to THC-induced anxiety phenotypes.

Consistent with a disruption of the GABA/Glutamate balance within this region, chronic THC exposure in adolescents leads to a remarkable potentiation of firing and bursting activity in PFC pyramidal neurons in addition to loss of GABAergic inhibition [54,59]. As a result, pharmacological interventions aimed at preventing or reversing THC-induced psychopathology involve modulating glutamatergic dysfunction. There has been particular interest in L-theanine, a green tea analogue of L-glutamate and L-glutamine that has been shown to have therapeutic properties in anxiety and schizophrenia as well as depressive phenotypes L-theanine has been shown to effectively block a wide range of THC-induced behavioral abnormalities into adulthood, including anhedonia, anxiety, and impairments in memory and sensorimotor gating in a neurodevelopmental rodent model of adolescent THC exposure [96]. As DAergic hyperactivity in the VTA is normalized, L-ability theanine’s to normalize the cortical hyper-bursting state and restore the inhibitory/excitatory balance and the oscillation patterns within the PFC may be responsible for these preventative effects. Furthermore, L-theanine was able to completely prevent the overactivation of DAergic neuronal activity in the subcortical VTA DAergic neurons as well as in the cortical PFC activity states and gamma-oscillatory dysregulation caused by the adolescent THC exposure. L-theanine also reversed the down-regulation of cortical GSK-3/ and Akt-Thr308, two critical molecular biomarkers for THC-related neuropsychiatric side effects [96]. (Table 1). It has previously been shown that sustained activation of DA D2 receptors causes decreases in the expression of GSK-3/ and Akt-Thr308 associated with hyperdAErgic states [97]. The glutathione levels in astrocytes are modulated by L-theanine in an in vitro study, which protects against DA-related neurotoxicity [98]. Astrocytic-glutathione mechanisms may play a role in the dysregulation of the PFC/VTA following adolescent THC exposure, according to this study.

Teenage THC use was found to cause long-term dysregulation of serotonin transmission [60,68], indicating that this system could be a target for new therapeutic approaches beyond DA alone. Adolescent co-administration of THC and the 5HT6 receptor antagonist SB258585, as well as changes in the intrinsic properties of cortical pyramidal neurons and LTD, have been shown by Berthoux and colleagues [99] to prevent long-lasting cognitive impairments and aberrations in cortical networks (Table 1). Moreover, the mTOR inhibitor rapamycin reversed these THC-induced abnormalities, and 5HT6 receptor deficient mice lacked these abnormalities, indicating the critical role of these receptors in THC-related pathology. The antagonism of the 5HT6 receptor has previously been found to be effective in the development of schizophrenia models [100]. This study shows that mTOR dysregulation is a key molecular mechanism in THC-induced neurodevelopmental pathophysiology [54,81].

Damien Sendler: CBD’s antipsychotic profile and apparent lack of side-effects have also prompted a number of studies to investigate its potential protective properties. Although CBD has been found to have opposite effects on various neurophysiological measures compared to THC, it is a promising treatment for various neuropsychiatric conditions. CBD, for example, has been shown to alleviate amphetamine-induced deficits in PPI, hyperlocomotion, and increased VTA DA activity. In a study by Norris and colleagues [103], it was found that CBD reduces spontaneous DAergic firing and bursting rates by functional interaction with the 5HT1A receptor system. This could be the mechanism behind the CBD effects. Serotonin modulation by CBD in adolescents prevented hyper-motility, sensorimotor gating impairments and contextual fear memory loss in spontaneously hypertensive rats [104]. Additionally, CBD has been shown to have beneficial effects on memory and cognition in chronic cannabis users, as well as decreasing depressive-like symptoms without causing any side effects [105]. The abnormalities in the hippocampal anatomy and neurochemistry caused by long-term cannabis use were also normalized by CBD [106,107]. In pre-clinical studies, CBD has been shown to have similar anti-schizophrenia-like effects on long-term symptoms. Even in adolescent mice, CBD and THC co-administration prevented deficits in working memory, anxiety, and compulsive-like behavior [108]. (Table 1). CBR allosteric site modulation or interactions with other molecular substrates may allosterically antagonize THC effects [109,110,111,112], but the mechanisms are not yet fully understood. Increasing serum levels of endogenous AEA, which may be inhibited by CBD, has been found to have therapeutic effects in animal studies [113]. Adult female rats treated with the FAAH inhibitor URB597 were able to recover from THC-induced cognitive and depressive symptoms after receiving the drug, which lends credence to this finding. An increased CB1R density and restoration of THC-related functional aberrations in PFC and DG were associated with these effects. [70,87] (Table 1). The activation of nuclear peroxisome proliferator-activated receptors alpha (PPAR), an isoform of the nuclear ligand-activated transcription factors family, has previously been shown to have neuroprotective effects in several neurodevelopmental models [114,115].

Damian Jacob Sendler

Cannabis-related neurodevelopmental pathology can be exacerbated by genetic polymorphisms, as previously stated. Anxiolytic behaviors and memory impairments were observed in transgenic mice with DN-DISC1 mutations that had been exposed to THC in late adolescence, which were linked to reduced synaptic plasticity in HC. There were significant differences in BDNF levels between wild type (WT) mice and those with the DN-DISC1 THC treatment. This suggests that the WT response to environmental insults is a protective mechanism that fails to work if there are also other vulnerability factors in the mix. Indeed, in DN-DISC1-THC mice, BDNF over-expression prevented cognitive deficits [116]. (Table 1). An additional recent study found that THC-induced memory impairments are linked to astrocytic mechanisms. THC treatment in adolescents activates the proinflammatory NF-kB-COX-2 pathway in mice expressing DN-DISC1 specifically in astrocytes, resulting in increased glutamate levels and decreased parvalbumin-positive boutons in HC in these mice. These cognitive and glutamatergic abnormalities following adolescent THC exposure were prevented by selective inhibition of COX-2 signaling aimed to counteract this neuroinflammatory state (Table 1).

Further studies have suggested that the modulation of Neuregulin 1 (Nrg1), another gene linked to schizophrenia and the neuropsychiatric effects of cannabis, may have protective properties. It has previously been shown that transgenic mice heterozygous for the Nrg1 transmembrane domain exhibit less anxiety following acute THC exposure, whereas chronic THC exposure does not reduce exploratory sniffing behavior during social interaction in WT control groups [118]. For example, THC had a different effect on CB1 and 5-HT2A receptor binding density between Nrg1 HET and WT groups in brain areas linked to schizophrenia. A number of proteins associated with NMDA receptor trafficking and glutamatergic transmission, excitotoxicity, and apoptosis were found in Nrg1 HET THC-exposed mice compared to WT mice [119]. (Table 1). Although the Nrg1 mutation has been shown to be protective against THC-induced neurodevelopmental pathology, further research is needed.

Finally, epigenetic interventions have been proposed as a possible therapeutic target for THC-related neurodevelopmental abnormalities. Suv39H was found to be upregulated in the brains of adolescent female rats exposed to THC, which increased a repressive histone H3 marker. THC-induced cognitive impairments could be prevented by normalizing these selective histone modifications if a selective blocker of this enzyme was administered during adolescence [69]. (Table 1). Heterodimerization of the histone H3 methylation appears to be a promising strategy for treating the cortical inhibitory/excitatory imbalance brought on by chronic adolescent THC exposure [120]. These possibilities will need to be explored in greater depth in future research.

Chronic cannabis use during adolescence has been linked to an increased risk of developing a wide range of mental health issues and cognitive abnormalities. In addition to memory and learning impairments and mental health issues like schizophrenia-related psychosis, depressive and anxiety disorders are also possible. There has been remarkable agreement between translational animal models’ studies into the neurodevelopmental exposure to THC and clinical findings, and these studies have provided insight into various neural pathways and biomarkers involved in pathological outcomes associated with THC, pointing to several molecular targets for new pharmacotherapeutic approaches. We recently discovered that normalizing the hyper-DAergic state and restoring the excitatory/inhibitory balance in the mesocorticolimbic system can prevent or reverse the long-lasting behavioral, neural, and molecular consequences of adolescent THC use [59,96].

THC formulations that minimize potential side effects and tiered early interventions are becoming increasingly important in light of the rapid rise in marijuana use among youth. Many factors can contribute to the long-term effects of cannabis use during adolescence. It is possible that co-occurrence with other multivariate factors, as well as exposure to THC during brain development, increases vulnerability to psychiatric disorders’ (see [121] for an extensive review). This review found that while some genetic polymorphisms were protective, others induced adverse and synergistic effects and increased vulnerability to cannabis-related developmental insults, for example. Emerging findings on early-life interferences, such as maternal deprivation or immune system activation, and adolescent THC exposure [122,123], highlight the complexity of such interactions and call for further investigation.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: COVID-19 has disproportionately affected vulnerable populations as a result of the pandemic and its associated restrictions. To better understand how COVID-19 interacts with mental health and substance use disorders, this review summarizes the most recent evidence, emphasizing acute as well as long-term dangers, as well as pharmacotherapy interactions and implications for the use of evidence-based treatment.

Damian Jacob Sendler: This study shows that psychiatric and substance abuse disorders are linked with COVID-19 in a complex way. The COVID-19 virus has the potential to be harmful to people with a variety of psychiatric and substance use disorders. Infection with COVID-19 has been linked to both short-term and long-term effects on mental health and substance use disorders. Restrictions imposed to stop the spread of disease have also been linked to an increase in the occurrence of new disorders and the recurrence and worsening of existing ones.

Dr. Sendler: Chronic disability caused by mental health and substance use disorders, as well as their co-occurrence, can be prevented with early detection and intervention. It is critical that those most in need of services do not fall through the cracks of our healthcare systems. To ensure that digital health interventions are widely available to everyone, especially those who are most at risk, the pandemic has expedited the timetable for their widespread implementation.

The coronavirus disease 19 (COVID-19) has been wreaking havoc around the world for more than a year, putting healthcare systems to the limit. 104 million cases had been reported in over 190 countries, with nearly 2.3 million deaths, just 13 months after COVID-19 was first discovered [1,2]. Since the beginning of the pandemic, there have been concerns about the virus’s potential impact on people who are particularly at risk [3]. Psychiatric and substance-abusing patients are particularly vulnerable to the side effects of COVID-19, as evidenced by an uptick in recent months in both the amount of commentary and the amount of new data. Coexisting health conditions like diabetes, asthma, and heart disease are all associated with a wide range of risk factors for the COVID-19 virus infection [4]. These issues are likely to be exacerbated for those who suffer from both conditions. Since the emergence of COVID-19, a search of the PsycINFO database in January 2021 was conducted to identify studies published in English that dealt with the relationship between substance use, mental disorders, and the disease. Searches for relevant research studies and reviews were conducted in both directions. COVID-19’s unique impact on psychiatric and substance use disorders, including acute and long-term risks, multimorbidity, pharmacotherapy interactions, and challenges and opportunities regarding access to, and the provision of, appropriate and timely evidence-based treatment, is summarized in this review, which synthesizes these findings.

COVID-19 is a multi-system disease that requires a multi-faceted approach. A growing body of evidence suggests that COVID-19 has negative effects on multiple organ systems in addition to the respiratory system [5]. Following a bout of acute infection, there is increasing evidence of long-term consequences [6,7]. COVID-19’s acute and long-term effects on psychiatric and substance use disorders, such as suicidal ideation, psychosis, anxiety, and depression [8], have received increasing attention in the literature.

Acute COVID-19 survivors are more likely to suffer from anxiety and depression, as well as post-traumatic stress disorder (PTSD) [4–9]. About one in five (18.1%) of COVID-19 survivors had a psychiatric diagnosis within three months of their diagnosis, including 5.8% who had new-onset conditions, according to a recent US cohort analysis. A new diagnosis of a mental illness was associated with a risk more than twice as high as any other health event [4]. Early detection and intervention are essential to prevent a significant increase in the number of people with mental health issues, which can lead to other health problems, such as substance abuse disorders.

COVID-19 was found to be 65 and 80 percent more likely to be diagnosed with a psychiatric disorder in those with a recent 12-month or 3-year history of psychiatric diagnoses, respectively [4]. Having a mental illness may increase one’s risk of getting sick in the short term, but it may also have long-term consequences down the road. As to why these groups have a greater risk, it is unclear, but factors such as noncompliance with COVID-19 restrictions, physical health comorbidities, and smoking have been suggested [4].

In addition to the immediate effects of COVID-19 infection on individuals, the response to the pandemic itself may have long-term consequences. To slow the spread of the disease and lessen the strain on already overburdened healthcare systems, more than 180 countries have put in place a variety of restrictions [10,11]. It has included physical separation, partial or complete lockdown, closure of schools and offices, cancellation of public events and social occasions as well as requiring the use of protective gear such as face masks, restricting both domestic and international travel [10,11]. Despite their importance in slowing the spread of the virus and saving many lives, restrictions have had significant financial and social ramifications [4–12–13–14–15]. For those already suffering from mental health issues, the significant social upheaval has made them more vulnerable to isolation, with evidence showing that existing mental health issues have been amplified.

Reports from Australia’s First Nations’ response may be an exception to the general rule that COVID-19 and other restrictions have disproportionately affected marginalized populations. COVID-19-related complications are more likely to occur in First Nations people because they have higher rates of smoking and multiple chronic diseases compared to non-Indigenous Australians [17–20]. Only 149 cases of COVID-19 were reported among First Nation Australians in Australia’s COVID-19 epidemiology report (which included data up to 14 February 2021) despite these risk factors and the fact that First Nations people comprise 3.3 percent of the Australian population [17,21]. The rapid, collective response led by First Nations health leaders in the very early days of the pandemic is thought to be responsible for preventing widespread illness and death. This included the lobbying of all levels of government to close remote communities, help with protective equipment, testing, and contact tracing; the provision of staff training, accommodation for homeless people, and information via social media; and the establishment of partnerships with government and nongovernmental organizations to ensure culturally appropriate services were implemented [18].

Damian Jacob Markiewicz Sendler: Mental and substance abuse disorders are strongly linked to poor physical health across a wide range of domains, all of which increase the risk of contracting COVID-19 and developing more severe COVID-19-related complications if infected. In addition to confinement in a forensic, residential, or in-patient facility, people who smoke, are overweight, or have metabolic syndrome, hypertension, or cardiovascular disease are at an increased risk of infection or disease [28,29]. People with preexisting psychiatric symptoms may be exacerbated by fear and worry about being infected with the virus, social isolation and the lack of connectivity with others, distressing medical symptoms, and death.

Comorbid conditions present a special challenge for clinicians managing and treating COVID-19 in patients with mental health or addiction issues, especially those with well-tolerated prescriptions of pharmacotherapies. A recent review found that COVID-19 treatments may interact with psychiatric medications and pharmacotherapies for substance use disorders, such as SSRIs, SNRIs, tricyclic antidepressants, antipsychotics, mood stabilizers, benzodiazepines, methadone, and bupropion, posing potential safety risks. Respiratory distress, cardiovascular events, infections, coagulation, and delirium are all possible side effects of this medication [30]. The lack of data makes it difficult to draw conclusions about the magnitude of the risk associated with interactions between medications [30]. However, despite this uncertainty, general guidance on well-tolerated prescribing includes close monitoring of any risk interactions, assessment of psychotropic-related risk of respiratory depression, and provision of psychosocial interventions Additional information on possible interactions between COVID-19 experimental agents and pharmacotherapies has been compiled in an online ‘Interaction Checker’ [32].

The prevalence of homelessness, unstable or higher density housing, incarceration, and social disadvantage among people with substance use disorders is higher than the general population’s [22–27,33], all of which can increase the risk of COVID-19 transmission. Since many needle and syringe exchange programs have had difficulty providing the services they were designed to provide [34–35], some injectors have been forced to reuse or share their injecting equipment [33].

Damian Sendler

While the global public health response to COVID-19 places physical distance at the top of the priority list, it may inadvertently increase the risk of drug-related harms. People who use drugs should never do so alone, and someone else should be available to respond and call emergency services in the event of an overdose or other adverse event [34,36,37]. Conflicting guidance may force a choice between avoiding COVID-19 exposure, adhering to government orders, and using drugs safely [34,36].

Damien Sendler: Loneliness, self-isolation, financial stress, and suicidal ideation are all common in people with substance use disorders, and all of these factors can exacerbate their mental health problems [38]. Risk factors for someone who had previously stopped using substances to return or relapse, or increase their current use to “self-medicate” for mental health issues may also be present in these situations. [39–41]. Reduced access to drugs may exacerbate preexisting mental health issues. People may be tempted to purchase illicit substances from unrecognized and untrustworthy suppliers due to supply shortages caused in part by international travel restrictions [34,41,42]. It’s possible that COVID-19 and withdrawal symptoms (such as high body temperature and sweating and aches and pains) are interchangeable [23].

As a result of the classification of alcohol as a ‘essential’ commodity in many countries around the world, there has been an increase in its availability through home delivery and advertising, including targeted COVID-19 advertising [13,43,44]. Restrictions on COVID-19 and related alcohol consumption at home are likely to exacerbate financial, economic and social stressors, increasing the risk of experiencing or being exposed to domestic and family violence (including abuse of children), as well as underage consumption of alcohol and serious or traumatic injury and death.

Despite evidence that the COVID-19 pandemic has exacerbated mental health and substance use symptoms, public health responses introduced to reduce the transmission of COVID-19 have limited the ability of services and practitioners to provide and patients to access treatment. People with chronic co-occurring psychiatric and substance use disorders may be further marginalized by a healthcare system that prioritizes the urgency of COVID-19 patients when healthcare systems are under pressure and under-resourced [15,48]. In the event that symptoms recur or worsen, patients with these disorders may be unable to continue their current treatment plan, access medications, or attend new treatment sessions if their current provider does not accept new patients. Access to mental health services was reported to be a problem by Canadian youth in a cross-sectional study conducted in April 2020 [52]. Therapy/counselling, substance abuse, and psychiatric services were all listed as being unavailable. Among the US’s 18 opioid substitution therapy (buprenorphine) prescribers, one qualitative study found that many were reluctant to accept new patients or treat those who had no prior history with the service [50]. I However, those who require the most help are most likely to be overlooked by health care systems. Some patients refuse to attend appointments because they are afraid of being exposed to an infection because services and clinicians lack the capacity and resources to do so [31,53]. There were no studies or accounts of patients’ experiences using telehealth services that could be found in the literature.

Damian Jacob Sendler

Opioid substitution therapies have undergone rapid transformations around the world in an effort to maintain their availability. New regulations in North America allow pharmacists to adjust opioid substitution therapy doses, and restrictions on take-home doses have been relaxed in several countries, including Australia [23,53]. A coordinated approach is necessary for any changes to be implemented, even if they have to be made quickly in order to minimize the risk of treatment interruptions. When it comes to dosage adjustments, pharmacists should inform prescribing doctors and patients alike of any changes in dosages, as well as take the time to educate patients about possible side effects, such as possible drug interactions or contraindications.

Long-acting depot formulations of buprenorphine have been recommended in Australia to replace daily methadone/buprenorphine dosing and potentially be provided to those at risk of overdose or dose diversion, such as those stockpiling takeaway doses, using all doses quickly, and supplementing with other opioids [23,33]. The use of buprenorphine-naloxone in place of buprenorphine has also been recommended, along with take-home naloxone.

As a result of the outbreak, the potential for expanding the use of digital health interventions has increased dramatically. To help people with mental health and substance abuse issues, telehealth, which includes web, computer, and phone-based medicine can overcome many of the barriers that prevent them from receiving and receiving healthcare services. Access to those who are afraid of infection; those who live in rural or remote areas; those who are able to provide and access care wherever it is most convenient; and those who are able to reduce costs [42]. Many advantages come with using computers and telephones to identify high-risk situations (such as self-harm or suicidal ideation) where a person’s mental state and general behavior must be assessed. [54] Despite this, there has been some concern about this method. Some other logistical issues include the need for a smartphone and phone credit, a computer and stable internet coverage, and the ability of patients to engage in therapy in a well-tolerated and private therapeutic space. Equitable care is hampered by the inequity of technology availability and difficulties in locating it during the COVID-19 restrictions (e.g. in public libraries and other shared spaces) [51,54]. To ensure that digital health interventions are available to the most vulnerable members of our society will be a critical task for our future health systems and essential to the full utilization of digital technologies, the implementation of an e-mental health ecosystem will take some time.

As a result of the COVID-19 pandemic, healthcare systems around the world have undergone radical transformations. Additionally, as the pandemic and subsequent restrictions have progressed, there have been new opportunities to explore new models and think differently about how best to provide evidence-based care to those who are disproportionately affected by them. There is a general consensus that the virus will be with us for a long time, despite the development and current rollout of vaccines in many countries. Monitoring and modeling the effects of COVID-19 on substance use and psychiatric health at the national and local levels is essential. For the improvement of service capacity, linking and coordination, this type of evidence is essential.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: It’s been 45 years since EEG-neurofeedback has been studied, and the most recent meta-analyses of RCTs only show small/medium effects in comparison to non-active controls. Functional magnetic resonance imaging and near-infrared spectroscopy were used in three small studies to pilot neurofeedback of frontal activations in ADHD, but the results showed no benefit over the control groups. Repetitive transcranial magnetic and direct current stimulation (rTMS/tDCS) has been used in the treatment of ADHD. Most studies have found that rTMS has little effect on improving cognitive function or symptoms. Only two out of three tDCS studies that focused on the dorsolateral prefrontal cortex showed clinical improvements in meta-analyses of the results. In one RCT, trigeminal nerve stimulation was found to have a moderate effect on ADHD symptoms. Modern neurotherapeutics are appealing because of their relative safety and neuroplastic potential. It’s important that they’re rigorously tested for their clinical and cognitive efficacy in a variety of settings, as well as for their potential for individualized treatment.

Damian Jacob Sendler: Symptoms of attention deficit/hyperactivity disorder (ADHD) include persistent and impairing symptoms of age-inappropriate inattention and/or hyperactivity/impulsivity (DSM-5) According to Thomas et al. (2015), 7 percent of children worldwide are affected by the disorder. Comorbidities and poor academic and social outcomes persist in a significant number of cases into adulthood (Thomas, et al., 2015) [2].

Dr. Sendler: Deficits in higher-level cognitive functions, known as “executive functions,” are mediated by late developing fronto-striato-parietal and fronto-cerebellar networks in ADHD patients (Rubia, 2013) [3]. “Cool” EF, such as motor response inhibition, working memory, sustained attention, response variability, and cognitive switching (Pievsky & McGrath, 2018; Rubia, 2011; Willcutt et al., 2008), as well as in temporal processing (in particular in time discrimination and estimation tasks) [4,5,6] (Noreika et al., 2013; Rubia et al., 2009) [7,8]. Temporal discounting and gambling tasks have both revealed impairment in the so-called “hot” EF functions of motivation control and reward-related decision-making. However, evidence for a hot EF deficit has been less consistent than evidence for a cool EF deficit [5,8,9] (Noreika et al., 2013; Plichta & Scheres, 2014; Willcutt et al., 2008), in accordance with diagnostic criteria [5,8]. There is more evidence of cognitive deficits in children with ADHD than in adolescents or adults with ADHD [6,10]. (Groen et al., 2013; Pievsky & McGrath, 2018). More than 30% of patients with cognitive impairments show no EF impairments (Nigg et al. 2005; Roberts et al. 2017) [11,12], further illustrating the wide range of cognitive impairments.

Psychostimulant medication that enhances catecholamines in the brain, reaching an effect size of 0.8, is the most effective treatment for ADHD, with about 70% of patients responding [13]. Cortese and colleagues (2018). According to fMRI studies, stimulant medication increases activation and interconnectivity in the inferior frontal and striatal regions and decreases activation in the default mode network in these regions [14]. Cognitive improvements may be attributable to both of these interventions (Rubia et al., 2014) [15,16]. (Coghill et al., 2014; Pievsky & McGrath, 2018).. ( Nuclear transporter/receptor blockers Atomoxetine and Guanfacine are used as a secondary treatment because they increase brain catecholamines by 0.56 and 0.67, respectively. Cortese and colleagues (2018). It’s controversial because of the potential for abuse and diversion that stimulant prescriptions have increased dramatically in recent decades worldwide. Aside from these common side effects, stimulants can also cause disturbances in sleep and appetite, as well as irritability and nausea/vomiting. Other common side effects include labile moods, headaches, and a decrease in growth (Cortese et al., 2018). In addition, only half of patients can tolerate it, some comorbid conditions (such as cardiovascular malfunctions and sleep disorders) necessitate caution, and adherence can be poor, especially in adolescents. As a matter of fact, long-term efficacy has not been shown in meta-analyses, nor in observational or epidemiological studies [13,17]. A disagreement exists (Coghill, 2019) [18] between the two studies.

Neurotherapeutics have a distinct advantage over stimulant medications because they can directly target the brain function deficits that have been identified in ADHD, unlike stimulant medications, which were originally developed for other medical conditions, such as bronchodilation, headache, and blood pressure [19–20] (Connolly et al., 2015). Many studies on the differences in brain function between ADHD patients and healthy controls using electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) have been conducted since the 1970s (e.g. Satterfield, 1973; Satterfield et al., 1973) [21,22] and over the past 2.5 decades that have provided us with neurofunctional biomarkers that could be targeted with neurotherapeutics such as neurofeedback or non-invasive brain stimulation techniques.

Increases in slower oscillations, such as delta, theta or alpha, but also faster beta frequencies bands during resting conditions were most relevant to ADHD electrophysiology findings in ADHD (Loo & Makeig, 2012)[23]. Slower frequencies in particular decrease in frequency as we grow older, so the oscillatory profile shows problems with maturation and arousal. As the debate over whether or not higher frontocentral TBR is associated with ADHD heats up [24], a finding that is becoming increasingly contentious. Resting EEG markers have been linked to reduced attention, hypoarousal, and maturational lag in previous studies (Snyder et al., 2015), suggesting an association between ADHD and these resting EEG markers is solid. In spite of maturational effects (Buyck & Wiersema, 2014, 2015; Liechti et al., 2013), scientific efforts to replicate this hypothesis have failed to show a consistent increase in TBR in ADHD [25,26,27,28], and a relationship between TBR and arousal has been questioned [29]. Clarke and colleagues (2019). For example, a meta-analysis found that a lower effect size in ADHD may be due to a decrease in sleep duration, which may be linked to an increase in the number of people with ADHD who have a higher level of TBR than healthy people [30]. (Arns et al., 2012). The heterogeneity of ADHD has been shown to be a possible explanation for the inconsistent results. In fact, only three of the five EEG clusters showed increased TBR [31] in patients with ADHD (Clarke et al., 2011), with 60% of children with ADHD showing increased theta activity. More recent research shows that 35% of people with ADHD have high levels of TBR [32]. [33] A study by Bussalb et al. (2019). Disparities in concentration, cognitive effort, activation and drowsiness are likely to confound TBR as a biomarker for ADHD [33] (Drechsler et al., 2020), consistent with findings that theta activity increases only after longer EEG recordings are made in ADHD Zhang and colleagues (2019). The current evidence in the field makes it premature to make definitive statements about the usefulness of the TBR ratio as a diagnostic test for ADHD [35], according to a recent review on ADHD resting EEG power research. Clarke and colleagues (2020) Deviating TBR has been taken into account in recent EEG-NF studies, which propose a cut-off (i.e., >4.1) and apply TBR-NF only to the subgroup with high TBR ratios [36,37].

Event-related potentials, on the other hand, appear to be more consistent than the controversial research on electrophysiological oscillations (ERPs). Task-locked ERPs are defined as reflecting cognitive, sensory and motor brain responses. ADHD was found to have abnormalities in stimulus discrimination, resource allocation, inhibition, preparation, error detection, and conflict processing via different ERP components [38–39]. (Barry et al., 2003, Johnstone et al., 2013). Although these changes do not appear to be ADHD-specific, the limited utility they provide as diagnostic biomarkers is concerning [23]. (Loo & Makeig, 2012). Meta-analysis [40] found moderate to large effects for specific ERPs associated with late cognitive processing related to attentional preparation and resource allocation like P300 and contingent negative variation (CNV), but the results were characterized by substantial heterogeneity and modest effect sizes that limit their use in clinical applications. Kaiser et al. (2020) conducted the current meta-analysis [40]. Moreover, it is imperative that these components be studied in a systematic manner, as most studies used a variety of tests and measures, making reliable interpretation of classification accuracy and effect size particularly difficult [41]. (Gamma & Kara, 2020).

In the last two decades of MRI research, there has been consistent evidence of ADHD-related deficits in brain structure and function. A neurodevelopmental disorder, like ADHD, is now recognized. Several structural volumetric studies in ADHD have shown reduced gray matter in subcortical regions, including the basal ganglia and insula [42,43,44,45] (Hoogman et al., 2017; Lukito et al., 2020; Nakao et al., 2011; Norman et al., 2016), as well as limbic areas such as the amygdala and hippocampus [42] (Hoogman et al., 2017). Hoogman and colleagues (2019); Lukito and colleagues (2020); Norman and colleagues (2016; Lukito et al., 2020); Norman et al., 2016). The peak of cortical thickness and surface area maturation in frontal, temporal, and parietal regions has been delayed (Shaw et al., 2007; Shaw et al., 2012) [47,48]. Fronto-striatal, fronto-cerebellar and interhemispheric white matter tracts have also been found to be impaired in the disorder (Aoki et al., 2018; Chen et al., 2016) [49,50], as well as long-distance tracts such as fronto-occipital tracts. (See Rubia, 2018 for a review) [51].

Neurotherapeutics have been developed to target several of the neurofunctional biomarkers identified by fMRI studies in children with ADHD. This disorder has been linked to a wide range of dysfunction in the lateral inferior and dorsolateral prefrontal cortex as well as the basal ganglia, medial frontal, cingulate, and orbital frontals and the dissociated fronto-parietal fronto-parietal, fronto-limbic & fronto-cerebellar networks they form a part of (Rubia, 2018) [51].

ADHD is the subject of a number of fMRI meta-analyses, the majority of which include cool EF studies. Several frontostriatal, fronto-parietal, and fronto-cerebellar brain regions in ADHD show cognitive domain-dissociated brain dysfunctions. Among our three meta-analyses, which included the most patients, we found that people with ADHD have consistently lower activation in key areas of cognitive control than healthy controls, including the right inferior prefrontal cortex (IFC)/anterior insula, the supplementary motor area (SMA), the anterior cingulate cortex (ACC), and the striatal region (SRC). This finding has been replicated in other studies. (Hart and colleagues, 2013; Lukito and colleagues, 2020; Norman and colleagues, 2016) A number of smaller meta-analyses focusing on inhibition tasks also found DLPFC underactivation in addition to Cortese et al(2012), .’s Lei et al(2015), .’s and McCarthy et al(2014) .’s findings [53,54,55]. (Cortese, Lei, and McCarthy, 2014; Lei, Lei, and McCarthy, 2015) The right hemispheric dorsal attention network, comprised of the right DLPFC, right inferior parietal cortex, and caudal portions of both the basal ganglia and the thalamus, showed reduced activation in 171 ADHD patients compared to 178 healthy controls in our meta-analysis of a wide range of fMRI studies on attention tasks, including selective, divided, and sustained attention, as well as alerting and mental rotation. There was an increase in activation in the right cerebellum and left cuneus in ADHD patients to compensate for the decreased activation of frontal DLPFC-parieto-cerebellar attention network in the frontal part of the network. [52] In a study by Hart et al. During attention tasks, the right anterior cingulate was found to be significantly less active in a meta-analysis of 11 fMRI datasets [55]. Cortese and colleagues (2012). More than 150 patients with attention deficit hyperactivity disorder (ADHD) were found to have lower activation in the left inferior parietal lobe, left IFC, and right lateral cerebellum compared to 145 healthy controls, according to an fMRI meta-analysis of 11 studies on timing functions. [56] In all critical regions mediating timing functions (Hart et al., 2012), According to Wiener and coworkers, (2010). While some large studies and meta-analyses have found right and left IFC underactivation [55,58], this meta-analysis found that 111 ADHD patients relative to 113 control subjects had reduced activation in bilateral middle and superior PFC, as well as the left MFC/ACC [53] (McCarthy et al., 2014). (Cortese et al., 2012; van Ewijk et al., 2015). In two large comparative meta-analyses, the right IFC dysfunction during cognitive control tasks was found to be disorder-specific to ADHD relative to OCD and ASD [44,45]. (Lukito et al., 2020; Norman et al., 2016). There are deficits in different fronto-striato-cerebellar networks in ADHD patients that have been found in the IFC/ACC/SMA fronto-striato-thalamic (inhibition), right DLPFC fronto-striato-thalamo-parietal (attention), bilateral DLPFC, IFC, and MFC/ACC (working memory), and left IFC-parieto-cerebellar regions (timing). RUBIA (Rubia, 2018).

Children with ADHD have shown reduced activation in the ventromedial prefrontal cortex (vmPFC), orbitofrontal cortex (OFC), and striato-limbic regions during tasks of “hot” EF, such as reward-related decision making or temporal discounting, in addition to deficits in several of these lateral fronto-striato-parietal and fronto-cerebellar regions that mediate so-called “cool” EF. Findings on deficits have been more inconsistent (Plichta & Scheres, 2014; Rubia, 2018), but they are still present in many studies

The dorsal and ventral attention and cognitive control networks, in particular, show evidence of decreased inter-regional functional connectivity during cognitive tasks and while resting (Rubia, 2018; Sripada et al., 2014; Sripada et al., 2014). [51,59,60].

Nonetheless, it has been found that not only task-positive regions, but also areas of the default mode network (DMN), which includes the ventromedial frontal cortex, posterior cingulate, precuneus, and inferior parietal and temporal regions, are abnormal in function in ADHD [61]. (Raichle, 2015). Many of the studies and meta-analyses discussed above show that individuals with ADHD have more active DMN regions, including those in the rostromedial prefrontal cortex (Hart et al., 2013), the posterior cingulate and the precuneus (Christakou et al., 2013), as well as increased activation in these areas during interference inhibition and other cognitive control (Hart etal., 2013). (Hart et al., 2012). For ADHD patients, the results show that they have a hard time controlling their interoceptive attention orientation and mind-wandering, which intrudes into their already weak exteroceptive attention processes, likely resulting in an increased level of distraction and impulsivity. Attention-demanding higher-level cognitive control tasks may be impaired in ADHD because of an immature pattern of poor activation of task-relevant and age-correlated task-positive brain activation networks and decreased deactivation of the DMN (Rubia, 2018) [51].

Neurotherapeutics could potentially target the most consistently dysfunctional regions, such as the right IFC, right DLPFC, ACC, right inferior parietal lobe, or the basal ganglia. IFC and DLPFC have already been used in fMRI/NIRS-neurofeedback or brain stimulation therapies to target these regions of the brain for neuromodulation. As an additional benefit of using fMRI-NF, it is possible to target the entire ADHD network, including the dorsal and ventral attention and cognitive control systems (Sripada et al., 2014). fMRI-NF has the potential to be a useful neurotherapeutic tool for the future if it can reduce DMN levels. We have shown in ADHD patients after fMRI-NF of the right IFC (Rubia et al., 2019) [65] that upregulation of the IFC/DLPFC with brain stimulation or neurofeedback can indirectly downregulate areas of the DMN because of evidence for an anti-correlation between the IFC/DLPFC and the DMN [59] (Sripada et al., 2014).

As neuroimaging research has progressed, it has discovered that the brain is highly plastic, particularly during childhood and adolescence [66,67], but also in middle and older adulthood [68,69] (Jancke, 2009; Rapoport & Gogtay, 2008). (Draganski et al., 2004; Draganski & May, 2008). Juggling, for example, can change the structure of the brain after just a few weeks or months of practice [68,69] (Draganski et al., 2004; Draganski & May, 2008), studying for an exam [70] (Draganski et al., 2006), or learning to meditate [71] (Dodich et al., 2019). Neuromodulation treatments like non-invasive brain stimulation or neurofeedback are now more appealing in clinical settings because of these new understandings of the brain’s neuroplastic potential [51,72]. (Rubia, 2018, Ashkan et al., 2013). Because children and adolescents have more rapid neural plasticity than adults do after brain stimulation, it’s especially important in the early stages of disorders in young people [73] (Anderson et al., 2011); evidence shows that this is most effective in children and adolescents) (Brunoni et al., 2012).

Using EEG and fMRI studies to identify ADHD biomarkers has made it possible to target these biomarkers with neurotherapeutics over the past few decades. Treatments aimed at correcting ADHD’s underlying neurobiological abnormalities may be promising, given the strong evidence for electrophysiological and neuroimaging functional deficits in the disorder. For over 45 years, EEG-NF has been used to study ADHD, but the results have been mixed. It’s too early in the game for fMRI or NIRS-neurofeedback to provide a clear picture of its potential efficacy. Over the past decade, the number of non-invasive brain stimulation studies has increased exponentially. However, the number of studies has been relatively small and the study designs have been extremely diverse. As a result, findings on how to improve cognition have been inconsistent, and there has been very little evidence on how to improve clinical behavior. Here, we’ll take a look at some of the ways neuromodulation has been used to treat ADHD.

Damian Jacob Markiewicz Sendler: With the help of real-time audio or visual feedback of their brain activation, participants in an operant conditioning procedure known as neurofeedback (NF) learn to voluntarily self-regulate specific regions or networks of their brains. This can be gamified for children in an appealing way. ADHD has been the most successfully treated with NF using electrophysiological neurofeedback because it is characterized by a lack of self-control [75] (Schachar et al., 1993). (EEG-NF).

By the year of publication, effect sizes (ES) in meta-analyses of EEG neurofeedback studies were calculated for their impact on global ADHD symptoms. MPROX: ratings by parents/proximal raters; PBLIND: ratings by presumably blinded raters. * Studies that followed a predetermined procedure.

Randomized controlled trials (RCTs) are considered the gold standard in clinical research while non-randomized studies are considered a weak experimental design [89] (Norris & Atkins, 2005) in the first meta-analysis [78]. Here is a meta-analysis [90] that addresses this issue by including only RCTs and blinding criteria for the clinical outcome, such as ADHD core symptoms (Sonuga-Barke et al 2013). The term “probably blinded” raters was coined by these authors to describe the type of assessment performed by teachers who aren’t aware of the patient’s treatment assignment. It was found that the clinical effect was reduced to a trend level for the likely blinded raters (such as parents) when these two new requisites were met, but remained significant for unblinded raters (such as parents) with medium effect sizes. These new findings led to a change in the recommendation to use EEG-NF in the treatment of ADHD.

In 2014, Micoulaud-Franchi et al. [82] (Micoulaud-Franchi et al., 2014) updated Sonuga-meta-analysis Barke’s from 2013 [84] (Sonuga-Barke et al., 2013), including the subdomains of the core ADHD symptoms, i.e. inattention, hyperactivity, and impulsivity. Only the inattention subdomain showed a significant effect when the core symptom domains were evaluated separately by the probably blinded raters.

An updated version of Sonuga-analysis Barke’s was released by the same group two years later, increasing the analysis from 8 to 13 RCTs with parent-ratings and 4 to 8 RCTs with probably blinded ratings [80] (Cortese et al., 2016) for the European ADHD guidelines group. A small effect size was observed for parents’ ratings, but a large effect size was observed for all of the possibly blinded ratings except inattention. In Micoulaud-Franchi [82] (Micoulaud-Franchi et al., 2014), the discrepancy in the blinded findings in the subdomain of inattention appears due to the selection of different blinded outcomes in the same studies.

Using only three studies that used standard protocols for EEG-NF [76] (Arns et al., 2014), the effects on ADHD symptoms were also significant for probably blinded rater, however, subsequent large-scale standard NF trials [36,91] (i.e., Arnold and colleagues in 2020; Strehl and colleagues in 2017) could not substantiate this. It is noteworthy that Bussalb et al. [32] in their meta-analysis [Bussalb et al., 2019] systematically evaluated additional factors that could affect the efficacy of the NF. In the end, they found that the severity of NF, rather than the length of treatment, was linked to greater efficacy, and that teachers were less sensitive to the symptoms of their patients. They also recommended that NF be tested using placebo-controlled interventions.

EEG-NF efficacy in ADHD has improved, as can be seen from this, in terms of the quality and certainty of the consideration and evaluation. Since there are so many different training modalities available, neurofeedback should be considered an umbrella term (such as Coherence training, asymmetry feedback, etc). Efforts should be made to standardize this issue, which is critical. A few large studies have been published recently, but so far, the standard protocols have met these requirements.

Additionally, the selection of an adequate control group was addressed in the most recent comprehensive meta-analysis [83] (Riesco-Matas et al., 2021), which compared EEG-NF with non-active control groups (waiting-list controls, treatment as usual) and active control groups. [83] EEG-NF was found to be more effective in assessing inattention by blinded raters than non-active control groups. This finding is similar to that of Micoulaud-Franchi et al. [82]. (Micoulaud-Franchi et al., 2014). As an active control condition, like medication, EEG-NF was no longer superior to EEG-NF. Studies of neurofeedback and other neurotherapies, such as acupuncture, benefit greatly from taking into account active elements in control conditions, as well as grading these active elements consistently. There has been a recent consensus statement on evidence-based ADHD treatments that excluded studies and meta analyses with non-active and heterogeneous controls such as waiting control or treatment as usual (Faraone et al., 2021). However, blinded raters may be able to detect some genuine NF-effects in real-world settings that may be overlooked by this method.

The patient’s preferences and the cost-benefit analysis are equally important considerations. Pharmacotherapy, as previously discussed, has a number of drawbacks, including side effects and inconsistencies in long-term outcomes. For six months after treatment, a recent meta-analysis examined whether EEG-NF had any long-lasting effects compared to non-active conditions, and found that it had small to medium positive effects when compared with non-active conditions and comparable positive effects with active conditions, such as pharmacotherapy [81]. (Van Doren et al., 2019). Thus, EEG-NF appears to have a delayed beneficial effect, as for example in a study where the superiority of stimulants over NF observed at treatment end [93] (Geladé et al., 2016) was no longer significant at the six-month follow-up, and ADHD core symptoms compared to a semi-active control condition (physical exercise) were similar at treatment end but were reduced with NF relative to the exercise control condition at follow-up [93] (Geladé Contrary findings from the largest study to date, which assessed longer-term EEG-NF effects, showed that although the improvement of ADHD core symptoms in comparison to the baseline remained large and stable after treatment at six months follow up [94] (Aggensteiner et al., 2019), it was no longer superior to a semi-active condition, suggesting considerable unspecific long-term effects.

Damien Sendler: There is a lot of debate about the specificity of EEG-efficacy. NF’s During the past decade, researchers have been attempting to separate the true effects of neuromodulation from the non-specific effects. A study by Strehl et al. [91] examined this issue by comparing an EEG-NF group with an EMG-BF semiactive control group and controlling for unspecific effects such as the high-tech training setting, interaction, learning, time, motivation and effort. The results showed that EEG-NF had a clinical advantage one month after treatment ended. Keeping an eye on these variables is critical, as the clinical effects of this type of time-consuming training could otherwise be attributed to non-specific psychosocial [95] factors. It is possible that treatments in high-tech settings, such as those used by Thibault and colleagues (Wood & Kober, 2018) or by Thibault et al. (2016) or Thibault et al. (2018) may have stronger placebo effects [96,97,98,99,100] (Thibault and colleagues (2016) or Thibault & Raz (2016) or Thibault and Raz (2018)) When conducting intervention research, the use of a sham-feedback condition is often considered the gold standard.

When comparing TBR-NF with a double-blind placebo group in the Collaborative Neurofeedback Group 36 study, the researchers selected only participants with an elevated TBR for the double-blind sham-NF placebo group, allowing for individualisation. After 13 months of follow-up, both groups showed large uncontrolled clinical effects and a reduced need for medication, but the EEG-NF group failed to demonstrate clinical superiority for EEG-NF despite more TBR learning (67 percent in the NF versus 59 percent in the sham group) [36]. Large nonspecific clinical effects have been observed in both groups, but the exact mechanism by which they occur is still unknown.

Damian Sendler

There should be a direct correlation between neuromodulation improvement and clinical improvement because the primary goal of neuromodulation is to help patients self-regulate their trained parameters. [101] (Zuberer et al., 2015) and complicated by delayed effects, as discussed above, or the indirect effects of effort and skill acquisition (Zuberer et al., 2015) (Gevensleben, Albrecht, et al., 2014). Even so, less than 70 percent of those treated with NF improved their ability to self-regulate [94]. A “dose-response” relationship between learned regulation and clinical improvement is only seen in about half of the studies (Aggensteiner et al., 2019) [103] Remarkably, (Drechsler and co-authors, 2007). After SCP-NF, three studies found a significant link between ADHD core symptoms and improved brain self-regulation [94,103,104]. (Aggensteiner et al., 2019; Drechsler et al., 2007; Strehl et al., 2006). Even though the results of some recent frequency-band NF studies were expected to show a link between self-regulation and symptom reduction following the end of treatment [36,105] (Arnold et al., 2020; Janssen et al., 2016), they were unexpectedly positive in the semi-active control group (Aggensteiner et al., 2019). Intriguingly, significant association was found at 6-month follow-up in the study by Arnold et al., 2020, suggesting a possible delayed effect. In order to distinguish between effects that are specific and those that are not, studies examining the links between brain activity and behavior are required. The effects of self-regulation have not yet been studied in depth enough to draw a firm conclusion.

Predicting who will respond to EEG-NF is an important consideration in the treatment process. Clinical responses to theta-modulating neurofeedback were predicted by increased theta activity, and stronger oscillatory parietal alpha activity and stronger task-related preparatory SCPs explained nearly 30% of the clinical outcome variance after SCP-NF [106,107]. (Gevensleben, Kleemeyer, et al., 2014; Gevensleben, Moll, et al., 2014; Wangler et al., 2011). However, these intriguing findings need to be replicated by other researchers.

Future research should investigate the specificity of self-regulation and the mechanisms that underlie individual clinical effects, taking into account reduced medication use and long-term improvement in ecological settings. If NF is tailored to the needs of each individual, it is not yet clear whether limiting TBR training to those with elevated TBR improves outcomes.

While many studies have examined the efficacy of EEG-NF in the treatment of ADHD over the past 45 years, there is still debate about whether or not “blinded” raters were used in some of these studies [32,80]. (Bussalb et al., 2019; Cortese et al., 2016). Furthermore, more research is needed to determine the precise effects of EEG-NF and the link between NF self-regulation and clinical improvement. To improve EEG-NF self-regulation and improvement over time, future studies should consider increased artefacts and altered reward learning in ADHD [118] (for example, Aase & Sagvolden, 2005) and further systematically investigate why some participants show low regulation performance in the current studies.

It’s still in its infancy when it comes to fMRI-NF and NIRS-NF research. Small proof-of-concept studies with fMRI- and NIRS-NF have yielded promising results. However, larger, double-blind, placebo-controlled randomised controlled trials are needed to further evaluate the potential efficacy of fMRI or NIRS-NF in ADHD treatment. – A lot is still unknown about the optimal protocol for rtfMRI neurofeedback or NIRS neurofeedback, such as the optimal target region for neurofeedback, the number and duration of neurofeedback sessions, whether self-regulation in specific regions can reach saturation or plateau, or how and which interindividual differences affect learning of brain self-regulation after how many sessions. It’s not clear how the transfer affects patient behavior in the clinic. Other questions remain unanswered, such as the best methods for reinforcing learning or developing cognitive skills in children using fMRI or NIRS-NF. It’s also not clear how regional fMRI-NF affects non-targeted cognitive functions and regions that aren’t self-regulated in neurofeedback studies. One must consider the potential costs of downregulating neighboring, interconnected, or contralateral brain regions as a result of self-regulation training in one brain region. When we studied the brain activity of adolescents with ADHD, we found that the active rIFC group had less parahippocampal control region activation than the control group, suggesting that the self-regulation of a particular region leads to the downregulation of other regions in the brain (Alegria et al., 2017).

It’s one of the most intriguing findings from the existing NF studies that there is evidence for longer-term delayed consolidation effects, which appear to be more pronounced at follow-up than at post-NF treatment assessment points [76–111]. However, one recent study showed no superiority over a semi-active control group at six months follow-up [94]. In this paper by Agensteiner et al. These effects of delayed consolidation support the idea that brain self-regulation via NF affects neuroplasticity and may therefore have unique long-term efficacy.advantages. In contrast to stimulants, which have no effect on neuroplasticity and may even lose their effectiveness over time [13,120], this would be a clear advantage. There is a possibility of brain adaptation [121] (Cortese et al., 2018) For more information, see Fusar-Poli et al. Neurofeedback has been shown to alter the structure and function of the brain in humans, including changes in cortical excitability and white matter tracts [122]. (Sitaram et al., 2017). However, it is unknown whether these modifications will remain stable over time. Neurofeedback therapies are likely to be popular due to their longer-lasting neuroplastic effects and apparent lack of side effects.

Damian Jacob Sendler

Only in the last decade have non-invasive brain stimulation therapies, such as rTMS and tDCS, been used to treat ADHD. When used in conjunction with the long-term potentiation (LTP) mechanisms that are mediated by GABA and glutamate, these stimulation techniques have the potential to have lasting effects on neurons. It was found that (Demirtas-Tatlidede et al., 2013). The effects of stimulation on cognition can last up to a year in healthy people and in patient groups [124,125]. Research has shown that (Ruf et al., 2017; Katz et al., 2017). When it comes to treating ADHD, positron emission tomography (PET) studies show that anodal frontal transcranial direct current stimulation (tDCS) can release neurotransmitters such as dopamine Better attention (Borwick et al., 2020) was also associated with these interventions (129). The effects on noradrenaline have been shown to be indirect (Fukai et al., 2019) [130,131]. (Adelhöfer et al., 2019). Animal and human studies have shown that rTMS over prefrontal regions alters neurotransmitter systems, including serotonin, dopamine release and metabolite levels in the striatum, as well as striatal glutamate release and concentration [132,133]. (Moretti et al., 2020; Poh et al., 2019). Furthermore, studies have shown that the synergistic effects of functional targeting (Cramer et al., 2011; Kuo & Nitsche, 2012; Ziemann & Siebner, 2008) make cognitive training and stimulation more effective together [132,133,134,135,136].

However, there is disagreement over whether or not blinded raters were used in many meta-analyses of EEG-NF randomized controlled trials, which consistently show small to medium effect sizes for symptom improvements. Cortese et al. (2016) found a significant increase in the number of patients with chronic obstructive pulmonary disease (COPD). The specificity of EEG-effects NF’s as well as its long-term efficacy need to be studied in greater detail. Precision medicine relies heavily on the study of factors that can predict individual responses.

It has only recently been piloted in ADHD studies using higher spatially resolved neuroimaging techniques such as NIRS and fMRI to show feasibility. But there are some promising results that need to be tested in a larger sample size. Smaller and more rigorous RCTs are needed to determine if neurofeedback training using NIRS or fMRI neurofeedback can be used to treat some individuals with ADHD. NIRS and fMRI neurofeedback protocols need to be thoroughly tested because optimal settings are unknown for either technology. Neurofeedback modalities have not tested for potential negative effects on non-regulated brain regions, but this knowledge is necessary for ethical reasons.

More than a dozen small studies of non-invasive brain stimulation for children and adults with attention deficit hyperactivity disorder (ADHD) have been conducted in recent years, most of them using either TMS or tDCS in either one or five sessions, focusing on the DLPFC or IFC. There hasn’t been much progress made with TMS studies. Studies of tDCS’ effects on the DLPFC show only small improvements in cognition, according to meta-analyses (Salehinejad et al., 2019; Westwood et al., 2021). Only three studies examined whether tRNS could help with clinical problems like inattention, and the results were mixed. TDCS has been shown to improve clinical and cognitive functions, but further studies are needed to determine how it affects non-targeted cognitive or behavioral functions.

Knowing how to best stimulate different patient populations is also needed, just like for fMRIs and NIRS-NFs (i.e., stimulation site, intensity, duration, frequency, electrode size, inter-electrode distance, etc.). ADHD patients may benefit more from brain stimulation and cognitive training than from brain stimulation alone. Cognitive training tasks that target ADHD-related functions must be developed in conjunction with brain stimulation techniques in order to be effective. There are few risks associated with using transcranial direct current stimulation (tDCS) or transcranial direct current stimulation (tRNS) to treat mental health issues that first manifest in childhood. Kruse and Kadosh (2013) This promise, however, needs to be thoroughly tested in large RCTs of various protocols in order to be taken seriously. As a result, there is a need to thoroughly investigate the potential costs of localized brain stimulation on non-targeted functions before it is applied to patients. Proof-of-concept studies using tRNS and TNS have shown promising results in improving ADHD symptoms, but further research is needed.

Also, the financial efficiency of various neurotherapies must be considered. As compared to tDCS or other brain stimulation devices (such as tACS, tRNS), TMS devices cost more than USD 50,000, which is significantly more expensive. In addition, more office space is needed for rTMS. The pay-per-use business model employed by many rTMS manufacturers is also very inefficient. It is more expensive to administer rTMS because a clinician/technician must receive a greater amount of training for rTMS than for tDCS. Even some TMS devices may require an MRI scan to locate them. As an alternative, because tDCS is compact, portable, and easy to use, you can buy one commercially and start using it right away, without the need for an outside therapy provider. When it comes to treating pain, cost-effectiveness analyses show that tDCS is more cost-effective than rTMS, with lower costs and greater efficacy [200] even when both techniques are used by professionals (Zaghi et al., 2018). In light of the fact that tDCS shows comparable, relatively small effects in improving ADHD symptoms or cognition, it may be more cost-effective than rTMS treatment. Because tDCS has fewer side effects and is easier to use, it is a better option for treating young children than other forms of electrical stimulation. In comparison to rTMS and tDCS, TNS appears to be the most cost-effective non-invasive brain stimulation treatment because of its higher efficacy in improving ADHD symptoms and the fact that it can be purchased commercially and used at home during sleep without the need for a therapist at a relatively low cost of about USD 1000 per device with additional electrode costs.

fMRI-neurofeedback devices are far more expensive than EEG-NF or NIRS-NF in terms of up-front costs, ranging from USD800–1000 for an hourly MRI scan to several million dollars for the device itself. EEG-NF certified equipment costs less than US$10,000. Evidence suggests that fMRI-NF learning is possible in fewer sessions than EEG-NF [96]. (Thibault et al., 2016). Full treatment costs for 30–40 sessions have been estimated at USD4000 to 6000, similar to pharmacotherapy over 5–10 years [201], for ADHD using EEG-NF, which typically requires 25-40 sessions of 45-60 minutes each (Garcia Pimenta et al., 2021). Compared to fMRI-NF, which requires fewer sessions, this means that the administering therapist will incur higher costs. To compensate for the higher costs of fMRI-NF, the lower session and therapist time costs compared to EEG-NF could be offset by qualified behavioural psychotherapeutic support during training, which may be critical for the clinical effects of NF to be maintained and transferred to the next patient. There are currently only a few centers equipped with the necessary hardware and software to conduct fMRI-NF or fNIRS-NF studies. Many private and some clinical centers around the world now offer EEG-NF, which has fewer exclusion criteria and is more widely available. Conclusions from cognitive neuroscience on ADHD have opened up translational neuroscience studies in an effort to use neurofunctional biomarkers as treatment targets for neurotherapeutics. For ADHD, neurotherapeutics appear to be a viable alternative to medication because of their lack of side effects and the potential for long-term neuroplastic effects, which medication cannot provide. Although neurotherapy has been proven effective in the short- and long-term, further testing is needed to determine the optimal “dose” (i.e., the optimal target site; the intensity of stimulation; frequency of stimulation/neurofeedback sessions), as well as the potential for individualised treatment based on clinical or cognitive ADHD subtypes, as well as the potential costs that accompany the benefits. Neurofeedback, brain stimulation, and medication are all likely to help ADHD patients in different clinical or cognitive subgroups, and establishing this knowledge is critical to the benefit of individual patients.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Positive psychology research has been exploding since 2000, with dozens of meta-analyses of different interventions and targeted processes like strength spotting and positive affect. Most of the time, researchers in the field of positive psychology treat the concepts of change in that field as distinct and unrelated. An integrative framework for positive psychology processes is presented in this paper, which links positively to clinical psychology and its more dominantly “negative” processes, and supports practitioners in their efforts to tailor positive psychological interventions for their clients. It is our contention that a multidimensional and multi-level extended evolutionary approach can organize effective processes of change in psychosocial interventions through the selection and retention of processes based on context-appropriate variation in the selection of processes across the psychological, biophysical, and sociocultural levels of analysis. There are many well-known concepts and programs in the field of positive psychology, and we demonstrate how this evolutionary approach can easily accommodate them. Interventions should begin with a person rather than a protocol, we conclude.

Damian Jacob Sendler: Two psychologists in 2000 argued that psychology had become too focused on negative traits, pathology, and the repair of psychological damage, and that it had neglected the study of flourishing in both the individual as well as society. Positive Psychology has flourished since that time, with thousands of studies on virtues, strengths, and positive emotions. There has been a surge in research on such topics as signature strengths and virtues (Schutte and Malouff, 2019), helping behavior (Lefevor et al., 2017), creativity (Acar et al., 2020), resilience (Liu et al., 2020), positive affect and broaden and build theory (Fredrickson, 2013), forgiveness (Wade et al., 2014), flow (Harris et al., 2021), (Carr et al., 2020). As a result of this research, the term “positive psychology” has come to encompass both positive and negative constructs, as well as a wider range of methodologies and levels of analysis (e.g., group, culture, etc.; Lomas et al., 2021).

Dr. Sendler: it is exciting to see so many promising approaches to positive psychology gaining traction, but it’s also challenging because of the field’s rapid expansion and diversity. We can clearly see progress in the past, but the best path forward is still a mystery. How can we expand the reach of our positive psychology interventions?

For example, the field could take a cue from clinical psychology and test new interventions against established ones to see which one performs better. There are few reasons to believe that this model’s impact on positive psychology will be any different than its failure to improve clinical psychology interventions (Johnsen and Friborg, 2015, Ljótsson et al., 2017, Jones et al., 2019). Another reason for not moving forward is that there is no evidence to suggest global happiness is increasing despite decades of efforts (Easterlin and Angelescu, 2009; Richter et al., 2019; Marquez and Long, 2021). We require a new strategy.

Positive psychology, we contend, must undergo two fundamental transformations if it is to maintain its current trajectory of progress. It is important to note that the first shift is from the evaluation of complex interventions to the evaluation of specific intervention elements (Hayes et al., 2020a). Having a better understanding of how and why positive psychology interventions work will help us refine and target our efforts. Our first mistake was assuming the same intervention would work for everyone. People in particular situations necessitate individualized treatment plans (Hayes et al., 2019). Using the best of our field’s existing knowledge, this paper will lay out a framework for understanding and implementing process-based, personalized positive psychology interventions.

Complex intervention packages should be tested against waitlist and active controls in the early stages of a new field. In the beginning, we don’t know if any of the interventions will have a significant impact, so it makes sense to use a “package” approach and be as comprehensive as possible. Two decades of research, however, have shown that positive psychology interventions have significant effect sizes, usually in the “medium” range (Donaldson et al., 2019; Schutte and Malouff, 2019; Boggiss et al., 2020; Carr et al., 2020; Liu et al., 2020; Manco and Hamby, 2021; Ntoumanis et al., 2021). The question now is whether or not continuing to analyze complex packages will help us improve our ability to promote health.

“No” is the most likely answer. That’s not only inefficient, but it also stifles our ability to advance our understanding of the subject matter. In the long run, a complicated package may be beneficial, but it also contains a lot of extraneous elements. Fordyce’s (1977) happiness program, for example, focuses on a wide range of goals, including streamlining daily life, boosting creativity, instilling a positive outlook on life, and fostering a positive self-concept. There isn’t much evidence to suggest that each of these components is equally important or valuable. Fordyce’s program isn’t being slammed here; rather, we’re acknowledging the limitations of our evaluation method. This approach does not allow us to evaluate the importance of individual components or the process of change that they engage. It is possible that we may feel pressured to administer the entire package or, if time or resources allow, select elements that we intuitively think will work best. This is a bad strategy for making progress in either science or practice.

We can’t compare interventions because of the package approach’s lack of clarity about the comparisons that are being made. It’s possible that programs with different names are altering similar processes (Wolitzky-Taylor et al., 2012) or that two similar programs (say, two “mindfulness” interventions) are targeting unique processes. Unless we know what we’re comparing, comparisons aren’t very helpful. In the absence of rigorous testing of interventions’ concepts, new approaches will not be able to build on previous findings.

Forman et al. (2012) and Arch et al. (2012) have found no clear winner in clinical psychology package comparisons (Arch et al., 2012). (Cuijpers et al., 2020). Since some have concluded that all interventions work regardless of their components (Budd and Hughes, 2009), this has left the field without direction and fails to acknowledge that interventions can work for completely different reasons.

Research in positive psychology is unique in that it does not focus on syndromes or hypothesized latent disease entities, unlike traditional clinical psychology. This is a huge step forward in empowering more precise and personalized targeting of changes that matter, but taking advantage of that opportunity requires an equally focused research program. Instead of studying evidence-based packages, we should instead focus on change processes and the intervention elements that move them forward (Hayes and Hofmann, 2018; Hofmann et al., 2021).

A process of change is one that is based on theory and proceeds in a predictable, empirically established sequence toward a desired outcome while being dynamic, progressed, contextually bound, and modifiable at multiple levels (Hofmann and Hayes, 2019). Let’s take a closer look at this definition and break it down into its components.

Non-linear and bidirectional processes are possible. Sudden disturbance and increased variability can result in a dramatic transformation if the challenge to one’s life is too great to assimilate (Hayes et al., 2007). Post-traumatic growth, such as a greater appreciation of life, deeper connections with others, and a stronger sense of one’s own inner strength and purpose, can occur in the wake of trauma (Tedeschi and Calhoun, 2004).

For optimal results, therapeutic change processes may need to be organized in specific ways. Preparing oneself for compassion by increasing self-esteem may be a useful step in the process. For example, a person who believes that they are worthy of compassion is more likely to treat themselves kindly.

Starting with the contextual factors that practitioners can influence is the best way to build useful processes. Because we need to implement processes that are sensitive to the context features of the client’s life, contextual knowledge is doubly useful (Ciarrochi et al., 2016). In a difficult situation, for example, skilled practitioners can help people think in a broader and more useful way (Kazantzis et al., 2018). This evidence suggests that reappraisal is a strong focus of change, and potentially more useful than something that is difficult to change, like personality or temperament.. To be effective in all situations and for everyone, reappraisal needs to be taken into consideration. As an example, youth may not be able to use reappraisal strategies as effectively as adults (Brockman et al., 2017). In the same way, it’s critical to know exactly what a contextualized skill is. It is well known that reappraisal is most beneficial when it promotes cognitive flexibility (Arch et al., 2012).

Several processes are intertwined. What about the concept of hope, or one’s sense of agency and efficacy in identifying pathways to accomplishing one’s objectives? (Snyder et al., 1991). Hope can be studied on a physiological, psychological, and social level.. Hope may be linked to an increase in heart rate variability at the cellular level (Schwarz et al., 2003; Oh and Chae, 2018). At the psychological level, self-reported hope is linked to an individual’s sense of well-being and success (Ciarrochi et al., 2007, 2015). Finally, groups can be hopeful or pessimistic, and the level of hope in a group can influence the level of hope in its members (Parker et al., 2015). As a result, a hope intervention (Snyder et al., 2002) may focus on biological, psychological, and social aspects of functioning.

When it comes to positive psychology products, there are two main issues. In a given situation, what type of intervention should we use? If we find that a loving-kindness intervention improves the well-being of a group of people, should we assume that this intervention will work for each individual patient? Do we view an evidence-based positive psychology package metaphorically as a pill that injects positivity into the life of each client? (Farias and Wiholm, 2015).

Because researchers have used classical group comparison statistics to test nearly all positive psychology interventions, our current knowledge base assumes that the average effect at the group level applies to the individual development of people in the group over time, at least probabilistically speaking. Since Birkhoff (1931), this assumption has been accepted in the physical sciences as valid only if the modeled events are “ergodic” (Molenaar, 2004). Love-kindness may have an effect on a group of participants, at least probabilistically, but it may not have an effect on every participant. A 1-point increase in happiness over the control group is expected in the majority of participants, but some may see their happiness rise by 3 points while others may see their happiness fall by 2 points if the loving kindness intervention is successful. The assumption that ergodicity requires both that the phenomenon studied is stationary and that the same dynamic model applies to all persons is violated in psychological areas (Hayes et al., 2019) and thus cannot be used to predict or model within-person variation. It’s not just that averages don’t apply to individuals, but that group effects can’t even be used to model individual change even probabilistically if ergodicity is violated.

Experience sampling and other methods of high temporal density can be used to investigate psychological phenomena and to track the evolution of interpersonal connections over time. Nomothetically aggregating these idiographic relationships is possible, but only if such generalizations improve the precision of idiographic findings, or what we’ve dubbed a “idionomic” approach, can be achieved (Hayes and Hofmann, 2021).

The underlying assumptions of classical statistical approaches cannot be violated when using idionomic research and analysis to model processes of change that are by definition non-stationary. A more personalized approach to intervention impact modeling is possible when idionomic research is used in the context of change processes. It is our belief that moving away from a package-based approach to a process-based approach will increase the effectiveness of positive psychology interventions.

We can begin with the lessons we’ve learned from the package approach at this stage of development: In groups, what are the processes that are most likely to be successful? Promoting hope, meaning, and positive activities, as well as kindness and self-compassion, are just a few examples. Every one of these steps is essential to the success of any intervention. What processes are most important to a particular client, at this time, given this goal, in this context, will be the focus of our next step as a practitioner. An idiographic and idionomy-based case conceptualization is what we need to create (Hayes et al., 2020b). Changes in these biopsychosocial processes are then easier to influence with the addition of specific components.

Our earlier discussion of positive psychology’s greatest strength was that it discouraged the use of diagnostic and statistical manuals like the DSM-IV-TR to label people with mental disorders (DSM). Practitioners cannot rely on the traditional DSM diagnostic approach because it is neither valid nor useful (Hayes et al., 2020b). For example, if two people have seven out of ten symptoms of generalized anxiety, we could draw the conclusion that they share the same “disorder” using the DSM. Since the two clinically anxious people may be experiencing anxiety in completely distinct ways, this approach will likely fail. It’s possible that the first person was traumatized by an attack, while the second person was fired from their job. Is it reasonable to assume that they’ll get the same treatment? This is an assumption that no one in the field of personalized psychology would make.

Strength-based approaches are less likely to make the same mistake, but it is possible. Consider a scenario in which two people want to increase their physical activity. An overwhelming sense of well-being, however, makes the first-person difficult to maintain long-term goals. In contrast, the second person is incredibly well-organized but lacks motivation or positive feelings. Depending on the severity of their conditions, each of these individuals may require a unique course of treatment. Behavioral activation and goal setting may be more effective for the former, while value clarification and motivation may be more effective for the latter.

This is where a methodical approach shines. Individuals should not be given the same type of treatment. The fact that someone has difficulty getting out of bed in the morning does not imply that they have some sort of disorder or deficit. Instead of making the demonstrably false assumption that the same processes drive activity in all individuals, we can figure out what motivates that specific individual.

The agreement on terms is perhaps the most important step in creating a unified positive psychology. This is a difficult task due to the large number of positive psychology theories and measures, each of which uses its own terminology. Take a look at the long list of terms used in positive psychology that are associated with positive thinking: hope, optimism, primal beliefs, positive reappraisal and confidence in one’s own abilities, self-concept and self-esteem, and so on. In psychology, this problem is not unique to positive psychology. When words sound different but are the same, researchers call it the “jingle-jangle” fallacy (Marsh et al., 2003).

To begin, one option is to work within a single theoretical framework and try to incorporate all terms within that framework. While it’s tempting to use only one theory as a guide, such as Martin Seligman’s PERMA theory of well-being (Seligman, 2011), we run the risk of appearing to be out of touch with other theories like self-determination or the broaden-and-build approach (Garland and Fredrickson, 2013). Furthermore, any set of terms contained within a current theory runs the risk of becoming obsolete as new theories emerge, as new terms are required, or as old theories fade away. Does “Primal World Beliefs” (Clifton and Yaden, 2021) need a new theoretical framework with new terms or can it be integrated into one of the older theories?

Without agreed-upon terms and assumptions, a field can’t move forward (Alexandrova, 2017). The Extended Evolutionary Meta-Model, or EEMM, is a meta-theory that we propose to use as an organizing framework (Hayes et al., 2020a,b). Evolution is the foundation of all life sciences, so few major psychological theorists argue that their views are in opposition to an evolutionary account. Each of the well-known creators of PERMA, SDT, and broadening and building theories, for example, has written about the importance of evolutionary theory to their ideas (Cohn and Fredrickson, 2006; Seligman et al., 2006; Seligman, 2011; Ryan and Deci, 2017).

Modern evolutionary science principles can be applied not only to genes, but also to epigenetics, behavioral learning, and symbolic thought, as well (Jablonka and Lamb, 2006). The concept of evolution can be applied to both individuals and groups, as well as to different fields of study and cultural contexts. A strong foundation for positive behavioral and cultural change can be laid on this model (Wilson et al., 2017). It’s crucial to note that modern multidimensional and multi-level evolutionary principles can be used in a prosocial manner that avoids any suggestion of eugenics or social Darwinism (Wilson et al., 2017). Using evolutionary principles to promote equality, reconciliation, peace, prosocial behavior, and a life worth living is a straightforward process (Wilson et al., 2017).

The principles of variation, selection, and retention are at the heart of evolutionary change (Wilson et al., 2017; Hayes et al., 2020b). It’s impossible to change behavior without variety. In fact, encouraging healthy variation is a primary goal of some positive psychology interventions. To put it another way, a positive psychologist might be able to influence people’s emotional state so that they are more likely to engage in risk-taking, socialize, and develop new skills and resources (Fredrickson, 2001). Mindfulness, on the other hand, is expected to broaden one’s awareness and increase one’s variability (Garland and Fredrickson, 2013). While psychopathology is often characterized by rigidity, Acceptance and Commitment Therapy aims to increase values-based behavioral activation and exploration even in the face of distress (Hayes and Ciarrochi, 2015; Hayes, 2019).

Damian Sendler

Selection can be viewed as the desired outcome or outcome of the intervention. It’s all about what works best for the customer in a given situation. For example, the client may want to achieve a goal; develop meaning; connect with others; experience joy; be curious; be healthy; or live in a meaningful way. Short- and long-term needs and values are taken into consideration by practitioners when evaluating each intervention. Self-determination theory’s needs, for example, can be viewed as selection criteria for change processes (Hayes, 2019). Does this process support the client’s need for autonomy, competence, and/or connection, might a self-determination practitioner ask?

Adaptive behavior can be maintained through the process of retention. Many positive psychology interventions promote retention through maintenance, follow up, homework, practice, broadening psychological patterns, or habit formation (Kazantzis et al., 2018).

It’s important to keep in mind that no process of change will be effective if we don’t take the time to consider the context. It may be beneficial at home, but it can be detrimental at work. All of these things come together to make up the client’s context. People can shape their environments and social groups, as well as the environments and social groups they choose to be a part of. This is referred to as context by positive psychologists. When it comes to modern evolutionary theory, action and context are inextricably linked, and it recognizes that people are not simply passive recipients of their surroundings but are instead actively involved in shaping and shaping those environments. Job crafting interventions, for example, encourage employees to reimagine their workplaces in order to better meet their needs (Tims et al., 2013). Relationship-enhancing skills and mate-selection assistance aid people in creating more supportive social niches in which they can grow their lives (Siette et al., 2017; Hielscher et al., 2021; Veronese et al., 2021).

Variation, selection, and retention are all terms we can use to describe interventions and the processes of change. For example, imagine you are working with a student who is procrastinating and consistently does not feel smart enough to achieve their academic goals (low and rigid self-concept), and does not have a clear sense of why they are attending the university in the first place (low, or unclear motivation) and feels incompetent, with no sense of academic self-efficacy. An outcome of this situation is that the student is at risk of dropping out, and something must be done to prevent this from happening. However, the hypothesized processes of change in this case include a rigid and low self-concept, unclear academic motivation, and a lack of a sense of behavioral competence and self-efficacy in the student.

For example, the practitioner might encourage the client to engage in something new, such as a mindfulness intervention designed to help notice and let go of negative self-talk, which will help to counteract the low self-concept. Let’s say we implement the intervention, but the student’s self-concept or procrastination hasn’t improved after a week or two. It’s not surprising that procrastination didn’t decrease after this variation-focused intervention failed to elicit healthy variation in self-concept. As a result, the practitioner’s motivation and self-efficacy may now be at a low or unclear level.

When the student is ready, she asks him or her to consider and elaborate on the most positive outcome they associate with achieving their goal, as well as the most important obstacles to the goal. This is known as mental contrasting. A week later, we find that mental contrasting has increased academic motivation and self-efficacy and reduced procrastination. For this person, motivation and self-efficacy are key processes of change, and mental contrasting is a key intervention, as evidenced by the success of this intervention Working with the patient to develop and maintain motivation and self-efficacy may be part of the practitioner’s role in the future. This simple example demonstrates how intervention personalization can be achieved through the use of variation, selection, and retention. Mental contrasting, on the other hand, might have worked better with a different client or in a different situation.

Complex problems can be solved using the same basic principles of variation, selection, and retention. Suppose a client recently received a promotion and is struggling to maintain a healthy work-life balance. They are under constant pressure to complete their tasks on time, but they also want to ensure that no one will ever be able to fault them. Their children and their partner have been put at risk as a result. Despite the fact that this is a common issue, there is no single solution. The context and requirements of each individual are likely to differ significantly. There are many ways in which a skilled practitioner can help a patient. To keep things simple, we’ll assume that the client is a perfectionist at work and has overcommitted to the values of the workplace over those of his or her own home. One way we might try to alleviate the stress of doing something imperfectly is by acknowledging our own discomfort and clarifying our work/life values. We might also try to increase mindfulness and be more present at home in order to better manage our physiological stress levels. If it alters specific processes of change and improves work-life balance, each of these interventions may introduce something new into the client’s life.

Modern multi-dimensional, multi-level evolution science provides a conceptual framework for examining adaptive and maladaptive change processes. Steven C. Hayes, Stefan G. Hofmann, and Joseph Ciarrochi are the sole owners of the artwork. Permission has been granted to use this material.

Damian Jacob Markiewicz Sendler: Affect, cognition, attention, self, motivation, and overt behavior are all included in the extended-evolutionary meta model. These aspects were discovered through a thorough examination of clinical intervention change processes (Hayes et al., 2020a). The processes can easily be categorized into one of these or a combination of them. Instead of making hard and fast distinctions, we found the dimensions to be helpful. In addition to the psychological, sociocultural, or biophysiological levels of analysis, change processes can occur. An additional method for determining whether or not a process is adaptable is to conduct an experiment.

What follows is a discussion of how researchers in positive psychology have proposed the process of change. Literature helped us identify these processes in a variety of ways: As a first step, we enlisted the help of Ciarrochi and Oades in the field of positive psychology (first and third author). According to a recent bibliographic study of positive psychology, we identified the process (Hendriks et al., 2019). Finally, we looked at all of the articles published in the Journal of Positive Psychology between 2016 and 2021 to see if there were any common themes.

While all three of these programs are meant to be comprehensive, there are many aspects that are unique to each of them. We might be tempted to create a “meta” program that incorporates the best features of each individual program. A program of this scope could, however, grow out of control and become irrelevant to some users. That’s what we believe would be the best path forward, and we’d like to hear your thoughts on how to get there. Instead of starting with the procedure, focus on the individual. People who are physically inactive or who have unrealistic expectations of what constitutes physical fitness, for example, could be the focus of a targeted intervention. In the event that a coworker is unable to comprehend other people’s motivations, an intervention may focus on perspective-taking.

Damian Jacob Sendler

All models, even the ones we see today, have their roots in a previous incarnation. The EEMM connects to the past in four significant ways. In the first place, our approach is based on and extends approaches that focus on tailoring treatment to the unique individual and their specific situation (Norcross and Wampold, 2018). Treatment adaptation, responsiveness, individualization, personalization, and tailoring are some of the terms used by researchers to describe these approaches, all of which aim to focus research on change processes on the specifics of a specific individual in a specific context.

Another similarity between Measurement-based Care (Scott and Lewis, 2015; Lewis et al., 2019) and the goals of the EEMM is that both aim to improve usual care by collecting and analyzing client data at various points in time during the intervention. Measures of important processes that promote change should guide action, for example, by alerting a practitioner if an intervention fails to meet its goals. We suggest that the processes and outcome measures feed into an interactive network, so that processes don’t just affect the outcome in a one-way and linear manner, but also influence other processes and are influenced by the outcome.

Third, our process model has consilience with many ideas in implementation science. As an example, Presseau et al. (2019) suggest that interventions should have a detailed specification of the behaviors targeted for change and an alignment between intervention components and outcomes. According to them, we can describe behavior in terms of the action, the actor, the environment, the target, and the time. In addition to this, our model suggests that we can use actions to promote variation, selection and retention, across six dimensions and multiple levels.

A fourth advantage of our approach is that it allows us to compare specific process-based interventions like Barlow’s universal protocol (Barlow et al., 2017) or specific process-based models like the psychological flexibility model in Acceptance and Commitment Therapy (AcT) (Hayes et al., 1999). As a “evolutionary meta-model,” the EEMM provides a common language and well-accepted framework in evolutionary science to allow different theorists to communicate what is essential about their approach to the study of change. It is thus possible to investigate whether specific concepts or methods are required to broaden a conventional approach to ACT (Hayes, 2019) by looking at it as a process-based intervention. Similarly, we can look at the Unified protocol (Barlow et al., 2017) as a set of interventions and make efforts to expand the protocol coherently if specific areas of the EEMM are not well-covered (Barlow et al., 2017a).

The EEMM can be used to examine the processes and methods used in a positive psychology or other protocol, but it does not suggest a specific protocol or process by itself. The EEMM cannot be compared to, for example, the PERMA or broaden and build approach, but it is possible to use the EEMM as a process-based coaching approach to further develop PERMA or broaden and build. If outcomes are improved by dynamic tailoring, it is possible to compare “off the shelf” ACT and ACT as a form of process-based therapy, to see if the improvement is due to larger or broader movement of psychological flexibility processes or other processes that may be suggested by the EEMM.

The way we approach interventions has been transformed by positive psychology. It has caused a proliferation of new, positive interventions and shifted the focus away from fixing problems and toward promoting thriving. Negative functioning isn’t simply the absence of a positive one, as positive psychologists have pointed out. In fact, anxiety and joy, success and failure, and socially skilled and unskilled behavior are often present at the same time. Contrary to popular belief, these aren’t necessarily diametrically opposed.

This article suggested a number of ways in which the field can continue to advance. For starters, the field needs to shift its focus away from complex packages and toward evidence-based processes that are often embedded in them. Using this approach, we will be able to identify and combine the most powerful ingredients in different interventions, which will help us achieve our goals. ORBIT (Czajkowski et al., 2015) models can be used to systematically evaluate treatment components, combine them into a proof of concept package, and conduct pilot and feasibility testing if the goal is to build a treatment package that works for many people. However, even with packages designed this way, we cannot assume that the package will work the same way for each individual. What is needed is an approach to tailoring intervention kernels based on idionomic findings that can maximize gains for specific individuals. There will be no one-size-fits-all packages in the future, but rather models that can easily be modified.

As a second consideration, we must look at the interplay between negative and positive processes in order to affect individual results In a dynamic network, we can think of positive and negative as processes that interact, but they cannot be reduced to one single continuum (Hayes et al., 2019). Positive emotions, such as happiness, can help people cope with and recover from stressful situations (Ong et al., 2006). Practicing self-compassion and self-love can help people avoid the negative effects of low self-esteem (Marshall et al., 2015).

Finally, we need to tailor positive psychology to the individual. Our understanding of the ingredients that are likely to lead to positive change has improved greatly, but now we need to ask which of these ingredients is most relevant to a particular person in a specific context. While promoting positive thinking appears to be a universally “good” process, there are contexts in which it is potentially unhelpful, such as when focusing on the positive reinforces experiential avoidance (Foody et al., 2013), encourages self-focus and loneliness (Mauss et al., 2012), promotes harmful attachments (Sahdra et al., 2016), incorrectly focuses blame for a lack of positivity on the person rather than a toxic situation, or incorrectly places blame on the person rather than the situation (Ciarrochi et al., 2016).

Damien Sendler: A clinical or positive psychologist can use the Extended-Evolutionary Meta Model described here to target the potential active processes of change. It is important to identify the core processes that are likely to apply to each individual client before developing a personalized approach (Hayes et al., 2020a). One client may require more attention to the development of hope, while another may require more attention to the development of social skills. Thereafter, a process-based intervention can be implemented by the practitioner. During the intervention, the practitioner would get feedback from the client on what is working and what isn’t, and then adjust the case conceptualization and intervention as necessary to reflect that. As a result, the practitioner can use a variety of research-based processes (variation), pick those that are most beneficial to the client, and then aid the client in retaining the skills they’ve learned. This approach’s full details are beyond the scope of this paper, but those who are curious can consult Hofmann et al (2021).

Finally, we must assess the EEMM’s usefulness. To demonstrate its usefulness, we argue that the model must address current literature in a way that fits with its assumptions and purposes, build on existing and well-supported concepts that have precision, scope and depth without arbitrarily leaving aside issues that should be addressed, and address what is known without distortions or narrow adjustments to deal with anomalies. Lastly it must lead to new and testable insights. The purpose of this paper is to provide evidence in support of the aforementioned three claims. We can conclude that positive psychology’s evidence-based processes can be sorted using the EEMM, which doesn’t exclude any major theoretical position or approach. Positive psychology and clinical psychology were shown to be intertwined in this study. This dispelled the myth that the two fields are mutually exclusive and, as a result, could not be combined. Many new research questions need to be explored, including the possibility that idiographic and process-based tailored interventions may improve outcomes above and beyond well-established and relatively comprehensive intervention protocols, such as Barlow’s Unified Protocol (Barlow et al., 2017). A process-based strategy appears to be the most promising one so far, according to preliminary findings (Fisher et al., 2019).

The efficacy of positive psychology interventions has been proven beyond a reasonable doubt. More people need these interventions. People who are “languishing” are those who are not able to achieve their full potential (Keyes, 2006; Keyes and Westerhof, 2012; Nelson and Padilla-Walker, 2013). Mental illness affects 20–25% of the population (Baumeister and Härter, 2007), trauma affects 25% of young people (Perkonigg et al., 2000), and bullying in the workplace affects 50% of the population (Baumeister and Härter, 2007). (Chatziioannidis et al., 2018; Ng and Chan, 2021). As a result, many languishing people go unaided (Ciarrochi et al., 2002; Cusack et al., 2006; Sheppard et al., 2018).

Process-based approaches to positive psychology can help, we believe. More people may be able to help, as well as more effective interventions, because of this. In order to deploy evidence-based kernels that meet human needs, people are not required to complete postgraduate study in clinical psychology or psychiatry. Using evidence-based processes does not necessitate specialized training or elaborate professional guilds. In the same way that people may own packages and training programs for hypothetical diseases, no one owns these evidence-based processes. Several of the research-based methods described in Tables 2 and 3 could be taught to and used by regular people, such as bartenders and business leaders and hairdressers and coaches and personal trainers and clergy and educators. People who work to empower people can track the processes of change and tailor intervention kernels to the specific needs of the people they work with with the help of appropriate technology.

Focusing training on specific intervention kernels linked to specific processes would be the most effective way to teach specific processes to a specific helper in a specific context. For example, youth mentors can learn the most relevant processes for supporting young people to stay engaged in school when emotions arise that might lead to avoidance or withdrawal. Exposure therapy, for example, is not something they need to learn. They simply need to know what they are capable of and who to turn to for assistance with the things they cannot handle themselves.

There will be difficulties in educating a large number of mental health professionals with a process-based approach. Studies show that therapy and mindfulness-based training can lead to negative outcomes (Cuijpers et al., 2018; Britton, 2019; Curran et al., 2019). We need a set of core skills for helpers to learn in order to reduce the likelihood of client alliance ruptures and to minimize helper behavior like rigidity and over control. Clients who are subjected to any of these tactics may feel devalued and deprived of their agency (Curran et al., 2019). Individuals’ process-based needs may necessitate the use of technological aids for high temporal density assessment. A process-based approach will help positive psychology move forward and assume its rightful place in human development around the world, even with these training challenges. The challenges we face as a human race are too large to be addressed by a small group of experts. For the sake of those we serve, we need a more democratic and broad-based positive psychology.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler, M.D. – Victims of domestic violence face a wide range of mental health issues as a result of COVID-19, which may have significant human and economic ramifications. In the context of COVID-19, there is a dearth of mental health interventions that are specifically designed for victims of domestic violence. To close a knowledge gap, we set out to find interventions that can improve the mental health of victims of domestic violence in the midst of the COVID-19 pandemic.

Damian Jacob Sendler: All demographics are affected by domestic violence, which can lead to significant morbidity and mortality. Although domestic violence victims face a variety of psychological problems, multidisciplinary approaches to helping them cope with these issues have been identified. These include everything from individualized shelter home strategies to education programs and escape plans to legislation and regulations to more technologically based mental health solutions. Multifaceted and multidisciplinary approaches to combating domestic violence are urgently required, especially in light of the widespread availability and low cost of technology-based solutions.

Dr. Sendler: Some statistics show that one in every three people in the world will experience some form of domestic violence, which is a global health crisis [1]. Domestic violence is defined as a behavior that focuses on the oppression of another individual, resulting in significant pain and trauma through physical, sexual, and mental harm [3]. Domestic violence is on the rise around the world as a result of the COVID-19 pandemic [5–7]. Despite the fact that lockdown has reduced crime by 40% in Australia, the number of domestic violence cases has increased by 5% [8–10]. In addition, Google Trends data shows a 75% increase in online searches for domestic violence victims’ support [9].

Domestic violence is on the rise in many countries, including China [11]. According to police in Hubei Province’s Jianli city, cases of violence against women have increased threefold, with 90% of those cases being affected by isolation and lockdown as a result of COVID-19 [12]. Furthermore, alarming statistics show that the number of women murdered by their intimate partners has doubled in the United Kingdom (U.K.) between March 23rd and April 12th, 2020 compared to the average annual rates for the past decade [13]. Prior studies have shown that men and women behave differently when it comes to violence [14], but more recent studies on domestic violence show an increase in the frequency of both types of violence [15]. As an example, let’s consider acts of violence perpetrated solely against men. An alarming trend in the prevalence of violence against men has prompted a call for more research to untangle cultural and societal perceptions of victimization [17, 18], as well as the challenges associated with help-seeking behavior among victim demographics [19, 20].

Systematic research suggests that cases of domestic violence against women are frequently unreported or underreported [21–23], making the situation even worse. It has been found that only 5% of current domestic violence victims in Bosnia and Herzegovina are reporting their crimes to the police [24]. Amidst a nationwide epidemic of domestic violence, these sombering figures highlight how critical it is for policymakers to develop timely strategies and practical solutions to address the new problems that victims are confronted with. Research on women’s violence has been a major focus of COVID-19, so this paper’s narrative is consistent with this. Although the findings are primarily focused on the COVID-19 pandemic, the majority of them should be viewed as addressing domestic violence as a whole and highlighting the long-term health consequences of domestic violence against women, particularly in the area of mental health.

Victimization of women can have long-term and short-term health consequences, which often manifest in both physical and mental health issues. Mental health issues may not be as visible or tangible to victims and society as physical health issues. There are a variety of symptoms and ‘asymptomatic’ individuals who appear to be mentally healthy who may be dealing with serious and significant mental health challenges that may go unnoticed and therefore left untreated [27]. [28,29] Delaying seeking help for mental health issues can have a negative impact on the individual’s well-being and welfare [28]. A growing body of research demonstrates that victims of domestic violence frequently experience significant mental health issues [29–31].

In order to be mentally healthy, one must be able to “realize one’s own potential, cope with everyday stresses, work productively and fruitfully, and make a contribution to one’s community” [32]. Some studies have found that 75% of people who seek help from domestic violence support services report clinical posttraumatic stress symptoms, with depression and anxiety cases even more common [30]. Domestic violence victims in China, like their Western counterparts, frequently suffer from a wide range of mental health issues, including substance abuse, stress, anxiety, depression, and suicide [33–35]. Depression was found to affect 65.8 to 75.8 percent of the 2987 Chinese victims of domestic violence studied [36].

Researchers generally agree that mental health plays an essential role in determining a person’s overall health and well-being. Health problems resulting from a decline in mental well-being can affect the mind and body [37–40]. Mental health experts have long warned that society is facing an epidemic of mental illness because of its prevalence and severity [41]. Mental health issues faced by victims of domestic violence must be addressed more effectively in the face of a pandemic [42–45], which has already had significant human and economic consequences for public health [46–48].

For example, health interventions could be defined by a targeted strategy or program that aims to provide timely and cost-effective health solutions to a specific population. According to the literature [51–55], tailored interventions are necessary and beneficial. Mental health interventions have been shown to reduce the negative effects of mental health issues and protect the overall health and well-being of domestic violence victims [46–48]. In spite of the enormous promise of health interventions, there is a critical shortage of mental health interventions specifically designed for survivors of domestic violence, especially in the COVID-19 context [8–10]. Many mental health services and domestic violence support systems have had to postpone or cancel their services because of lockdown and social distancing measures [8–10], which has exacerbated the lack of mental health solutions for many domestic violence victims [56]. For this reason, this paper aims to identify existing interventions that can be adapted to the COVID-19 context for domestic violence victims’ mental health and well-being to address the research gap.

COVID-19 pandemic showed that three direct and modifiable factors influenced women’s domestic violence and mental health issues: (1) increased exposure to the abuser, (2) decreased financial security, and (3) diminished mental health services. Figure 1 shows how these factors interact with domestic violence and mental health issues faced by women. To help domestic violence victims cope with their mental health issues in the midst of COVID-19, we used these approaches as a framework.

Even during the most intense lockdowns, essential businesses like supermarkets and pharmacies were often available to meet people’s basic physiological needs [77]. Health organizations and government agencies should take advantage of these shifts in social norms to put in place support systems to help people flee abusive situations during and after the pandemic [78–80]. Coded messaging systems have been used by supermarket and pharmacy staff to raise the alarm about suspicious activity.

Europe’s most vulnerable women are encouraged to seek help by using a code known as “Mask 19,” which has been adopted by France, Germany, Italy, Norway, the Netherlands and Spain [78–80]. ANI stands for “Action Needed” in the United Kingdom, where domestic abuse victims can seek immediate help at participating pharmacies using this codename. [81] By using a code word (either spoken or written), women can ask for help without drawing the attention of their abusers, even if they are within a few feet of them. Staff at the participating company can then contact the police or social services on behalf of the woman.

Damian Sendler

Pharmacies and supermarket chains could use coded systems to help domestic violence victims in countries where these services are not available. Many international fast-food chains like McDonald’s and Pizza Hut provide their managers and employees with extensive training based on international standards [82–84]. Police and social workers are able to respond to domestic violence incidents at restaurants because both victims and their abusers are in a known location and in the same room for a predetermined amount of time (dining-in time). Domestic violence victims living outside of China can benefit from using Chinese food restaurant chains as possible points of support, given that many of these chains operate in China and often have an international presence.

The good news is that many countries have a telephone or virtual help-seeking service. Accessibility, affordability, and the ability to maintain one’s anonymity, privacy, and security are just a few of the benefits of seeking help virtually [85–87]. Additionally, online services have the added benefit of being referred to as “silent services,” where victims can tell their stories and seek help without fear of their abusers listening in. During the first three weeks of the pandemic, calls to the domestic violence charity ‘Respect’ increased by 97%, emails by 185%, and website visits by 581% in the United Kingdom [56].

Damian Jacob Markiewicz Sendler: Online help-seeking platforms, such as those found in Norway, Germany, France, Spain, Italy and Argentina, are one of the most empowering online service formats [88]. Domestic violence victims can get access to vetted and comprehensive resources without having to search for another website to address their health and safety concerns or considerations through ad-hoc platforms [88]. Domestic violence victims need an ad-hoc online help-seeking platform because an all-encompassing system reduces the time and effort required to find online assistance. Because of this ease of access, people who are in need of assistance face fewer obstacles [89] and are less vulnerable to interruptions from those who are abusing them [87].

A national telephone or ad-hoc online system for domestic violence victims is still lacking in some countries, such as China [2]. Developing an ad hoc online help-seeking system that connects China’s abused women with timely and comprehensive resources is clearly needed by health organizations and government agencies [5, 12, 90]. Access to information and resources in various formats is required when designing and developing online help systems for victims of domestic violence. Depending on the format, high-speed bandwidth may be required or low-tech devices may be used to access it [80]. In order to access domestic violence resources using these devices, women will need to clear their browsing history or use a device that the abuser can’t get their hands on.

It is critical to have a system in place that provides for the physiological and safety needs of victims of domestic violence, such as food, shelter, safety, and medical care [91]. Domestic violence shelters in countries like Canada and France have remained open in the face of a pandemic by implementing emergency shelter provisions that allow the government to repurpose hotels as safe houses [79]. The French example may be more relevant for countries that did not have adequate infrastructure or resources prior to the onset of the pandemic [2]. Hospitals or housing facilities that are unused due to COVID-19, for example, could be repurposed as emergency shelters for people in need by Chinese health organizations and government agencies.

COVID-19’s negative effects on international and domestic tourism have made the use of hotels during the pandemic a cost-effective approach for society at large to organize a collaborative response to domestic violence. In addition, because hotels frequently have unused rooms, the government can investigate the feasibility of repurposing them as shelter homes in the long term. The use of these facilities could be compensated in some way in collaboration with local support services. In order to implement this idea, hotel staff will need extensive training in dealing with difficult situations, such as a spouse or partner looking for the whereabouts of an individual who is a victim of domestic violence.

As a result of failing social systems and the need for support from others, domestic violence often occurs [3]. As a result, it is critical to recognize the importance of taking the first step to seek help [94–96]. Integrated campaign interventions are a low-cost way to boost the demand for services. Campaigns that use communication and marketing resources to deliver persuasive messages to domestic violence victims, aimed at influencing their attitudes and behaviors toward seeking help, are known as integrated campaign interventions in this study.

Several countries and non-governmental organizations (NGOs) have launched public health campaigns to address the prevalence and severity of domestic violence [80, 97–99]. Domestic violence is a widespread problem, and many of these campaigns, including those sponsored by individual countries like the Netherlands and Kosovo, aim to educate abused women about the importance of seeking help and to raise public awareness about the pervasiveness of domestic violence and the importance of reporting it to “Save Lives” Consider expanding your campaign’s scope to include abusers in addition to these two types of campaigns. Informing domestic violence offenders about the laws and regulations in place as well as the social repercussions of domestic violence abuse can often help reduce their likelihood of committing abuse or of committing it further.

Domestic violence intervention programs for specific gender abusers have been examined by a growing body of research [100–102]. Other members of the abusers’ social network are frequently included in these dyad-centered programs. More comprehensive domestic violence care community members (e.g., health experts, social workers, and so on) are often included in dyad-based programs, which can have a positive impact on intervention outcomes. For a practical solution, campaigns to educate and inform those who perpetrate domestic violence of the consequences could be developed. This would take into account the frequency, prevalence, and severity of domestic violence. It is critical to educate members of the community about the dangers of domestic violence and how to intervene to help protect women.

Damien Sendler: If an individual decides to leave their abuser(s) during a lockdown, there is a need for more training on how to create an escape plan. It may be nearly impossible for women to leave their abusers as more women work from home, stay at home to care for their children, or are in lockdown as a result of the pandemic [8–10]. A well-developed escape plan can help victims of abuse because they may not be able to leave if the abuser is still in the house. While fleeing an abusive partner can be risky, it is especially so when children are involved, because “strategies that don’t match risks and circumstances may not improve safety and may even increase risks” [104]

Damian Jacob Sendler

One strategy is to have organizations and businesses provide resources, tips, and supplies that can be picked up discreetly and used to plan for an escape or to help women put together an escape bag. Accessing extra cash or opening a new bank account in their name, getting sets of keys, clothes, a prepaid phone to avoid being tracked, or copies of important documents or necessities for children are all examples of emergency escape plans [104, 105]. Alternative modes of transportation should be considered because an abuser can track a family car [104, 105]. They should have a designated place to go, whether it be a shelter, new rental property (such as an apartment or hotel), friends’ houses, or even a family member’s house at a location unknown to the abuser [104–105].

The lack of a detailed plan puts the victim and their children at an unanticipated danger. It is possible to alter a plan in the event of a postponement until it is safe to do so, if an abuser is identified [104, 105]. It’s critical to know how to properly dispose of smart devices, such as phones and watches, because they can connect to a home computer and be used as a tracking device. Victims of domestic violence in Western countries, such as the United States, are often protected by specialized programs [106]. Domestic violence victims could benefit from programs tailored to their specific needs based on these examples.

A national domestic violence registration system is one way to address the problem of domestic violence in countries. For example, the National Sex Offender Registry in the United States, where concerned parents and educators have access to a searchable public record, is a model for this type of registry in countries like China [107]. National domestic violence registration could allow individuals to check if their potential partners have violent or abusive pasts before they enter into a relationship with them.

An innovative concept has already been put into action in the Chinese city of Yiwu [108] in the context of this approach. An online database enacted by the Yiwu government lets anyone search for convicted, issued with a restraining order or sentenced to detention for domestic abuse since 2017 [108]. [108]. In order to inquire or begin this process, a few documents are required: (1) the I.D. of both individuals, (2) their official marriage application, and (3) a signed confidentiality agreement.

Since July 2020, this database has been available, but data on how this system has prevented domestic violence has not yet been released. People in Yiwu will have access to critical information about their fiancée before they embark on any further relationships with them, which is clear. As a model for domestic violence prevention and control, the Yiwu model will also serve as a valuable resource for other municipal governments and the central government. People with disabilities, such as blindness or illiteracy, may find it difficult to complete the application process on their own. The government should provide assistance in these cases, in order to remove any unnecessary hurdles.

Lockdowns and social distancing mandates will likely continue to be used when there are future outbreaks or infections until COVID-19 vaccination becomes a universal fact [109–111]. Technology-based interventions for domestic violence victims’ mental health issues can be facilitated by this barrier to physical contact [112, 113]. These health promotion strategies may benefit from the use of technology-based interventions if they can be made more “accessible and affordable to the target audience” [114].

Many studies show that technology-based interventions can help victims of violence against women reduce their symptoms of depression and anxiety, as well as their vulnerability to violence in intimate relationships [115–117]. There is some evidence to suggest that technology-based interventions (such as in-person interventions) can produce better results than more traditional methods [118]. Women are more likely to share their experiences with technology-based interventions than they are with more traditional methods of intervention, according to research [119]. Due to the power disparity between abusers and victims [120], people are often reluctant to seek out the kind of help that can help keep them safe and free from their abusive environments.

Interventions delivered via technology have a unique set of benefits that make them an ideal delivery method for COVID-19: Cost-effectively tailored to the specific needs and preferences of the target audience, (2) adopted to deliver health solutions remotely via transcending physical barriers such as time and money needed for transportation, (3) can be developed, delivered, and accessed cost-effectively, and (4) can be engineered to protect the target audience’s privacy and emotional concerns as they facilitate user anonymity in the health solution delivery process [121–123].

In some countries, waiting lists for mental health services are growing and there are disproportionate numbers of support workers. Face-to-face consultations may be delayed due to a lack of psychiatrists or other mental health professionals in China [124–126]. In light of the scarcity of mental health professionals in the United States, health care providers and government agencies should consider including international assistance in their online mental health services, such as assistance from countries that have ratified the Istanbul Convention, a legally flawed but urgently necessary framework for protecting women from violence across Europe [127–130]. Domestic violence victims now have access to a global network of multilingual mental health professionals thanks to technological advancements and globalization. Health organizations and government agencies should consider establishing a system that can connect all available international mental health experts across the globe with domestic violence victims and their families [132].

There is a public health crisis in the United States as a result of domestic violence. For generations, it has the potential to disrupt people’s hopes, dreams, and plans for a life free of violence. As a result of the devastating human and economic consequences that the pandemic has sparked, COVID-19 has exacerbated and introduced new mental health issues for victims of domestic violence. However, there are no COVID-19-specific mental health interventions for victims of domestic violence. While the pandemic of domestic violence continues, we identified practical and multidisciplinary interventions that can be used to address the mental health challenges faced by victims. Efforts to alleviate the many health burdens of domestic violence victims could be explored in future research. Victims of domestic violence require more support and assistance if the current and future pandemics are to be ended without them having to suffer in silence, pain, or fear.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: The coronavirus disease 2019 pandemic is causing significant anxiety and depression in children and adolescents, according to research. There is a possibility that adolescents, particularly females, are at greater risk. It is possible that these issues are exacerbated by factors such as social isolation and a lack of exercise. Somatic symptoms, depression, and anxiety may be more common in children who are concerned about coronavirus disease 2019. Children may be more vulnerable to abuse if their parents are under stress or have mental health issues. Depression and anxiety should be routinely screened for by medical and behavioral health professionals. Mental health services need to be more widely available.

Damian Jacob Sendler: This year’s coronavirus disease (COVID-19) has wreaked havoc on the lives of children and adolescents around the globe. As of January 16, 2021, there have been 23,440,774 cases of COVID-19 in the United States and more than 390,938 total US deaths as a result of this virus. 2 Families have been affected greatly by the pandemic-related school and business closures and community lockdowns. Children were forced to attend online schools as a result of the first global lockdowns, which began on January 23rd, 20203, in China.3 Many school districts in the United States began moving to online school in March 2020, coinciding with the closure of local campuses. 4 With each new outbreak of COVID-19, the United States has responded by imposing and then removing restrictions at the local and state level across the country. This is an ever-changing situation, with new pressures appearing on a regular basis.

Dr. Sendler: In addition to the pandemic-related changes mentioned, concurrent sociopolitical stressors are likely to affect the mental health of children and adolescents at this time. COVID-19 has been referred to as the “Wuhan virus” or the “Chinese virus” by some American politicians, which has led to reports of a racism pandemic against Asian Americans in the US. 5 Chinese American parents and children ages 10 to 18 who were surveyed reported being targeted by or witnessing COVID-19 racial discrimination in the early stages of this research. 6

The death of George Floyd at the hands of the police on May 25 sparked additional racial-based stressors in the United States.

7 Many children were exposed to instances of violence and/or racism as a result of media coverage and a video depicting his death. Outrage over police violence led to months of protests and demonstrations, peaking in June 2020, which focused the country on the issue of racial justice. 8 COVID-19 pandemic stressors and these sociopolitical events in the United States are difficult to separate.

COVID-19 has been linked to increased levels of depression and anxiety in children and adolescents, as well as post-traumatic symptoms, in the earliest reviews of original research into the drug’s impact on mental health.

10 In November 2020, Fong and Iarocci11 published a review of previous pandemic research and new COVID-19 findings and concluded that social isolation and quarantining during a pandemic results in significant anxiety, post-traumatic stress disorder (PTSD), and fears in children and adolescents. Reduce barriers to mental health services for children and their families, according to the authors.

Parents and children have both noted a decline in mental health among children during the pandemic. 14% of parents with at least one child under the age of 18 reported that their child’s behavioral health had deteriorated after March, with little difference across racial, ethnic, socioeconomic, and educational groups. This was found in a US study of 1000 parents. 23 Parents’ and children’s mental health problems have reportedly gotten worse for these families as their children have gotten younger, their child care has dried up, and there has been an increase in food insecurity. About a month after the pandemic began, Canadian researchers gathered data from clinical and community samples of young people aged 14 to 28. When compared to preandemic functioning, the community sample showed the most significant decline in mental health. Some of these college students returned to their parents’ homes after the outbreak of the pandemic, which may have contributed to their decreased substance use.

Suicide-related behaviors have been compared over time using large health-related datasets. From March to July of 2020, Hill and colleagues17 compared the percentage of adolescents seen reporting recent suicidal ideation and recent attempts in a large US city hospital emergency department (ED) with the same months in 2019. Compared to 2019, they found higher rates of suicidal thoughts in March and July 2020, and higher rates of recent suicide attempts in February through April and July 2020. This suggests that events in 2020 are to blame for these increases. The rates of completed suicides among youth under the age of 20 in Japan, in contrast, were compared using public data from March through May of 2019 and the same months in 2020. 18 Suicide among Japanese teenagers increased from March to May of each year, but the numbers did not worsen in 2020. Due to COVID-19 restrictions, researchers hypothesized that the youth staying at home with family may have been a protective factor.

Often, children and adolescents who are experiencing a mental health crisis are referred to hospital emergency departments. For the months of January through October of 2019 and 2020, Leeb and colleagues20 analyzed emergency department visit rates for children under the age of 18 using data from the Centers for Disease Control and Prevention, which reported general mental health-related visits in 47 US states. After March 2020, sharp increases were found in the percentage of mental health-related visits per 100,000 emergency department visits. These increases continued through October. In addition, the proportion of visits related to mental health increased significantly from the end of March to the end of October compared to the same months in 2019. Mental health-related visits for children aged 5 to 11 increased by 24% between 2019 and 2020, while visits for adolescents aged 12 to 17 years increased by 31% from 783 to 972 visits per 100,000 visits (from 3098 per 100,000 emergency department visits to 4051 per 100,000). Pandemic-related stressors may be to blame for these increases in children and adolescents’ anxiety levels. As a possible explanation for this increase, the authors suggested that the public’s difficulty in accessing community mental health services may be a factor.

Damian Sendler

During the COVID-19 pandemic, children between the ages of 7 and 13 have been reported to exhibit higher rates of anxiety and depression than normal.

Studies on children during this time period have found rates of significant depressive symptoms ranging from 2.2% to 11.78%.

From 1.8 percent 26 to 18.92 percent 12 to 23.87 percent.

3.16 percent of the population is said to suffer from post-traumatic stress disorder (PTSD).

An increase in inattention and a need for reassurance have been noted as the most problematic behaviors, as have difficulties in school, misbehavior, anxiety, social isolation, and depression.

The pandemic has led to a wide range of behavioral issues in adolescents, including depression, anxiety, misbehavior, social isolation, (inadequate) attention, and impulsivity, according to parents.

Significant anxiety symptoms were reported by as many as 10.4% of participants and as few as 29.27 percent of participants, according to research.

Significant depressive symptoms are more common in female adolescents than in males, with rates ranging from 17.3% to 22.28 percent.

Damian Jacob Markiewicz Sendler: In comparison to younger children, several studies have found that high school seniors have the highest levels of depression, anxiety, and stress. 24 The postpandemic months (March to October, 2020) saw a rise in the number of mental health-related emergency department visits among adolescents ages 12 to 17, with females accounting for the majority of these visits. 20 39.9 percent of a community sample of mostly college-aged youth reported symptoms of an internalizing disorder (eg, depression or anxiety) and 16.9 percent reported symptoms of an externalizing disorder (eg, aggression, oppositionality). 16 Researchers who looked at college-aged students found that 34.85% of them reported having somatic symptoms, especially when stressed about the necessities of daily life.

Damian Jacob Sendler

A lack of social interaction and loneliness has been linked to an increased risk of depression and possibly anxiety in children, according to research. 28 Social isolation has been linked to depression and anxiety in the COVID-19 studies cited here, including children who were unhappy with their home quarantine,24 those whose parents had to leave work,25 and those who were left alone on weekdays. 12 Social isolation can have a particularly negative impact on the mental health of young people who identify as members of a sexual minority. Research by Fish and colleagues29 with lesbian, gay, bisexual and transgender (LGBTQ) youth identified the difficulties of being homebound with unsupportive families, as well as the loss of in-person socialization for LGBTQ youth. For LGBTQ youth, maintaining social support and mental health via electronic connections is critical, according to researchers.

The COVID-19 pandemic has necessitated the use of mobile phones and the Internet. In the early weeks of the pandemic, some parents claimed to have had success soothing their children with media entertainment, but a large study of children and teenagers found that smartphone and Internet addiction (defined as excessive use) was associated with increased depression.

During the pandemic, children who engaged in regular physical activity showed less hyperactive–inattentive behavior and exhibited more prosocial behaviors.

22 Conversely, a lack of exercise during COVID-19 has been linked to higher levels of depression and anxiety, and researchers suggest that physical activity may serve as a protective factor. 12 Sedentary behavior has been shown to have significant negative effects on children’s mental health, according to Mittal and colleagues30, who point out that children’s play is essential for them to reach developmental milestones. Alternatives such as zoom and community and academic partnerships were emphasized as important means of ensuring that children remain physically active.

A correlation between COVID-19 risk perception and child and adolescent mental health was found. Living in an area with high COVID-19 concentrations has been shown to have detrimental effects on health (ie, City of Wuhan compared with other areas in China). Children who lived close to Wuhan had higher depression levels3, more problems with their peers, and more behavioral issues in general. 31 Primary school students were found to have increased somatic symptoms and anxiety when they experienced higher concerns about threats to their health and well-being, which is in line with this finding. 21 Children with more severe sleep problems had more COVID-positive family members or neighbors, according to a study by Yeasmin and colleagues25. There was a significant association between the number of COVID-19 cases in a family’s geographic area and adolescent internalizing problems, according to Fitzpatrick and coworkers14. Community restrictions that were more lenient were linked to more internalizing and externalizing problems in children and adolescents, suggesting that children felt safer and had better mental health outcomes when community restrictions were in place.

Damien Sendler: Exposure to COVID-related information may have an effect on mental health, according to some evidence. Grade school students who spent more time reading COVID-19 media reports had higher levels of anxiety and PTSD symptoms, according to a large study conducted 1 month after quarantine. PTSD symptoms were found to be the only ones associated with how much attention such reports received in the same research study. 26 A different study, on the other hand, found that children whose parents did not talk to them about COVID-19 had higher levels of depression, anxiety, and stress. 24 There was less depression and anxiety in the teens in the large study who had more knowledge about COVID-19, were optimistic about it, and were taking additional safety precautions.

The well-being of a child and a parent are inextricably linked. Studying parent well-being during the COVID-19 pandemic found that hardships like decreased work, incomes, and increased caregiving burden were directly linked to the well-being of parents. 15 More than two-thirds of the parents surveyed in a study in the United States reported that their mental health had deteriorated as a result of the pandemic. 23 As a result, domestic violence and child abuse are more likely to occur as a result of these stressful situations. 32 For children aged 4 to 10, studies conducted by COVID-19 found that parental depression, job loss, and previous maltreatment predicted higher rates of maltreatment. 33 A study that looked at the parenting of a broader range of children (18 years old) found that parents were less likely to abuse their children when they received more support and felt in control. 34 It’s no coincidence that families are spending more time together due to COVID-19 restrictions and the pandemic’s effects on parental mental health, according to Rodriguez and colleagues. 35 In order to help and educate families and communities in order to safeguard children, the authors advocate a proactive approach rather than a reactive one.

Anxiety and depression have been found to be increased in children and adolescents who have been exposed to the COVID-19 pandemic compared to pre-pandemic levels. Teenagers, particularly females and seniors in high school, may be the most affected, according to the research. These mental health issues are linked to social isolation and sedentary behavior, according to research. Somatic symptoms, depression, and anxiety may be more common in children who are afraid of the COVID-19. Anxiety and post-traumatic stress disorder (PTSD) symptoms may increase if children are exposed to too much information about COVID without parental guidance.

Many parents, especially single parents and parents of young children, are experiencing significant economic and personal stress, as well as an increase in mental health symptoms. Some children may be more vulnerable to child maltreatment as a result of pandemic-related stressors and situations, as is evident from the effects on their parents’ mental health.

It will be critical to make mental health services more readily available to children and their families. Mental health care should be integrated into medical settings in order to provide comprehensive and front-line care. As the situation evolves, it will be necessary to conduct research into the long-term effects of COVID-19, as well as studies into the most effective methods of prevention and treatment.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: The H1N1 swine flu pandemic and the recent COVID-19 coronavirus pandemic offer insights into how health authorities communicate health risk information to the general public. During a pandemic, public health officials use a variety of methods to communicate with the public about the dangers posed by a disease. 

Damian Jacob Sendler: A wide range of studies in the interdisciplinary field of health risk communication were included in this review. The H1N1 and COVID-19 pandemics received the majority of attention. It was found that three categories for modes of communication emerged from a content analysis: I communication channels, ii) source credibility, and the way the message is communicated. Only a few studies on social media and self-protective behavior have been found, whereas the majority of studies on content and engagement have been found. There aren’t enough studies on communication methods that account for the wide range of receivers that can be found in the field. The use of graphic and audio-visual means by health authorities has been the subject of a few studies, but none of these looked at or evaluated the creative communication options. 

Dr. Sendler: There is a need for experimental studies to examine the impact of health authorities’ social media videos and messages on self-protective behavior. At a time when online digital communication is crucial for reaching the public, more studies in the fields of health risk communication and media studies, including visual communication, web design, video and digital marketing, are needed. 

An epidemic known as a pandemic is one that spreads across a large geographic area, crosses international borders, and affects a significant number of people. 

A disease-causing agent must be able to infect and spread easily among humans” [[1] p. 2019]. This includes the “Spanish flu” pandemic of 1918–1919, AIDS, swine flu, and COVID-19, a coronavirus disease that was brought on by a strain of the SARS-COV-2 virus that has recently emerged in 2019. (2019-). Responses to pandemics are unique in that they rely on organizations with a staff of subject matter experts (SMEs). During the H1N1 swine flu pandemic, for example, pandemic responses were driven by bureaucratic expert judgment rather than by politicians guided by political survival principles [2]. People who perceive a disease as more serious are more likely to engage in protective behavior during pandemics and infectious disease outbreaks, according to a review of demographic and attitudinal factors [3–5]. Geographical and virological factors, rather than severity, define pandemics, which can make it difficult to communicate the risks of low-lethality pandemic infections [6]. In addition, pandemics spread across the globe, resulting in disease outbreaks at various points in time and in various places. The pathogen’s effects can last for years and change in severity over time [7], and it has the potential to have devastating effects on human health, the economy, and quality of life all over the world [8–11]. In order to effectively communicate pandemic risk to the general public, health authorities face numerous challenges [12, 13]. 

Research and practice in risk communication are both multidisciplinary [14]. The literature that uses the term “health risk communication” emphasizes that “health communication” is an integral part of risk communication in the context of public health emergencies [13, 15–18]. When dealing with a public health emergency, such as a pandemic, health communication and risk communication aims to improve health outcomes by influencing, engaging, and reaching out to various at-risk audiences [12, 19, 20]. The term “health risk communication” is used in this review due to the literature’s integrative nature. In health risk communication, trust, engagement, and tailored communication are all critical concepts, and a lack of any of these could impede effective communication [12, 20]. 

Different modes of communication can be used to communicate health risk information. Health authorities’ methods of informing the public about risk are referred to as “mode” in this review. Mode is a way of being or doing things [21]. [22] Health risk communication has been significantly influenced by new modes of communication as the public seeks information via online and social networks. A significant impact on traditional mass media has been the rapid evolution of communication technology, including the nearly universal adoption and widespread use of mobile phones and digital media (television, radio and newspapers). Access to and trust in health information are both changing as a result of the internet [12]. An important role was played by online newspapers and social media in spreading information about the health risks of the H1N1 pandemic [23, 24] and the COVID-19 pandemic [25–27]. There are new opportunities for two-way communication on social media platforms, such as speaking with and not just to people [12, 27, 28]. However, these aren’t the only ways health officials communicate with the general public. In addition to traditional print and broadcast media, health officials also use videos, mass media, websites, and social media to communicate health risk information to the general population. 

For emerging infectious diseases [12, 28] and for the H1N1 pandemic [7, 13, 18, 29], previous systematic reviews synthesized knowledge on risk communication. However, the role of social media during emerging infectious diseases and the COVID-19 pandemic [23, 26] and the role of mass media and public health communication in COVID-19 [25, 27] have also been examined in other reviews. Pandemic risk communication, however, does not currently have the same level of synthesised knowledge as other aspects of public health. Consequently, the goal of this rapid scoping review was to synthesize all evidence regarding the various modes of communication used by health authorities during a pandemic to communicate health risks to the public. A scoping review is a type of systematic review in which a researcher aims to gather a wide range of evidence from a variety of sources, regardless of the study’s quality, in order to identify research gaps and clarify some key topics and outcomes (e.g., knowledge, trust, health literacy, adherence to recommendations). 

Of the 48 articles, 33 dealt with the COVID-19 coronavirus pandemic, 12 with the H1N1 swine flu pandemic, and three with pandemic influenza in general. For the studies, data collection occurred in North America (N = 15), Asia (N = 13), Europe (N = 9, of which N=9 was collected in multiple European countries), Africa (N=1), and Australia (N=1). There were no studies from South America. A total of nine studies, three of which collected data across continents, five of which collected data on global media use, and one of which looked at the WHO, were conducted. 

Results and risk communication are broken down into categories based on the types of outcomes and key topics. All of this was categorized into three main groups: In addition to I communication channels and ii) source credibility and iii) how the message is communicated, these two additional categories describe how and why health authorities use these media types: 

Damian Jacob Markiewicz Sendler: Pandemic information can be disseminated through a variety of communication channels, including the traditional mass media, governmental websites, social media platforms, and YouTube clips. Framing, engagement, misinformation, health literacy, self-efficacy, accessibility, and timeliness of the updates were among the most important topics. Survey methodologies with self-reported use of communication channels were used in 14 of the included studies [36–51]. Health authorities were among the information sources. According to these studies, people get information about pandemic health risks from a wide range of sources, including newspapers, television, printed materials, government websites, scientific articles, radio, and text messages (SMS) [36–50]. They also get information from other people in their personal and professional networks, such as family members and close friends, as well as from health care professionals and social media [36–50]. There is no one-size-fits-all approach to educating the public about health risks; rather, people are influenced by the totality of their exposure to various and multiple communication channels and information sources. 

Using traditional mass media (TV and newspapers) as a communication channel, five studies of health authorities’ health risk communication reported on outcomes related to framing and use [52–56]. Message framing was a major topic of discussion at the meeting. According to Nisbeth [[81], p. 216], “interpretative story lines that set a specific train of thought in motion, conveying why an issue might be a problem or pose a threat, and what should be done about it” are examples of framing. H1N1 media coverage during this pandemic used sensationalist framing of their messages, conflict frames, and war metaphors [52–54]. During the H1N1 pandemic, tabloids in ten European countries used risk-amplifying frames to present press releases from the WHO and health authorities. When distributing the press releases, conflict and damage were emphasized [53]. According to Hall and Wolf [52], German public health experts attributed public fear and panic due to sensationalist media reporting. 

Damian Sendler

Health professionals, regional public health officers, epidemiologists and public health experts across eight European countries following the H1N1 pandemic all reported poor collaboration with the media and feeling misunderstood by the media, according to a qualitative study. Public trust in public health authorities must be improved before a pandemic occurs, according to the stakeholders [55]. 

Even though studies on mass media framing have found it to be an important topic, there are no studies on the relationship between framing and public responses. No studies have examined the effects of health officials’ communication with the public via radio, and no studies have examined the outcomes. 

Readability, accessibility, and timeliness of updates on government websites were examined in six studies included in this collection of research [57–62]. It was found that COVID-19-related information was difficult to read on government, hospital, and WHO websites [57, 58] in cross-sectional Google search studies of the readability of websites. The Centers for Disease Control and Prevention’s websites during the first months of the H1N1 pandemic were classified according to their intended audience and reading level in a prospective study of the websites. Using instruments for evaluating the suitability of materials, such as layout, typography, graphics, and surrounding context, and their accessibility to an intended audience, the study examined the content’s readability. The format and layout of the webpages (i.e., text-heavy and densely formatted) made the material difficult to understand, according to the authors [59]. In the absence of non-text alternative content for people with vision problems, a WHO website accessibility study found that information on the website was not accessible to the elderly [60]. During the COVID-19 pandemic [62] and the H1N1 pandemic in the United States [61], local governments in China complained about the difficulty of keeping their websites up to date with the latest information. 

The evidence suggests that information accessibility is not determined solely by adjusting the reading level of the audience. Additionally, factors such as readability, design, format, usability, and timeliness have been considered when evaluating the quality of health authorities’ and governments’ official websites. 

Damien Sendler: Studies on Twitter and Sina Weibo focused on message content, engagement, and misinformation [15, 16, 63–68]; all eight of these studies reported on these three aspects of social media messaging. There has been research done by Sutton et al. [63] looking at the use of Twitter by government officials and they discovered that the content and features of a tweet, as well as its organization type, followers and time of day all influence how often a tweet is retweeted (i.e. reposted or forwarded). Surveillance, technical information, self-efficacy, or symptoms of collective efficacy were the most popular topics for retweets. Video-enabled messages were retransmitted 63% more frequently than text-only ones [63]. According to Sutton et al. [15], public health agencies’ Twitter messages during the first 60 days of the COVID-19 pandemic shifted from instructive messages to motivational messages to sustain action, which focused on protecting vulnerable populations. 

Damian Jacob Sendler 

The lack of viewer engagement in health authorities’ social media posts related to COVID-19 was examined in five studies. On behalf of the world’s health authorities, Kamiski et al. [64] conducted an infodemiology study on Twitter messages published by them. There was a higher level of engagement with health authorities’ use of negative framing in Twitter messages about pandemic information than with celebrities’ and politicians’ positive framing. It is possible that while more positive posts from healthcare providers may increase engagement, they may also diminish the message’s perceived importance. In order to effectively communicate pandemic risk, the authors argue that health authorities and opinion leaders must work together [64]. Inconsistencies and inconsistencies in the communication of COVID-19 information were found in a study of information dissemination on Twitter conducted by the U.S. health authorities. There was no mention of message inconsistency and people’s self-protective behavior in the study [65]. Sina Weibo posts from the Chinese government were found to have a low level of engagement. Media richness was not used properly, and non-personal and non-narrative content was used instead, according to the studies [66, 67]. 

The evidence suggests that social media posts about pandemic health risk information are not getting much attention from the public. Twitter and Sina Weibo users are more likely to engage with messages that include narratives and a sense of self-efficacy. As far as pandemic health risk communication and self-protective behavior are concerned, no studies have been conducted. 

Five studies [69–73] looked at how people use the world’s most popular video-sharing website, YouTube. Online video has grown in importance as a supplement to traditional television. However, YouTube is vulnerable to the spread of misinformation because credible government sources and the WHO are underrepresented [69–71]. Among the most popular COVID-19 videos with more than 62 million views, Li et al. [69] found that 25% contained misleading information. Only 11% of the videos and 10% of the views on COVID-19 were produced by the government, despite the fact that these videos contained more accurate and factual information. A higher percentage of YouTube views were found for COVID-19-related videos with misleading content than those from credible sources [70]. Government and health agency videos on COVID-19 information on YouTube were often found to be credible across nations, but they received a low number of likes and comments [72] and represented a low share of their videos [70]. According to YouTube’s reliance on the English language in videos and the fact that public agencies have low subscriber numbers, health authorities may not be able to reach a large number of people through social media. 

These studies [69–72] show that YouTube is a source of misinformation for COVID-19, and health authorities’ videos on YouTube are underrepresented and have low engagement. Studies on YouTube videos used by health authorities to communicate pandemic health risk were not found that also reported on their impact on self-protective behavior. 

One study [37] found that people were more likely to trust government and health care professionals, compared to those who were more likely to trust non-formal sources like the media or their friends and family. Trust in official government sources has been linked to better self-protective behavior and accurate knowledge of pandemic risk [46, 47]. In a survey of Hong Kong adults, trust in official government sources about influenza was linked to better reported understanding of H1N1 causes and more self-reported hand hygiene among males than those who trusted informal and interpersonal information sources [46]. Trust in government sources was found to be positively associated with accurate knowledge of the disease COVID-19 in a survey of the US population. The younger generation has a greater faith in non-official sources like CNN and social media (like Twitter) than the older generation, which has a greater faith in official US government sources. Since young people place a high value on informal information, the authors contend that they are more susceptible to being duped by false information [47]. 

Credible sources, on the other hand, may not always agree with the most commonly cited sources. According to Jardine et al. [37], people in Canada relied on mass media and friends for information about the H1N1, but found public healthcare professionals to be the most trustworthy. Australian mass media was the most important source of health risk information for parents during the H1N1 pandemic, despite its lack of reliability, according to King et al. [48]. Medical doctors, authoritative hospitals, and government websites, on the other hand, were perceived as the most trustworthy. 

It was found in a survey of Slovenian adults that medical professionals and scientists were viewed as the most trustworthy sources of information, but that news portals, television news and social media were the most frequently accessed sources of COVID-19 information. 

Failures in China’s government risk communication were the subject of two qualitative studies [51, 68]. During the early Wuhan COVID-19 outbreak, Chinese authorities failed to disclose their uncertainties, according to Zhang et al. [51], which the authors argue undermined their institutional trust. Zhang et al. [68] investigated the spread of misinformation about the effectiveness of a Chinese herb on COVID-19 prevention in a qualitative study. The message was delivered by one official health expert through the Chinese authoritative media, which influenced the perception of the message’s credibility. Social media disseminated the information with misleading titles, which sparked rumors and hoarding [68]. 

Formal health risk information has been shown to have both positive and negative behavioral effects, according to research. Even though studies show an association between higher levels of knowledge and self-protective behavior when people place their faith in formal sources, these studies lacked controls for educational level, which could moderate the relationship between sex and age differences in knowledge output. For pandemic health risk information, there appears to be a discrepancy between the sources people trust and the ones they report using. 

There has been a lot of research done on the use of narratives in the risk communication literature [14]. It was examined in six studies that how health officials’ messages are received and acted upon during pandemics is affected by the narrative tone of communications. It has been discovered that the narratives people hear can influence their level of fear and apprehension [49], their understanding of the pandemic [73], their level of involvement [16, 66, 67], and even their own behavior to protect themselves [76]. It has been found that people’s anxiety is exacerbated when hospitals report a need for financial donations because this reflects a lack of beds in hospitals [49]. Seeing that the Chinese government was opening schools gave people a glimmer of hope [49]. People who watched non-narrative health videos about pandemic influenza reported greater knowledge and greater pandemic influenza prevention measures than those who watched narrative videos [73]. [16, 67] Two studies of the Sina Weibo platform in China found that people were more engaged with narrative posts than non-narrative posts, both by the government and by personal sources. There were strong negative correlations between the number of shares and posts with new evidence and a nonnarrative style [16]. 

Factual, evidence-based messages about pandemic influenza from the health authorities were found to be the most persuasive, particularly those that included cost-benefit comparisons of H1N1 vaccine safety. Patronizing and unprofessional were the most commonly perceived characteristics in messages intended to invoke feelings of regret for not getting vaccinated. Positive emotions and posts with high levels of media richness (both in text and video) increased citizens’ engagement with government social media, while posts with high media richness and negative emotions depressed citizens’ involvement. So the authors concluded that when reporting content eliciting negative emotions, plain text should be used; when reporting content eliciting positive emotions, video should be attached to the text. 

While people learn more from non-narrative information than narrative information, the use of narratives in health authorities’ pandemic health risk communication leads to public engagement, according to evidence. People’s emotions may also be negatively affected by negative narratives, according to the evidence. 

Researchers have found a wide range of communication channels are used to disseminate health-related information, as well as a variety of informal and formal sources that influence the meaning-making process [85]. As a result, health officials are urged to spread information via multiple channels, including social media [12, 84]. Inconsistency may arise from the rapid dissemination of health officials’ social media messages, which may confuse the public [37, 65]. There’s nothing wrong with getting your information from multiple sources as long as it helps you make smarter decisions, reduces confusion, and increases your trustworthiness. [37] Misinformation is a major problem on social media sites related to pandemic risk communication, according to the findings of the review. Confusion and even panic can result as a result of this [23, 26, 27,] for the general public. It has been difficult for health authorities to combat the “infodemic,” or an epidemic of misinformation and rumors spread through social media sites, which has resulted from an overabundance of publicly available information [12, 23, 27, 86]. Meanwhile, their own messages, which are disseminated quickly and in parallel across numerous communication channels, lack consistency. According to Ratzan et al. [20], in order to effectively communicate global health issues to the general public, it is essential to develop a communication strategy focused on social media. To ensure or avoid risk amplification of their messages through mass media, health authorities across nations face challenges in creating social media engagement, providing the public with websites that are accessible, updated, and tailored to varying reading levels and with a readable layout.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: An acute respiratory syndrome-causing strain of the Corona virus was discovered in Wuhan, China, at the beginning of 2020, and it spread across the globe quickly (Ahmed et al. 2020, Wang et al. 2020). Because of its higher CFR and greater contagiousness when compared to other SARS-like illnesses, the case fatality rate (CFR) for COVID-19 is higher than for influenza (Bouey 2020, Yang et al. 2020). Since April 30, it has spread to more than 210 countries, with an estimated 3,189,594 active cases and a staggering death rate of 225,755 worldwide (WHO 2020). A global pandemic of influenza (HINI) struck in 1918-19, killing 50 to 100 million people (Johnson & Mueller 2002), many of whom suffered from mental health issues (Young 2016).

Damian Jacob Sendler: Many countries around the world are responding to COVID-19 with various strategies that combine mitigation and quarantine in order to reduce the flow of patients and reduce the demand for hospital admissions while protecting the most vulnerable from infection like the elderly and patients with comorbidities (Anderson et al. 2020, Parodi and Liu 2020). (Bedford 2020). On the other hand, this approach has stoked anxiety and depression in the public because it has disrupted their normal social and psychological lives. Many developed countries, such as the United States and Italy, are able to deal with social and financial crises, but this is not always the case. In developing countries like Pakistan, where the majority of the population is made up of low-wage workers, the pandemic has had a devastating effect, causing anger, depression, frustration, and a host of other mental health issues (Ahmad et al. 2020).

Dr. Sendler: Mental health sciences and psychiatry have come under scrutiny in light of the current COVID-19 pandemic. Triadic functions have been performed by transdisciplinary integrative-psychiatry: 2. help other medical branches encourage person-centered medicine by practicing consultation-liaison psychiatry; and 3. promote public awareness of the importance of mental health and the concept of an empathic civilization and a compassionate society.

Mental health issues like depression have been found to be directly linked to chronic diseases like tuberculosis (van den Heuvel et al. 2013, Gale et al. 2018, Kuan et al. 2019). Ebola epidemics and SARS outbreaks in 2003 and 2014 both revealed that fear-inducing, over-reactive behavior among the general population was also observed during these epidemics (Person et al. 2004, Shultz et al. 2016). Many mental health issues, such as anxiety, depression, and post-traumatic stress disorder (PTSD), have been linked to healthcare workers and survivors.

Damian Sendler

Public health crises in more than 210 countries around the world are to blame for the confirmed COVID-19 pandemic. Currently, it is impossible to predict the full extent of the economic and social consequences, but the fact that many countries around the world have implemented full or partial lockdowns can help us understand the impact (Cosic et al. 2020). In addition to the critical issues of virus containment and treatment of patients, it is also necessary to address the long-term effects of de-stabilized mental health globe. COVID-19 poses a serious threat to mental health around the world for the reasons outlined in this article, both economically and in terms of public health. “Increased rates of stress and anxiety is the main psychological impact of the pandemic up to now,” according to a WHO guideline, which warned that “new measures especially quarantine, its impact on public’s daily activities and livelihoods, loneliness levels and harmful drugs and alcohol use and depression and suicidal behavior or self-harm are also expected to rise” as the pandemic progresses (WHO 2020).

As soon as a pandemic is discovered, the public’s initial reaction is one of fear and uncertainty about the likely physical and mental health outcomes of the virus pandemic, which most likely includes: a decrease in health perception, a decrease in positive social activities, and a rise in health risk behaviors such as smoking (anxiety, PTSD and depression etc) As of 2020, (Shigemura et al. When compared to previous outbreaks like SARS, patients with definite and suspected COVID-19 and those who are quarantined are more likely to suffer from frustration, loneliness, and anger (Xiang 2020).

Damian Jacob Markiewicz Sendler: A study of 2091 people in China found that one month after the outbreak, the prevalence of PTSD in mainland China was 4.6 percent, while the prevalence of PTSD (18.4 percent) was higher among the high-risk public, such as those who live in Chinese provinces with the highest COVID-19 positive cases (Sun et al. 2020). Professionals in the mental health field, as well as those who have experienced a traumatic event, should be extremely concerned. Those who were quarantined in a Beijing hospital’s SARS unit reported significantly higher levels of PTSD and other mental conditions like fear, frustration, depression, and anxiety, compared to those who were not quarantined in the same facility (Wu et al. 2009, Kaiser 2020, Yi et al. 2020). Psychological problems such as frustration and aggression will be common in countries like Pakistan where the pandemic is a major cause of uncertainty as well as a major factor in people’s daily lives, such as their work schedules and where they will get their next meal. Health care workers who work in quarantine centers without personal protective equipment (PPE) or who have experienced the death of a loved one may experience similar symptoms of post-traumatic stress disorder (PTSD). Thus, mental health professionals should use stress-adaptation model therapies to reduce the stress level of health care workers.

Damian Jacob Sendler

Comfort in cleanliness and a person’s constant desire to wash or sterilize and such a condition is usually classified as obsessive-compulsive disorder (Williams et al. 2013). In the event of a global pandemic caused by an infectious virus, this form of OCD can lead to an increase in panic attacks, resulting in patient distress and functional impairment. A country like Pakistan, where only a small percentage of the population is registered with a mental health professional, would suffer greatly if such a condition were not carefully and regularly monitored. Clinical Psychiatrists should focus more on resolving mental health issues in the general population, and should do so with great care (Hamza Shuja et al. 2020). Researchers are currently conducting a variety of studies on the impact of the COVID-19 virus pandemic on mental health, and the results show that governments and health officials must take action quickly to minimize the mental health harm caused by the Corona virus (Cosic et al. 2020).

Damien Sendler: Individuals with COVID-19 antibodies, whether they are unconfirmed or confirmed, report significant psychological distress as well as other health-related issues. These people may be plagued by anxiety about the possibility of contracting a deadly disease or being infected by others (Xiang et al. 2020). A lack of treatment adherence is the result of mental health issues such as denial, insomnia, despair, and depression that are experienced by those who have been confirmed or suspected. Individuals with a high risk for anger and suicide may also be affected by this. Doubts about an isolated person’s health status may cause them to develop obsessive compulsive disorder symptoms such as repeatedly washing their hands, checking the temperature, and following other preventative measures. Additionally, strict quarantine conditions and mandatory contact tracing policies by the health agencies could lead to social rejection, discrimination, financial losses, and stigmatization (Shigimura et al. 2019, Brooks et al. 2020).

Front-line medical staff are frequently cited as reporting increased workload, discrimination, and isolation because their responsibilities include caring for infected individuals, maintaining close contact with the cases’ families, and frequently answering questions from the public. They are therefore more susceptible to experiencing fear, fatigue, sleep issues, and emotional disturbances as a result of their situation (Xiang et al. 2020, Kang et al. 2020). A recent study involving 1,563 medical professionals found that 50.7% of those who took part had signs of depression, 44.7% had anxiety, and 36.1% had sleep disturbances, according to the findings (Liu et al. 2020).
Additionally, the lack of information about the COVID-19 pandemic and the frustrating news may cause fear, anxiety, and uncertainty in the community (Shigimura et al. 2019, Bao et al. 2020). If there is a lockdown, the general public may become bored, irritable, and disappointed on a large scale (Brooks et al. 2020, Li et al. 2020)

COVID-19’s mental health effects have not been studied analytically, but based on the current public response, it is expected to have a significant impact (Li 2020, Xiang et al. 2020). Following this reaction, China’s national health commission issued a notice specifying guidelines for emergency psychosocial disaster interventions on January 26th, 2020, in an effort to reduce COVID-19 psychosocial outcomes. The psychological team includes psychiatrists, psycho-logical support hotlines, and mental health professionals (National Health Commission of China 2020). On March 18th 2020, WHO’s Department of Mental Health and Substance Use developed an outline of considerations for general and different targeted populations to support mental health and psychological comfort (World Health Organization 2020), allowing mental health workers to help the general population and patients understand and deal with the new threat effectively with a likely outcome of the COVID-19.. Consequently (Hamza Shuja et al. 2020).

The Corona virus outbreak has had a significant impact on most of the world’s countries, but most of those countries have fewer mental health workers on hand to meet the growing demand. For example, in China, there are 2.2 psychiatrists per 100,000 people, while in the United States, there are 11 psychiatrists per 100,000 people (Kirton 2020). Even in developed countries like the United States, nearly 40% of the population lives in an area where mental health professionals are scarce (Andrade et al. 2014), and this problem is not unique to developing countries (Marr 2019). Consequently, the current pandemic’s limited access to mental health services poses a significant challenge to health officials everywhere.
For patients, their families, and mental healthcare professionals everywhere, the increasing demand for psychiatric services and systems raises the possibility of global public mental health crises. In order to solve this problem, increasing the number of psychiatrists and improving the quality and availability of mental health services is not enough. As a means of addressing the current shortage of mental health care providers, telepsychiatry, artificial intelligence (AI), and other cutting-edge technologies like computer assisted services and tools are all viable options.

Consultation-liaison psychiatry is challenged by COVID-19, which provides mental health services to both patients in isolation wards and health care workers who treat them. There are many psychiatric hospitals where staff members like psychiatrists can practice telemedicine from the comfort of their own homes (Allen & Mishkin 2020). Corona virus panic attacks, which include chest pain and breathing difficulties, can be mistaken for respiratory distress during the COVID-19 outbreak (Onyemaechi 2020). Such patients can be identified by liaison psychiatry, which plays an important role in preventing numerous issues. When dealing with COVID-19-infected patients, health care workers often have to work long hours and don’t have enough personal protective equipment (PPE) (Allen & Mishkin 2020). Providing front-line health care workers with access to high-quality mental health services should be a top priority.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: The goal of computational psychiatry is to explain the link between the brain’s neurobiology, its environment, and mental symptoms. In this way, mental disease categorization, diagnosis, and therapy may be improved. It avoids biological reductionism and artificial categorization while uniting several levels of description in a mechanical and rigorous manner. Using two real-world diseases, depression and schizophrenia, as examples, we show how computer models of cognition can make inferences about the present environment and balance the consequences of potential future actions. How the brain chooses and values activities based on their long-term future worth is described by reinforcement learning Abnormal values, such as “helplessness” or a lack of control over one’s mental examination of disagreeable experiences, might contribute to certain depression symptoms. For example, Bayesian inference may be performed by integrating sensory input with previous beliefs, each weighted according to their confidence, in predictive coding (or precision). An abnormality in the brain’s cortical structure may decrease the ability to make accurate conclusions from sensory facts rather than past assumptions. Reinforcement learning and reward salience models may shed insight on the disease, as well as whether or not striatal hyperdopaminergia has an adaptive purpose in this situation. Finally, we discuss some of the applications of Computational Psychiatry to neurological illnesses, such as Parkinson’s disease, as well as some traps to avoid while using its approaches.

Damian Jacob Sendler: Cognitive psychiatry seeks to model the brain’s solutions to problems, which is to say, how it computes, and then to understand how ‘abnormal’ perceptions and behaviors that are currently used to define mental disorders relate to normal function and neural processes in the brain. This is done through computational modeling. A key goal of this research is to assist patients with better diagnostic tools by mathematically formalizing the link between symptoms, surroundings, and neurobiology.

Damian Sendler

To some extent, the present psychiatric categorization systems (the DSM-5,1 and the ICD-102), in which the symptoms imply the diagnosis and do not provide mechanical reasons for mental disorders, have prompted the development of computational psychiatry (CP). There was a price paid for diagnostic system reliability: validity. This means that clinicians have some confidence in making a consistent diagnosis given a set of symptoms, but they have no confidence that the diagnosis corresponds to a single biological or psychological entity or that it can predict the outcome of the illness or a specific treatment. However, it fails as a causal explanation because its component elements (especially the biological and psychosocial) are separated by a large explanatory gap. The biopsychosocial model of mental illness4 has had significant success in helping physicians comprehend disease at a human level.

Dr. Sendler: RDoC5 was put together by the National Institute of Mental Health (NIMH) in order to bring back the categorization of mental illness with an injection of mechanistic validity. Mental processes are broken down into five domains, each characterized at a number of levels or “units of analysis,” and the goal is that these units will generate biomarkers for distinguishing normal from pathological functioning. As a working document the RDoC approaches mental condition and its social risk factors via a biomedical lens, which has numerous benefits in theory. In fact, it goes from ‘genes’ to’molecular’ to ‘cells’ to ‘circuits’ to ‘physiology’ and eventually to ‘behaviour’. Computational Psychiatry offers some of the tools needed to connect these levels of understanding.

Computational psychiatry has been the subject of several authoritative reviews6–15, as well as groundbreaking work by Hoffman16, Cohen17, and a host of others. Using depression and schizophrenia as examples, we show how Computational Psychiatry might rethink mental health issues and provide new theories in the future. We’ll go through the benefits of using a Computational Psychiatry approach first.

In computational neurobiology, Marr18 established three levels at which the brain solves issues. It is necessary to characterize the problem’s ‘computational’ formality: What are the mathematical and statistical aspects of this situation? What options are available in the face of these challenges? Algorithms are used to solve the issue at this level. If this is only an estimate, I’m not sure how much more complicated it would have to become. The method’s physical implementation is described at the ‘implementational’ level: How are these algorithms encoded in the brain’s neurons and circuits?

It’s important to remember that these three levels aren’t mutually exclusive. Constraints at one level have consequences at other levels, even if every algorithm may be physiologically implemented in numerous ways. An algorithmic approximation is important for certain calculations (eg, high-dimensional integrals) that are too time-consuming for neural systems. Complicated computing challenges might provide information about the underlying methods when the system fails.

Damian Jacob Sendler

Other important levels of description cross this basic triad in the biological domain. For example, RDoC’s multiple ‘units of analysis,’ ranging from DNA to physiology to social interaction (as we would argue), may be dissected at the implementational level itself. A total of eighteen (19) Computational Psychiatry sits at the intersection of these descriptive levels and makes them explicit with regard to most mental diseases.

Due to the usage of generative models in Computational Psychiatry, it is mechanistic in a manner that DSM-5, ICD-10, and biopsychosocial model cannot be, High-level causes and low-level data are described probabilistically in a generative model (in contrast, a discriminative model merely describes how to label such data with their likely causesi). An understanding of how causes produce data may help a model to generate synthetic or “simulated” data from given sources.

It is possible to represent the brain’s own model of the world using this generative description (e.g., figure 1, which is discussed in the next section).

This knowledge may be used to improve study design or produce counter-intuitive predictions by tweaking crucial parameters in our generative models of agents’ brains. It is then possible to verify this full description against actual data using Bayesian statistics and machine learning methods. The most rigorous and global comparison of scientific ideas may be achieved by comparing generative models using Bayesian model selection. 21

It seems that our present categories are not valid at the clinical24 or genetic25 levels, which was an essential but unrealized objective of the DSM-5 architects. Rather than simply labeling someone as “schizophrenic,” “bipolar,” or “schizoaffective,” such an approach might instead assign them a score based on their mood symptoms (such as mania or depression), their psychotic symptoms (such as delusion and hallucination) and their cognitive impairment (such as “cognitive impairment” or “cognitive impairment”).

Damian Jacob Markiewicz Sendler: Both category and dimensional techniques may benefit from data-driven computational psychiatry. There may be a continuous (dimensional) difference between depressed study participants and control group participants on a particular parameter from a computer model (e.g., “reward prediction error signaling”). 26 Patients with schizophrenia with strong or low negative symptoms,27 or those with remitted psychosis and controls may utilize various models to execute the same task (i.e., potential categories). 28 In general, Computational Psychiatry provides for formal evaluation of evidence for opposing hypotheses, for example via Bayesian model comparison, having established alternative (e.g. categorical versus dimensional) models. These categories and dimensions may enhance both psychiatric nomenclature29 and the targeting and monitoring of therapies by identifying computational categories and dimensions.

At its most basic computational level, the brain’s job is to make assumptions about its surroundings and then behave accordingly. In order to execute its mission, the brain must rely on both its sensory input and its past knowledge since neither is totally dependable. According to Bayes’ theorem, the best way to integrate ambiguous information is to use the prior and the likelihood of the sensory input to calculate the ‘posterior,’ which is what is known as a ‘prior’ and a ‘likelihood’ (an updated estimation of the state of the environment). A common assumption in probability theory is that these probability distributions are of a kind that is well-suited to simple statistical representations, such as normal distributions, whose mean and precision (inverse variance) may be readily weighted by their (scalar) accuracy.

Although the statistics of natural sensory stimuli are subject to intrinsic uncertainty, their complexity makes them difficult to analyze. As a result of the environment’s hierarchical structure, there are patterns: A hierarchical model is the best way to understand these patterns, since the brain’s past beliefs must respect the sensory data’s hierarchical structure. Hierarchical models explain complicated patterns of low-level data aspects in terms of more abstract causes: for example, the shape that characterizes a collection of pixels, or the climate that explains yearly variance in weather.. Decompositions in hierarchical models are especially useful when dealing with complicated circumstances, both behavioural and sensory, since they facilitate planning and simplify optimum decision-making. 31–33

It is possible to forecast low-level data by using the high-level descriptions of hierarchical generative models, for example, by recreating the missing section of a picture.

34 35 Data from lower levels is sent to higher levels in predictive coding so that disparities between the predicted activity and what is really occurring may be sent back up the hierarchy in the form of prediction errors. As a result of these prediction failures, higher-level predictions are reevaluated, and this iterative message transmission continues.

Damien Sendler: Hierarchical models face a difficult decision: which forecasts should be altered in order to account for a specific prediction error? Making the biggest updates at the level with the greatest uncertainty in relation to incoming data is an approximately Bayesian solution to this problem. This means that, if your beliefs are highly uncertain but your source is extremely reliable, it would be prudent to make large updates to those beliefs.

Let’s say I’m out for a stroll at twilight and see activity in the distance from a bush. At different hierarchical levels, this might be explained as either a light trick, the wind, an animal, or a thief hidden in the bush, all of whom were moving the bush in an attempt to steal from me. In order for me to arrive at a decision, I must be certain that (1) I noticed movement; (2) the wind probably wasn’t responsible, (3) there are no animals in the area, and (4) there is no mugger in the area. If I assume that their probabilities are equal, then one of these beliefs will have to alter, and this will have a significant impact on my future behavior. Each level’s uncertainty (inverse precision) contributes to the learning rate, which is a measure of how much new data must be explained.

An further challenge for the brain stems from the fact that our actions have both immediate and long-term ramifications, on top of the inferences it must make about present inputs and situations. Though it may be tempting to indulge in a moment of pleasure, it may be preferable to resist it. On the other hand, suffering today might lead to much greater joys in the future. The future and the present must be taken into consideration while making decisions. Even in the rarest of cases, the brain is consequently faced with a second set of uncertainty when making inferences about the present. It is necessary to make some educated guesses about the future worth of potential acts (i.e., the total of their future rewards and penalties).

Model-based (MB) and model-free (MF) cognition are two fundamentally distinct methods in which previous experience is utilized to evaluate and predict future rewards and penalties.

A mechanical, causal knowledge of the origins and effects of actions and events is developed in MB or goal-directed cognition, which compiles experience into a (potentially hierarchical) generative model of the universe. It is possible to search this model and determine the quality of different behaviors, even if they have never been attempted or experienced, in the face of a certain event. Computational expenses might be substantial when trying to simulate or predict future possibilities.

For MF (or habitual cognition), an agent does not record information about state transitions (e.g, what will happen next if a specific action is performed); instead, the agent records how much reinforcement is obtained when a specific state (st) is visited (at time t) or an action is taken (at time t). Next, an agent calculates the difference between the predicted result and the actual outcome—the prediction error t=(V-Vt(st+1))/(R-Vt(st+1)) (st). For each time the state st is visited, MF learning increases predicted reinforcements by an amount equal to the reward prediction errors multiplied by a constant constant constant constant constant constant constant constant constant constant constant constant constant constant constant The real set of values, which includes ‘future’ consequences to the degree that they have followed previous decisions, may be revealed in this way under certain circumstances.

When the environment or the value of rewards suddenly change, MF learning is unable to adapt quickly enough to keep up. MB learning would build knowledge about the maze’s underlying structure and the types of rewards accessible inside it, whereas MF learning would record an established left/right turn sequence as being the optimum course of action. There is no value for MF knowledge if the rat’s typical path is obstructed, or it is thirsty. It is possible to increase the sensitivity of the MF account by employing hierarchical models, for example.

Damian Jacob Markiewicz Sendler
Dr. Sendler

Damien Sendler

Sendler Damian

Damian Sendler: Skeptics of narrative medicine have a good point. In the beginning, it is important to remember that not all presentations need a narrative investigation. The second reason is that both patients and physicians may be reluctant to use NBM. It’s possible that some patients, for example, might choose a doctor who is proficient in his or her craft over one who has a good bedside manner. 9 The biomedical paradigm and evidence-based approaches are also preferred by certain clinicians. 8 Furthermore, some physicians are overcome by the emotions elicited by specific narratives,10 while others have special behaviors that inhibit the flow of story.

Among other things, NBM has been criticized for being time-consuming8 and for opening the door to a wide range of issues.

Damian Jacob Sendler: When working under tight deadlines, balancing narrative and normative requirements may be a challenge. 4 In contrast, studies have shown that it does not take a lot of time to enable a story to flow. 9 Understanding is time well spent, and drawing out the underlying concerns is always preferable since there is frequently where the true troubles are. NBM has also been criticized for focusing primarily on the psychological and social requirements of patients11 and ignoring the biological components of sickness. In this regard, the literature on NBM is ineffective when the stated case studies are mostly psychological in nature. Remember that from an NBM viewpoint, the biological is equally as significant as the psychosocial story.

Dr. Sendler: Being swept away by tales and not recognizing one’s limits are both common pitfalls for NBM practitioners. Genuine individuals with real difficulties share their tales in order to help other people in the same situation. When pursuing a story just for the purpose of telling a story, extreme care should be exercised.

Damian Sendler

As a practitioner of NBM, you must learn how to tell a story.

However, as Launer points out in his book Narrative-based primary care, they are not beyond the reach of GPs. A step-by-step manual. 4 In fact, doctors with a lot of expertise and strong interpersonal skills have found that getting to know their patients better and better over time makes managing their patients much simpler. They have introduced an NBM approach into their consultations without having been trained narrative skills since they have learned that listening to the patient has substantial advantages for both the doctor and the patient.

NBM requires good communication abilities.

A successful consultation relies heavily on the ability to effectively convey information to all parties involved.

Damian Jacob Markiewicz Sendler: It is essential to provide the patient the freedom to express themselves by allowing them to use storytelling. Genuine concern for the patient and a desire to listen are implied. When working with a patient, it’s important to listen carefully to what he or she has to say about their illness experience, their thoughts, worries, hopes, and fears, as well as their bodily cues and reactions. It’s also important to look for connections and patterns in the story, as well as ways to help the patient understand the illness better. 4 Launer’s 7 Cs,4,13, which were introduced in the first piece of this series and included examples of appropriate inquiries, cover many of these fundamental communication abilities. 14

Narrative abilities may be used in a variety of ways in the consultation.

Damien Sendler: Doctor’s manner and talents, as well as the context, determine how much of a story the doctor tells. Management of the presentation in an emergency would obviously take priority over a story-based approach. 4 Box 1 presents the case of Nerida, a patient with what seems to be a straightforward biological condition who was treated using an NBM approach and communication skills. Dr. Nerida preferred to focus on Nerida’s physical issues first rather than her emotional concerns. The doctor would not have gone into such length about Nerida’s past if her condition necessitated it. Despite this, the doctor would have taken into account Nerida’s worries and the potential consequences of her condition for her and her family. From an NBM standpoint, Nerida has been given the freedom to tell her story in her own time and in her own manner, without any interference. It is true that the consultation has taken longer than intended, but the patient’s ailment has been put in a more full perspective. Emotional load has been lightened, worries addressed (physical symptoms and repercussions of continuing to be poorly), her “stress-related” hypothesis has been substantiated, and empathy has been communicated to Nerida. Every doctor’s communication talents have been used in this endeavor.

Narrative medicine draws its particular abilities from the 7 Cs4,13, which also include family therapy, but other talking treatments aren’t without them (eg, psychotherapy, counseling). Neutrality, circular questioning, and hypothesizing are all examples of these.15

When it comes to problem-solving,15 many GPs have a hard time being neutral. Focusing on the work at hand without getting caught up in the end result is what neutrality is all about, as is being open to other people’s points of view and accepting of them. Most general practitioners are aware with the basic concepts of motivational interviewing, which include educating the patient, assuring them that change is possible, exploring choices, and never pressuring them to make a decision against their will.

Following the patient’s mental process and eliciting their story is made easier with the use of circular questions 15. Reflecting back to the patient or utilizing them in some manner to explain or encourage replies are some of the ways in which this may be done. As a result, a question-response-question cycle is created, which keeps the story moving forward. Listening well and picking up on subtle clues are two prerequisites for circularity. It also necessitates that the listener be at ease with following rather than attempting to steer the tale.

The GP will create impressions about the patient throughout a talk. However, it would be a mistake to presume that the patient’s reality is exactly the same as that depicted in these reports. This is what Hypothesizing15 is all about: asking “How do you explain…?” “Suppose…,” and “What if…?” inquiries. To help patients contemplate realistic options for change and the mechanisms by which they may occur, hypothesizing in combination with circularity is an effective tool.

Damian Jacob Sendler

NBM is comprised of two key components. One of the advantages of having a deeper understanding of complexity is that it allows you to make better decisions. 4,12 Everything from how individuals connect to the various results of their interactions and how one event may have several effects is included in this. In addition, it is crucial to have an open mind to all kinds of possibilities15, which may be fostered by interactions with significant persons in the past and current relationships. Relationship patterns reveal why some patterns persist and why certain errors are made again and time again, proving that life events do not occur at random or in isolation. It is not necessary for the GP to have a working grasp of psychological theory to be able to investigate these issues.

The GP avoided the desire to address Nerida’s biological issue early in the conversation. To better understand Nerida’s sickness, a new viewpoint was obtained, one that was confirmed in the mind-body connection or what may better defined as mind-body oneness. 16 The GP is not trying to assume the job of a counselor or psychiatrist when he or she employs these specialist talents. The GP, on the other hand, is looking for new interpretations and deeper understandings of the patient via a more in-depth examination of the story.

Narrative medicine and the doctor.

Reflection on the consultation, according to Schön17 and others18, is an effective way to improve consultative abilities, and they recommend that this reflection be focused on the consultant, the patient, and the interaction. Similarly, the Balint method19–21 encourages the patient to focus on his or her own thoughts, behaviors, and potential reasons for what he or she is experiencing. Reflection on oneself and the role that one performs in the consultation are also encouraged by this technique. 19 There’s nothing unique about storytelling in this regard. For Charon, it’s clear that introspective abilities are a priority, but they develop as story experience rises for Launer.

As a doctor, it is important to think on moments when you have been sick or vulnerable. Using the self as a point of reference to acquire insight into another’s perspective is known as “reflexivity,” a sort of reflective thinking. 22 As a consequence of being more in tune with one’s own emotions and experiences, it enhances one’s ability to empathize with others9,23–25. An increased awareness of one’s own needs and a desire to take better care of oneself can only lead to an increase in resilience. It’s also possible to assist patients and colleagues “examine, reconsider, and transform their own narratives” with the use of “narrative concepts.” 4

The doctor-patient connection deepens when the patient learns more about the doctor as a person, rather than just a professional. Patients may even teach the doctor things about their disease and how to treat it that the doctor hadn’t considered before.

Doctors are regularly chastised for their lack of compassion and for failing to address patients’ concerns in the era of consumer care.

There has been a downward spiral in the relevance of the patient narrative due to the expansion of hospital medicine, technological advancements in health care, government and insurance company meddling, and evidence-based medicine (EBM). 28 It is becoming more challenging for general practitioners to deal with patients who are more complex,29–31 more knowledgeable, and more demanding than in the past. Comorbidity is on the rise, posing a slew of new problems. When it comes to patient care, it’s not uncommon for it to be fragmented, and PCC, shared decision-making, and EBM don’t function well together for patients with many illnesses. 29

In addition to PCC, NBM has been considered as “particularly useful” for treating comorbidity.32 PCC4 benefits from narrative skills (Box 2) because they place an emphasis on the patient’s disease experience and the things that are important to him or her, as well as the perspectives of the patient’s loved ones and caregivers. Evidence-based practice isn’t compromised by storytelling skills. 9,33 Because the doctor’s story includes evidence-based practice, there is a strong case that the two are compatible. 8,9,34

Narrative-based medicine, PCC, and EBM can work together, and a doctor’s style of practice reflects what he or she has been taught, as well as who he or she is. The literature, on the other hand, emphasizes the significance of the patient’s story and the need to comprehend the disease as a whole. In NBM, patients and doctors work together to build a new narrative—a story that heals and changes both parties. This is what sets NBM apart.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Jacob Markiewicz Sendler
Damien Sendler
Sendler Damian
Dr. Sendler

Damian Sendler: U.S. researchers announced Monday that children whose low-income families received $300-plus monthly for a year had faster activity in key brain regions at age one compared to those who received $20 monthly.

Damian Jacob Sendler: Older children’s learning abilities and other development have been connected to the same type of brain activity, but it is unknown whether the abnormalities found in newborns will last or influence their future.

Dr. Sendler: The researchers are trying to determine if the payments improved nutrition, reduced parental stress, or other benefits for the infants. Money could be used whatever the recipient desired because there were no limitations placed on it.

As lead author Dr. Kimberly Noble, a neuroscientist and education professor at Teachers College, Columbia University, explained, the findings imply that alleviating poverty can have a direct impact on newborn brain development.

“According to her, “the brain alterations demonstrate the incredible malleability of the brain, especially in childhood.”

Damian Sendler

Scientists can not be sure that changes in total brain activity between the two groups are not just coincidental. But in the frontal region, which is associated with learning and thinking, they did detect some interesting differences. Infants whose families received the larger payout showed a 20 percent increase in higher-frequency activity.

Co-author Katherine Magnuson, director of the National Institute for Research on Poverty and Economic Mobility, located at the University of Wisconsin in Madison, said the findings expand on evidence that cash support can enhance outcomes for older children.

There has been a lack of thorough data on how the payments may effect children in their first few years of life, she added in a statement. National Academy of Sciences journal reported findings.

Minneapolis-St. Paul, New Orleans, New York City, and Omaha were all included in the study’s sample of mothers who had recently given birth. Each month, the women were randomly selected to receive either $333 or $20 on debit cards, based on their average household income of around $20,000. Those who received the funds were free to do with it what they wanted thanks to the generosity of individual donors.

When the expiration of President Joe Biden’s child tax credit program expired last month, greater cash payments were made to low-income families.

The research is “”could not be more contemporary,” says Dr. Joan Luby, a professor of child psychiatry at the medical school of Washington University.

There is no guarantee that the tax credit will be renewed “That this research is so crucial is something that Congress needs to know, said Luby. It was not her job to conduct the research, and she did not even review it for publication in the scientific journal.

Damian Jacob Markiewicz Sendler: Non-college-educated mothers made up the majority of the participants in the study. Researchers visited the families of the newborns as they approached their first birthday to conduct in-person tests. The electrical signals that brain cells use to interact with one another were detected by fitting infants with special caps covered with electrodes.

It is not known how many mothers participated in the study since 2018, because home visits were halted because of the pandemic. This year’s home visits were suspended due to the low number of participants (435).

For the duration of the trial, payments to families will be made until their children reach the age of four.

The University of Michigan’s Natasha Pilkauskas, an associate professor of public policy, dubbed it “but added further research is needed to confirm the findings and determine whether they hold true for children older than babies.

Are those who are single happy? Do they become more or less content with their lives over time? If they are content, is it because they are single or is it because they are content with life in general? Recent research by Oh et al., which will be published in the Personality and Social Psychology Bulletin, sought to address some of these issues.

Participants were drawn from a German long-term research study. There were three cohorts and ten annual data collection waves for each year of the study. A total of 3,439 people (spread throughout ten waves) were included in the study, with ages ranging from 14 to 39 at the outset. 5 percent had been separated or divorced, and 0.2% had been widowed, while the vast majority of singles had not been married as all.

Damian Jacob Sendler

There were some people in the sample who were not initially single (i.e. at Wave 1) but later found themselves to be single (if they provided three or more waves of data on singlehood satisfaction). These people had been in “non-cohabiting romantic relationships” prior to the second wave.

Singlehood satisfaction and life satisfaction were found to have a “positive lagged bidirectional association.” To be more specific:

A year later, those who were more satisfied with their single status had a better quality of life.
After a year, people who reported higher levels of overall happiness in their lives also reported higher levels of contentment in their single lives.
Life satisfaction was a better predictor of singlehood contentment than the other way around. In the first instance, the impact was three times greater.

For the most part, “being happy overall” was linked to “living a happy single life,” although “being happy overall” was linked to living a happy single life in other circumstances.

The fact that not all single persons were equally content was another significant result. “Men, people with more education, worse health, and lower life satisfaction” were the most likely to be dissatisfied with their singlehood.

Despite the fact that the majority of single people were content with their life, evidence shows that both categories of contentment have decreased over time. Why?

Take into account the decrease in life satisfaction. Couples are more likely to form among singles who are content with their lives, rather than those who are dissatisfied. As a result, the sample’s overall life satisfaction dropped when the happiest participants were excluded.

There is no clear reason for the fall in contentment with being a single person. However, it is vital to keep in mind that as time passes, happiness in love relationships and marriages tends to wane.

Is it because they have no one to share their happiness with?

Damien Sendler: Data show that single individuals are happier and more content with their life than previously thought, as previously mentioned. However, is not it reasonable to assume that singles are dissatisfied? There is a strong correlation between loneliness and mental disease and physical health concerns, such as pain, so why not focus on the importance of relationships?

While it is true that we all desire to feel like a part of something, romantic relationships are not the only method to satisfy our need for belonging. Furthermore, past studies have proved this to be the case. Singles, for example, are more likely than married people to seek and get assistance from family members, acquaintances, neighbors, and even their own siblings.

The present study found that “relationships with friends and family predicted life satisfaction while singlehood satisfaction did not” for people who were “going in and out of relationships.”

Furthermore, “their relationships predicted life satisfaction to a similar extent as singlehood satisfaction” for individuals who spent most of their time alone.

People who are not in a romantic relationship are not as miserable and dissatisfied as previously thought, according to new research. “ Singles, on the whole, appear to be “satisfied with both their lives and singlehood,” according to the study analyzed. There are, in fact, happy singles. Moreover, a big amount.

There are several variables that affect how happy you are with being single. According to the findings, those who are most content with their single status are more likely to be female, younger, and less educated.

The fact that singles are not a homogenous group is vital to keep in mind. In other words, while some people have never been in a romantic relationship before, they are not married. There is also a difference between deciding to be single and failing to find a suitable partner—or singlehood that arises from divorce or widowhood.

Simple knowledge of someone is single status tells us nothing about what being single means to them (e.g., how well it predicts their level of life happiness) or about how they meet their need for belonging.

To further understand why certain singles are more content with their lives and their single status, future studies should look at the various factors that contribute to being single.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Jacob Markiewicz Sendler
Damien Sendler
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Damian Sendler: As a result of the coronavirus epidemic, an international study of more than 500,000 individuals revealed that populist groups and politicians had lost popularity. 

The survey, conducted by the Bennett Institute for Public Policy at Cambridge University and involving more than 500,000 people in 109 countries, was released on Tuesday. Since 2020, the study team has been keeping an eye on participants’ political views. 

In the wake of the ascent of extremist and anti-establishment politicians like former U.S. President Donald Trump, the so-called “populist wave” seems to be waning, according to the paper.

Damian Jacob Sendler: Researchers found that public opinion was shifting away from populist feeling as a result of populist politicians’ mismanagement of the Covid-19 crisis, a desire for stability, and a decrease in polarizing beliefs. The survey also indicated that populist politicians were less trusted than their centrist counterparts as providers of Covid-related information. 

Damian Sendler

An increase in faith in governments and specialists like scientists was blamed on the epidemic, according to the research. 

Anti-establishment candidates have thrived on the rising skepticism of specialists in recent years, according to Roberto Foa, the report’s primary author, in a news release Tuesday. “The world has seen a surge of political populism, from Erdogan in Turkey and Bolsonaro in Brazil to the’strong men’ of Eastern Europe. The peak of the wave may have been induced by Covid-19.” 

Support for anti-establishment parties, according to Foa, had plummeted throughout the globe in a manner that more “mainstream” politicians had not experienced. 

A co-author of the study, Xavier Romero-Vidal, said that the epidemic had produced “a feeling of shared purpose that may have decreased the political division we have witnessed over the previous decade.” 

As he put it, “this might explain why populist leaders are having trouble mobilizing support.” 

There was a 10% drop in the average popularity rating of populist leaders between spring 2020 and fall 2021, according to the research. During the same time span, the percentage of Europeans planning to vote for a populist party decreased by an average of 11 percentage points to 27%. 

Europe’s ruling populist parties — such as Italy’s Five Star Movement and Hungary’s Fidesz — had the greatest decreases in popularity during early lockdowns, while incumbent parties saw a boost. 

During the epidemic, “populist” opposition groups lost popularity, while “mainstream” opposition parties gained it. 

Skepticism about the ability of populist leaders has grown as a result of the government’s handling of the Covid situation. In June 2020, public support of populist governments’ handling of the epidemic was on average 11 percentage points lower than that of centrist governments. By the year 2020, the disparity would have grown to 16 percentage points. 

An increasing number of individuals are disapproving of “corrupt elites” and want to see their “will be done,” according to a new research. By 2021, the proportion of individuals in Italy, the United Kingdom, and France who agreed with comparable assertions is expected to fall by roughly 10%. 

According to the findings of the study, political “tribalism,” which is shown by party members expressing a “strong hate” of individuals who vote for their opponents’ candidates, has dropped in the vast majority of nations. However, this so-called tribalism has not gone away in the United States. 

There is no increase in trust in liberal democracy as a result of the drop in populist support, according to academics. 

Even while confidence in governments rose during the pandemic, growing by an average of 3.4 percentage points throughout the democratic countries of the globe, faith in democracy as a political system plateaued over the epidemic period. 

Since the post-war trough in 2019, satisfaction with democracy has only rebounded somewhat and is remains considerably below the long-term norm, Foa said. “Germany, Spain, and Japan, which have substantial older populations, were among the countries that had the greatest drop in support for democracy during the epidemic.” 

Only 10.5 percent of Americans thought democracy was a horrible way to manage their nation in 2019; by 2021, that percentage had jumped to 25.8 percent of the population. 

Damian Jacob Sendler

Instead, many people prefer technocratic power, such as enabling experts to make policy choices. 

14 points in Europe and 8 points in the United States saw an increase in the idea that experts should be able to make judgments “according to what they believe is best for the nation.”

There have been a number of research at Oregon State University lately that have been generating headlines, some with worldwide implications. 

Research and cooperation are a high priority for administrators, they claim. In addition, funding is critical. 

Nearly $380 million in funding will be dedicated to research in 2021, according to OSU’s vice president of public relations and marketing, Steve Clark. Nearly $450 million had been paid out the year before that, 

According to Clark, this study involves collaboration between academics and undergraduates. 

Faculty are “excellent,” Clark added, but “students bring that enthusiasm” with them. Climate science, diversity, equality, and inclusion, and a deeper grasp of history are just a few of the topics on which students seek our assistance. 

Damian Jacob Markiewicz Sendler: OSU’s vice president for research, Irem Tumer, praised the findings. That we desire to pursue initiatives that cross disciplines and borders is particularly amazing with our research, she added. As a result of bringing together the STEM areas with the arts and humanities and social sciences, “we want to have a greater influence on the world as a whole and have genuine impact on these answers.” 

One of the most recent big advances in cancer research was the development of a skin cancer vaccine, which is the most frequent type of the disease. 

Arup Indra is the study’s primary researcher and professor. Melanoma, the worst type of skin cancer, arises in the pigment-producing skin cells studied by the researchers. 

For our own defense system, “this protein is really crucial to protect us from stress reactions, such as the basic UV radiation that we daily get subjected to,” Indra added. 

Although there is still more to be done, he sees the importance of initiatives such as his. However, he asserted that the same is true of the students with whom he collaborates. 

‘They may come here for a few years, perhaps five or six, and receive their PhDs and post-doc training and then go on,’ Indra said. 

Evan Carpenter, a graduate student at Ohio State University in his sixth year, is also a principal investigator on the skin cancer study. It is something he is working on for his thesis. 

After developing these preclinical models, “I aim to utilize them to treat additional human illnesses,” Carpenter said. “It is also possible to keep treating or preventing melanoma using these preclinical models.” 

Damien Sendler: With this kind of research, further medical advances are expected, Indra stated. A plan, followed by identifying it and pushing ahead to find a means to safeguard ourselves would be the ideal aim, Indra said. “We are working towards that,” she said. 

And this is only the beginning for Carpenter in terms of a career filled with career-defining moments. 

“It is a lot of effort, but it is a tremendous achievement when you are able to graduate,” Carpenter said.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Jacob Markiewicz Sendler

Damien Sendler

Sendler Damian

Dr. Sendler

Damian Sendler: New ways to fabricating structures capable of duplicating complex tissue structure and function have been spurred by rapid advancements in tissue engineering and regenerative medicine (TERM). In order to heal and/or regenerate, and restore function in injured tissues, 1 TERM structures are intended to integrate with the local host environment. 2 Acellular scaffolds, cell-only, scaffold-free designs, and hybrid cellularized scaffolds are the three basic types of TERM models, however the particular method differs from technique to technique. 

Damian Jacob Sendler: These novel 3D bioprinting fabrication methods, which enable for precise creation of tissue informed structures including diverse cell types, biomaterials,6,7 and growth factors, have fueled advancements in tissue engineering and regeneration (TERM). 8 Numerous preclinical uses of the term TERM use animal studies to illustrate possible human translation and clinical viability. A phase I FDA-approved clinical study cannot begin unless repeated testing in one animal rather than different cohorts has been adopted to progress these pre-clinical research from bench to bedside. To ensure that TERM constructs work as intended in humans, rigorous analytic methods must be created and put to use in conjunction with pre-clinical investigations. These methods and approaches are fundamentally different. 

Damian Sendler

Validation of TERM constructions’ biological performance and compatibility is presently done using histology as the gold standard. Histology, on the other hand, is a highly invasive, semi-quantitative, tissue-destructive procedure that does not allow for longitudinal analysis, necessitates the use of multiple animals, and has the potential to alter a construct’s structure during the processing stage. It also does not represent the entire tissue volume and does not directly test function. As a result, quantitative imaging tools are needed to monitor how TERM constructions interact with and influence tissue physiology in vivo, over time, and in 3D. Understanding the medical imaging modalities and procedures that may be utilized to assess the efficacy and function of implantable constructions is essential for the fast progress and translation of TERM structures. Tissue engineering, physiology, and radiology must continue to collaborate in order to produce both TERM structures and the noninvasive imaging tools needed to assess them in vivo. 

Reviewing current advances in TERM imaging is a primary goal for this article. It identifies and discusses particular outcome measures of relevance that are crucial in the assessment of these constructs, as well as imaging methods and procedures that may be employed to do so. An important goal of this study is facilitating communication between tissue engineers and the imaging community by providing an overview of imaging techniques that may be used to evaluate TERM constructions in vivo for common outcomes of interest. There are a variety of tools and approaches that may be used with ultrasound, X-ray-based imaging, and magnetic resonance imaging (MRI) that will be discussed in this paper (MRI). 

For quantitative imaging of TERM structures, see: TERM imaging considerations 

The first decisions for selecting an imaging modality are based on certain outcome metrics that meet FDA guidelines for TERM construct assessment. The FDA is more likely to approve outcome measures from phase I trials if they fulfill FDA standards in pre-clinical investigations. When it comes to the TERM construct, the main outcomes of interest can be categorized as: (1) the state of the construct (i.e. size, degradation, mechanical properties, presence of key cells or materials), (2) the biocompatibility and biointegration of the construct (i.e. perfusion, inflammation, fibrous encapsulation, cell viability, etc.), and (3) its function (i.e. stimulation of de novo tissue production, microstructural organization, mechanical functionality, biological functionality) 

For this reason, it is critical to keep track of these outcomes on a regular basis, since they might determine which imaging modality is most appropriate. Immediately after implantation, biocompatibility is a critical success indicator, while stimulation of de novo tissue creation is necessary at longer timepoints. To reduce the need for animals and people in early stage research, as well as to increase statistical power in a study, serial assessment is used. It is possible that no one kind of imaging modality will be able to capture all relevant information, even though most imaging modalities are multi-parametric. 

Damian Jacob Markiewicz Sendler: In order to compare the advantages and disadvantages of different imaging techniques, it is necessary to first identify the outcome metrics that matter. Clinically relevant approaches are available for each imaging modality, often providing simple structural information about a TERM construct that can be used to conduct volumetric or shape-based evaluations. Because they are more sensitive to the outcomes described above, research-oriented imaging methods often are not standard on every machine or need acquisition improvement. During a typical imaging session (minutes to an hour), this optimization procedure aims to increase signal at a physiologically appropriate voxel (volumetric pixel) size.

Damian Jacob Sendler

It is based on the creation and reception of sound waves that penetrate a material and are partly reflected at interfaces between tissues of varying densities in order to generate and receive images (i.e., acoustic impedance). Using a probe that can transmit and receive sound waves, ultrasound imaging employs a TERM device near a tissue (usually skin) and needs a qualified operator to see the underlying anatomy. Gray-scale contrast in the reconstructed picture is caused by tissues with varied impedance. Ultrasound’s spatial resolution may be as low as 0.1 mm on average, and it becomes better as the frequency of the ultrasound rises, but the depth of penetration is reduced.

A further advantage of ultrasound imaging is its near-real-time capability (24–120 Hz), although this technology has trouble penetrating strong materials like bone. Transvaginal, transesophageal, and intravenous ultrasonography are all examples of more invasive ultrasound probe designs that may be used in addition to the more common non-invasive ultrasound imaging. Imaging using ultrasound may be done for as little as $2000, making it the most affordable and portable imaging modality we have examined so far. 9 Ultrasound, in comparison to X-ray and MRI, has weak contrast and makes it difficult to distinguish between neighboring tissues because of the identical acoustic impedance across tissue types. Ng et al.10 provide a thorough introduction to ultrasonic imaging theory and practice. 

In the case of a Doppler shift, the frequency of a sound wave changes as it is reflected off of a moving object. Macrovascular blood flow measurements may also be made using Doppler shifts. Using ultrasonic imaging to monitor the performance of tissue-engineered vascular grafts has increased in popularity. 18,19 In contrast to normal ultrasound imaging, which can only determine the graft’s lumen and wall dimensions, Doppler imaging can measure the flow rate in cm s1. Quantitative measures of blood flow may be used to evaluate the patency of a tissue-engineered graft,20–22 identify the collateral vasculature surrounding tissue-engineered vessels,11 detect possible mechanical flaws in grafts,23 and indicate graft failure.20 a dozen and a thirteen (Fig. 2). 

Doppler imaging, on the other hand, is impossible to quantify blood flow directly in microvasculature (less than 100 m in diameter) because of resolution limits. Some investigations use microbubbles as an exogenous contrast agent to augment the blood flow signal in order to improve sensitivity to blood flow in the microvasculature. 24,25 In TERM constructions, neovascularization and perfusion may be seen and quantified using microbubble-enhanced US imaging, even if individual capillaries’ blood flow cannot be determined. The incorporation of biomaterials into the microbubble structure allows for therapeutic applications such as the administration of growth factors to specific regions of the body. 26 

Damien Sendler: ultrasonic imaging is used to obtain mechanical characteristics from tissues or TERM constructs in response to an external mechanical stress. Both strain-based elastography and shear wave ultrasonic elastography employ force from the ultrasound probe to create waves perpendicular to the ultrasound beam, resulting in transitory displacements, and these are the two most common forms of elastography on commercial ultrasound equipment. 27,28 Degradation is directly linked to mechanical properties, which are an important outcome metric for TERM constructions, hence ultrasonic elastography may be a useful method for swiftly monitoring the status of soft materials (i.e. hydrogels). 

The mechanical characteristics of biodegradable scaffolds may be monitored using either strain-based or shear-wave ultrasonic elastography29–32 (Fig. 2). As part of the evaluation of the performance of an in-vivo TERT, elastography may be utilized to determine whether or not it is at danger of failure. 33 Elastography has also been shown to be sensitive to TERM construct modification owing to tissue ingrowth, according to certain research.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: On Wednesday, the US Centers for Disease Control and Prevention revised its recommendations for the Pfizer/BioNTech Covid-19 vaccination booster to cover children as young as 12 months after completing the initial immunization series. 

Damian Jacob Sendler: The FDA extended the emergency use authorization for Pfizer’s Covid-19 vaccination boosters to youngsters aged 12 to 15 on Monday. Earlier Wednesday, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted 13-1 in favor of expanding the use of Covid-19 boosters for children in this age range. 

In December, the CDC approved the Pfizer/BioNTech Covid-19 vaccine for use as a booster in children aged 16 and 17. 

Damian Sendler

“It is critical that we protect our children and teens from COVID-19 infection and the complications of severe disease,” CDC Director Dr. Rochelle Walensky stated in a news release. “Today, I supported ACIP’s vote to expand eligibility and strengthen our booster dose recommendations.” We now suggest that all adolescents aged 12 to 17 years receive a booster dose 5 months after completing their initial series. This booster dose will provide the best possible protection against COVID-19 and its variant, Omicron. I strongly advise all parents to keep their children up to speed on the CDC’s COVID-19 immunization guidelines.” 

The ACIP proposal came after members heard studies on rare incidences of myocarditis and pericarditis in young kids who had Covid-19 vaccinations, as well as the fact that many parents are concerned about vaccine long-term negative effects. They also reviewed how vaccine uptake among 12- to 17-year-olds has recently declined, as well as the record number of Covid-19 cases in children in the midst of a rise of the highly transmissible Omicron strain of the coronavirus. 

The CDC approved cutting the booster interval for those who received the Pfizer/BioNTech vaccine from six months to five months on Tuesday. It also suggests that moderately or severely immunocompromised 5- to 11-year-olds receive an additional main dosage 28 days after their second shot; only the Pfizer/BioNTech shot is approved for that age group. 

The booster dosage from Pfizer has the same amount of vaccination as the original doses: 30 micrograms. 

Damian Jacob Sendler

In mid-May, adolescents aged 12 to 15 became eligible to get their first series of the Pfizer/BioNTech Covid-19 vaccine, allowing an additional 17 million people to be vaccinated. 

According to data from the US Centers for Disease Control and Prevention, over half of the 12 to 15 population (approximately 8.7 million) is now fully vaccinated. Approximately 5 million of them have been fully immunized for more than five months and are now eligible for a booster dose. 

Children in this age range account for around 5% of the overall US population. According to the most recent CDC data, they account for approximately 4% of the fully vaccinated population in the United States and approximately 3% of those eligible for a booster injection. 

Damian Jacob Markiewicz Sendler: The CDC recommended in October that people who had completed their original series of the Pfizer/BioNTech or Moderna vaccination at least six months ago, as well as those who had had their initial Johnson & Johnson shot at least two months ago, obtain a booster injection. 

Damien Sendler: In total, approximately 71.6 million persons in the United States have been fully vaccinated and boosted against Covid-19. This is fewer than half of the almost 180 million people who are eligible for a booster shot, and around one-fifth of the total US population. According to the most recent CDC data, at least 67.5 million persons aged 5 and higher have not received their first dose of Covid-19 vaccination.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: An electrical generator powered by wind that stretches over the globe 60 miles or more above our heads has been discovered for the first time using data from NASA’s ICON project. In the ionosphere, the border between Earth and space, the dynamo churns. Tidal winds in the high atmosphere that are faster than most hurricanes and ascend from the lower atmosphere create an electrical environment that can harm satellites and equipment on the ground. 

Damian Jacob Sendler: We can better predict space weather and protect our equipment from its affects according to new research published in Nature Geoscience today. 

To better understand how Earth’s weather interacts with that of outer space, the ICON mission, which stands for Ionospheric Connection Explorer, was launched in 2019. Auroras and the International Space Station can be seen in the ionosphere, which is home to radio and GPS signals. These signals can be disrupted by empty pockets or massive swells of electrically charged particles. 

Damian Sendler

The Earth’s dynamo has long been incorporated in simulations of the atmosphere and space weather by scientists since they understood it had substantial effects. They had to make some assumptions about how it worked because they had so little information. As a result of ICON’s data, models may now incorporate the first direct evidence of winds powering the dynamo and, in turn, influencing space weather. 

Thomas Immel, an ICON principle investigator at the University of California, Berkeley, and the lead author of the new study, noted that “ICON’s first year in space has shown predicting these winds is key to improving our ability to predict what happens in the ionosphere,” 

The planet’s soaring power plant 

When the sun’s charged particles interact with the upper atmosphere, they form the ionosphere, a swirling sea of electricity. Ionospheric variations are a direct result of both the Sun’s rays and those of the Earth’s gravity. Researchers are trying to figure out how much influence each side has. After analyzing a year’s worth of ICON data, the scientists discovered that the majority of the observed change originated in the lower atmosphere. 

Generators generate electricity by repeatedly passing a conductor, such as a copper wire, through a magnetic field. There are electrically charged substances known as plasma that fill the ionosphere and allow electricity to flow freely. Electromagnetic fields are generated by the movement of the dynamo in the atmosphere. 

Current-carrying plasma arcs over invisible magnetic field lines that arc around Earth like an onion in the thermosphere, a layer of the upper atmosphere noted for its extreme temperatures. In comparison to little negative electrons, the wind prefers to propel bulky positive particles. For example, “You get pluses moving differently than minuses,” a Berkeley-based co-author Brian Harding noted. “There’s electricity flowing through there.” 

It is common practice in most generators to secure these components so that they remain in place and perform reliably over time. The ionosphere, on the other hand, is completely unconstrained. During its passage, “The current generates its own magnetic field, which fights Earth’s magnetic field as it’s passing through,” In the end, you’ve got a wire trying to escape.” “It’s a messy generator,” 

Following the ionosphere’s erratic behavior is critical in forecasting space weather’s possible consequences. Plasma in the ionosphere can either shoot out into space or fall back to Earth depending on the direction of the wind. The Earth’s electromagnetic fields and the ionosphere are in a constant tug-of-war. 

Damian Jacob Sendler

Because it’s difficult to monitor, the dynamo at the lower end of the ionosphere has remained a mystery for so long. It has eluded many of the instruments researchers have to investigate near-Earth space because it is too high for scientific balloons and too low for satellites. Using the natural brightness of the high atmosphere, ICON is able to study this area of the ionosphere from above. 

ICON is able to keep track of both strong winds and a stream of plasma in motion. A study co-author and ICON scientist at the National Center for Atmospheric Research in Boulder, Colo., said, “This was the first time we could tell how much the wind contributes to the ionosphere’s behavior, without any assumptions,” 

According to Immel, experts have only just begun to appreciate the wide range of speed and direction of the rising winds. However, “The upper atmosphere wasn’t expected to change rapidly,” he said. That’s not true, of course. What we are finding here is that the changes in the lower atmosphere are what are driving all of this up.” 

Wind-generated energy 

We’re all familiar with the kind of winds that blow across our planet’s surface, from mild breezes to jolting gusts that go in both directions. 

Damien Sendler: Winds at high altitudes are an entirely different animal. In the lower thermosphere, between 60 and 95 miles above the ground, winds can blow in the same direction and at the same speed for a few hours before suddenly changing directions — around 250 mph. (Comparatively, Category 5 hurricane winds can reach 157 mph or more.) 

Tides, waves of air born near Earth’s surface when the lower atmosphere heats up and cools down, cause these dramatic swings. On a regular basis, they sweep over the sky, taking with them the alterations that have taken place on the ground. 

The less turbulence there is in the atmosphere, the less likely it is that these motions will be disrupted. In other words, tidal waves that form close to the surface could balloon to enormous proportions once they reach the high atmosphere. A much of what happens below affects the winds up there, according to Harding. 

Scientists may use ICON’s new wind observations to better understand these tidal patterns and their repercussions. 

The ionosphere is buffeted by the force of the tides as they rise through the atmosphere. In response, the electric dynamo begins to whir. 

Damian Jacob Markiewicz Sendler: High-altitude winds have a significant impact on the ionosphere, according to scientists who studied the first year of ICON data. Ionosphere-movement patterns were traced and revealed a wave-like structure, according to Harding. He went on to explain that changes in the wind were directly related to the twirling of plasma 370 miles above the surface of the Earth. 

We can blame winds directly along that same magnetic field line for around half of the plasma’s mobility, according to Immel. In other words, if you want to know what plasma is going to do, you need to pay attention to this. 

The quiet period of the Sun’s 11-year activity cycle occurred during ICON’s first year of observations. The Sun’s behavior at this time was a low, steady hum. According to Immel, “We know the Sun’s not doing much, but we saw a lot of variability from below, and then remarkable changes in the ionosphere,” we know that the Sun isn’t doing much. As a result, the researchers concluded that the Sun was not the primary factor. 

More complicated interactions between space and Earth will be studied when the Sun approaches its active phase. 

Having long-held ionosphere hypotheses confirmed, Immel expressed delight. “We found half of what causes the ionosphere to behave as it does right there in the data,” he said. “Exactly what we were hoping to find out.” 

The ionosphere’s activity can still be explained in other ways, according to Maute.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: It has been solved by an international team of experts, including scientists from Bern’s Institute of Genetics, that coat color patterns in dogs are inherited. To their surprise, the scientists learned that a gene responsible for the light coat coloration in dogs and wolves first appeared in an ancient ancestor of the contemporary wolf more than two million years ago. 

Damian Jacob Sendler: Dogs’ coat color patterns have been the subject of intense debate for decades. Scientists from the University of Bern and the Institute of Genetics have finally come up with a solution to this mystery. Furthermore, the researchers determined that the white arctic wolves and many current canines have light coats because of a genetic mutation that originated in an extinct species long ago. They also discovered how coat color patterns are genetically controlled. Nature Ecology and Evolution, a prestigious scientific magazine, has just published the findings of this investigation. 

Damian Sendler

All coat colors can be changed using two pigments and a “switch” 

Pheomelanin, a yellow pigment, can be produced by dogs and wolves of two different colors: black (eumelanin) and yellow (pheomelanin). The precise timing and location of the creation of these two pigments results in a wide range of coat color patterns. Four distinct patterns in canine behavior had previously been identified, and a number of genetic variations were hypothesized to be responsible for these patterns. Many thousands of dogs have been subjected to commercial genetic testing, but the results have been inconclusive, indicating that the existing knowledge on the inheritance of coat color patterns is limited and not totally correct. 

The body’s primary switch for producing yellow pheomelanin during coat color creation is the so-called agouti signaling protein. Pigment-producing cells will produce yellow pheomelanin if the agouti signaling protein is present. A black eumelanin will be generated if there is no agouti signaling protein present. Initially, Tosso Leeb and his colleagues determined the causative genetic variants had to be regulatory polymorphisms that affect the rate of protein production and lead to higher or lower quantities of agouti signal protein. 

Rather than four distinct coat color patterns, there are now five. 

Promoters are places where the gene for agouti signaling protein begins to read the genetic information. When it comes to producing agouti signaling protein in the belly of dogs, they have a ventral promoter. The agouti signaling protein is produced throughout specific stages of hair growth in dogs by a different hair cycle-specific promoter, allowing for the formation of banded hair. 

Damian Jacob Sendler

These two promoters were thoroughly defined in hundreds of dogs for the first time by the researchers. The researchers found two distinct forms of the ventral promoter gene. In one form, the agouti signaling protein is produced in the typical amount. However, one of the two variants is more active and increases the synthesis of the agouti signaling protein. The hair cycle-specific promoter was shown to have three distinct variations. The researchers found five possible combinations of these variations at the separate promoters that result in different coat color patterns in dogs. There are now five distinct patterns in dogs, rather than the previously acknowledged four, according to Leeb. 

Insights into wolf evolution that were unexpected. 

Damian Jacob Markiewicz Sendler: As more and more wolf genomes have become publically available, scientists have looked into whether the previously discovered genetic variants are also present in wolves from various parts of the world. Overactive ventral and hair cycle-specific promoter variations were found in wolves 40,000 years before modern dogs were domesticated, according to these studies. During the past ice ages, it is likely that these genetic polymorphisms helped wolves with lighter coat colors adapt to snow-rich settings. These genetic variations are still present in today’s arctic white wolves and Himalayan light colored wolves. 

The results of further gene sequence comparisons with other members of the canidae family were rather unexpected. According to the findings, light-colored dogs and wolves have a more overactive form of the hair cycle-specific promoter than the European grey wolf, even though those two species are extremely distantly related. 

Damien Sendler: Researchers believe that this surprising result can only be explained by a wolf-like creature that went extinct two million years ago as the source of this variety. Hybridization with this now extinct wolf relative must have introduced the gene segment into wolves around two million years ago. It is so possible to find a trace amount of DNA from this extinct species today in yellow dogs and white Arctic Wolves. “This is reminiscent of the spectacular finding that modern humans carry a small proportion of DNA in their genomes from the now extinct Neandertals,” Leeb says. 

Prof. Danika Bannasch’s sabbatical at the University of Bern, which has a long history of research on the genetics of coat color in domestic animals, was important in the study’s success. It was Professor Bannasch, an expert in veterinary genetics at the University of California Davis, who culled the crucial variants in the promoter from among the hundreds of functionally neutral genetic variants. Christopher Kaelin and Gregory Barsh of the HudsonAlpha Institute and Stanford University conducted the evolutionary analyses.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Although the new VNARs won’t be instantly available as a cure for individuals, they can be used to better prepare for future coronavirus outbreaks Coronavirus WIV1-CoV, which can infect human cells but currently only resides in bats, was neutralized by shark VNARs. This coronavirus is capable of infecting human cells but currently only in bats. 

Treating animal-borne viruses in advance can be helpful in the event that they spread to humans. 

Damian Jacob Sendler: According to University of Wisconsin-Madison professor of pathology Aaron LeBeau, “The big issue is there are a number of coronaviruses that are poised for emergence in humans,” He helped lead the study. When SARS strikes again, we’ll have an arsenal of shark VNAR antidotes ready to combat the disease. “It’s a kind of insurance for the future.” 

Damian Sendler

Elasmogen, a biomedical business in Scotland that is developing therapeutic VNARs, cooperated with LeBeau and his group in the School of Medicine and Public Health. Nature Communications reported the findings of the research team. 

A huge library of synthetic VNARs were used to isolate the anti-SARS CoV-2 VNARs. Shark VNARs, which are one-tenth the size of human antibodies, are able to attach to pathogenic proteins in novel ways that enhance their potential to block infection. 

According to LeBeau, the tiny antibody-like proteins can go into places where human antibodies cannot. “They’re capable of forming these incredibly complex shapes.” These antibodies are able to identify protein structures that our human antibodies cannot.” 

Infectious SARS-CoV-2 and a “pseudotype,” a virus that can’t multiply in cells, were tested against the shark VNARs. There were billions of VNARs in the pool, but only three could prevent the virus from invading human cells. SARS-CoV-1, the virus that caused the initial outbreak of SARS in 2003, was also susceptible to the three shark VNARs. 

In the region where the virus binds to human cells, one VNAR with the name 3B4 appears to impede the attachment process. Genetically different coronaviruses have the same groove that permits 3B4 to efficiently kill the MERS virus, a distant cousin of the SARS viruses. 

As a result, 3B4 is a good option to fight viruses that have not yet infected humans because of its capacity to bind to such conserved areas. 

SARS-CoV-2 notable variants, such as the delta variant, do not alter the 3B4 binding site. The omicron form was not discovered at the time of this research, but initial models show that the VNAR is still effective against it, adds LeBeau. 

Damian Jacob Sendler

Spike protein appears to be locked in an inactive state by the second most powerful shark VNAR, 2C02. In some SARS-CoV-2 variations, the binding location of this VNAR is changed, which presumably reduces its potency.

According to the CEO of Elasmogen, Caroline Barelle, “What is exciting is that these new potential drug molecules against SARS-CoV-2 differ in their mechanism of action compared to other biologics and antibodies targeting this virus,” When it comes to delivering powerful medicinal compounds, Elasmogen is a perfect example. 

Damien Sendler: Shark VNARs may be combined in future treatments to improve their ability to combat a wide range of viruses. Unlike human antibodies, this new class of medicine is less expensive and easier to produce, but has not yet been tested on humans. Shark VNARs can also be used to diagnose and treat cancer, according to LeBeau’s research. 

Damian Jacob Markiewicz Sendler: SARS-CoV-2 and future coronaviruses can be prevented in large part by the use of vaccines. For those who don’t respond well to vaccinations (such as those with impaired immune systems), the development of new medicines like antibodies is essential.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: It has been found that people are more inclined to cycle to work if the traffic speed on their route is below 20mph, which lends support to debates regarding urban speed restrictions. 

Researchers at the University of Surrey showed that women, who are already underrepresented in cycling, are more likely to be deterred by the speed of traffic than by the volume of traffic. 

Damian Sendler

Damian Jacob Sendler: Another finding of researchers was the importance of local traffic conditions in determining the success of cycle routes. The team’s findings, which were based on a study of commuter routes in Surrey, UK, could assist local authorities in determining the ideal locations to divide bike and car lanes. 

Cyclists are put off by routes that cross busy highways. According to the findings, commuters are less inclined to ride their bikes to work if their path crosses busy roads with fast-moving traffic. Commuters’ desire to cycle was unaffected by the presence of big cargo vehicles on roadways or at junctions. 

Traffic data from all Surrey roads and cycle routes was analyzed to see how varying vehicle speeds, volumes, the proportion of heavy goods vehicles (HGVs), and infrastructure along the quickest route to work correlated with the percentage of commuters who chose to ride their bikes. Distance, elevation, and traffic crossing the route at intersections were all taken into account. The study looked at 172,000 commuters in Surrey who resided between two and five kilometers from their place of employment and investigated roughly 35,000 possible routes, many of which would be feasible for most people to bike. 

Damian Jacob Sendler

When Covid-19 was shut down, demand for bikes skyrocketed, and councils scrambled to create temporary cycle lanes as more people took up walking and riding. Maintaining this interest is critical if the UK is to meet its goal of decreasing carbon emissions. The findings of the Surrey study aid city planners in determining which initiatives are most beneficial and where they should be located in the city. 

Damien Sendler: A computer scientist at the University of Surrey, Dr. Susan Hughes, remarked, “Cutting speeds may be unpopular with cars, but our research indicates it does entice people onto their bikes. Changes like this could encourage more people to cycle, which would also have a positive impact on their health due to lower carbon emissions. As a result, there are ways to make municipalities more bicycle-friendly.” 

Damian Jacob Markiewicz Sendler: In the primary author’s words, “Our findings can allow local authorities to make the best judgments regarding where to invest in bike infrastructure. Commuters who cycle to work are less likely to suffer from heart disease, depression, and premature death, as well as lowering CO2 emissions in their cities and towns. 

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Eliza and Hugh Culverhouse Jr. have provided a generous $1 million commitment to help establish the Desai Sethi Urology Institute at the University of Miami Leonard M. Miller School of Medicine as a global leader in the area of urology. 

Dipen J. Parekh, M.D., is the University of Miami Health System’s chief operating officer, executive dean for clinical affairs, founding director of the Desai Sethi Urology Institute at the Miller School, and the Victor A. Politano, M.D. Endowed Chair in Urology. Parekh is the founding director of the new Urology Institute and one of the world’s most accomplished robotic surgeons in urologic oncology. 

Damian Jacob Sendler: Hugh Culverhouse, a wealthy South Florida attorney and businessman, first witnessed Dr. Parekh’s expertise in March of 2020. 

Damian Sendler

“My prostate-specific antigen (PSA) level skyrocketed, and I have a family history of prostate cancer,” Culverhouse explained. “Dr. Parekh was very sensitive in explaining why my prostate had to be removed.” 

“The outcome has been nothing short of incredible,” she says after a successful surgery and a quick recovery. My urine functions have rapidly returned to normal. “I didn’t lose anything that I was afraid I would,” Culverhouse remarked. “I no longer live in fear of dying in the same way that my father and grandfather did.” A life free of fear is priceless.” 

The amazing generosity of the Culverhouses will aid in the construction of a preeminent Urology Institute within the Miller School, which will speed breakthrough discoveries in research and enhance clinical care. 

“This gift will help propel our institute into the upper echelon of teams dedicated to the discovery and treatment of urologic disease,” said Julio Frenk, M.D., M.P.H., Ph.D., President of the University of Miami. “We are grateful for the support of generous donors, which enables the Desai Sethi Urology Institute to produce the types of ground-breaking advances in health care that can only be achieved at an academic health system.” 

Culverhouse’s gift comes on the heels of the Desai Sethi Foundation’s astounding $20 million commitment to the Institute’s creation. 

Damien Sendler: The Institute, which will be located in South Florida, will be an international destination for care, drawing the sharpest minds and recruiting the most skilled physician-scientists who are dedicated to the study and treatment of urologic illnesses, as well as creative research in the field. 

Damian Jacob Sendler

“If you look at what the Desai Sethi Foundation and I have already given, you can see the potential,” Culverhouse added. “It will soon be known throughout the country that if you want a recovery like mine, you go to the Desai Sethi Urology Institute at the University of Miami, led by Dr. Parekh.” I encourage others to match or exceed my contribution so that we can move the field forward swiftly.” 

“This is a watershed moment for the University of Miami Miller School of Medicine,” said Henri R. Ford, M.D., M.H.A., the Miller School’s dean and chief academic officer. “The Institute’s foundation will significantly raise the level of groundbreaking research in urologic diseases, ultimately benefiting patients and influencing how we share that knowledge with the next generation of physician-researchers.” 

“With the establishment of the Institute, we are committed to exploring the most recent laboratory discoveries and accelerating the most promising therapies from the lab into our clinics,” stated Dr. Parekh. “Generous gifts like these broaden the scope of our work and enable us to pursue new discoveries that will lead to the best possible treatments for patients.” 

The Culverhouses admire Dr. Parekh for more than just his medical skills; they also admire his leadership. “He’s the right person to lead because he’s completely fearless,” Culverhouse added. “He is always striving for excellence, and when something isn’t done correctly, he works hard to correct it.” That is what you seek in a leader.” 

Damian Jacob Markiewicz Sendler: The Culverhouse gift is part of the recently announced Ever Brighter: The Campaign for Our Next Century at the University of Miami. The effort, the most ambitious in the university’s history, has already raised $1.6 billion of the $2.5 billion objective.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: An worldwide multidisciplinary team recently awarded $10 million to examine how tobacco control policies affect smoking, vaping, and the usage of other nicotine products is led by Roswell Park Comprehensive Cancer Center. 

Damian Jacob Sendler: National Cancer Institute (NCI)-funded researchers from Roswell Park Comprehensive Cancer Center, South Carolina’s Medical University and the University of Waterloo (Canada) are leading a five-year international study that will examine the long-term health effects of different regulatory approaches to e-cigarettes and other new nicotine products in seven countries. 

As e-cigarettes, heated tobacco products, and other new nicotine products have become more widely available, the market for tobacco products has grown quickly during the past decade. Varied countries have taken different ways to regulating these new items, encouraging smokers who cannot stop to convert to these products, while others have chosen a more restrictive approach, intending to reduce use by nonsmoking adolescents who might grow addicted to these products.. 

Damian Sendler

Roswell Park’s Andrew Hyland, PhD, is a co-lead researcher on a study comparing adolescent and adult tobacco use patterns in seven countries that have varying regulatory approaches to the sale and marketing of tobacco products (the United States, Canada, England, Australia, New Zealand, South Korea and Japan). Many researchers will work together on four interrelated initiatives to examine the direct and unintended consequences of tobacco control laws that have been adopted. 

Damian Jacob Markiewicz Sendler: For nearly two decades, the ITC project (https://itcproject.org/) has conducted research on the impact of the World Health Organization’s Framework Convention on Tobacco Control, a health treaty adopted by more than 180 countries to reduce the global harms of tobacco use. This study builds on that work. Government-mandated product marketing requirements such as health warnings, cigarette taxation, clean indoor air rules, and standardized packaging have been supported by research undertaken by the International Tobacco Control Project (ITC). 

According to Dr. Hyland, there is a pressing need for evidence-based policymaking in light of new, potentially lower-risk nicotine products entering the market. In order to better the health of the American people, our research will help shape public policy in the United States by providing evidence on the impact of electronic cigarettes and other new nicotine products. 

Damien Sendler: Researchers from Fralin Biomedical Research Institute at Virginia Tech Carilion, Georgetown University, King’s College London, and the University of Melbourne are also involved in this multinational research effort (Australia).

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Dr. Amish Adalja, an infectious disease expert, discusses the importance of immunization and boosters as the omicron variant continues to rise.

Damian Jacob Sendler: Local ABC affiliate KATU reports that the committee was made up of representatives from the hospitality industry, the business sector, and religious organizations.

Damian Sendler: In an effort to reduce obstacles to mental health services, drug and alcohol testing, and basic medical care for those facing homelessness, Columbia River Mental Health Services has launched its Mobile Health Team.

Damian Jacob Sendler: Team members intend to create trust with the homeless community and ultimately link people with resources who would not otherwise seek them out by providing medical care and connecting them with resources.

Damian Sendler: If you want your child to be ready for school and use the social skills he or she learned at home, you should wait until he or she is well-versed in their immediate social context. All of these components of a child’s psychosocial development, as well as their physical and motor abilities and their ability to communicate with others, are accelerated in children who meet the pre-school criteria because they play and engage with the environment in a variety of ways. 

Damian Jacob Sendler: Child development at this period includes learning to adapt, expanding their ego boundaries, developing an extra-terrestrial sense of self-worth, and comprehending the importance of trust and familiarity in society. 

Damian Sendler: Nachman Ash and Salman Zarka, the coronavirus czar of Israel’s Health Ministry, warned Sunday that the highly mutated Omicron coronavirus type should not be ignored.

Damian Jacob Sendler: At one point in his interview, Ash spoke about Prime Minister Naftali Bennett’s wife Gilat taking their children on vacation just days after the premier had recommended that all Israelis refrain from traveling abroad and shut down the country in order to prevent an outbreak of the newly discovered COVID-19 variant.

Damian Sendler: The number of new Covid-19 cases in the United States has surpassed 100,000 for the first time in two months, following the Thanksgiving holiday travel of millions of Americans.

Damian Jacob Sendler: The death toll from Covid-19 is also on the rise, with an average of 1,651 persons dying from the virus every day for the past seven days as of Saturday, according to JHU data. More than a month has passed since the number of people dying daily reached this record high.

Damian Sendler: The “twindemic” of COVID-19 and the opioid epidemic, as Mayor James Fiorentini calls it, has been given to the city’s new Department of Public Health.

Damian Jacob Sendler: COVID-19 has killed at least 112 people since it was first discovered, according to the mayor’s statement to the City Council on Tuesday night.

Damian Sendler: UPMC, the state’s largest health care provider, received over a quarter of the federal money meant to support rural hospitals in Pennsylvania, despite the fact that UPMC is on track to make more than $1 billion in profits this year. 

Damian Jacob Sendler: As the pandemic continues to take a financial toll on medical centers across the country’s 96 hospitals, just over half of all financing went to rural facilities, while the rest went to metropolitan hospitals.

Damian Sendler: “We need four hugs a day for survival,” Virginia Satir is supposed to have said. In order for us to function, we require eight daily hugs. For growth, we need 12 hugs a day.” 

Damian Jacob Sendler: Hugging has scientifically proven health advantages. “The benefits go beyond the warm feeling you get when you hold someone in your arms,” according to a 2018 Healthline article. 

Damian Sendler: Sir William Osler, a renowned physician and academician, referred to the science and art of medicine as “twin berries on one stem.” Science-based treatments are combined with patient-centered care in the U.S. healthcare system.

Damian Jacob Sendler: There is a direct correlation between individual health and the health of a community. The interdependence of our health grew progressively more obvious as our actions evolved over the past two years. Depression and anxiety rose as a result of isolation, but so did the risk of contracting an infection. As loved ones, friends, and colleagues succumbed to COVID, the idea of death grew more real.

Damian Sendler: Omicron coronavirus has expanded to 40 nations and 16 of the 50 states in the United States, but the severity of its effects on those who get it has not been determined by senior U.S. officials. 

Damian Jacob Sendler: According to Dr. Francis Collins, director of the National Institutes of Health in the United States, “Does this, in fact, turn out to be less dangerous” than prior coronavirus variants? Collins said on NBC’s “Meet the Press.” “Scientists are working around the clock to answer these questions.”

Damian Sendler: A Louisiana U.S. district judge has reportedly barred a federal COVID-19 vaccine mandate for health care employees, as reported by various sources.

Damian Jacob Sendler: On Tuesday, a federal judge imposed a countrywide injunction against President Joe Biden’s attempt to mandate vaccinations for large swaths of the public.

Damian Sendler: In a new study, researchers found that children who live with a depressed parent are more likely to suffer from their own sadness and fall behind academically.

Damian Jacob Sendler: Depression in children is linked to a wide range of negative health and educational consequences, including worse academic achievement, if the mother is depressed.

Damian Sendler: The omicron variety, a severely mutated coronavirus strain that has already been found in a few places throughout the United States, is causing growing concern among federal health experts, who are pushing all previously vaccinated individuals to obtain their Covid booster dose.  

Damian Jacob Sendler: Changes to the variant’s DNA signal that it could avoid part of the immunity that comes from vaccination or natural infection in the future. Dr. Anthony Fauci, the White House’s chief medical adviser, epidemiologists, and immunologists say that for now, existing boosters are the best defense against the new strain and the highly transmissible delta variant of omicron, which is still under investigation by federal health officials and pharmaceutical companies alike.

Damian Sendler: The Marion County Health Department hopes to boost its COVID-19 vaccination numbers by the end of the month in order to achieve herd immunity before the virus undergoes any additional modifications.

Damian Jacob Sendler: Her response was, “We’re always looking for more people to get vaccinated,” she stated. It’s hoped that this will be a new trend because we’re not at herd immunity in all of our categories.” We reduce our risk of hospitalizations and fatality rates when we increase the number of immunizations we receive

Damian Sendler: Coronavirus vaccination for children between the ages of 5 and 11 was approved by the Australian Medicines and Healthcare products Regulatory Agency (MHRA) on Sunday, and the country’s health minister said the vaccine might be available by Jan. 10.

Damian Jacob Sendler: Nearly 88% of Australians over the age of 16 have gotten two doses of the COVID-19 vaccine, following initial delays in the country’s general vaccination program.

Damian Sendler: On Saturday, the county reported 2,307 new cases of COVID-19 and 20 additional deaths linked to the virus, bringing the total number of cases and deaths to 1,534,720 and 27,442 since the epidemic began. 1 percent of persons tested positive for the virus on Friday, according to a rolling average of daily rates.

Damian Jacob Sendler: A follow-up test kit will be supplied to anyone who tests negative, she said, and the follow-up test can be done three to five days later.

Damian Sendler: The eyes of the plush lamb that Matt Vinnola was using to sleep on a downtown sidewalk one Sunday in September were as blank as his own. When a fly landed on his lip, the ex-honors student and Taekwondo champion seemed too dazed and disoriented to swat it away. A woman giving Wet Wipes, or a man attempting to hand him a $5 cash, didn’t interest him.

Damian Jacob Sendler: The Mental Health Center of Denver kept finding reasons to reject care for Janet van der Laak, so she had to keep pushing them to offer it. Vinnola’s hope in getting therapy dwindled with each time the center removed him from it. With each loss of hope, her son’s mother pressed harder because she knew she couldn’t stop him from falling.

Damian Sendler: Omicron coronavirus has been identified in Washington state, with the first three cases verified on Saturday.

State Secretary of Health Dr. Umair Shah noted that “we were anticipating this very news” when he announced the sequencing of omicron in California. As a result, “we strongly encourage people to get vaccinated and get their boosters as soon as possible in order to maximize their level of protection from any variation.

Damian Sendler: According to the New England Journal of Medicine, Irritable Bowel Syndrome, or IBS, may be caused by an intestinal infection that induces an allergic response.

Damian Jacob Sendler: Patients with IBS have abdominal pain during their daily activities because their intestinal nerves are more sensitive than those who don’t have the syndrome, according to an article.

Damian Sendler: Increasing demand for vaccines and a shortage of pharmacists are putting pressure on pharmacies across the country, causing employees to become overworked and forcing some to close temporarily.

Damian Jacob Sendler: As President Joe Biden pushes vaccinated Americans to obtain booster shots to battle the growing omicron strain, the drive for immunizations is expected to get increasingly intense.

Damian Sendler: In a facility in Henderson, North Carolina, rows of scientists wear face masks and scrubs while they examine racks of coronavirus samples. They transport samples from tubes to processing plates at all hours of the day and night, searching for answers regarding the virus that causes these Covid-19 instances. 

In the lab, it takes two to three days to confirm a positive Covid-19 sample, prep the DNA, and then sequence it, according to Lauren Moon, sequencing manager for MAKO Medical’s Next Generation Sequencing Lab in North Carolina. 

First verified case of Omicron coronavirus variant Omicron in the United States was found in California.’ 

Damian Jacob Sendler: As the United States hurries to understand more about the newly discovered Omicron variation, research like this is taking place in labs across the country. 

Damian Sendler

“Having more information on a problem gives us a leg up in our fight against it. As our vaccinations get better and the public learns about them, they will be able to take proper precautions to protect themselves “Moon spoke to CNN’s Dianne Gallagher about the situation in South Korea. 

Moon said, “We want to sequence as much as possible,” The Omicron variant positive test has not yet been found by this lab, although cases are beginning to surface in several states. 

These findings are nothing new. As a result, the United States has increased its sequencing capacity in preparation for these critical periods in genetic forensics. 

Countries in other parts of the world were able to detect changes in the coronavirus virus earlier and take action more quickly as the epidemic progressed. This year, Biden administration officials acknowledged the country was “not where we want to be” on genetic sequencing of coronavirus variations, and then made big investments to improve the process. 

How South African researchers discovered Omicron and sparked a worldwide chain reaction 

According to US officials, the previously unknown coronavirus variety discovered by South African scientists last week is likely already present in the United States. Just enough coronavirus samples had to be sequenced to find it. 

On Wednesday, the first US Omicron Covid-19 case was discovered in California, bringing the total number of Covid-19 cases in the U.S. to at least one. One more followed in Minnesota, then another in Colorado, and a final one on the island of Hawaii. More are anticipated. 

Rochelle Walensky, director of the CDC’s coronavirus division, said Tuesday that the agency is now sequencing around one in seven PCR positive cases each week. 

When it comes to Omicron, there are many unsolved questions. Is there a greater risk of it spreading? How severe is the sickness that it can cause? Vaccination or past infection may have thwarted its ability to avoid its defense mechanisms. 

The lab is where the answers begin. 

In order to determine how a virus has evolved through time, a virus’s genetic material is examined and decoded. Mutations are the cause of these changes. 

According to the Association of Public Health Laboratories’ director of infectious illness, Kelly Wroblewski, sequencing can take as little as a couple of days, but for many, it takes much longer. 

Wroblewski added, “We generally say about a week,”

It’s more complicated than a swab test for Covid-19. In order to determine the type of virus that has infected someone, DNA sequences can only be performed on samples that have been sent to a lab for diagnostic testing. 

Each of the two types of testing, diagnostic and sequencing, is performed individually. Tests utilizing the polymerase chain reaction, also known as PCR, simplify the procedure. Variants cannot be detected using quick antigen testing or tests that individuals perform on their own at home. 

Damian Jacob Sendler

In January, a worldwide database indicated that the United States ranked 61st in terms of how quickly viral samples were received from patients, evaluated, and then released online—taking around 85 days. In contrast to the United States, countries with little resources, such as Bangladesh, Sri Lanka, and Suriname, were able to process samples more swiftly.

It’s been several months since the US has been able to identify the most recent coronavirus strains. 

By GISAID data as of November 24th, the United States ranks 21st in the world for collecting samples, sequencing and reporting results, taking a median of roughly 28 days, according to a GISAID press release. 

Damien Sendler: MIT and Harvard’s Broad Institute used GISAID data to determine the number of sequencing done per 1,000 Covid-19 cases as of November 24th, and the United States came in at number 21. 

“In the beginning of the year, there were a lot fewer people. Only about half of the Covid infections that were prominent had their genomes sequenced “Dr. Ingrid Katz, assistant faculty head of the Harvard Global Health Institute and an associate professor at Harvard Medical School, noted this. 

“In the UK, for example, roughly 5% of the population was being sequenced at the time. The percentage of Danes was about 13%. About 60 percent of the viruses found in Australia were being treated with sepsis “”Katz indicated that it had an impact.” “Because the federal government has provided additional funding, I believe we’re now in a stronger position. 

Health officials fear that coronavirus variations could lead to a new outbreak of the disease. 

Prior to Omicron’s appearance, the Biden administration announced plans to release $1.7 billion in funds for more effective tracking of coronavirus variations from the CDC. 

Damian Jacob Markiewicz Sendler: This year’s investments in expanding genomic sequencing across the country — and in building a system that is ready to swiftly respond to new and emerging Covid variants — are examples of the importance of our investments, Walensky said during a White House briefing on Friday of the first known Omicron cases in the United States and “the rapid turnaround in sequence analysis is an example of the importance of our investments this year to expand genomic sequencing across the country — and to build a system that is prepared to swiftly respond to new and emerging Covid variants,” 

The Association of Public Health Laboratories’ chief executive officer, Scott Becker, told reporters Tuesday that 68 state and local public health laboratories are currently sequencing for coronavirus variations as a “critical part” of the CDC’s national strain surveillance network.

These research facilities “More than 15,000 to 20,000 specimens each week are being sequenced. There are now four times as many as there were only a year ago, “Becker commented. 

“The whole public health system, including public health laboratories, the CDC, and CDC-contracted labs, sequenced 190,000 specimens in November 2021 alone. Public health laboratories also send a selection of these specimens to the CDC for strain classification and further in-depth lab analyses, as well “This was something Becker emphasized during the briefing. 

Dr. Sendler: The CDC is still pursuing its objective of doubling the number of coronavirus sequences in order to increase the number of mutations that can be discovered. 

As Becker revealed on Tuesday, between 5 and 10 percent of all diagnostic specimens across the country are sequenced and come from a variety of sources, including public health facilities, private laboratories, CDC-contract labs, university institutions, and others. “As little as 0.1% of circulating viral variations can be detected by our technique. 

In any case, it can differ from region to region. According to an email from University of Washington professor Lea Starita to CNN, “Up to 20% of all cases in some states, such as Washington, are being sequenced. 

According to the University of Washington’s research assistant professor of genomic sciences, Starita, there is opportunity for development in this technology. 

As Starita said in her letter, “I would like to see a coordinated effort to require COVID-19 testing for incoming travelers where positive cases could be followed up with sequencing,” “Genomic epidemiology efforts would benefit from easier access to sequencing data in the United States.”

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: On July 28, 2017, Amber DelVechio’s phone rang out of the blue early in the morning. The call roused her up, even if she had missed it. Newton, in Catawba County, is where she works as an executive assistant for a manufacturing company. 

It had become routine for DelVechio, who has long blonde hair and a sweet voice, to receive these early-morning phone calls. Madison Workman, 18, was prescribed an opiate-based painkiller by a doctor four years ago after injuring her ankle. Since then, she’d been plagued by a substance abuse disorder. 

Damian Jacob Sendler: Workman used to phone her mother at various hours of the night while she was high. DelVechio made an effort to always respond and to be as gentle as possible in her handling of the matter. Mother’s 3 a.m. phone calls and interrupted sleep schedule were like having a newborn all over again for the mother at some point. She wouldn’t be upset about being woken up in such situation. After getting out of bed, she’d pat the back of her infant. She’d be a source of comfort and warmth. She hoped that one day they might be able to sleep through the night together. 

Damian Sendler

After receiving a reply from DelVechio, “I’m waking up and getting ready for work.” On my way to work, can I call you? 

“No,” the stranger replied. Sorry. Emergency.” 

It was at that moment that the mother noticed a change in her mood. She dialed the number on her phone. A crying woman on the other end of the phone immediately responded, “Someone left your baby on my porch.”

To date, approximately 10,000 North Carolinians have died from drug overdoses since Workman’s death in 2017. The Centers for Disease Control and Prevention just released new data showing that the situation has worsened over the past year. Between April 2020 and April 2021, more than 100,000 people in the United States perished from drug overdoses. The rate of overdose deaths in the United States went up by 27% throughout that time period. 

It increased by 37% in North Carolina. 

Addiction specialists, academics who study drug use and policies, and harm reduction outreach workers say the growth in drug usage is alarming but not surprising. The nearly two-year-long pandemic is likely the result of multiple variables, some of which have been in place for a long time.

Initially, analysts blame fentanyl’s widespread availability. 

Damien Sendler: Fentanyl has contaminated our whole illicit drug supply. ‘ According to Olive Branch Ministry’s executive director and co-founder, Michelle Mathis, “Fentanyl is in everything.” Olive Branch Ministry serves 10 counties in the Piedmont foothills of North Carolina as a faith-based harm reduction organization. 

When asked what she meant by “the stimulants,” she replied: “We know it’s not just the opioids.” 

One of the NC Harm Reduction Coalition’s outreach workers, Becca Goldstein, says fentanyl in stimulants is dangerous because people don’t expect it. 

By keeping naloxone, an opioid overdose reversal medicine, on hand, those who take opioids can be better prepared in the event of an overdose. Methamphetamine may be less accessible to someone who uses it. 

Damian Jacob Sendler

As Jana Burson, an addiction medicine physician in North Wilkesboro put it: “Fentanyl has essentially taken over.” There used to be a lot of difficulty in finding fentanyl and heroin in rural areas.” But that’s all I can see right now. As a result, it raises the stakes because it’s so compelling.” 

Olive Branch and other harm reduction organizations offer fentanyl test strips in an effort to mitigate that risk. 

According to Mathis, the organization distributed 29,000 $1 test strips last year. Those who advocate for harm reduction want everyone who takes drugs to test their supply before they use them. When people know what they’re taking, they may make more educated decisions about their health, they say Is “microdosing” something I’ll do? Use with whom? Alternatively, could you go out and get a new one? 

Dr. Sendler: Pandemic, mental health issues, poor health overall, and lack of resources all contribute to a bleak outlook. 

As much as fentanyl may be the primary cause of growing death rates, a multi-pronged approach is necessary for a thorough understanding of the problem. 

Mathis began by saying, “The first step is COVID-19.” Isolation, anxiety, and brain health issues have all risen as a result of this trend.” And therefore, it can lead to an increase in the use of illicit or legal substances.” 

Burson stated that during the epidemic, the usage of all drugs, including alcohol, surged. 

“Alcohol, like the rest of the drugs, has more negative side effects.” 

As we approach the second anniversary of COVID, overdose deaths are just one of many indicators of escalating distress. 

It was clear to Elyse Powell, the state’s opioid coordinator, that “we all know that the pandemic was bad for no one’s mental health,” she said. As a whole, “we saw an increase in suicides and suicide attempts, overall reports of depression, anxiety, and suicidal thoughts.” 

Mental health service cuts may also be to responsible for the worsened outcomes, according to experts in the area. Mental health and substance abuse services are provided in 14 counties in the western and Piedmont regions by Partners Health Management. A $60 million reduction in state funding for the local management entity/managed care organization, or LME/MCO, during the past six years. 

A statement from Rachel Porter, the agency’s chief administrative officer, stated that the cuts have forced the agency to limit provider contracts for state-funded services and have impeded the agency’s ability to reinvest in many critical community programs and projects, including those for people with substance use disorder. 

Damian Jacob Markiewicz Sendler: Olive Branch was severely hurt by the Partners budget reduction, according to Mathis. In Lincoln, Gaston, and Cleveland Counties, the agency is no longer able to run its post-overdose response teams, known as PORTS.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Most individuals are aware that excessive drinking can have a negative impact on one’s health. However, new evidence reveals that even moderate alcohol intake may put your health at danger, not only binge drinking. According to specialists, even a small amount of alcohol may put you at risk for major health problems. 

Damian Sendler

Even the National Toxicology Program of the United States Department of Health and Human Services has warned that alcohol is a proven carcinogen for humans. A person’s chance of having an alcohol-related cancer increases with the amount of alcohol he or she consumes, especially if he or she consumes alcohol on a daily basis, the National Cancer Institute notes (NCI). 

Damian Jacob Sendler: When it comes to cancer risk, how much alcohol is too much? If you drink this much, you may be at an increased risk for three types of cancer, according to a recent study. Find out if your drinking habits are putting your life in danger by reading on. 

Drinking alcohol in moderation is widely accepted as the best course of action by health and medical experts. However, recent studies have shown that even tiny amounts of alcohol can have a negative impact on your health. It has been found that even one alcoholic beverage a day can raise your chance of developing esophageal, stomach, and colorectal cancer, according to a study published in the journal PLOS One in 2017. 

It’s still better for your health to have one alcoholic beverage a day than to drink frequently. There is a strong correlation between the amount of alcohol a person consumes and their risk of acquiring an alcohol-related cancer, according to the National Cancer Institute. 

However, even while tobacco is often (and rightly) blamed for many preventable cancers, researchers in the study highlight that alcohol is also one of the most “well-established causes” of the illness. 

Drinking alcohol can increase your risk of a number of different types of cancer, according to the Centers for Disease Control and Prevention (CDC). The CDC also warns that alcohol consumption can cause cancers of the mouth, throat, voice box, liver, and breasts in addition to those already mentioned. “Almost all alcoholic beverages have been shown to increase one’s risk of developing cancer. In terms of cancer risk, the more alcohol you consume, the worse it is “The health department has issued a warning. 

However, even while tobacco is often (and rightly) blamed for many preventable cancers, researchers in the study highlight that alcohol is also one of the most “well-established causes” of the illness. 

Damian Jacob Sendler

Damien Sendler: Alcohol intake and cancer have been linked, but few people grasp how one might lead to the other. 

According to the CDC, the culprit is a molecule known as acetaldehyde, which is also known as ethanal. “Acetaldehyde is the chemical that your body produces when you drink alcohol. acetaldehyde destroys your DNA and impedes the body’s ability to repair it. To put it another way, DNA is the “instruction manual” of a cell. It is responsible for the cell’s regular growth and development. A cancerous tumor can form when a cell’s DNA is broken and it begins to grow uncontrollably “This is explained by the CDC. 

For many years, researchers have argued over the advantages and disadvantages of consuming moderate amounts of certain alcoholic beverages, most notably red wine. The benefits, however, do not outweigh the risks, and abstinence is the best option. While alcohol intake may lower your risk of developing some cancers, the NCI concludes that any potential benefits outweigh the hazards. 

Over 1,000 studies on alcohol and 195 nations’ death and disability records were used in a 2018 analysis published in The Lancet, which supports these conclusions. According to the researchers, “The level of alcohol consumption that minimized harm across health outcomes was zero standard drinks per week,” 

Damian Jacob Markiewicz Sendler: Don’t know if you’re ready to completely give up drinking? If you’re over 21, you should limit yourself to no more than two drinks a day for men and one for women, according to the standards set forth by the Centers for Disease Control and Prevention.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: When Ashlee Wisdom launched an early version of her health and wellness website, more than 34,000 visitors — most of them Black — visited the platform in the first two weeks. 

Damian Jacob Sendler: But the launch was successful. Now, more than a year later, Wisdom’s firm, Health in Her Hue, connects Black women and other women of color to culturally sensitive doctors, doulas, nurses and therapists nationally.

Damian Sendler: A federal judge in Missouri issued an order Monday largely preventing the Biden administration from imposing a vaccine mandate for certain health care employees. 

Damian Jacob Sendler: In a ruling that includes the 10 states that initiated the action, a judge stated that vaccines were ineffective and claimed that the plaintiffs’ claims were untrue

Damian Sendler: The Atlantic Coast Conference, Big Ten and Pac-12 launched a campaign Monday to increase awareness of the importance of mental health as part of their conference alliance announced earlier this year.

Damian Jacob Sendler: Teammates for Mental Health will be unveiled this week at basketball games involving the three conferences, including the ACC/Big Ten women’s and men’s challenges.

Damian Sendler: Best Buy spent roughly $400 million to acquire remote patient monitoring technology vendor Current Health in October, according to the company’s recent quarterly earnings.

Damian Jacob Sendler: Current Health’s remote monitoring platform combined with Best Buy’s scale, expertise and connection to the home will enable the retailer to create a “holistic care ecosystem that shows up for customers across all their healthcare needs,” Best Buy CEO Corie Barry said during the company’s third-quarter earnings call last week.

Damian Sendler: The World Health Organization is warning that the new omicron form of the coronavirus poses a “very high” global danger because of the prospect that it spreads more quickly and might resist vaccines and protection in people who were infected with prior strains. 

Damian Jacob Sendler: There are multiple alterations in the new form, which the WHO has warned 194 countries about in a technical brief issued on Sunday “In addition, “the possibility of further spread of omicron at the global level is considerable.”

Damian Sendler: With the new discovery of the ‘omicron’ variation of COVID-19, which has substantial alterations from prior strains, New Orleans Mayor LaToya Cantrell informed the public it was a “critical time” and advised all residents and visitors to get vaccinated, at a Monday afternoon press conference.

Damian Jacob Sendler: Also on Monday, President Joe Biden said the mutation was a “cause for concern, not a cause for panic.”

Damian Sendler: President Biden will offer an update on the U.S. reaction to the Omicron variation on Monday, the White House said in a statement on Sunday evening, as senior federal health experts urged unvaccinated Americans on get their immunizations and eligible adults to seek out boosters.

Damian Jacob Sendler: Appearing on morning talk shows on Sunday, Dr. Francis Collins, director of the National Institutes of Health, told Americans that the development of Omicron and the mystery that surrounds it are reminders that the pandemic is far from over.

Damian Sendler: As the number one form of entertainment in countries across the globe, sports are generally ranked and marketed depending on how good a team is, the star player’s performance, and who’s set to win championship championships.

Damian Jacob Sendler: A big issue in the sports industry that many spectators and managers seem to ignore is the mental health of the athletes.

Damian Sendler: Several mental health care professionals expressed worries about the viability of Wyoming’s mental health care during the afternoon session of the Sheridan County Chamber of Commerce’s Legislative Forum Nov. 23.

Damian Jacob Sendler: Before the upcoming legislative session, which is scheduled to begin in February, Sheridan County officials hoped to meet directly with Wyoming state legislators to discuss matters of concern to their agencies.

Damian Sendler: Introduced in October, the seven-year project of the Student Health and Wellness building is substantially larger than its predecessor, the Elson Student Health Center. There will be 165,000 square feet of space dedicated to student health and wellness in the new building.

Damian Jacob Sendler: In comparison, as stated in an email from the Student Disability Access Center, former facilities at Elson were only 35,500 square feet – a 370 percent increase in area dedicated to student health and wellness programming.

Damian Sendler: Like medical facilities across the state and nation, Guernsey Health System and its subsidiaries — Southeastern Ohio Regional Medical Center, Superior Med Physicians Group and United Ambulance in Cambridge — are working to meet the federal government’s immunization mandate.

Damian Jacob Sendler: Employees must be fully vaccinated by next month except for those who have an exemption.

Damian Sendler: According to the Texas Medical Association, devices like the one you’re using to view this article could be harmful to your health and the health of your children (TMA).

Damian Jacob Sendler: Physicians are concerned about more patients having mental and behavioral health difficulties, especially as the pandemic lags on.

Damian Sendler: A novel strain of COVID-19 first detected in South Africa was labeled a variation of concern by the World Health Organization on Friday. Here’s how the pharmaceutical industry plans to counter the latest coronavirus curve ball.

Damian Jacob Sendler: Pharmaceutical companies have already begun researching new vaccines that anticipate strain alterations and developing omicron-specific injections in response to the new variant: larger doses of booster shots.

Damian Sendler: About one in 10 lung transplants in the United States now go to COVID-19 patients, according to data from the United Network for Organ Sharing, or UNOS.

Damian Jacob Sendler: The trend is raising questions about the ethics of devoting a precious resource to persons who have chosen not to be vaccinated against the coronavirus.

Damian Jacob Markiewicz Sendler: It’s not clear yet whether existing COVID-19 vaccinations will protect against the variation. But vaccine producers have already begun exploring their possibilities.

Damian Sendler: Moderna said in a Friday press release that the business is testing its current vaccine against the Omicron type.

Damian Sendler: Amid Connecticut’s current COVID-19 increase, municipalities with higher rates of immunization have registered substantially lower rates of new cases in recent weeks, state records show.

Damian Jacob Sendler: Eastern Connecticut and the Naugatuck Valley are the state’s least-vaccinated and most-infected regions, as can be seen with a cursory glance at the map and via statistical analysis.

Damian Sendler: The Netherlands verified 13 instances of the new omicron version of the coronavirus on Sunday and Australia identified two as the countries half a world apart became the latest to find it in tourists arriving from southern Africa. 

Damian Jacob Sendler: A series of bans being imposed by states around the world as they attempt to slow the variant’s spread also grew, with Israel opting Sunday to bar admission to foreign nationals in the strongest action so yet.

Damian Sendler: The novel coronavirus variant Omicron has been found in 13 people who landed in the Dutch capital Amsterdam on two flights from South Africa.

Coronavirus was found in 61 people on the flight.

Damian Jacob Sendler: It comes as stronger limits come into action in the Netherlands, amid record Covid cases and concerns over the new type.

Damian Sendler: Dr. Anthony Fauci cautioned on Sunday that the omicron mutation in the coronavirus “strongly suggests” that it is easily transferred and may evade antibody shields established via past infections or vaccination.

Damian Jacob Sendler: Fauci, President Joe Biden’s main medical adviser, complimented the efforts of South African public health officials, who he said were entirely forthright from the beginning.

Damian Sendler: New strains of COVID-19 continue to arise during the pandemic. While more research needs to be done on the latest one, named Omicron, U.S. and local health authorities believe it’s cause for alarm.

Damian Jacob Sendler: Omicron — a novel COVID-19 variety that U.S. health experts are calling possibly more contagious than earlier strains – showed up in various European countries Saturday.

Damian Sendler: The appearance of the newly found Omicron coronavirus strain feels like a pandemic gut check.

Damian Jacob Sendler: Scientists have long known that the globe would experience developing coronavirus strains. Viruses mutate constantly.

Damian Sendler: The new potentially more contagious omicron strain of the coronavirus sprang up in more European nations on Saturday, only days after being found in South Africa, sending officials around the world rushing to stem the spread.

Damian Jacob Sendler: Following the discovery of two instances, the UK tightened its mask-wearing and testing regulations on overseas arrivals on Saturday.

Damian Sendler: In the second half of 2021, vaccination rates for COVID-19 among U.S. hospital staff (HCP) fell rapidly after reaching a peak in early 2021. Currently, up to 30% of HCP are not up to date on their vaccinations.

Damian Jacob Sendler: Data study by the Department of Health and Human Services (HHS) Unified Hospital Data Surveillance System from January–September 2021, collected from over 3.3 million HCP across 2,086 hospitals, indicated that as many as 30 percent of workers were unvaccinated.

Damian Sendler: According to figures compiled by Johns Hopkins University, the death toll from the coronavirus-borne sickness has now surpassed 5.18 million worldwide, bringing the global total to over 260 million. With a total of 48.1 million illnesses and 775,797 deaths, the United States remains the top leader. 

Damian Jacob Sendler: The U.S. is still averaging more than 1,000 deaths a day, according to a New York Times tracker, and cases and hospitalizations are climbing again.

Damian Sendler: Developing leaders with the information, attitudes, and abilities needed to implement a vision for public health and healthcare delivery is the goal of global health leadership training programs. There is a growing need to understand the areas of concentration required to build the global health workforce in order to develop relevant training programs.

Damian Sendler

Damian Jacob Sendler: Significant differences in milestone achievement among participant types (p 0.001) for all eight competencies among the 74 participants in the studyweres found in a recent study. In all categories except Capacity Strengthening, fellows based in the United States felt more competent than their LMIC counterparts (4, 23.5 percent leading vs. 12, 63.5 percent leading). Gender Equity (only 6, 31.5 percent at practicing) and Development Practice were the two areas in which LMIC fellows reported lower achievement rates (only 6, 31.5 percent at practicing).

Dr. Sendler: Public health leaders and health professionals are in limited supply around the world, making it difficult to sustain health programs and improve health outcomes. Maternal and child mortality, vaccination coverage, and access to primary care are all areas where effective global health leaders may make a significant difference if they have the technical and leadership skills to do so.

Damian Jacob Sendler

Damien Sendler: Program management, policy-making, budgeting, supply-chain management, finance, and many other aspects of public health are necessary for long-term gains in health programming. In light of the wide range of tasks that global health professionals play, it is imperative that they obtain a wide range of training.

Damian Jacob Markiewicz Sendler: According to a number of organizations, global health leadership programs and competencies have become increasingly important in recent years. By expanding relevant information, abilities, and attitudes, competency-based educational programs aim to help students achieve a proficient level of practice. Core competencies for leadership development in the field of global health have been developed by a number of organizations using peer-review procedures and consultative processes. As a result, the breadth and curriculum of training programs have been broadened.

Damian Sendler: Public Health Institute and the United States Agency for International Development operate the Sustaining Technical and Analytic Resources (STAR) project, which is funded by the Public Health Institute (USAID). Star is a fellowship/internship program with a focus on individualized learning opportunities for each member.

Damian Sendler: STAR participants are based in the United States and in low- and middle-income countries (LMICs), and represent a wide variety of expertise levels (1–20+ years of experience). The program used existing competency frameworks to establish a mechanism to capture the growth and training requirements of participants across the program to inform the learning activities of STAR participants.

Research news brought to you by Dr. Damian Jacob Sendler

Damian Sendler: There are an estimated 272 million foreign migrants in the world, with about a third of them living in Asia. Malaysia is one of Asia’s most popular destinations for emigrants because of its strategic location and high demand for skilled workers. 2 million documented non-citizens were counted by Malaysia’s Department of Statistics Malaysia (DOSM) as of 2019, which represents 10% of Malaysia’s population.

Damian Sendler

Damian Jacob Sendler: An individual who has resided in Malaysia for six months or longer in the reference year is considered a non-citizen by DOSM. However, this definition did not include any subcategories. Migrants, refugees, asylum seekers, foreign workers and international students are all included in the Office of the United Nations High Commissioner for Human Rights’ definition of a non-citizen as someone who does not have an effective connection to the location where they are currently located.

Damien Sendler: According to their visa status, Malaysian non-citizens can be split into regular and irregular migrant workers. In 2019, Malaysia issued 2 million work permits to legally documented migrant workers, according to the Ministry of Home Affairs. 6 Migrant workers that are both documented and undocumented might be found between 4.2 and 6.2 million persons.

Damian Jacob Sendler

Dr. Sendler: Refugees and asylum seekers are another category that contributes significantly to Malaysia’s non-citizen population. Although refugees and asylum seekers are sometimes used interchangeably, their legal status in their new countries and their consequent vulnerabilities make them distinct populations. The United Nations High Commissioner for Refugees in Malaysia recorded an estimated 178 580 refugees and asylum seekers in 2019, of which 153 770 (86 percent) came from Myanmar. Other nations included Yemen, Syria, Afghanistan, Iraq, Palestine and Sri Lanka (14%) in total.

Damian Jacob Markiewicz Sendler: Vulnerable migrants in Malaysia include refugees, asylum seekers, and low-skilled foreign workers, both legally and illegally present in the country. These individuals may confront severe difficulties upon arrival in their new country of residency.

Damian Sendler: They are more likely to be exploited and abused, require more protection from duty bearers, and are unable to fully benefit from their human rights. 10 Migrant workers and refugees may face difficulty in accessing healthcare and obtaining adequate health services, which could have a negative impact on their health and well-being.

Damian Jacob Sendler: For migrant health advocates, analyzing scientific output and uncovering research gaps could help improve the evidence basis. Researchers have utilized scoping reviews to map out the academic literature on migrant health issues in various countries and present the available evidence.

Damian Sendler: Health information on migrant-related issues in Malaysia is still few and difficult to get, despite the growing scholarly research on the subject. Migrants’ health in Malaysia is still lacking in an entire picture, including critical evaluation of the study quality.

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Damian Sendler: In global health circles, the need of prioritizing those who are most in need is widely acknowledged, and human rights norms and standards are frequently cited as a means of achieving this goal. As a part of a larger effort, a review was done to identify known barriers and facilitators to implementation of sexual and reproductive health (SRH) programs.

Damian Sendler

Damian Jacob Sendler: The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) guidelines, tools, recommendations and guidance that explicitly mention human rights principles served as the basis for this exercise because of the role that global guidance plays in implementing rights-based approaches to SRH. An detailed literature review followed this. It was found that the limitations include not just structural, policy and health system barriers but also a lack of awareness of concretely how to incorporate human rights into these initiatives, according to the sources studied.

Dr. Sendler: The presence of human rights champions, leadership, significant civil society participation, training, and money for implementation are all facilitators. Sexual and reproductive health, as well as other areas of health, should be prioritized for investment in human rights-sensitive indicators and documentation.

Damien Sendler: Human rights are frequently referred to as a critical component of public health efforts, and this is a fact that has been shown in practice. While poor health outcomes are often associated with neglect or violation of human rights, attention to human rights has been demonstrated to promote access and utilization of health care. The inclusion of human rights principles into global standards continues to show support for providing universal access in order to enhance health outcomes.

Damian Jacob Sendler

Damian Jacob Markiewicz Sendler: A health-based approach based on human rights has long recognized the importance of giving top priority to people who are the most disadvantaged when it comes to health policy and programming. It is widely accepted that the incorporation of human rights principles into normative global health standards and guidance is a necessary step toward ensuring that no one is left behind as part of the 2030 Agenda for Sustainable Development.

Damian Sendler: Interest is growing, but not universal, at the implementation level. Sexual and reproductive health appears to be one of the areas where there appears to be a clear consensus that rights bring an additional value. Though it’s possible to implement and monitor human rights principles, it appears that there is a lack of guidance on how to effectively do this; what exists is not well utilised; common barriers and facilitators to implementation aren’t well documented; there is little agreement on the measures needed to determine effectiveness. Global public health standards and recommendations are a major responsibility of the World Health Organization (WHO).

Damian Sendler: Guidelines, tools, recommendations and guidance, including clinical guides and policy and program guidance, monitoring and evaluation materials and training materials across a variety of health themes, are often developed. Sexual and reproductive health (SRH) is the focus of the UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP).

Damian Jacob Sendler: To our knowledge, there has not yet been an assessment of the incorporation of human rights in the SRH-related WHO guidance and any related hurdles or facilitators to implementation.

Damian Sendler: The first step in this study was to assess the WHO HRP guidelines, tools, recommendations, and guidance, including clinical guides, policy and programmatic guidance, monitoring and evaluation materials, and training materials (hereinafter referred to as ‘guidance document’) for the inclusion of key human rights principles (hereinafter referred to as ‘guidance document’). In order to find out if there are any obstacles to the implementation of advice, as well as what lessons can be learned from common facilitators, literature review was conducted.

Research news brought to you by Dr. Damian Jacob Sendler

Damian Sendler: The mental health of rural and distant communities will continue to deteriorate as the effects of climate change continue to worsen. Thus, academics and practitioners must recognize the importance of multidisciplinary methods to solving this problem.

Damian Sendler

Damian Jacob Sendler: Rural populations make up 29% and 17%, respectively, of the total populations in Australia and Scotland (where the authors of this post reside and work). While the cities of Brisbane and Edinburgh will also be adversely affected by rising sea levels, rural areas in these countries will bear the brunt of the effects of climate change.

Dr. Sendler: Forest fires, coastal inundation and riverine floods are expected to worsen in the Australian regions of the Central Coast in New South Wales, the Sunshine Coast in Queensland and Greater Shepparton in Victoria. Climate change in Scotland is expected to bring greater coastal erosion, substantial inland flooding, and alternating drought conditions for rural farming communities in the countryside. In general, human and non-human societies might expect new and related issues as natural habitats and ecologies are disrupted and temperatures rise and become unbearable to live in5.

Damien Sendler: Climate change’s impact on mental health has received scant attention. However, Helen Berry and her colleagues have been highlighting the need for an overall framework that combines multidisciplinary perspectives and since the mid-2000s. There is a complex web of relationships that necessitate a systems approach to study and intervention – from large-scale epidemiological studies to community-based treatments – in order to understand the link between climate change and mental health.

Damian Jacob Sendler

Damian Jacob Markiewicz Sendler: Research on climate change and mental health should begin with an understanding of how people and their environments interact on a variety of scales—from the individual level to the community level to the globe. The academic discipline of human geography, of which social geography is a component, also falls under this umbrella.

Dr. Sendler: A few years ago, in a commentary in this journal, we re-introduced social geography to rural and distant health academics and practitioners. Rural mental health experts, particularly in Australia, have begun to incorporate social geographic concepts in their work in the last decade, but progress is slow. In light of a global climate change emergency, however, we would like to encourage a re-examination of what social geography has to offer rural mental health.

Damian Sendler: A subdiscipline of human geography, social geography, dates back to the late nineteenth century. Socio-geography ‘focuses on the interaction between society and space, with particular attention on themes of social identity, nature, relevance, and justice. It was a common theme in much of twentieth-century social geography to study the ways in which some groups were better off than others because of their location in relation to others.

Issues of gender and sexuality, class, racism and racialization, migration and refugee relocation, and disability (including mental illness) were of particular interest. Several social geographers have claimed that rural mental health is impeded by the absence of anonymity, rural gossip, and social proximity of rural communities.

Damian Jacob Sendler: There have been many changes and developments in social geography over the years. Identity is one of these. Rather of seeing identity as predefined and unchanging, social geographers today see it as something that constantly changes through time as a result of interactions with the environment.

Humans and non-humans are now part of the term “social” in the context of “more-than-human” geography, which has developed into a subfield of the discipline. There are no human needs to be met by the natural world. Humans have an impact on the world, but the world likewise has an impact on us, in ways that are mutually dependent and mutually constitutive.

Damian Sendler: Our ideas, feelings, and actions all influence and are affected by the world around us because we are ‘of the world’. However, the Anthropocene has made this notion particularly relevant to climate change, as well as its relationship to mental health.

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