Early screening spots emergency workers at greater risk of mental illness

Ambulance

Study offers new direction for preventative interventions to increase mental resilience to stress and trauma

Emergency services workers who are more likely to suffer episodes of mental ill health later in their careers can be spotted in the first week of training. That’s the conclusion of a Wellcome Trust funded study carried out with trainee paramedics.

Researchers from the University of Oxford and King’s College London wanted to see if they could identify risk factors that made people more likely to suffer post-traumatic stress (PTSD) or major depression (MD) when working in emergency services. Their results are published in the journal Psychological Medicine.

Dr Jennifer Wild from the University of Oxford explained: ‘Emergency workers are regularly exposed to stressful and traumatic situations and some of them will experience periods of mental illness. Some of the factors that make that more likely can be changed through resilience training, reducing the risk of PTSD and depression. We wanted to test whether we could identify such risk factors, making it possible to spot people at higher risk early in their training and to develop interventions that target these risk factors to strengthen their resilience.’

The researchers followed a group of around 400 new ambulance staff through the first two years of their three-year training period. During the initial six-week classroom phase of the training, the students were given a number of assessments to establish their thinking styles, coping behaviour, psychiatric history and personality traits.

Follow up sessions were carried out every four months for the next two years to see if any of the participants had had PTSD or depression. After two years, a final assessment looked at quality of life, as well as smoking, alcohol and drug use, days off work, weight change, burnout and insomnia.

Professor Anke Ehlers said: ‘While just under one in five experienced PTSD or depression in the two years, most got better by the next four-month follow-up.

‘However, there were still lasting effects. Those who had reported mental ill health were more likely to have sleep problems at 2 years. They were also more likely to have days off work. Paramedics who developed an episode of PTSD were also more likely to report gaining weight and smoking.’

The team found that even accounting for past psychiatric history, people were more likely to experience PTSD and depression if they had lower perceived resilience to trauma, or if they dwelled on stressful events from the past before they started their training.   Significantly, the number of traumatic incidents they experienced could not be used to predict PTSD but was relevant to predicting MD, suggesting a cumulative risk of different exposures to trauma for depression.

Dr Wild said: ‘This is not about screening out particular people in training. Early assessment means that those who are more at risk can be offered training to improve their resilience to stressful and traumatic experiences. That has the potential to reduce episodes of PTSD and major depression and improve the long term health of a valued and essential workforce.’

The full paper has been published Open Access in Psychological Medicine, ‘A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression’ by  J. Wild et al. can be viewed here free of charge.

Source: Early screening spots emergency workers at greater risk of mental illness- University of Oxford/News

Announcing the publication of the first papers in GHEG

GHG blog image - cover
We are delighted to announce the publication of the first papers in Global Health, Epidemiology and Genomics. As GHEG is fully Open Access, these papers, and all papers published in the future, are freely accessible online. Here we provide a brief summary of our first three publications.

 A forum for global population health, technological advances and implementation science
 Manjinder Sandhu

A welcome editorial by our Editor in Chief, marking the launch of Global Health, Epidemiology and Genomics. Dr Sandhu highlights the strengths of the broad interdisciplinary scope of the journal and its international editorial board and invites the global health community to engage and contribute to the journal so that it becomes a valuable, practical and informative resource.
Read the full article here

 

favicon Study Profile: The Durban Diabetes Study (DDS): a platform for chronic disease research
 Thomas Hird et al.

A study profile of The Durban Diabetes Study (DDS), an on-going population-based cross-sectional survey of an urban black population in Durban, South Africa. The DDS was established to investigate a broad range of lifestyle, medical and genetic factors and their association with diabetes. It provides a rich platform for investigating the distribution, interrelation and aetiology of other chronic diseases and their risk factors, which can be utilised for other research studies.
Read the full article here

 

Favicon long Capitalizing on Natural Experiments in Low- to Middle- Income Countries to Explore Epigenetic Contributions to Disease Risk in Migrant Populations
 J. Jaime Miranda et al.

 

A commentary on the value of epigenetics as a tool for understanding differential disease risk in migrant populations. The authors highlight the merit of exploring migrant chronic disease risk in low- to middle-income countries, particularly in the context of rural-to-urban migration, with increasing urbanisation in this setting.
Read the full article here
More articles will be published in the coming weeks, and you can be notified when new articles are published by signing up to content alerts here. Here’s a preview of what’s coming soon:

  • H3Africa Multi-Centre Study of the Prevalence and Environmental and Genetic Determinants of Type 2 Diabetes in Sub-Saharan Africa: Study Protocol
    Kenneth Ekoru et al.
  • Regulatory Developments in the Conduct of Clinical Trials in India
    Dhvani Mehta and Ranjit Roy Chaudhury

GHEG accepts original research articles, brief reports, structured reviews and commentaries as well as protocols, research resources and analysis. We are waiving the Article Processing Charge for all articles submitted to GHEG before the end of 2016. We invite contributions from a range of disciplines:
Epidemiology, Clinical trials, Genetics, Observational studies, Qualitative studies, Anthropological studies, Social science, Community intervention, Health systems, Health services, Population genetics, Population history.
For further information on the journal and how to submit please visit our website. Or if you wish to submit your manuscript directly please visit: http://mc.manuscriptcentral.com/gheg.

Cambridge launch new open access journal – Global Health, Epidemiology and Genomics

GHG blog image - cover

Cambridge unveils new Open Access journal – Global Health, Epidemiology and Genomics (GHEG)

Cambridge University Press is delighted to announce a major new open access journal, Global Health, Epidemiology and Genomics (GHEG), dedicated to publishing and disseminating research that addresses and increases understanding of global and population health issues through the application of population science, genomics and applied technologies.

Global Health, Epidemiology and Genomics is the Press’s second Open Access journal in the field of global health, joining Global Mental Health which launched in 2014. Spanning both non-communicable and communicable diseases, GHEG will specifically integrate epidemiology, genomics and related technological advances in the global health context. Topics relevant to GHEG will include studies, methods and resources relating to global population health, disease aetiology, variation in disease susceptibility, drug resistance and surveillance, health care and health care systems, pharmacogenomics and stratified medicine, as well as the challenges of implementing new developments into clinical practice and the community, globally. In addition to more traditional Original Research and Review Articles, GHEG will support submission of Resources and Analyses that provide a framework for integrating and facilitating genomics and global health studies.

The Editor-in-Chief of GHEG is Dr Manjinder Sandhu, head of the Global Health Group based at the University of Cambridge and the Wellcome Trust Sanger Institute. The international Editorial team includes recognised leaders in global health, epidemiology and genomics from around the world who have taken a lead in shifting attention and action to global health and populations, as well as a wider Editorial Board that will reflect and emphasize the broad scope of the field.

Dr Sandhu said, “I am committed to making GHEG an innovative, engaging and practical resource for the global health research community through which we can publish new scientific research, exchange ideas within and across our related disciplines and share resources to facilitate efforts to increase our understanding of human health and shape effective disease management worldwide.”

Professor Alex Brown, Deputy Director of the South Australia Health & Medical Research Institute (SAHMRI) and one of the journal’s Associate Editors commented, “I am delighted to be involved with GHEG, an exciting venture which recognises the relevance and importance of the work being undertaken in the field of global health, epidemiology and genomics and the widespread benefits to be gained by applying technological advances and innovations to research into population health including within disadvantaged population groups. By facilitating discussion and encouraging the sharing of resources GHEG looks to actively support contributions in these areas.”

Katy Christomanou, Publishing Director for STM Journals at Cambridge University Press, added, “This launch affirms our long-term commitment in the global health field and reflects our strong investment in maintaining and extending our successful presence in this area. We are highly enthusiastic at the prospect of working alongside such an outstanding editorial team.”

Global Health, Epidemiology and Genomics will be hosted on Cambridge’s industry-leading platform, Cambridge Journals Online (CJO). The Journal will benefit from a range of the latest author services including article level usage metrics and Altmetric data. In addition, for articles submitted during 2015 and 2016, Cambridge University Press will waive all article processing charges.

For more information please visit the journal website: journals.cambridge.org/gheg

 

Pregnant women lack guidance on iodine intake levels


Pregnant women are not getting enough information about the need to include iodine in their diets, despite high awareness of general advice for pregnancy nutrition.

While 96% of pregnant women surveyed by researchers were aware of general nutritional recommendations for pregnant women, only 12% were aware of iodine-specific advice.

The study, published in the British Journal of Nutrition, estimated the median intake of iodine during pregnancy was 190 micrograms (ug) per day, with 74% consuming less than the World Health Organisation (WHO) recommended intake of 250ug daily.

Iodine is required for the production of thyroid hormones, which are crucial for fetal development with links between iodine deficiency and developmental impairments.

Dr Emilie Combet, who led the reserch at the University of Glasgow, said: “Women aren’t receiving the message about the importance of iodine in pregnancy, meaning they cannot make informed choices to ensure they get the amount they require.”

Iodine deficiency affects 1.9 billion people globally and is the most preventable cause of intellectual disability. The UK is ranked 8th in a list of iodine-deficient countries in the world.

The main sources of iodine-rich foods are seafood and dairy products, and in some countries iodine-fortified salt or bread. In the UK, the Reference Nutrient Intake (RNI) for adults is 140ug per day, with no proposed increment for pregnant and lactating women.

Unborn children and young infants are entirely reliant on their mother for iodine supply, making babies and pregnant or lactating mothers the most vulnerable groups of the population.

At present there is no recommendation for routine iodine supplementation in the UK unlike folic acid and Vitamin D, or routine testing in pregnancy that would reflect iodine levels, as there is with iron.

The study surveyed 1,026 women across the UK who were pregnant or mothers of children aged up to 36 months. Participants were asked about their awareness of nutritional guidelines and completed a food frequency questionnaire.

Knowledge of iodine-rich foods was low, with 56% unable to identify any iodine-rich food and the majority wrongfully believing dark green vegetables and table salt had high levels. Most, 84% were unaware that iodine from diet is important for the healthy development of the unborn baby, and only 11% had heard about iodine from a healthcare professional.

Dr Combet said: “Iodine is crucial during pregnancy and the first months of life, to ensure adequate brain development, but achieving over 200ug a day of iodine through diet requires regular consumption of iodine-rich foods such as milk and sea fish. Not everyone will have the knowledge, means or opportunity to achieve this.

“There is an ongoing debate as to whether there should be some form of fortification of food with iodine. Iodine-fortified salt is common in other countries, but using salt as the delivery method has raised concerns since it is perceived to clash with public health messaging around reducing salt intake to combat high blood pressure. However, other countries have demonstrated that both measures could be held simultaneously. We need to work toward a solution.

“The most important issue to come from this study, however, was the lack of awareness of the important role iodine plays in fetal development and how to consume adequate levels of this essential mineral. This is something that needs to be addressed. Our current Yorkhill Children Charity – funded project us developing tools and resources for health care professionals and women either pregnant or planning a pregnancy.”

This paper is freely available for 2 weeks

Related links

Dr Emilie Combet: researcher profile

Media enquiries: stuart.forsyth@glasgow.ac.uk / 0141 330 4831

A provisional consensus clinical and research definition for Agitation in cognitive disorders

Cloud 3 (1)

The January International Psychogeriatrics Article of the Month is entitled ‘Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition’ by Jeffrey Cummings, Jacobo Mintzer, Henry Brodaty, Mary Sano et al.

Agitation is common across neuropsychiatric disorders and contributes to disability, institutionalization, and diminished quality of life for patients and their caregivers. There is no consensus definition of agitation and no widespread agreement on what elements should be included in the syndrome.

Agitation is a common clinical manifestation of many neuropsychiatric disorders. It is a frequent manifestation of Alzheimer’s disease (AD), frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), and other dementia but also occurs in schizophrenia, bipolar illness, and depression. While agitation may include aggressive behaviors, it is not identical to aggression, and agitation can occur without aggression (e.g. pacing, rocking, repetitious mannerisms).

The International Psychogeriatric Association (IPA) formed an Agitation Definition Work Group (ADWG) to develop a provisional consensus definition of agitation in patients with cognitive disorders that can be applied in epidemiologic, non-interventional clinical, pharmacologic, non-pharmacologic interventional, and neurobiological studies. A consensus definition will facilitate communication and cross-study comparison and may have regulatory applications in drug development programs.

The ADWG implemented a transparent process that included nearly 1,000 survey respondents and engaged the memberships of the IPA, IPA affiliates, and other organizations involved in the care and research of neuropsychiatric disorders in patients with cognitive impairment. The group used a combination of electronic, face-to-face, and survey-based strategies to develop a consensus based on agreement of a majority of participants. Nine-hundred twenty-eight respondents participated in the different phases of the process.

An initial survey provided valuable insights from those involved in the care of agitated patients, and key elements of the definition were identified. Of the items listed as possible behaviors to be included in a definition of agitation, the following were endorsed by at least 50% of the respondents: pacing, aimless wandering, verbal aggression, constant unwarranted requests for attention or help, hitting others, hitting self, pushing people, throwing things, general restlessness, screaming, resistiveness, hurting self, hurting others, tearing things or destroying property, shouting, and kicking furniture. This information guided the elements included in the definition by the ADWG.

Agitation was defined broadly as: (1) occurring in patients with a cognitive impairment or dementia syndrome; (2) exhibiting behavior consistent with emotional distress; (3) manifesting excessive motor activity, verbal aggression, or physical aggression; and (4) evidencing behaviors that cause excess disability and are not solely attributable to another disorder (psychiatric, medical, or substance-related). A majority of the respondents rated all surveyed elements of the definition as “strongly agree” or “somewhat agree” (68–88% across elements). A majority of the respondents also agreed that the definition is appropriate for clinical and research applications.

The development of a provisional definition of agitation is the first step in advancing a research agenda for the definition. Not all elements were unanimously endorsed; a consensus was achieved on all aspects of the definition. Validity studies using other agitation assessments, reliability of the application of the definition, usefulness in clinical trials, usefulness in non-pharmacologic research, and real-world application in clinical and healthcare settings will lead to refinements and adjustments that will enhance the definition and advance the study of neuropsychiatric syndromes in cognitive impairment disorders.

 

The full paper “Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition” has been published Open Access and is available here.

The commentary on the paper, “Defining agitation in the cognitively impaired–a work in progress” is also available free of charge here.

Football focus: A study into preparedness of the health sector in Brazil for the 2014 FIFA World Cup

brazil world cup

This post is taken from the abstract of the paper “Hospital Preparedness in Advance of the 2014 FIFA World Cup in Brazil” published in Prehospital and Disaster Medicine.

Regardless of the capacity of the health care system of the host nation, mass gatherings require special planning and preparedness efforts within the health system. Brazil will host the 2014 Fédération Internationale de Football Association (FIFA) World Cup and the 2016 Olympics. This paper represents the first results from Project ‘‘Prepara Brasil,’’ which is investigating the preparedness of the health sector and pharmaceutical services for these events.

This study was designed to identify the efforts taken to prepare the health sector in Brazil for the FIFA World Cup 2014 event, as well as the 2016 Summer Olympics.

Key informant interviews were conducted with representatives of both the municipality and hospital sectors in each of the 12 host cities where matches will be played. A semi-structured key informant interview guide was developed, with sections for each type of participant. One of each municipality’s reference hospitals was identified and seven additional general hospitals were randomly selected from all of the inpatient facilities in each municipality. The interviewers were instructed to contact a reference hospital, and two of the other hospitals, in the jurisdiction for participation in the study.

Questions were asked about plans for mass-gathering events, the interaction between hospitals and government officials in preparation for the World Cup, and their perceptions of their surge capacity to meet the potential demands generated by the presence of the World Cup events in their municipalities.

In all, 11 representatives of the sampled reference hospitals, and 24 representatives of other general private and public hospitals in the municipalities, were interviewed.

Most of the hospitals had some interaction with government officials in preparation for the World Cup 2014. Approximately one-third (34%) received training activities from the government. Fifty-four percent (54%) of hospitals had no specific plans for communicating with the government or other agencies during the World Cup. Approximately half (51%) had plans for surge capacity during the event, but only 27% had any surge capacity for isolation of potentially infectious patients.

Overall, although there has been mention of a great deal of planning on the part of the government officials for the World Cup 2014, hospital surge to meet the potential increase in demand still falls short.

 

The full paper “Hospital Preparedness in Advance of the 2014 FIFA World Cup in Brazil” can be viewed free of charge for a limited time here.

 

Long term effects of childhood bullying

bullying

Childhood bullying shown to increase likelihood of psychotic experiences in later life

New research has shown that being exposed to bullying during childhood will lead to an increased risk of psychotic experiences in adulthood, regardless of whether they are victims or perpetrators.

The study assessed a cohort of UK children (ALSPAC) from birth to fully understand the extent of bullying on psychosis in later life – with some groups showing to be almost five times more likely to suffer from episodes at the age of 18.

The analysis, led by researchers from the University of Warwick, in association with colleagues at the University of Bristol, shows that victims, perpetrators and those who are both bullies and victims (bully-victims), are at an increased risk of developing psychotic experiences.

Even when controlling for external factors such as family factors or pre-existing behaviour problems, the study found that not only those children who were bullied over a number of years (chronic victims), but also the bullies themselves in primary school were up to four and a half times more likely to have suffered from psychotic experiences by the age of 18. Equally concerning is that those children who only experienced bullying for brief periods (e.g. at 8 or 10 years of age) were at increased risk for psychotic experiences.

The term ‘psychotic experiences’ covers a range of experiences, from hearing voices and seeing things that are not there to paranoia. These experiences, if persistent, are highly distressing and disruptive to everyday life. They are diagnosed by GPs or psychiatrists as “psychotic disorders” such as schizophrenia . Exact diagnosis is difficult and requires careful assessment as in this study.

Professor Dieter Wolke of the University of Warwick explained, “We want to eradicate the myth that bullying at a young age could be viewed as a harmless rite of passage that everyone goes through – it casts a long shadow over a person’s life and can have serious consequences for mental health”

“These numbers show exactly how much childhood bullying can impact on psychosis in adult life. It strengthens on the evidence base that reducing bullying in childhood could substantially reduce mental health problems. The benefit to society would be huge, but of course, the greatest benefit would be to the individual.”

Wolke’s team have previously looked at the impact of bullying on psychotic symptoms in 12 year olds, and there have been a range of short term studies that confirm the relation between being a victim of bullying and psychotic symptoms. This study, however, is the first to report the long term impact of being involved in bullying during childhood – whether victim, bully or bully-victim – on psychotic experiences in late adolescence or adulthood.

Professor Wolke added, “The results show that interventions against bullying should start early, in primary school, to prevent long term serious effects on children’s mental health. This clearly isn’t something that can wait until secondary school to be resolved; the damage may already have been done.”

View the full paper “Bullying in elementary school and psychotic experiences at 18 years: a longitudinal, population-based cohort study” free for a limited time here.

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