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Introduction Little is known regarding how the risk of suicide in refugees relates to their host country. Specifically, to what extent, inter-country differences in structural factors between the host countries may explain the association between refugee status and subsequent suicide is lacking in previous literature. Objectives We aimed to investigate the risk of suicide among refugees in Sweden and Norway according to their sex, age, region/country of birth and duration of residence. Methods Each suicide case between the age of 18-64 years during 1998 and 2018 (17,572 and 9,443 cases in Sweden and Norway, respectively) was matched with up to 20 population-based controls, by sex and age. Multivariate-adjusted conditional logistic regression models yielding adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) were used to test the association between refugee status and suicide. Results The aORs for suicide in refugees in Sweden and Norway were 0.5 (95% CI: 0.5-0.6) and 0.3 (95% CI: 0.3-0.4), compared with the Swedish-born and Norwegian-born individuals, respectively. Stratification by region/country of birth showed similar statistically significant lower odds for most refugee groups in both host countries except for refugees from Eritrea (aOR 1.0, 95% CI: 0.7-1.6) in Sweden. The risk of suicide did not vary much across refugee groups by their duration of residence, sex and age. Conclusions The findings of almost similar suicide mortality advantages among refugees in two host countries may suggest that resiliency and culture/religion-bound attitudes could be more influential for suicide risk among refugees than other post-migration environmental and structural factors in the host country. Disclosure No significant relationships.

ABSTRACT We investigated the individual and combined effects of diet and physical exercise on metabolism and the gut microbiome to establish how these lifestyle factors influence host-microbiome cometabolism. Urinary and fecal samples were collected from athletes and less active controls. Individuals were further classified according to an objective dietary assessment score of adherence to healthy dietary habits according to WHO guidelines, calculated from their proton nuclear magnetic resonance (1H-NMR) urinary profiles. Subsequent models were generated comparing extremes of dietary habits, exercise, and the combined effect of both. Differences in metabolic phenotypes and gut microbiome profiles between the two groups were assessed. Each of the models pertaining to diet healthiness, physical exercise, or a combination of both displayed a metabolic and functional microbial signature, with a significant proportion of the metabolites identified as discriminating between the various pairwise comparisons resulting from gut microbe-host cometabolism. Microbial diversity was associated with a combination of high adherence to healthy dietary habits and exercise and was correlated with a distinct array of microbially derived metabolites, including markers of proteolytic activity. Improved control of dietary confounders, through the use of an objective dietary assessment score, has uncovered further insights into the complex, multifactorial relationship between diet, exercise, the gut microbiome, and metabolism. Furthermore, the observation of higher proteolytic activity associated with higher microbial diversity indicates that increased microbial diversity may confer deleterious as well as beneficial effects on the host. IMPORTANCE Improved control of dietary confounders, through the use of an objective dietary assessment score, has uncovered further insights into the complex, multifactorial relationship between diet, exercise, the gut microbiome, and metabolism. Each of the models pertaining to diet healthiness, physical exercise, or a combination of both, displayed a distinct metabolic and functional microbial signature. A significant proportion of the metabolites identified as discriminating between the various pairwise comparisons result from gut microbe-host cometabolism, and the identified interactions have expanded current knowledge in this area. Furthermore, although increased microbial diversity has previously been linked with health, our observation of higher microbial diversity being associated with increased proteolytic activity indicates that it may confer deleterious as well as beneficial effects on the host.

Food banks provide supplemental food to low-income households, yet little is known about the cardiovascular health of food banks members. This study therefore described cardiovascular disease (CVD) risk factors among food bank members and explored associations between food insecurity and CVD risk.Adults ≥18 years (n = 77) from three food bank sites in metro Vancouver, British Columbia completed surveys and physical assessments examining a range of socio-demographic variables and CVD risk factors. A composite measure of myocardial infarction (MI) risk called the INTERHEART score was assessed and household food insecurity was measured using the Household Food Security Survey Module. Regression models were used to explore associations between food insecurity and CVD risk measures, including the INTERHEART score.Ninety-seven percent of food bank members reported experiencing food insecurity, 65% were current smokers, 53% reported either chronic or several periods of stress in the past year, 55% reported low physical activity levels and 80% reported consuming fewer than five servings of fruit and vegetables daily. Prevalence of self-reported diabetes and hypertension were 13% and 29% respectively. Fifty-two percent of the sample were at high risk of non-fatal MI. No statistically significant associations were found between increased severity of food insecurity and CVD risk factors among this sample where both severe food insecurity and high CVD risks were prevalent.Food bank members were at elevated risk for CVD compared with the general population. Strategies are needed to reduce prevalence of food insecurity and CVD risk factors, both of which disproportionately affected food bank members. Keywords: Food insecurity, Food banks, Cardiovascular disease, Risk factors, Canada

This exploratory study investigated the disruption to schools ministry caused by the COVID-19 pandemic. Perspectives of church leaders, Christian parents, Christian teachers and organisations involved in schools ministry were consulted using online surveys, interviews and focus groups, to examine how schools ministry could be rebuilt, incorporating reflective practice and hence bringing positive change. The severe impact of extensive school closures and restrictions strongly solidified the move from being largely provision of RE, lunchtime events and collective worship, to much broader methods in response to listening to the needs of the school (both staff and pupils in a secular/mainstream setting). A striking observation was that schools ministry was viewed in many of these case study settings as a peripheral aspect of local church ministry and often devolved to specialist organisations. Arising needs and models of ministry have emphasised the value and effectiveness of relational approaches and listening to the needs of schools and responding accordingly. This reinforces the need for collaborative approaches and long-term development of relationships between church and school. Training needs identified concerned relationship building and vision and strategy development, with many stakeholders perceiving this as the way forward to more effective ministry activity.

Objective: 'Drunkorexia' is characterized by compensating for alcohol-related calories using physical activity (PA). Drunkorexia is common on college campuses but little is known about the PA behaviors within the drunkorexia paradigm. Methods: First-year college students living on campus completed an online survey collecting drunkorexia, PA, and alcohol consumption data. A total of 127 participants reported engaging in drunkorexia behaviors. Results: Fifty-three participants were classified as preemptively physically active (e.g., PA and drink on Tuesday) compared to 74 as non-preemptively physically active. Preemptively physically active participants consumed more alcohol on Fridays and Saturdays than those non-preemptively physically active. Preemptively physically active participants engaged in significantly greater amounts PA. Females accounted for all significant differences between groups. Discussion: Among drunkorexia-positive participants, many made preemptive efforts to control their calories before consuming alcohol, which may predispose them to higher incidences of adverse outcomes such as alcohol poisoning, unwanted sexual advances, and death.

Leaf nitrogen and leaf surface area influence the exchange of gases between terrestrial ecosystems and the atmosphere, and play a significant role in the global cycles of carbon, nitrogen and water. The purpose of this study is to use field-based and satellite remote-sensing-based methods to assess leaf nitrogen pools in five diverse European agricultural landscapes located in Denmark, Scotland (United Kingdom), Poland, the Netherlands and Italy. REGFLEC (REGularized canopy reFLECtance) is an advanced image-based inverse canopy radiative transfer modelling system which has shown proficiency for regional mapping of leaf area index (LAI) and leaf chlorophyll (CHLl) using remote sensing data. In this study, high spatial resolution (10–20 m) remote sensing images acquired from the multispectral sensors aboard the SPOT (Satellite For Observation of Earth) satellites were used to assess the capability of REGFLEC for mapping spatial variations in LAI, CHLland the relation to leaf nitrogen (Nl) data in five diverse European agricultural landscapes. REGFLEC is based on physical laws and includes an automatic model parameterization scheme which makes the tool independent of field data for model calibration. In this study, REGFLEC performance was evaluated using LAI measurements and non-destructive measurements (using a SPAD meter) of leaf-scale CHLl and Nl concentrations in 93 fields representing crop- and grasslands of the five landscapes. Furthermore, empirical relationships between field measurements (LAI, CHLl and Nl and five spectral vegetation indices (the Normalized Difference Vegetation Index, the Simple Ratio, the Enhanced Vegetation Index-2, the Green Normalized Difference Vegetation Index, and the green chlorophyll index) were used to assess field data coherence and to serve as a comparison basis for assessing REGFLEC model performance. The field measurements showed strong vertical CHLl gradient profiles in 26% of fields which affected REGFLEC performance as well as the relationships between spectral vegetation indices (SVIs) and field measurements. When the range of surface types increased, the REGFLEC results were in better agreement with field data than the empirical SVI regression models. Selecting only homogeneous canopies with uniform CHLl distributions as reference data for evaluation, REGFLEC was able to explain 69% of LAI observations (rmse = 0.76), 46% of measured canopy chlorophyll contents (rmse = 719 mg m−2) and 51% of measured canopy nitrogen contents (rmse = 2.7 g m−2). Better results were obtained for individual landscapes, except for Italy, where REGFLEC performed poorly due to a lack of dense vegetation canopies at the time of satellite recording. Presence of vegetation is needed to parameterize the REGFLEC model. Combining REGFLEC- and SVI-based model results to minimize errors for a "snap-shot" assessment of total leaf nitrogen pools in the five landscapes, results varied from 0.6 to 4.0 t km−2. Differences in leaf nitrogen pools between landscapes are attributed to seasonal variations, extents of agricultural area, species variations, and spatial variations in nutrient availability. In order to facilitate a substantial assessment of variations in Nl pools and their relation to landscape based nitrogen and carbon cycling processes, time series of satellite data are needed. The upcoming Sentinel-2 satellite mission will provide new multiple narrowband data opportunities at high spatio-temporal resolution which are expected to further improve remote sensing capabilities for mapping LAI, CHLl and Nl.

Objective: The objective of this study was to explore the acceptability and feasibility of a therapeutic assessment protocol for the Screening and Support of Youth (SASY). SASY provides brief but comprehensive community-based screening and support for diverse youth in the community. Methods: SASY screening evaluates symptoms, functioning and clinical risk. The Kiddie Computerized Adaptive Test was used to evaluate seven different diagnoses and symptom severity. The Weiss Functional Impairment Rating Scale-Self was used to measure functional impairment. Measures were scored according to nationally developed norms. An algorithm was developed to aggregate symptom and function ratings into an overall score for clinical risk. The results are discussed with participants in a motivational interview designed to promote insight, followed by the opportunity for the participant to engage in an online intervention. Protocol changes necessitated by social distancing during the pandemic led to innovative methods including the use of a QR code for recruitment, integration of both online and offline participation, and expansion from in-person recruitment within the schools to virtual engagement with youth throughout the community. The final sample included disproportionately more Black or African American and Hispanic youth as compared to school and community statistics, suggesting that optimization of online and offline methods in research may facilitate the recruitment of diverse populations. Qualitative interviews indicated that the screening and feedback raised youth awareness of their wellbeing and/or distress, its impact on their functioning, and engagement with options for improved wellbeing. Conclusions: The emergence of innovative methods optimizing the advantages of both online and offline methods, developed as a necessity during the pandemic, proved advantageous to the feasibility and acceptability of community-based recruitment of at-risk, minoritized youth.

The immune response to SARS-CoV-2 infection is variable but has been linked to prognosis and the development of severe immunopathology. Here the authors assess a range of immune parameters in both peripheral blood and respiratory samples, providing a comparative assessment of the immune response between these compartments and their potential impact on immune-pathogenesis.

By 13,000 BP human populations were present across North America, but the exact date of arrival to the continent, especially areas south of the continental ice sheets, remains unclear. Here we examine patterns in the stratigraphic integrity of early North American sites to gain insight into the timing of first colonization. We begin by modeling stratigraphic mixing of multicomponent archaeological sites to identify signatures of stratigraphic integrity in vertical artifact distributions. From those simulations, we develop a statistic we call the Apparent Stratigraphic Integrity Index (ASI), which we apply to pre- and post-13,000 BP archaeological sites north and south of the continental ice sheets. We find that multiple early Beringian sites dating between 13,000 and 14,200 BP show excellent stratigraphic integrity. Clear signs of discrete and minimally disturbed archaeological components do not appear south of the ice sheets until the Clovis period. These results provide support for a relatively late date of human arrival to the Americas.

Clandestine marriage--the medieval institution of Christian marriage undertaken outside the recognition of legal authorities--was increasingly the object of anxiety and renegotiation in the early modern world. Its illicitness undermined marriage [...]

Disparities in health and academic achievement affect large cross-sections of the same population subgroups. This study examined the relationship metabolic health and academic achievement in youth “at risk” for school dropout in rural Mississippi. Fifteen adolescents participated in a studio based learning educational summer camp and subsequent follow-up sessions during the regular school year that were aimed at developing knowledge of core curriculum subjects by developing design projects based on the camp STEM-related theme. These projects are characteristic of a pedagogical technique known as Studio Based Learning (SBL) and involve more movement than a traditional classroom setting. Participants' metabolic health was assessed via measurements of blood lipids and glucose, blood pressure, BMI and waist circumference, and examined individually and as a combined risk score. Academic achievement measurements were obtained from district standardized testing. Mean BMI for this sample was classified as overweight; however, other metabolic parameters (blood lipids and glucose, and resting blood pressure) were in normal ranges for this age group. Little association was found between metabolic health and academic achievement and in this sample for math of language (r = −0.56 and 0.20, respectively). Participants took part in notable amounts of moderate-to-vigorous physical activity during the SBL camp and very little in the traditional classroom setting (approximately 30 vs. 7 min/day, respectively). Actively engaging teaching strategies, such as SBL, may impart a meaningful impact on physical activity levels of school-aged children, which may have long term, positive health outcomes. Keywords: Studio based learning, Obesity, Metabolic syndrome, Rural public health

Abstract Background Large-scale genomic studies of within-host diversity in Staphylococcus aureus bacteraemia (SAB) are needed to understanding bacterial adaptation underlying persistence and thus refining the role of genomics in management of SAB. However, available comparative genomic studies of sequential SAB isolates have tended to focus on selected cases of unusually prolonged bacteraemia, where secondary antimicrobial resistance has developed. Methods To understand bacterial genetic diversity during SAB more broadly, we applied whole genome sequencing to a large collection of sequential isolates obtained from patients with persistent or relapsing bacteraemia. After excluding genetically unrelated isolates, we performed an in-depth genomic analysis of point mutations and chromosome structural variants arising within individual SAB episodes. Results We show that, while adaptation pathways are heterogenous and episode-specific, isolates from persistent bacteraemia have a distinctive molecular signature, characterised by a low mutation frequency and high proportion of non-silent mutations. Analysis of structural genomic variants revealed that these often overlooked genetic events are commonly acquired during SAB. We discovered that IS256 insertion may represent the most effective driver of within-host microevolution in selected lineages, with up to three new insertion events per isolate even in the absence of other mutations. Genetic mechanisms resulting in significant phenotypic changes, such as increases in vancomycin resistance, development of small colony phenotypes, and decreases in cytotoxicity, included mutations in key genes (rpoB, stp, agrA) and an IS256 insertion upstream of the walKR operon. Conclusions This study provides for the first time a large-scale analysis of within-host genomic changes during invasive S. aureus infection and describes specific patterns of adaptation that will be informative for both understanding S. aureus pathoadaptation and utilising genomics for management of complicated S. aureus infections.