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The aim of our study was to test the efficacy of the nominative technique for estimating the prevalence of wildlife part use within a small sample. We used the domestic consumption of bear Ursus thibetanus and Helarctos malayanus parts in Lao People's Democratic Republic (Laos) as a case study and performed 179 semi-structured interviews in Luang Prabang, northern Laos, in August 2017 and April 2019. We also assessed whether the specialized questioning of the nominative technique could be used for qualitative data collection methods, such as semi-structured interviews. The technique theoretically ensures more accurate statements of illegal wildlife consumption by maintaining the anonymity of an individual's sensitive behaviour through asking about the behaviour of peers. We also directly asked about participants’ use of bear parts. The nominative technique suggested that c. 11% of the participants’ peers used bear parts, whereas respondents’ direct admittance of using bear parts was approximately double, at 23%. Use of bear parts appears not to be sensitive in northern Laos. In addition, we found a strong association between responses to questioning using the nominative technique and direct questioning, indicating that users of bear parts have social networks with higher levels of use. This lends supports to theories that use of wildlife products is directly influenced by social group. The underreporting resulting from use of the nominative technique indicates the high variability of response that can occur within small samples. However, our results show that the nominative technique may be a simple, useful tool for triangulating data, assessing users’ integration into social networks of use, and assessing changes in behaviour prevalence.
Understanding the drivers of health care utilization patterns following disasters can better support health planning. This study characterized all-cause hospitalizations among older Americans after eight large-scale hurricanes.
The objective of this study was to characterize all-cause hospitalizations for any cause among older Americans in the 30 days after eight large-scale hurricanes.
A self-controlled case series study among Medicare beneficiaries (age 65+) exposed to one of eight hurricanes was conducted. The predicted probability of sociodemographic factors associated with hospitalization using logit models was estimated.
Hurricane Sandy (2012) had the highest post-hurricane admission rate, a 23% increase (incidence rate ratio [IRR] = 1.23; 95% CI, 1.22-1.24), while Hurricane Irene in 2011 had only a 10% increase (IRR = 1.10; 95% CI, 1.09-1.11). Higher likelihood of hospitalization occurring after hurricanes included being 85 or older (36.8% probability of hospitalization; 95% CI, 34.7-39.0) and being dually eligible for Medicare and Medicaid (62.8%; 95% CI, 60.7-64.9).
Planning to address the surge in hospitalization for a longer time period after hurricanes and interventions targeted to support aging Americans are needed.
The Eating Assessment in Toddlers FFQ (EAT FFQ) has been shown to have good reliability and comparative validity for ranking nutrient intakes in young children. With the addition of food items (n 4), we aimed to re-assess the validity of the EAT FFQ and estimate calibration factors in a sub-sample of children (n 97) participating in the Growing Up Milk – Lite (GUMLi) randomised control trial (2015–2017). Participants completed the ninety-nine-item GUMLi EAT FFQ and record-assisted 24-h recalls (24HR) on two occasions. Energy and nutrient intakes were assessed at months 9 and 12 post-randomisation and calibration factors calculated to determine predicted estimates from the GUMLi EAT FFQ. Validity was assessed using Pearson correlation coefficients, weighted kappa (κ) and exact quartile categorisation. Calibration was calculated using linear regression models on 24HR, adjusted for sex and treatment group. Nutrient intakes were significantly correlated between the GUMLi EAT FFQ and 24HR at both time points. Energy-adjusted, de-attenuated Pearson correlations ranged from 0·3 (fibre) to 0·8 (Fe) at 9 months and from 0·3 (Ca) to 0·7 (Fe) at 12 months. Weighted κ for the quartiles ranged from 0·2 (Zn) to 0·6 (Fe) at 9 months and from 0·1 (total fat) to 0·5 (Fe) at 12 months. Exact agreement ranged from 30 to 74 %. Calibration factors predicted up to 56 % of the variation in the 24HR at 9 months and 44 % at 12 months. The GUMLi EAT FFQ remained a useful tool for ranking nutrient intakes with similar estimated validity compared with other FFQ used in children under 2 years.
Life course research embraces the complexity of health and disease development, tackling the extensive interactions between genetics and environment. This interdisciplinary blueprint, or theoretical framework, offers a structure for research ideas and specifies relationships between related factors. Traditionally, methodological approaches attempt to reduce the complexity of these dynamic interactions and decompose health into component parts, ignoring the complex reciprocal interaction of factors that shape health over time. New methods that match the epistemological foundation of the life course framework are needed to fully explore adaptive, multilevel, and reciprocal interactions between individuals and their environment. The focus of this article is to (1) delineate the differences between lifespan and life course research, (2) articulate the importance of complex systems science as a methodological framework in the life course research toolbox to guide our research questions, (3) raise key questions that can be asked within the clinical and translational science domain utilizing this framework, and (4) provide recommendations for life course research implementation, charting the way forward. Recent advances in computational analytics, computer science, and data collection could be used to approximate, measure, and analyze the intertwining and dynamic nature of genetic and environmental factors involved in health development.
UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.
Describe the development, implementation and results of this questionnaire.
An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.
A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45–82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Healthcare personnel (HCP) were recruited to provide serum samples, which were tested for antibodies against Ebola or Lassa virus to evaluate for asymptomatic seroconversion.
From 2014 to 2016, 4 patients with Ebola virus disease (EVD) and 1 patient with Lassa fever (LF) were treated in the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital. Strict infection control and clinical biosafety practices were implemented to prevent nosocomial transmission of EVD or LF to HCP.
All personnel who entered the SCDU who were required to measure their temperatures and complete a symptom questionnaire twice daily were eligible.
No employee developed symptomatic EVD or LF. EVD and LF antibody studies were performed on sera samples from 42 HCP. The 6 participants who had received investigational vaccination with a chimpanzee adenovirus type 3 vectored Ebola glycoprotein vaccine had high antibody titers to Ebola glycoprotein, but none had a response to Ebola nucleoprotein or VP40, or a response to LF antigens.
Patients infected with filoviruses and arenaviruses can be managed successfully without causing occupation-related symptomatic or asymptomatic infections. Meticulous attention to infection control and clinical biosafety practices by highly motivated, trained staff is critical to the safe care of patients with an infection from a special pathogen.
Two species of bear are endemic to East and Southeast Asia, the Asiatic black bear or ‘moon’ bear (Ursus thibetanus), and the sun bear (Helarctos malayanus). The moon bear primarily occurs at more northerly latitudes, while the sun bear occurs at more southerly latitudes, although there is overlap in their ranges throughout Southeast Asia (Garshelis and Steinmetz 2016; Scotson et al 2017). Historically, the parts of both species have been used and traded as medical and non-medical commodities in East and Southeast Asia. As commodities and thus objects of consumption, bear parts assist individuals in ‘symbolic actions’ (Gell 1986). As an example of one identified symbolic consumption chain, elder Vietnamese males use bear bile as a means of communicating ‘respect and identity’ and as a means of maintaining good health (Drury 2009a).
Knowledge of the historic bear part trade and consumption throughout East Asia is dominated by information about their use by the Chinese. Bear parts have been used in China for thousands of years (Mills and Servheen 1994), and it is estimated that the first written use of bear gallbladder was around 600 CE (Common Era), when it was prescribed for ailments such as liver disease and haemorrhoids (Dutton et al 2011; Mills and Servheen 1994). Other parts of the bear were prescribed medically in China as well, with the bone, blood and fat all stated to be effective in curing various diseases. Use is still common throughout China, particularly because bears are farmed for their bile, and thus bile products are relatively accessible (Dutton et al 2011).
Bear populations in Asia were noted to be declining nearly three decades ago (Mills and Servheen 1991). Despite subsequent efforts to understand the extent to which these populations were declining, little has been found other than overwhelming evidence that, along with deforestation of bear habitat, the bear part trade is precipitating this decline (Crudge et al 2018a). Even though understanding the illegal trade in wildlife parts necessitates understanding of the human actors involved (Wallen and Daut 2018), sociological research has only recently begun to emerge. Additionally, this research has to date been largely focused on the Vietnamese and Chinese markets.
Abundance thresholds are of fundamental importance in our attempts to understand the dynamics of wildlife infection. Identifying and manipulating these thresholds may also have substantial applied significance. The plague system in the Pre-Balkhash region of Kazakhstan has been extensively studied, including an unusually thorough investigation of the nature and importance of an abundance threshold for the infection. Great gerbils are the main reservoir host, with plague transmitted between them by a variety of flea species. Initial work identified such a threshold from time-series data, with great gerbil abundance being measured by level of occupancy (the proportion of the burrow systems in the landscape supporting an extended family group). However, this and other refinements of the threshold were better at predicting the absence of plague (below the threshold) than in guaranteeing its presence (above). Further analysis indicated that the threshold was a critical point in the percolation of plague across the landscape, rather than in a mass-action random mixing process. The performance of the threshold was also improved by incorporating both gerbil and flea abundance to generate a hyperbolic threshold curve.
Infants with CHD often experience growth failure. Ensuring optimal growth before surgery is associated with improved outcomes and has emerged as a significant cause of parental stress. Parents have reported a perceived lack of accessible feeding information for infants with CHD. To address this gap, the aim of this study was to develop feeding information to better support parents.
Materials and methods:
A search for existing material on six electronic databases and an internet search for unpublished (grey) literature on feeding information for infants with CHD were carried out. Following the development of feeding information, semi-structured interview(s) with parents/health-care professionals were completed, focusing on whether the information was easy to understand, relevant, provided sufficient information around feeding/feeding difficulties, and whether there were any information gaps. Iterative changes were made to the information following each interview. The process was completed until thematic saturation was achieved.
A total of 23 unique articles were identified of which 5 studies were included. From the grey literature, four web pages were reviewed. A total of 22 parents and 25 health-care professionals were interviewed. All parents/health-care professionals felt that the feeding information developed provided sufficient information; however, many wanted information on how to introduce complementary food, particularly if weaning was delayed.
This study describes the development of feeding information for infants with CHD. From parent interviews, gaps identified focused on the introduction of complementary foods and uncertainty regarding the feeding journey beyond surgery.
Filarial nematodes possess glutathione transferases (GSTs), ubiquitous enzymes with the potential to detoxify xenobiotic and endogenous substrates, and modulate the host immune system, which may aid worm infection establishment, maintenance and survival in the host. Here we have identified and characterized a σ class glycosylated GST (OoGST1), from the cattle-infective filarial nematode Onchocerca ochengi, which is homologous (99% amino acid identity) with an immunodominant GST and potential vaccine candidate from the human parasite, O. volvulus, (OvGST1b). Onchocerca ochengi native GSTs were purified using a two-step affinity chromatography approach, resolved by 2D and 1D SDS-PAGE and subjected to enzymic deglycosylation revealing the existence of at least four glycoforms. A combination of lectin-blotting and mass spectrometry (MS) analyses of the released N-glycans indicated that OoGST1 contained mainly oligomannose Man5GlcNAc2 structure, but also hybrid- and larger oligommanose-type glycans in a lower proportion. Furthermore, purified OoGST1 showed prostaglandin synthase activity as confirmed by Liquid Chromatography (LC)/MS following a coupled-enzyme assay. This is only the second reported and characterized glycosylated GST and our study highlights its potential role in host-parasite interactions and use in the study of human onchocerciasis.
Despite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.
Materials and methods
The modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation.
Paediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting.
Nutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.
UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.
An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.
An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.
157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Declaration of interest
G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.
The northern New England region includes the states of Vermont, New Hampshire, and Maine and encompasses a large degree of climate and edaphic variation across a relatively small spatial area, making it ideal for studying climate change impacts on agricultural weed communities. We sampled weed seedbanks and measured soil physical and chemical characteristics on 77 organic farms across the region and analyzed the relationships between weed community parameters and select geographic, climatic, and edaphic variables using multivariate procedures. Temperature-related variables (latitude, longitude, mean maximum and minimum temperature) were the strongest and most consistent correlates with weed seedbank composition. Edaphic variables were, for the most part, relatively weaker and inconsistent correlates with weed seedbanks. Our analyses also indicate that a number of agriculturally important weed species are associated with specific U.S. Department of Agriculture plant hardiness zones, implying that future changes in climate factors that result in geographic shifts in these zones will likely be accompanied by changes in the composition of weed communities and therefore new management challenges for farmers.
Tier 4 CAMHS aim to meet the needs of children and young people with the most complex, severe or persistent mental health problems. Tier 4 services include in-patient care (see Chapter 29), as well as a range of day care and intensive community home-based and outreach services for specific groups of children and young people.
Early descriptions of child and adolescent mental health day units emphasised 5-day ‘milieu’ provision with a strong emphasis on education and behaviour management (Brown, 1996), whereas now they frequently provide daily focused activities to which children and families are invited, depending on their needs. Currently, about half of UK day services are linked to in-patient units, and many in-patient units have a day programme (Green & Jacobs, 1998). It is impossible to classify day services owing to the enormous range in milieu and interventions provided (Green & Worrall- Davies, 2008). However, day services broadly offer:
• support and transition to community services following in-patient admission;
• intensive 5 days per week treatment packages for children and their families;
• treatment of disruptive behaviour, using multimodal treatment strategies with a combination of individual, family and psychopharmacological interventions;
• specialist management and programmes of care for younger children with developmental disorders such as autism, speech and language disorders or neuropsychiatric disorders;
• intensive intervention aimed at improving family functioning in situations of family breakdown or child maltreatment.
Provision and organisation
Day units can offer assessment and therapeutic services that are more specialised, complex and intensive than out-patient services, although they are still community-based and less disruptive than in-patient admission. Most also have the benefit of educational input. Close liaison with specialised education and Social Services is central to their work. There is general acceptance of the central importance of maintaining attachments and working with whole systems if the complex needs of children are to be met. Day units can work with children and young people individually and in groups, as well as with their families, while keeping the focus of concern within the community and avoiding the ‘out of sight, out of mind’ dilemma of in-patient services.
‘“It all comes”, said Pooh crossly, “of not having front doors big enough.”’
A. A. Milne, Winnie the Pooh
Despite the development of home treatment teams and early intervention psychosis services, the demand for in-patient child and adolescent beds remains. It is rare for young people with mental disorders to require inpatient services, but when they do, beds are few and far between. Reasons for admission include severity of illness, deterioration in psychological functioning despite community treatment, high risk to self or others, or family difficulties making treatment difficult, any of which may lead to the need for 24-hour care (Green & Worrall-Davies, 2008). In-patient care is a specialised field providing treatment for young people with serious psychiatric illness by skilled and experienced staff.
Who and what are in-patient units for?
There is a range of psychiatric, educational, social, criminal and societal indicators for admission to an in-patient service. It is usually impossible to separate the different aspects or contributors to the young person's disorder so that each can be provided by the different agencies responsible for it. Psychological disorders, because of adverse life experiences, are common and pure psychiatric disorders are rare, but they all have educational and social precursors and sequelae. Trying to compartmentalise children into unidisciplinary treatment pigeonholes is problematic as:
• admission to psychiatric in-patient units considerably disrupts education and the young person's functioning in the community
• education authorities have to meet young people's special educational needs but cannot isolate these from other social and mental health factors, which they often do not have the resources to address
• residential policies of Social Services departments tend to address young people's mental health and educational needs only as secondary considerations
• the Home Office and Ministry of Justice, which will provide care in a prison setting, have little investment in childhood preventative work for the large proportion of young people with conduct disorder and complex needs when they become adults.
Work on sharing residential responsibility and input requires considerable inter-departmental and inter-agency working, but each agency will be uncertain who is going to reap the most for investing in them, and the harvest is not guaranteed.