Factors Affecting the Sense of Coherence (SOC) for Long-term Evacuees after a Large-Scale Disaster in Japan

Disasters has been occurring frequently all over the world, and an increasing number of people have been forced to continue their evacuation life for a long time. In the aftermath of the 2011 Great East Japan Earthquake and the Fukushima nuclear power plant accident in Japan, some people are still unable to return to their homes due to radioactive contamination and are forced to live as evacuees for long periods of time. It is considered a serious public health issue to keep mentality healthy under the stress of living after the disaster. Therefore, the purpose of this study was to examine the factors that affect the sense of coherence (SOC), which is considered as the ability to cope with stress and maintain health, in residents who continue to live as evacuees after a large-scale disaster. The method was a self-administered questionnaire survey of 1,602 long-term evacuees in Japan. Multiple logistic regression analysis was conducted with the high and low SOC score groups as dependent variables in order to identify factors that predicted high and low SOC. The results showed that the SOC tended to decrease in the elderly and those with deteriorating mental health. On the other hand, those who were active in education and hobbies, and those who socialized with their neighbors and friends tended to have the higher SOC. In order to support residents who have been forced to continue living as evacuees for a long period of time, it is important to provide them with psychological and emotional support to prevent them from being emotionally overwhelmed, as well as living environment improvement and economic support. It was suggested that the promotion of resident-led activities that lead to mental relaxation and the introduction of stress reduction methods that can be easily adopted by residents are effective in maintaining mental health.

ICD-11 Posttraumatic Stress Disorder and Complex PTSD Among Hospital Medical Workers in China: Impacts of Wenchuan Earthquake Exposure, Workplaces, and Sociodemographic Factors

BackgroundPrevious studies address posttraumatic stress disorder (PTSD) following disasters as a public health issue. However, few studies investigate the long-term effect of disaster exposure on PTSD among hospital medical workers (HMWs).ObjectivesThis study aimed to study the prevalence of ICD-11 PTSD and complex PTSD (CPTSD) among exposed and non-exposed HMWs 11 years after the Wenchuan earthquake in China, to identify the factors associated with PTSD and CPTSD scores, and to examine the factor structures of PTSD and CPTSD models.MethodsA cross-sectional study was conducted using a self-administered online questionnaire. Two thousand fifty-nine valid samples were collected from four hospitals in 2019. Descriptive statistical analysis, multivariate regression models, and confirmatory factor analysis (CFA) were performed.ResultsThe prevalence of PTSD and CPTSD was 0.58 and 0.34%, respectively. The unexposed group reported higher PTSD and CPTSD scores than the exposed group. The type of workplace and marital status were significantly associated with the PTSD and CPTSD scores of HMWs. The CFA results indicate that both the correlated first-order model and the correlated two-layer model were a good fit to explain the structure of PTSD and CPTSD.ConclusionThese findings suggest that few HMWs who were exposed to the Wenchuan earthquake suffered from PTSD or CPTSD 11 years following the disaster. However, psychological support was still necessary for all HMWs, especially for unmarried HMWs who were Working in smaller hospitals. Further research is required to analyze mental health status using ICD-11 PTSD and CPTSD to provide ongoing evidence to help HWMs cope effectively with the challenges of future disasters.

Application of a Machine Learning Technology in the Definition of Metabolically Healthy and Unhealthy Status: A Retrospective Study of 2567 Subjects Suffering from Obesity with or without Metabolic Syndrome

The key factors playing a role in the pathogenesis of metabolic alterations observed in many patients with obesity have not been fully characterized. Their identification is crucial, and it would represent a fundamental step towards better management of this urgent public health issue. This aim could be accomplished by exploiting the potential of machine learning (ML) technology. In a single-centre study (n = 2567), we used an ML analysis to cluster patients with metabolically healthy (MHO) or metabolically unhealthy (MUO) obesity, based on several clinical and biochemical variables. The first model provided by ML was able to predict the presence/absence of MHO with an accuracy of 66.67% and 72.15%, respectively, and included the following parameters: HOMA-IR, upper body fat/lower body fat, glycosylated haemoglobin, red blood cells, age, alanine aminotransferase, uric acid, white blood cells, insulin-like growth factor 1 (IGF-1) and gamma-glutamyl transferase. For each of these parameters, ML provided threshold values identifying either MUO or MHO. A second model including IGF-1 zSDS, a surrogate marker of IGF-1 normalized by age and sex, was even more accurate with a 71.84% and 72.3% precision, respectively. Our results demonstrated high IGF-1 levels in MHO patients, thus highlighting a possible role of IGF-1 as a novel metabolic health parameter to effectively predict the development of MUO using ML technology.

Chronic loneliness: neurocognitive mechanisms and interventions

Loneliness has been associated with detrimental effects on mental and physical health and is increasingly recognized as a critical public health issue which may be further exacerbated by societal challenges such as increasing urbanization, an aging society as well as the COVID-19 pandemic. We here review recent findings on the neurocognitive mechanisms and brain alterations that underpin social disconnectedness, therapeutic approaches for chronic loneliness and how these lines of research can be integrated to improve the efficacy of loneliness interventions in healthy individuals and patients with mental disorders.

Family caregiver’s loneliness and related health factors: what can be changed?

Background Loneliness is a public health issue which may affect the entire population. Loneliness is associated with depression, sleep disorders, fatigue and increase the risk of obesity and diabetes. Risk factors for loneliness include poor social network and poor physical and mental health. The main objective was to study factors related to loneliness of family caregivers caring for independent older people. Methods We performed a non-interventional observational cross-sectional study in south-eastern France. Family Caregivers caring for people aged 70 and over living at home were included. These older people were independent, without long-term conditions and who applied for professional social assistance for daily living. Data were collected through a questionnaire, administered face-to-face or by telephone. Loneliness and perceived health status were measured through a single-question. Burden was assessed through the Mini-Zarit Scale, frailty was measured through the Gerontopole Frailty Screening Tool. Results Of the 876 caregivers included, 10% felt lonely often or always. They reported more physical and mental health issues than those who did not feel loneliness (p<0.001). Family caregivers with loneliness were more likely to be looking after a parent and were twice as likely to have a moderate to severe burden (OR=2.6). They were more likely to feel anxious (OR=5.6), to have sleep disorders (OR=2.4), to be frail (OR=2) and to feel their health as poor or bad (OR=2). Conclusions Loneliness has a negative impact on health, frailty and burden of family caregivers. Means must be implemented to anticipate the consequences of the loneliness felt by family caregivers, notably by orienting them towards the relevant services.

Attitudes & behaviors toward the management of tobacco smoking patients: qualitative study with French primary care physicians

Background Smoking cessation is a major public health issue. In France, primary care physicians (PCP) are the first contact points for tobacco management. The objective of this study was to understand how PCPs are involved in the management of smoking cessation: ownership, commitment, barriers. Methods A qualitative study was conducted using group and individual semi-structured techniques with PCPs. A thematic analysis of verbatim transcripts was performed to identify concepts and sub-concepts of interest. Saturation was evaluated retrospectively to ensure adequate sample size. Results A sample of 35 PCPs were interviewed, 31 in four focus groups and four in individual interviews. PCPs discussed their roles in the management of tobacco smoking cessation, including the different strategies they are using (e.g., Minimal Intervention Strategy, Motivational Interviewing), the multiple barriers encountered (e.g., lack of time, patients’ resistance to medical advice), the support resources and the treatment and intervention they prescribed (e.g. nicotine replacement therapy, supporting therapist). Conclusions This study provides a better understanding of the beliefs, attitudes, and behaviors of PCPs in managing smoking cessation. Guiding and encouraging patients toward smoking cessation remains a major objective of PCPs. While PCPs reported that progress has been made in recent years in terms of tools, technology and general awareness, they still face major barriers, some of which could be overcome by appropriate training.

Snakebite Associated Thrombotic Microangiopathy and Recommendations for Clinical Practice

Snakebite is a significant and under-resourced global public health issue. Snake venoms cause a variety of potentially fatal clinical toxin syndromes, including venom-induced consumption coagulopathy (VICC) which is associated with major haemorrhage. A subset of patients with VICC develop a thrombotic microangiopathy (TMA). This article reviews recent evidence regarding snakebite-associated TMA and its epidemiology, diagnosis, outcomes, and effectiveness of interventions including antivenom and therapeutic plasma-exchange. Snakebite-associated TMA presents with microangiopathic haemolytic anaemia (evidenced by schistocytes on the blood film), thrombocytopenia in almost all cases, and a spectrum of acute kidney injury (AKI). A proportion of patients require dialysis, most survive and achieve dialysis free survival. There is no evidence that antivenom prevents TMA specifically, but early antivenom remains the mainstay of treatment for snake envenoming. There is no evidence for therapeutic plasma-exchange being effective. We propose diagnostic criteria for snakebite-associated TMA as anaemia with >1.0% schistocytes on blood film examination, together with absolute thrombocytopenia (<150 × 109/L) or a relative decrease in platelet count of >25% from baseline. Patients are at risk of long-term chronic kidney disease and long term follow up is recommended.

Targeted Genome Mining Reveals the Psychrophilic Clostridium estertheticum Complex as a Potential Source for Novel Bacteriocins, Including Cesin A and Estercticin A

Antimicrobial resistance in pathogenic bacteria is considered a major public health issue necessitating the discovery of alternative antimicrobial compounds. In this regard, targeted genome mining in bacteria occupying under-explored ecological niches has the potential to reveal such compounds, including bacteriocins. In this study, we determined the bacteriocin biosynthetic potential of the psychrophilic Clostridium estertheticum complex (CEC) through a combination of genome mining and phenotypic screening assays. The genome mining was performed in 40 CEC genomes using antiSMASH. The production of bacteriocin-like compounds was phenotypically validated through agar well (primary screening) and disk diffusion (secondary screening) assays using cell free supernatants (CFS) and partially purified extracts, respectively. Stability of four selected CFS against proteolytic enzymes, temperature and pH was determined while one CFS was analyzed by HRMS and MS/MS to identify potential bacteriocins. Twenty novel bacteriocin biosynthetic gene clusters (BBGC), which were classified into eight (six lantibiotics and two sactipeptides) distinct groups, were discovered in 18 genomes belonging to C. estertheticum (n = 12), C. tagluense (n = 3) and genomospecies2 (n = 3). Primary screening linked six BBGC with narrow antimicrobial activity against closely related clostridia species. All four preselected CFS retained activity after exposure to different proteolytic, temperature and pH conditions. Secondary screening linked BBGC1 and BBGC7 encoding a lantibiotic and sactipeptide, respectively, with activity against Bacillus cereus while lantibiotic-encoding BBGC2 and BBGC3 were linked with activity against B. cereus, Staphylococcus aureus (methicillin-resistant), Escherichia coli and Pseudomonas aeruginosa. MS/MS analysis revealed that C. estertheticum CF004 produces cesin A, a short natural variant of nisin, and HRMS indicated the production of a novel sactipeptide named estercticin A. Therefore, we have shown the CEC, in particular C. estertheticum, is a source of novel and stable bacteriocins that have activities against clinically relevant pathogens.

The global epidemiology of chikungunya from 1999 to 2020: A systematic literature review to inform the development and introduction of vaccines

Chikungunya fever is an acute febrile illness that is often associated with severe polyarthralgia in humans. The disease is caused by chikungunya virus (CHIKV), a mosquito-borne alphavirus. Since its reemergence in 2004, the virus has spread throughout the tropical world and several subtropical areas affecting millions of people to become a global public health issue. Given the significant disease burden, there is a need for medical countermeasures and several vaccine candidates are in clinical development. To characterize the global epidemiology of chikungunya and inform vaccine development, we undertook a systematic literature review in MEDLINE and additional public domain sources published up to June 13, 2020 and assessed epidemiological trends from 1999 to 2020. Observational studies addressing CHIKV epidemiology were included and studies not reporting primary data were excluded. Only descriptive analyses were conducted. Of 3,883 relevant sources identified, 371 were eligible for inclusion. 46% of the included studies were published after 2016. Ninety-seven outbreak reports from 45 countries and 50 seroprevalence studies from 31 countries were retrieved, including from Africa, Asia, Oceania, the Americas, and Europe. Several countries reported multiple outbreaks, but these were sporadic and unpredictable. Substantial gaps in epidemiological knowledge were identified, specifically granular data on disease incidence and age-specific infection rates. The retrieved studies revealed a diversity of methodologies and study designs, reflecting a lack of standardized procedures used to characterize this disease. Nevertheless, available epidemiological data emphasized the challenges to conduct vaccine efficacy trials due to disease unpredictability. A better understanding of chikungunya disease dynamics with appropriate granularity and better insights into the duration of long-term population immunity is critical to assist in the planning and success of vaccine development efforts pre and post licensure.

Understanding the Experience of Service Users in an Integrated Care Programme for Obesity and Mental Health: A Qualitative Investigation of Total Wellbeing Luton

Obesity is a complex public health issue with multiple contributing factors. The emphasis on joined care has led to the development and implementation of a number of integrated care interventions targeting obesity and mental health. The purpose of this study was to examine user experience in an integrated care programme for obesity and mental health in Luton, UK. Semi-structured interviews were conducted with a purposeful sample of service users (N = 14). Interview transcripts were analysed using thematic analysis. Analysis of the interviews identified six main themes for understanding service users’ experiences of integrated care: (1) ‘A user-centered system’, (2) ‘Supports behaviour change’, (3) ‘Valued social support’, (4) ‘Communication is key’, (5) ‘Flexible referral process’, and (6) ‘Positive impact on life’. These themes describe how the service is operated, evidence perceived value service users place on social support in behavior change intervention, and address which service areas work well and which require improvement. The findings of these interviews have offered a significant contribution to understanding what service users value the most in an integrated healthcare setting. Service users value ongoing support and being listened to by healthcare professionals, as well as the camaraderie and knowledge acquisition to support their own behaviour change and promote self-regulation following their participation in the programme.