Various studies have reported differences in early visual processing, gain control and integration for patients with schizophrenia spectrum disorders (SSD). However, Oppel – Kundt (OK) illusion is not studied well enough among subjects affected by SSD. We decided to study the illusion to get more insights in visual perception for individuals with SSD.

To investigate the OK illusion manifestation among people with SSD.

In the prospective study were included 15 patients, who were diagnosed with SSD and 15 matched comparison group (CG) without any mental, neurological diseases or visual impairment. OK figures used in the experiments consisted of three white spots presented horizontally against the black background. We used 3 different types of distractor stimuli – either straight one or two-sided line or circle. Using computerized equipment in OK figures the subjects were asked to adjust the unfilled part of the stimulus to be equal in length to the filled (referential) one. ANOVA, T-test and post hoc Bonferroni correction were used for statistical analysis.

People with SSD tended to make bigger mistakes when evaluating OK figures with the statistical difference which was the most eminent for the subgroup of individuals affected by paranoid schizophrenia. The manifestation of the illusion in the SSD group was contrariwise (respectively to zero point) to the CG group.

OK illusion tended to manifest stronger for patients with SSD, this tendency was mostly expressed for the patients diagnosed with paranoid schizophrenia. The manifestation of OK illusion among persons with SSD was diametrically opposite to that seen for the healthy individuals.

No significant relationships.

Background: Copy-number variants (CNVs) of chromosome 15 have been associated with neurodevelopmental disorders like autism spectrum disorders (ASDs) and developmental delay.

We report 6 patients with autistic features and other neurodevelopmental problems carrying CNVs of chromosome 15.

Materials and methods: The probands belong to a group of patients referred to our clinic and laboratory with autism as main feature. A complete clinical evaluation was performed with focus on neurologic, psychiatric, and psychological evaluation with specific autism tests. Array-based comparative genomic hybridization (array-CGH) was performed using 180K platform (Agilent technology).

six patients investigated by array-CGH had a CNV involving chromosome 15. Four of these patients, previously reported by us (ref 1), had small duplications of 15q13.3 involving CHRNA7 and OTUD7A genes. The other two patients had large deletions of 15q21q22 and 15q24, respectively. A deletion of 15q21.2 - q22.2 was detected in one patient. The deleted region contains 62 genes and has been rarely reported in patients with neurodevelopmental disorders. A deletion of 15q24.1 - q24.2 was detected in the other patient. This region is recurrently deleted in developmentally delayed patients (ref 3).

Our data highlight that chromosome 15 is a hub for neurodevelopmental disorder and illustrates the utility of array-CGH in the investigation of patients with autism, specifically in the context of complex phenotypes. Acknowledgment: The research leading to these results has received funding from the EEA Grant 2014-2021, under the project contract No 6/2019. References: Genes (Basel). 2021 Jul 1;12(7):1025. https://www.omim.org/entry/618060 Clinical Genome Resource. https://dosage.clinicalgenome.org/clingen_region.cgi?id=ISCA-46296

No significant relationships.

Social Media (SM) have recently gained substantial popularity among youth. However, the relationship between problematic use of social media (PUSM) and psychopathology in children and adolescents remains unclear.

To study in a population of children and adolescents followed in outpatient psychiatry unit, the prevalence, and psychopathological factors linked to PUSM.

A descriptive study was led among child and adolescent’s psychiatry patients. Parents were asked to provide answers for the Child Behaviour Checklist (CBCL). PUSM was assessed using the Bergen Social Media Addiction Scale (BSMAS). Mental disorders’ related data were extracted from patients’ medical records.

Our study included 76 patients with a mean age of 14.2 ± 2.6 [11,18] years and a sex-ratio of 1. The prevalence of PUSM was estimated at 9.2% in our population according to the conservative approach, rising to 48.7% according to the liberal approach. Anxiety (32.4%) and depressive disorders (24.3%) were most prevalent among patients with PUSM. BSMAS scores were significantly higher among patients with smoking habits (p=0.03). CBCL T-scores interpretation showed internalizing and externalizing disorders among 80.3% and 64.5% patients respectively. BSMAS scores were significantly higher among patients belonging to the clinical range of all the CBCL syndrome scales, except for social problems, and among patients suffering from both internalizing and externalizing disorders (p=0.005).

PUSM was shown to be more prevalent among clinical populations compared to healthy controls. Research has indicated a potential link between PIUSM and psychopathology; however, the significance of the correlation remains unclear.

No significant relationships.

Body image dissatisfaction entails an activity, which is nothing else but an attempt for deliberate regulation of their body. It has different kinds and manifestations. Most researchers focus on such body regulation practices as weight control, muscles build-up, or cosmetic surgery.

Our goal is to work out a psychological hierarchical model of body regulation practices aimed at abating a person’s dissatisfaction with their body image.

Using a method of agglomerative hierarchical clustering, we carried out a multivariate classification of 122 respondents’ answers to the Body Regulation Practices Survey (E. Nikolaev), which allows establishing the frequency of the respondents’ use of each of the 11 variants of body regulation practices offered in the survey.

Based on the results of 11 variables of a dendrogram, we established two data arrays, combining correspondingly 4 and 7 versions of body regulation practices. The first array comprises two pairs of clusters – physiological practices and weight control, as well as practices of personality and spiritual development. We identified it as “developmental body regulation practices”. The second array includes two paired clusters – aesthetic medicine and body modifications; image making and hetero-aggressive practices. Merging with the four practices mentioned above on a higher level of the hierarchy are auto-aggressive and inertial practices. We identified this array as “compensatory – non-adaptive body regulation practices”.

The devised model can become the basis for further advanced research in the area of body regulation in cases of dissatisfaction with body image.

No significant relationships.

Climate change is increasing the frequency and intensity of severe heatwaves, storms, floods, droughts, and wildfires. These events cause widespread economic and social disruption and are undermining population health worldwide. Despite a growing literature on how climate change threatens mental health, its influence on harmful substance use has not been systematically addressed.

We propose an explanatory framework explicating the plausible links between climate change-related stressors and an increase in harmful substance use.

We critically review and synthesise literature documenting the pathways, processes and mechanisms linking climate change to increased substance use vulnerability.

Several plausible pathways link climate change to increased risk of harmful substance use worldwide. These include: (1) anxiety about the impacts of unchecked climate change, (2) destabilisation of psychosocial and economic support systems, (3) increasing rates of mental disorders, and (4) increased physical health burden. Children may face disproportionate risk due to their vulnerability to both mental disorders and substance use, particularly during adolescence. We argue that a developmental life-course perspective situated within a broader ‘systems thinking’ approach provides a coherent framework for understanding how climate change is aggravating the multiple, persistent, interacting risks that influence harmful substance use pathways.

Climate change is already undermining health and wellbeing of global populations. By inference, it is also aggravating pathway to harmful substance use. This is a critical psychosocial problem for individuals and communities alike. Conceptual and methodological work is urgently needed so that effective adaptive and preventive action can be taken.

No significant relationships.

There is paucity of epidemiological studies from the Arab world and most of the focus of available international data is on the early months of the pandemic.

We conducted the first cross-sectional national phone survey of adults in Qatar during the end of the first wave of the pandemic (December 2020 -January 2021) to estimate the prevalence and determinants of depression and/or anxiety.

We used the Physician Health Questionnaire-9 and Generalized Anxiety Disorder-7 with cut-off scores of ≥10; the revised UCLA loneliness scale; and questions related to COVID-19 status, death of family or friend, quarantine, health and changes in living arrangements. Bivariate and logistic regression models estimated associations between thirteen variables and combined depression-anxiety (score of 20 or higher).

The two-week prevalence of depression was 6.5% (95%CI: 5.1-8.4), of anxiety 5.1% (95%CI: 3.8-6.9), but only 2.5% sought mental health professional help since the pandemic started. When including loneliness (OR=1.57, p (<0.001) in the model, the following variables were statistically significantly associated with depression-anxiety: female gender (OR=1.90, p=0.037), Qatari nationality (OR=2.37, p=0.018), Arab ethnicity (OR=3.14, p=0.007), and COVID-19 death of family or friend (OR=3.06, p=0.003). Without adjusting for loneliness, younger age (18-29 versus 40+ years of age: OR=2.9, p=0.004) and chronic health conditions (OR=2.0, p=0.029) were significantly associated with depression-anxiety.

Prevalence of depression and/or anxiety during the end of the first wave of COVID-19 pandemic in Qatar was similar to pre-pandemic estimates. Mental health service should focus on young adults, women, the bereaved, lonely and those with chronic health problems.

No significant relationships.

One of the negative consequences of the COVID-19 pandemic may be an increase in somatization.

identification of implicit characteristics of texts indicating the peculiarities of the opinion about the pandemic by people with high somatization level.

Survey (03/23/2020–01/29/2021, N=1188). Used: SCL-90-R, COPE, Constructive Thinking Inventory (CTI). It was offered to express an opinion on the pandemic. The statements were divided into the two text arrays - “high somatization” and “low somatization” (based on the parameter “somatization” SCL-90R). The frequency of words in these text arrays was estimated (LIWC).

The analysis showed an increase in somatization as the pandemic developed (Std.J-T Statistic=4,327). The relationship between somatization and anxiety, sleep disturbances, and depression was revealed. Higher rates of somatization are associated with a decrease in emotional coping, «global constructive thinking» and «personal superstitious thinking», an increase in «categorical thinking». The connection between somatization and a number of non-constructive copings is shown. Texts associated with high somatization demonstrate higher number of pronouns of the first person (30.77%, 17.19%), a decrease in the tonality of words, a vocabulary (LIWC) of suffering, negative sthenic emotions (1,53%, 0,93%), a decrease in the vocabulary of motivation and resistance (0,93%, 1,49%), a decrease in vocabulary associated with the body (0,20%, 0,32%).

The connection between somatization and high emotional distress, which manifests itself in negative emotional vocabulary and is associated with a low level of emotional coping, is shown. The “representation” of the pandemic, presented in the text, is “divorced” from somatic manifestations, fear of illness and death.

No significant relationships.

In recent years, physical activity as a potential intervention for attention-deficit hyperactivity disorder (ADHD) became into the focus of researchers, however the results are conflicting.

Our aim was to investigate the effect of acute moderate physical activity on executive functions requiring inhibition.

The study included 50 treatment-naïve ADHD children, 50 medicated children with ADHD and 50 typically developing children, aged 6–12 years. To diagnose ADHD, we applied the Mini International Neuropsychiatric Interview for Children and Adolescents. To measure executive functions, the pediatric version of the Test of Attentional Performance (KiTAP) was used. Half of the children in each study group participated in a 20-minute, moderately intense exercise while watching a cartoon video. In the control intervention, the other half of the children from all three study groups watched the same cartoon video in a sitting position for 20 min.

Regarding distractibility, flexibility and inhibition, physical activity had a significant positive effect on two of 10 parameters (number of total errors and errors when distractor was presented, both in the distractibility task) in the treatment-naïve ADHD group.

Our results suggest that moderate acute physical activity has some significant positive effects on certain executive function parameters among children with ADHD. Future studies should consider determining the optimal form, intensity, and duration of physical activity to become a potential adjunctive intervention for children diagnosed with ADHD.

No significant relationships.

Patients with mental disorders mainly schizophrenia represent a vulnerable population. In Covid-19 pandemic situation, could schizophrenia be considered as a significant mortality risk factor ?

In this study, we aimed to explore the odds of significant COVID-19 mortality among schizophrenia patients

Our literature review was based on the PubMed interface and adapted for 2 databases: Science Direct and Google Scholar using the following combination ( schizophrenia [MeSH terms]) AND (COVID-19, mortality[MeSH terms])

Our review included 4 population-based cohort studies covering the period from december 2019 to May 2021. The data showed increased mortality risk among individuals with schizophrenia who have had COVID-19. Indeed, this high rate of mortality maybe associated with multiple factors such as unhealthy lifestyle, low socioeconomic status and comorbidities as obesity, diabetes and cardiovascular conditions. The use of antipsychotics can be considered as a risk factor regarded its immunomodulatory effects. Furthermore, stigma and discrimination towards mental illnesses particularly schizophrenia might have contributed to a worse prognosis.

Schizophrenia is a severe mental disorder ,associated with an increased high risk Covid-19. Thus, this population require enhanced preventive and disease management strategies.

No significant relationships.

In response to COVID-19, paediatric providers have shifted to providing outpatient health care appointments through telehealth.

While research has been published previously on this topic, we felt it important to add current Canadian youth perspectives to the mix, specifically on changes due to COVID-19.

Semi-structured discussions were held on virtual care in June and October 2020 with our youth members, who are patients with various health conditions, aged 13 to 19 years which allowed us to glean their unique opinions regarding virtual care in the midst of a pandemic.

Youth who contributed to this commentary reported that major benefits of virtual care included time savings, ease of access, continuity of care, and ability to participate in health appointments from the comfort of one’s own home without a risk of COVID-19 exposure. These youth also recognized limitations to virtual care, including the inability to complete laboratory or imaging tests, and the lack of physical examination capabilities.

Additionally, they stressed the importance of visual components of virtual appointments and health care providers needing to consider privacy restrictions youth may have. Overall, our cohort of youth feel positive about virtual care and hope care providers can work with youth individually to determine the best solution for them.

No significant relationships.

The WHO would increase diagnosis and treatment of viral hepatitis in the world by 2030, based on the high efficacy of direct-acting-antivirals against HCV, extended vaccination programs in HBC, and epidemiological data. Diagnostic of HCV/HBV infection has been simplified by point-of-care (POC) devices (cheap/easy-to-use/interprete/qick-results), detecting anti-HCV-antibodies or HBV-antigen in capillary blood at the patients´site. The current seroprevalence of viral hepatitis B/C in general population in Spain is 0.5%/1% and would be higher (3-17%) in people with severe-mental-disorder due to risk factors and traditionally less access to health care.

To design a screening protocol for HCV eradication and HBV-detection, and risk factors among severe-mental-disorder patients in a CommunityMentalHealthCenter. To guarantee equal access to viral hepatitis screening and therapy among this population.

Outpatients visited along one-year who accepts participate. Using POC-device for qualitative detection of anti-HCV-antibodies (Quickview-of-Lumiquick-Diagnostics®)/HBsAG (Abbott-Rapid-Diagnostics®). Socio-demographic data; mental disorder(ICD-10); HCV/HBV risk-factors; Neurotoxicity-scale (mood/cognition/sleep/gastrointestinal/sickness/motor); SF-12; Patient-satisfaction. Subjects with positive HCV/HBV POC-test will have a on-site venopuncture to assess hemograme/liver tests, and HCV-RNA (Cobas-TaqMan-RocheDiagnostics)/HBsAg-ELISA (Atellica-Siemens). In positive HCV-RNA (active infection) the psychiatric-team will inform the hepatology-team for non-invasive liver fibrosis assessment and DAA prescription. The patient will receive 8-12-weeks on-site treatment, and assessed (Neurotoxicity/SF-12).HCV cure will be confirmed by HCV-RNA in blood. Chronic-cases will be managed at Hepatology-Unit.

We will present the results of the implementation of the programme and their ability to detect viral-hepatitis-positive cases among patients with severe-mental-disorders and to treat them effectively.

Our results may support the generalisation of the programme in among CMHC’s.

No significant relationships.

No significant relationships.

Alcohol consumption is a risk factor for various comorbidities, such as cirrhosis, chronic sclerosing stomatitis, and neuropsychiatric disorders.

Our study examined the associations between psychological factors and alcohol addiction of the individuals with alcohol use disorder (AUD) in Southern Taiwan.

Demographic information as well as suicidal history and sources of stress were collected from 177 participants. The extent of alcoholism was assessed by AUDIT questionnaire. Demographic and linear regression analyses were performed with the Statistical Software Stata version 12.0 (StataCorp LP, College Station, TX, USA).

Demographic data, suicidal history and the causes of stress of patients divided by AUDIT scores are shown in Table 1. Among 177 participants, 17 (9.6%) had suicidal thoughts, 4 (2.3%) had suicide plan, 22 (12.5%) self-injured, and four-fifth of patients lived under pressure. Patients who self-harmed were with significant lower AUDIT scores of -7.24 (95% CI: -11.49 – -3.00) (Table. 2). The AUDIT scores of patients with physical stress, interpersonal difficulties and loneliness increased significantly by 6.71 (95% CI: 3.19 – 10.30), 6.14 (95% CI: 2.15 – 10.13) and 5.02 (95% CI: 0.93 – 9.11), respectively (Table. 3).

Our findings indicated negative correlation with alcohol use and auto-inflicted injury. However, previous study showed systematic assessment of the association between suicide and AUD, and considered alcohol an important risk factor for suicide, which is related to mental health and affected by different genders and drinking patterns. Our results may provide reference for estimation of the alcohol-related psychological effects in Taiwan.

No significant relationships.

Studing the scope of differences found in terms of gender in First Psychotic Episodes patients, should enhance our understanding of such disorders and improve the therapeutic approaches.

Our main objective was to compare the sociodemographic variables between men and women included in the Early Intervention Program in Psychosis of the Regional University Hospital of Malaga between the years 2016-2020.

Retrospective study in which the characteristics of 135 patients who started the Early Intervention Program in Psychosis of the Regional University Hospital of Malaga between the years 2016-2020 were analyzed. Statistical analysis was performed using SPSS 25.0. For the comparison of variables, Student’s t was used for quantitative variables and Chi square for dichotomous variables.

Patients included in the Program; 32% were women and 68% were men. The average of age at the beginning was 35.56 for women and 28,47 for men. Most of the women were married and most of the men were single. The majority of men lived with their original family and for women with their own family. In relation with the consumption of toxins, alcohol and to smoke, were more frequent in men. More results in poster.

Despite the limitations due to our study design, the results obtained are in agreement with some of the discussions that are currently in force. Given that, female gender is associated with lower risk of psychosis, better premorbid adjustment, lower drug consumption and a later onset of the disease in the first-episode psychosis.

No significant relationships.

Despite numerous studies of the mental health and well-being of the population depending on various factors, insufficient attention is paid to the research of the relationship between well-being and mono- and multilingual regional specifics in multilingual and multicultural Russia.

This study aims to identify a possible relationship between mental well-being in some regions of the Russian Federation and monolingualism and multilingualism inherent in these regions.

The study involved 966 participants (29.5% men and 70.5% women) aged 11 to 80 years (M=24.8; SD=12.19) from six regions of the Russian Federation: Crimea, Adygea, Bashkortostan, Sakha, Tatarstan and Kabardino-Balkarian region. The mental well-being of participants was assessed using the Warwick-Edinburgh Mental Well-being Scale (Tennant et al., 2006; Tennant et al., 2007).

The measures of mental well-being were compared among residents from the regions as following categories: native Russian language speakers in monolingual regions (144 participants); native Russian language speakers in multilingual regions (193 participants); native national language speakers in multilingual regions (325 participants); native Russian and national languages speakers in multilingual regions (304 participants). Using one-way analysis of variance (ANOVA), it was found that there were no significant differences in the assessments of mental well-being (F = 0.852; p = 0.521) among residents from the above categories.

Residents who are native speakers in Russian and national languages and are living in Russia’s regions with monolinguism and multilinguism demonstrate no difference in mental well-being measures. The reported study was funded by the RFBR, project number 17-29-09167.

No significant relationships.

No significant relationships.

Kleptomania is characterized by recurrent failure to resist the impulse to steal items of little value despite the ego-dystonic impulse and awareness of the wrongfulness of the act. Its prevalence is considered to be 0.6–0.8% in the general population and it is mostly comorbid with other psychiatric disorders. Kleptomania is a disabling disorder since patients suffer from emotional distress and impaired functioning.

Although there is no cure, treatment may help prevent Kleptomania worsening and its negative consequences. We propose a review of the therapeutic approach to this disease.

Non-systematic literature review.

No effective treatment is available for Kleptomania. Better efficacy can be achieved by combining psychotherapy with pharmacotherapy. Different treatment interventions can be selected based on clinical similarities to other disorders, co-occurring conditions or behavioral core features. Patients with significant mood symptoms may benefit from mood stabilizers or antidepressants. For patients with shoplift cravings and/or family history of substance use disorders, Naltrexone may reduce symptoms. Stimulants may be useful for Kleptomania bassociated with Attention Deficit Hyperactivity Disorder impulsivity. Benzodiazepines are effective in tension relief when used as adjuvants, at the beginning of treatment. Electroconvulsive therapy should be reserved for patients with treatment-resistant symptoms and comorbid depression. Cognitive-behavioral therapy has replaced Psychoanalytic and Psychodynamic psychotherapies.

Treatment helps decrease disruption to the person’s life, preventing the intense shame, legal, social, family, and occupational repercussions of Kleptomania. Although pharmaceutical and psychosocial interventions are available, we still lack specific treatments for Kleptomania.

No significant relationships.

At Kiskunhalas Semmelweis Hospital, a special mobile container hospital was set up to care for patients infected with SARS-CoV-2 during the first wave of the pandemic.

We aimed to create a proactive integrated mental health protection system for the frontline healthcare workers that provides an opportunity for psychophysiological monitoring of stress and crisis during shifts, as well as providing staff with more lasting methods of coping with difficulties.

From the ascending branch of the second wave, every two weeks on the workers’ rest day, mental helpers initiated a phone call to each employee participating in the program. If it was necessary, we provided psychological counseling, crisis intervention, brief psychotherapy, and psychopharmacotherapy. In addition, self-operated psychophysiological screening devices were used at the frontline work site, which provided an opportunity for continuous telemedicine monitoring.

In our department, three psychologists and three psychiatrists kept in touch with an average of 150 frontline workers per month. Interventions were needed for a total of over 24% in December and January, over 17% in February and March, almost 9% in April, and only 4% in May. Helpers rated an average of two-thirds of these cases as moderate. They faced severe stress 2-3 times a month in sum, and for 2-3 workers needed medication.

Without a mental support system, self-report-based data suggest that nearly half of responders working at the frontline reached the threshold of clinically significant mental syndromes (Greenberg et al, 2021). Using our mental health support system, one-fifth of the workers needed intervention.

No significant relationships.

Recently, several antidepressants, mood stabilizers, and antipsychotics have been suggested to have favorable effects in the treatment of COVID-19.

The aim of this systematic review was to collect evidence from preclinical and clinical studies concerning the scientific evidence for the repurposing of psychotropic drugs in COVID-19 treatment.

Two independent authors searched PubMed-MEDLINE, Scopus, PsycInfo, Clinical Trial Registration Site US (ClinicalTrials.gov) databases, and reviewed the reference lists of articles for eligible articles published up to May 31st, 2021. All preclinical and clinical studies on the effect of any psychotropic drug on Sars-CoV-2 or patients with COVID-19 were included. The Newcastle-Ottawa scale was used for the quality assessment of clinical studies. This systematic review adheres to the PRISMA guidelines.

22 studies were included in the synthesis: 9 clinical studies, 9 preclinical studies, and 4 computational studies. The use of antidepressants, both SSRI and non-SSRI, was associated with a reduced risk of severe complications of COVID-19. Several antipsychotics showed an increased risk for both Sars-CoV-2 infection and severe complications during COVID-19.

The current evidence supports a potential anti-SARS-CoV-2 role for several antidepressants, while the evidence on mood stabilizers or antipsychotics remains controversial. Drug repurposing proved highly successful in response to the current pandemic and psychotropic medications are widely used in clinical practice with well-known safety and tolerability profiles, showing antiviral, immunomodulatory, and anti-inflammatory properties, being perfect candidates for possible treatment of COVID-19. Further research will deliver optimized and specific therapeutic tools that will increase the preparedness of health systems for possible future epidemics.

No significant relationships.

The COVID-19 pandemic seems associated with a worsening in mental health issues as well as a widening of pre-existing social and health inequalities. Assessment of its impact on suicidal behavior might therefore be relevant.

To assess factors associated with suicidal ideation in the general population, using data from the French nationwide Epicov study

In the nationally representative Epicov study, data on occurrence of suicidal ideation from November 2019 to November 2020 were available, including timing with respect to France’s lockdown periods. We studied the incidence of suicidal ideation among participants without a prior history of suicidal behavior, after May 11, 2020, when first COVID-19 related lockdown was suspended. Studied factors assessed sociodemographic and health status, including mental health, as well as COVID-19 related information such as symptom. Associations between selected factors and suicidal ideation were assessed in sex-stratified adjusted logistic regression models.

In the Epicov study, prevalence of suicidal ideation was of 2,9%, as opposed to around 4% pre-pandemic. Among 48 702 female and 41 016 male participants, health or financial issues were associated with a higher incidence of suicidal ideation. Interestingly, Covid19-like symptoms were also associated with higher risk of suicidal ideation. While an impaired mental health has been observed in survivors of past pandemics, given the unprecedented context of the current pandemic, this association needs further investigation.

While the COVID-19 pandemic might have lowered suicidal ideation, it’s aftermaths may reverse the trend. To prevent this rise, identification of vulnerable groups is crucial to promote tailored public health strategies.

No significant relationships.