Monitoring Adverse Psychosocial Outcomes One and Two Years After the Lac-Mégantic Train Derailment Tragedy (Eastern Townships, Quebec, Canada)

AbstractIntroduction:In July 2013, a train carrying 72 cars of crude oil derailed in the town of Lac-Mégantic (Eastern Townships, Quebec, Canada). This disaster provoked a major conflagration, explosions, 47 deaths, the destruction of 44 buildings, the evacuation of one-third of the local population, and an unparalleled oil spill. Notwithstanding the environmental impact, many citizens of this town and in surrounding areas have suffered and continue to suffer substantial losses as a direct consequence of this catastrophe.Problem:To tailor public health interventions and to meet the psychosocial needs of the community, the Public Health Department of Eastern Townships has undertaken repeated surveys to monitor health and well-being over time. This study focuses on negative psychosocial outcomes one and two years after the tragedy.Methods:Two cross-sectional surveys (2014 and 2015) were conducted among large random samples of adults in Lac-Mégantic and surrounding areas (2014: n = 811; 2015: n = 800), and elsewhere in the region (2014: n = 7,926; 2015: n = 800). A wide range of psychosocial outcomes was assessed (ie, daily stress, main source of stress, sense of insecurity, psychological distress, excessive drinking, anxiety or mood disorders, psychosocial services use, anxiolytic drug use, gambling habits, and posttraumatic stress symptoms [PSS]). Exposure to the tragedy was assessed using residential location (ie, six-digit postal code) and intensity of exposure (ie, intense, moderate, or low exposure; from nine items capturing human, material, or subjective losses). Relationships between such exposures and adverse psychosocial outcomes were examined using chi-squares and t-tests. Distribution of outcomes was also examined over time.Results:One year after the disaster, an important proportion of participants reported human, material, and subjective losses (64%, 23%, and 54%, respectively), whereas 17% of people experienced intense exposure. Participants from Lac-Mégantic, particularly those intensely exposed, were much more likely to report psychological distress, depressive episode, anxiety disorders, and anxiolytic drug use, relative to less-exposed ones. In 2015, 67% of the Lac-Mégantic participants (76% of intensely exposed) reported moderate to severe PSS. Surprisingly, the use of psychosocial services in Lac-Mégantic declined by 41% from 2014 to 2015.Conclusion:The psychosocial burden in the aftermath of the Lac-Mégantic tragedy is substantial and persistent. Public health organizations responding to large-scaling disasters should monitor long-term psychosocial consequences and advocate for community-based psychosocial support in order to help citizens in their recovery process.

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Marked increases in psychopathology found in a 30-year cohort comparison of suicide attempters

Psychological Medicine ◽

10.1017/s0033291703001867 ◽

2004 ◽

Vol 34 (5) ◽

pp. 833-841 ◽

Cited By ~ 14

Author(s):

G. R. HENRIQUES ◽

G. K. BROWN ◽

M. S. BERK ◽

A. T. BECK

Keyword(s):

Public Health ◽

Drug Use ◽

Illicit Drug ◽

Suicide Attempts ◽

Epidemiological Studies ◽

Suicide Attempters ◽

Suicide Intent ◽

History Of ◽

Major Variable ◽

Over Time

Background. Although several epidemiological studies have found increases in the percentages of people who have made a suicide attempt, few cohort comparisons have been conducted to determine changes within this population over time. The purpose of this investigation was to determine if there have been changes in the clinical profile of suicide attempters in recent decades.Method. Comparisons between a sample of 258 suicide attempters evaluated between 1970 and 1973 and a second sample of 179 suicide attempters evaluated between 1999 and 2002 were made on depression, hopelessness, suicide intent, drug use, history of suicide attempts and subsequent suicide attempts.Results. Present-day suicide attempters were found to exhibit greater levels of depression (p=0·031), hopelessness (p=0·008), suicide intent (p<0·001), and had much higher rates of illicit drug use (p<0·001). Almost twice as many of the present-day suicide attempters had histories of four or more suicide attempts (p<0·001), and the present-day suicide attempters made subsequent suicide attempts at close to four times the rate in the year following the index attempt (p<0·001).Conclusions. The present-day suicide attempters exhibited greater levels of psychopathology on every major variable assessed. Replication is necessary and public health implications are discussed.

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The relationship among psychological distress, employment, and drug use over time in a sample of female welfare recipients

Journal of Community Psychology ◽

10.1002/jcop.10052 ◽

2003 ◽

Vol 31 (3) ◽

pp. 223-234 ◽

Cited By ~ 12

Author(s):

John S. Atkinson ◽

Isaac D. Montoya ◽

Donna D. Whitsett ◽

David C. Bell ◽

Carl W. Nagy

Keyword(s):

Psychological Distress ◽

Drug Use ◽

Welfare Recipients ◽

The Relationship ◽

Over Time

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Alcohol consumption trajectories and self-rated health: findings from the Stockholm Public Health Cohort

BMJ Open ◽

10.1136/bmjopen-2018-028878 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028878 ◽

Cited By ~ 1

Author(s):

Katalin Gémes ◽

Jette Moeller ◽

Karin Engström ◽

Anna Sidorchuk

Keyword(s):

Public Health ◽

Psychological Distress ◽

Alcohol Consumption ◽

General Health Questionnaire ◽

Lifestyle Factors ◽

Moderate Drinking ◽

Self Rated Health ◽

Life Course Approach ◽

Longstanding Illness ◽

Over Time

ObjectiveTo investigate whether poor self-rated health and psychological distress are differentially associated with drinking trajectories over time.MethodsFrom the Stockholm Public Health Cohort, two subcohorts surveyed in 2002–2010–2014 and 2006–2010–2014 (n=23 794 and n=34 667 at baseline, respectively) were used. Alcohol consumption, self-rated health, psychological distress (measured by General Health Questionnaire-12), lifestyle factors and longstanding illness were assessed by questionnaires. Demographic and socioeconomic variables were obtained by register linkage. Logistic regression was fitted to assess the associations with eight alcohol consumption trajectories, which were constructed among 30 228 individuals (13 898 and 16 330 from the 2002 and 2006 subcohorts, respectively) with measures of consumption at three time points.ResultsCompared with stable moderate drinkers, all other trajectories were associated with poor self-rated health with multiadjusted OR for stable non-drinkers of 2.35 (95% CIs 1.86 to 2.97), unstable non-drinkers (OR=2.58, 95% CI 1.54 to 3.32), former drinkers (OR=2.81, 95% CI 2.31 to 3.41) and stable heavy drinkers (OR=2.16, 95% CI 1.47 to 3.20). The associations were not fully explained by sociodemographic and lifestyle factors and longstanding illness. Former drinking, but no other trajectories, was associated with psychological distress (OR=1.24; 95% CI 1.10 to 1.41).ConclusionWe found a U-shape association between alcohol trajectories and self-rated health, but not with psychological distress. Compared with stable moderate drinking, former drinking was associated with the highest odds of both poor self-rated health and psychological distress. The study confirms the importance of a life-course approach to examining the effect of alcohol consumption on health and highlights the poorer general and mental health status of non-drinkers who were former drinkers.

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Predictors of historical change in drug treatment coverage among people who inject drugs in 90 large metropolitan areas in the USA, 1993–2007

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-019-0235-0 ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Barbara Tempalski ◽

Leslie D. Williams ◽

Brooke S. West ◽

Hannah L. F. Cooper ◽

Stephanie Beane ◽

...

Keyword(s):

Public Health ◽

Drug Treatment ◽

Resource Availability ◽

People Who Inject Drugs ◽

Census Data ◽

Poverty Rate ◽

Community Action ◽

Historical Change ◽

Treatment Coverage ◽

Over Time

Abstract Background Adequate access to effective treatment and medication assisted therapies for opioid dependence has led to improved antiretroviral therapy adherence and decreases in morbidity among people who inject drugs (PWID), and can also address a broad range of social and public health problems. However, even with the success of syringe service programs and opioid substitution programs in European countries (and others) the US remains historically low in terms of coverage and access with regard to these programs. This manuscript investigates predictors of historical change in drug treatment coverage for PWID in 90 US metropolitan statistical areas (MSAs) during 1993–2007, a period in which, overall coverage did not change. Methods Drug treatment coverage was measured as the number of PWID in drug treatment, as calculated by treatment entry and census data, divided by numbers of PWID in each MSA. Variables suggested by the Theory of Community Action (i.e., need, resource availability, institutional opposition, organized support, and service symbiosis) were analyzed using mixed-effects multivariate models within dependent variables lagged in time to study predictors of later change in coverage. Results Mean coverage was low in 1993 (6.7%; SD 3.7), and did not increase by 2007 (6.4%; SD 4.5). Multivariate results indicate that increases in baseline unemployment rate (β = 0.312; pseudo-p < 0.0002) predict significantly higher treatment coverage; baseline poverty rate (β = − 0.486; pseudo-p < 0.0001), and baseline size of public health and social work workforce (β = 0.425; pseudo-p < 0.0001) were predictors of later mean coverage levels, and baseline HIV prevalence among PWID predicted variation in treatment coverage trajectories over time (baseline HIV * Time: β = 0.039; pseudo-p < 0.001). Finally, increases in black/white poverty disparity from baseline predicted significantly higher treatment coverage in MSAs (β = 1.269; pseudo-p < 0.0001). Conclusions While harm reduction programs have historically been contested and difficult to implement in many US communities, and despite efforts to increase treatment coverage for PWID, coverage has not increased. Contrary to our hypothesis, epidemiologic need, seems not to be associated with change in treatment coverage over time. Resource availability and institutional opposition are important predictors of change over time in coverage. These findings suggest that new ways have to be found to increase drug treatment coverage in spite of economic changes and belt-tightening policy changes that will make this difficult.

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Increasing Voluntary Public Health Reporting to the NHSN Antimicrobial Use Option

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.877 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s296-s297

Author(s):

Heather Dubendris ◽

Amy Webb ◽

Melinda Neuhauser ◽

Arjun Srinivasan ◽

Wendy Wise ◽

...

Keyword(s):

Public Health ◽

Antimicrobial Stewardship ◽

Self Report ◽

Antimicrobial Use ◽

Health Departments ◽

Public Health Reporting ◽

Use Stage ◽

Education And Development ◽

Health Registry ◽

Over Time

Background: The CDC NHSN launched the Antimicrobial Use Option in 2011. The Antimicrobial Use Option allows users to implement risk-adjusted antimicrobial use benchmarking within- and between- facilities using the standardized antimicrobial administration ratio (SAAR) and to evaluate use over time. The SAAR can be used for public health surveillance and to guide an organization’s stewardship or quality improvement efforts. Methods: Antimicrobial Use Option enrollment grew through partner engagement, targeted education, and development of data benchmarking. We analyze enrollment over time and discuss key drivers of participation. Results: Initial 2011 Antimicrobial Use Option enrollment efforts awarded grant Funding: to 4 health departments. These health departments partnered with hospitals, which encouraged vendors to build infrastructure for electronic antimicrobial use reporting. CDC supported vendors through outreach and education. In 2012, with CDC support, Veterans’ Affairs (VA) Informatics, Decision-Enhancement, and Analytic Sciences Center and partners began implementation of Antimicrobial Use Option reporting and validation of submitted data. These early efforts led to enrollment of 64 facilities by 2014 (Fig. 1). As awareness of the antimicrobial use option grew, we focused on facility engagement and development of benchmark metrics. A second round of grant Funding: in 2015 supported submission to the Antimicrobial Use Option from additional facilities by Funding: a vendor, a healthcare system, and an antimicrobial stewardship network. In 2015, CMS recognized the Antimicrobial Use Option as a choice for public health registry reporting under Meaningful Use Stage 3, resulting in an increase in participating hospitals. Antimicrobial Use Option enrollment increased in 2015 (n = 120), coinciding with national prioritization of antimicrobial stewardship. In 2016, the SAAR, was released in NHSN. We leveraged the SAAR to encourage participation from additional facilities and began quarterly calls to encourage continued participation from existing users. In 2016, the Department of Defense began submitting data to the Antimicrobial Use Option, resulting in 207 facilities enrolled in 2016, which grew to 616 in 2017. As of November 2019, 12 vendors self-report submission capabilities and 1,470 facilities, of ~6,800 active NHSN participants, are enrolled in the Antimicrobial Use Option. Two states have passed requirements regulating Antimicrobial Use Option reporting with Tennessee’s requirement going into effect in 2021. Conclusions: The Antimicrobial Use Option offers evidence that collaboration with partners, and leveraging of benchmarking metrics available to a national surveillance system can lead to increased voluntary participation in surveillance of high-priority public health data. Moving forward, we will continue expanding analytic capabilities and partner engagement.Funding: NoneDisclosures: None

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Health Disparities and the Law: Wrongs in Search of a Right

American Journal of Law & Medicine ◽

10.1017/s0098858800002884 ◽

2003 ◽

Vol 29 (2-3) ◽

pp. 363-380

Author(s):

Mary Anne Bobinski

Keyword(s):

Public Health ◽

Health Planning ◽

Healthy People ◽

Public Action ◽

Traditional Health ◽

Obesity And Diabetes ◽

Wide Range ◽

State Coercion ◽

Healthy People 2010 ◽

Over Time

Healthy People 2010 provides our Nation with the wide range of public health opportunities that exist in the first decade of the 21st century. With 467 objectives in 28 focus areas, Healthy People 2010 will be a tremendously valuable asset … . Healthy People 2010 reflects the very best in public health planning—it is comprehensive, it was created by a broad coalition of experts from many sectors, it has been designed to measure progress over time, and, most important, it clearly lays out a series of objectives to bring better health to all people in this country.The current responses to the traditional health perils … have been weakened. At the same time, it seems to this outsider as though the entire public health establishment is united around the proposition that massive public action should be taken to deal with the new “epidemics,” such as obesity and diabetes … . But the use of the term “epidemic” is just the wrong way to think about this issue. There are no noncommunicable epidemics … . Yet the designation [of] obesity as a public health epidemic is designed to signal that state coercion is appropriate … .

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SARS-CoV-2 shifting transmission dynamics and hidden reservoirs potentially limit efficacy of public health interventions in Italy

Communications Biology ◽

10.1038/s42003-021-02025-0 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Marta Giovanetti ◽

Eleonora Cella ◽

Francesca Benedetti ◽

Brittany Rife Magalis ◽

Vagner Fonseca ◽

...

Keyword(s):

Public Health ◽

Epidemiological Data ◽

Health Interventions ◽

Transmission Dynamics ◽

Public Health Interventions ◽

Viral Spread ◽

Three Phase ◽

Phylodynamic Analysis ◽

Epidemic Wave ◽

Over Time

AbstractWe investigated SARS-CoV-2 transmission dynamics in Italy, one of the countries hit hardest by the pandemic, using phylodynamic analysis of viral genetic and epidemiological data. We observed the co-circulation of multiple SARS-CoV-2 lineages over time, which were linked to multiple importations and characterized by large transmission clusters concomitant with a high number of infections. Subsequent implementation of a three-phase nationwide lockdown strategy greatly reduced infection numbers and hospitalizations. Yet we present evidence of sustained viral spread among sporadic clusters acting as “hidden reservoirs” during summer 2020. Mathematical modelling shows that increased mobility among residents eventually catalyzed the coalescence of such clusters, thus driving up the number of infections and initiating a new epidemic wave. Our results suggest that the efficacy of public health interventions is, ultimately, limited by the size and structure of epidemic reservoirs, which may warrant prioritization during vaccine deployment.

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Multiple Outbreaks of Gastroenteritis That Were Associated with 16 Funerals and a Unique Caterer and Spanned 6 Days, 2011, Québec, Canada

Journal of Food Protection ◽

10.4315/0362-028x.jfp-13-079 ◽

2013 ◽

Vol 76 (9) ◽

pp. 1582-1589 ◽

Cited By ~ 4

Author(s):

COLETTE GAULIN ◽

SOULYVANE NGUON ◽

MARIE-ANDREE LEBLANC ◽

DANIELLE RAMSAY ◽

SOPHIE ROY

Keyword(s):

Public Health ◽

Food Samples ◽

Viral Gastroenteritis ◽

Epidemiological Investigation ◽

Food Handlers ◽

Duration Of Symptoms ◽

Causative Agents ◽

Stool Samples ◽

The Mean ◽

Over Time

In January 2011, multiple acute gastroenteritis outbreaks that spanned many days and were related to attendance at funerals were reported to public health units in Quebec. An epidemiological investigation was initiated to identify the source of the contamination and to explain the extent of the contamination over time. Thirty-one cohorts of individuals attended different funerals held between 14 and 19 January. All attendees were served a cold buffet made by the same caterer. Of these 31 cohorts, 16 (with a total of about 800 people) contained individuals who reported being ill after the funeral. Symptoms were mainly diarrhea (89 to 94% of individuals), vomiting (63 to 90%,) and fever (26 to 39%), with a median incubation period of 29 to 33 h and a median duration of symptoms of 24 to 33 h, suggesting norovirus-like infection. Among the 16 cohorts, 3 were selected for cohort studies. Among those three cohorts, the mean illness rate was 68%. Associations were found between those who fell ill and those who had consumed pasta salad (relative risk [RR] = 2.4; P = 0.0022) and ham sandwiches (RR = 1.8; P = 0.0096). No food handlers reported being sick. No stool samples were provided by individuals who became ill. Environmental and food samples were all negative for causative agents. Although the causative agent was not clearly identified, this investigation raised many concerns about the importance of preventing foodborne transmission of viral gastroenteritis and generated some recommendations for management of similar outbreaks.

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Increases in Risky Drinking During the COVID-19 Pandemic Assessed via Longitudinal Cohort Design: Associations With Racial Tensions, Financial Distress, Psychological Distress and Virus-Related Fears

Alcohol and Alcoholism ◽

10.1093/alcalc/agab019 ◽

2021 ◽

Author(s):

William V Lechner ◽

Natasha K Sidhu ◽

Jackson T Jin ◽

Ahmad A Kittaneh ◽

Kimberly R Laurene ◽

...

Keyword(s):

Psychological Distress ◽

High Risk ◽

Alcohol Use ◽

Financial Distress ◽

Daily Life ◽

Drinking Patterns ◽

Risky Drinking ◽

Factors Associated ◽

High Risk Drinking ◽

Over Time

Abstract Background The COVID-19 pandemic has created disruptions to daily life resulting in wide-spread unemployment and psychological distress. Recent studies have reported high rates of alcohol use during this time; however, longitudinal data remain scarce and factors associated with increases in high-risk drinking observed over time are unknown. Aims The current study examined changes in high-risk drinking patterns across four 7-day observation periods, prior to and following a university wide campus closure. Additionally, factors associated with changes in alcohol use patterns were examined including financial distress, psychological distress, impact of racial tensions and virus-related fears. Method Students (N = 1001) in the Midwestern USA completed repeated assessments between March and June 2020. Each survey included a timeline follow-back measure of alcohol use. Pandemic-related distress spanning several factors was assessed at the final follow-up. Results Risky drinking patterns increased significantly over time. Overall, psychological distress and impact of racial tensions were associated with higher rates of risky drinking, whereas COVID-19-related fears were associated with lower rates. However, only financial-related distress was associated with an increase in risky drinking patterns over time. Conclusions Increased risky drinking patterns observed in the current study may signal problems that are likely to persist even after the direct impact of the COVID-19 pandemic on daily life ends. Individuals experiencing financial distress may represent a particularly high-risk group. Interventions targeting the cross-section of job loss, financial stress and problematic alcohol use will be important to identify.

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Comorbidity and COVID-19: Investigating the Relationship between Medical and Psychological Well-being

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2021.37 ◽

2021 ◽

pp. 1-22

Author(s):

Owen Stafford ◽

Anna Berry ◽

Laura K. Taylor ◽

Sinead Wearen ◽

Cian Prendergast ◽

...

Keyword(s):

Public Health ◽

Psychological Distress ◽

Vulnerable Populations ◽

Illness Perceptions ◽

Medical Condition ◽

Well Being ◽

Control Group ◽

Medical Conditions ◽

Significant Difference ◽

The Relationship

Abstract Objective: The unprecedented occurrence of a global pandemic is accompanied by both physical and psychological burdens that may impair quality of life. Research relating to COVID-19 aims to determine the effects of the pandemic on vulnerable populations who are at high risk of developing negative health or psychosocial outcomes. Having an ongoing medical condition during a pandemic may lead to greater psychological distress. Increased psychological distress may be due to preventative public health measures (e.g. lockdown), having an ongoing medical condition, or a combination of these factors. Methods: This study analyses data from an online cross-sectional national survey of adults in Ireland and investigates the relationship between comorbidity and psychological distress. Those with a medical condition (n128) were compared to a control group without a medical condition (n128) and matched according to age, gender, annual income, education, and work status during COVID-19. Participants and data were obtained during the first public lockdown in Ireland (27.03.202008.06.2020). Results: Individuals with existing medical conditions reported significantly higher levels of anxiety (p<.01) and felt less gratitude (p.001). Exploratory analysis indicates that anxiety levels were significantly associated with illness perceptions specific to COVID-19. Post-hoc analysis reveal no significant difference between the number of comorbidities and condition type (e.g. respiratory disorders). Conclusion: This research supports individualised supports for people with ongoing medical conditions through the COVID-19 pandemic, and has implications for the consideration of follow-up care specifically for mental health. Findings may also inform future public health policies and post-vaccine support strategies for vulnerable populations.

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