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To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students.
An online survey was administered. Food insecurity was assessed using the ten-item Adult Food Security Survey Module. Sleep was measured using the nineteen-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health.
Twenty-two higher education institutions.
College students (n 17 686) enrolled at one of twenty-two participating universities.
Compared with food-secure students, those classified as food insecure (43·4 %) had higher PSQI scores indicating poorer sleep quality (P < 0·0001) and reported more days with poor mental (P < 0·0001) and physical (P < 0·0001) health as well as days when mental and physical health prevented them from completing daily activities (P < 0·0001). Food-insecure students had higher adjusted odds of having poor sleep quality (adjusted OR (AOR): 1·13; 95 % CI 1·12, 1·14), days with poor physical health (AOR: 1·01; 95 % CI 1·01, 1·02), days with poor mental health (AOR: 1·03; 95 % CI 1·02, 1·03) and days when poor mental or physical health prevented them from completing daily activities (AOR: 1·03; 95 % CI 1·02, 1·04).
College students report high food insecurity which is associated with poor mental and physical health, and sleep quality. Multi-level policy changes and campus wellness programmes are needed to prevent food insecurity and improve student health-related outcomes.
There is a growing literature in support of the effectiveness of task-shared mental health interventions in resource-limited settings globally. However, despite evidence that effect sizes are greater in research studies than actual care, the literature is sparse on the impact of such interventions as delivered in routine care. In this paper, we examine the clinical outcomes of routine depression care in a task-shared mental health system established in rural Haiti by the international health care organization Partners In Health, in collaboration with the Haitian Ministry of Health, following the 2010 earthquake.
For patients seeking depression care betw|een January 2016 and December 2019, we conducted mixed-effects longitudinal regression to quantify the effect of depression visit dose on symptoms, incorporating interaction effects to examine the relationship between baseline severity and dose.
306 patients attended 2052 visits. Each visit was associated with an average reduction of 1.11 in depression score (range 0–39), controlling for sex, age, and days in treatment (95% CI −1.478 to −0.91; p < 0.001). Patients with more severe symptoms experienced greater improvement as a function of visits (p = 0.04). Psychotherapy was provided less frequently and medication more often than expected for patients with moderate symptoms.
Our findings support the potential positive impact of scaling up routine mental health services in low- and middle-income countries, despite greater than expected variability in service provision, as well as the importance of understanding potential barriers and facilitators to care as they occur in resource-limited settings.
To report our experience of diagnosis, investigation and management in patients who had undergone laryngectomy secondary to previous squamous cell carcinoma, who were subsequently infected with severe acute respiratory syndrome coronavirus-2 during the coronavirus disease 2019 pandemic.
Four post-laryngectomy patients with laboratory-proven severe acute respiratory syndrome coronavirus-2 infection were admitted to our institution from 1 March to 1 May 2020. All patients displayed symptoms of coronavirus disease 2019 and underwent investigations, including swab and serum sampling, and chest X-ray where indicated. All were managed conservatively on dedicated coronavirus disease 2019 wards and were discharged without the requirement of higher level care.
It is hypothesised that laryngectomy may offer a protective effect against severe or critical disease in severe acute respiratory syndrome coronavirus-2 infection. We hope sharing our experience will aid all practitioners in the management of this, often intimidating, cohort of patients.
Australian conservation cropping systems are practiced on very large farms (approximately 3,000 ha) where herbicides are relied on for effective and timely weed control. In many fields, though, there are low weed densities (e.g., <1.0 plant 10 m−2) and whole-field herbicide treatments are wasteful. For fallow weed control, commercially available weed detection systems provide the opportunity for site-specific herbicide treatments, removing the need for whole-field treatment of fallow fields with low weed densities. Concern about the sustainability of herbicide-reliant weed management systems remain and there has not been interest in the use of weed detection systems for alternative weed control technologies, such as targeted tillage. In this paper, we discuss the use of a targeted tillage technique for site-specific weed control in large-scale crop production systems. Three small-scale prototypes were used for engineering and weed control efficacy testing across a range of species and growth stages. With confidence established in the design approach and a demonstrated 100% weed-control potential, a 6-m wide pre-commercial prototype, the “Weed Chipper,” was built incorporating commercially available weed-detection cameras for practical field-scale evaluation. This testing confirmed very high (90%) weed control efficacies and associated low levels (1.8%) of soil disturbance where the weed density was fewer than 1.0 plant 10 m−2 in a commercial fallow. These data established the suitability of this mechanical approach to weed control for conservation cropping systems. The development of targeted tillage for fallow weed control represents the introduction of site-specific, nonchemical weed control for conservation cropping systems.
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.
Between 2010 and 2019 the international health care organization Partners In Health (PIH) and its sister organization Zanmi Lasante (ZL) mounted a long-term response to the 2010 Haiti earthquake, focused on mental health. Over that time, implementing a Theory of Change developed in 2012, the organization successfully developed a comprehensive, sustained community mental health system in Haiti's Central Plateau and Artibonite departments, directly serving a catchment area of 1.5 million people through multiple diagnosis-specific care pathways. The resulting ZL mental health system delivered 28 184 patient visits and served 6305 discrete patients at ZL facilities between January 2016 and September 2019. The experience of developing a system of mental health services in Haiti that currently provides ongoing care to thousands of people serves as a case study in major challenges involved in global mental health delivery. The essential components of the effort to develop and sustain this community mental health system are summarized.
Lieder and Griffiths rightly urge that computational cognitive models be constrained by resource usage, but they should go further. The brain's primary function is to regulate resource usage. As a consequence, resource usage should not simply select among algorithmic models of “aspects of cognition.” Rather, “aspects of cognition” should be understood as existing in the service of resource management.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
The widespread use of herbicides in cropping systems has led to the evolution of resistance in major weeds. The resultant loss of herbicide efficacy is compounded by a lack of new herbicide sites of action, driving demand for alternative weed control technologies. While there are many alternative methods for control, identifying the most appropriate method to pursue for commercial development has been hampered by the inability to compare techniques in a fair and equitable manner. Given that all currently available and alternative weed control methods share an intrinsic energy consumption, the aim of this review was to compare methods based on energy consumption. Energy consumption was compared for chemical, mechanical, and thermal weed control technologies when applied as broadcast (whole-field) and site-specific treatments. Tillage systems, such as flex-tine harrow (4.2 to 5.5 MJ ha−1), sweep cultivator (13 to 14 MJ ha−1), and rotary hoe (12 to 17 MJ ha−1) consumed the least energy of broadcast weed control treatments. Thermal-based approaches, including flaming (1,008 to 4,334 MJ ha−1) and infrared (2,000 to 3,887 MJ ha−1), are more appropriate for use in conservation cropping systems; however, their energy requirements are 100- to 1,000-fold greater than those of tillage treatments. The site-specific application of weed control treatments to control 2-leaf-stage broadleaf weeds at a density of 5 plants m−2 reduced energy consumption of herbicidal, thermal, and mechanical treatments by 97%, 99%, and 97%, respectively. Significantly, this site-specific approach resulted in similar energy requirements for current and alternative technologies (e.g., electrocution [15 to 19 MJ ha−1], laser pyrolysis [15 to 249 MJ ha−1], hoeing [17 MJ ha−1], and herbicides [15 MJ ha−1]). Using similar energy sources, a standardized energy comparison provides an opportunity for estimation of weed control costs, suggesting site-specific weed management is critical in the economically realistic implementation of alternative technologies.
Furnished cage housing for laying hens has been introduced in some countries as a ‘welfare-friendly’ alternative to conventional cage systems. Whether this housing system would be acceptable to the public remains unknown. This pilot study aimed to engage the public through online discussions in order to investigate their knowledge, support and perception of laying hen welfare housed in furnished cages. During these discussions, a science-based information statement about furnished cages was introduced. Through a mixed method approach, surveys to assess beliefs and knowledge were administered to participants before and after the online discussion. We qualitatively analysed the online discussion transcripts to determine recurrent themes, and quantitatively measured levels of knowledge and support for furnished cages using pre- and post-forum surveys. Support for the introduction increased from 55% pre-forum to 65% post-forum. Additionally, the participants’ perceived welfare of laying hens in furnished cages and objective knowledge of furnished cages significantly increased after online discussion. These results suggest that engagement with the public combined with the delivery of science-based information may be important factors when considering whether to introduce new farming practices. Trust in industry through transparency and willingness to engage in discussions with the public might also mitigate public concerns.
There is community concern about the treatment of farm animals post-farm gate, particularly animal transport and slaughter. Relationships between lamb behavioural and physiological variables on farm, stockperson, dog and lamb behavioural variables pre-slaughter and plasma cortisol, glucose and lactate in lambs post-slaughter were studied in 400 lambs. The lambs were observed in three behavioural tests, novel arena, flight distance to a human and temperament tests, before transport for slaughter. Closed-circuit television video footage was used to record stockperson, dog and lamb behaviour immediately before slaughter. Blood samples for cortisol, glucose and lactate analyses were collected on farm following the three behavioural tests and immediately post-slaughter. The regression models that best predicted plasma cortisol, glucose and lactate concentrations post-slaughter included a mixture of stockperson and dog behavioural variables as well as lamb variables both on-farm and pre-slaughter. These regression models accounted for 33%, 34% and 44% of the variance in plasma cortisol, glucose and lactate concentrations post-slaughter, respectively. Some of the stockperson and dog behaviours pre-slaughter that were predictive of the stress and metabolic variables post-slaughter included the duration of negative stockperson behaviours such as fast locomotion and lifting/pulling lambs, and the duration of dog behaviours such as lunging and barking at the lamb, while some of the predictive lamb behaviour variables included the durations of jumping and fleeing. Some of the physiological and behavioural responses to the behavioural tests on farm were also predictive of the stress and metabolic variables post-slaughter. These relationships support the well-demonstrated effect of handling on fear and stress responses in livestock, and although not direct evidence of causal relationships, highlight the potential benefits of training stockpeople to reduce fear and stress in sheep at abattoirs.
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.
One of the biggest medical challenges after the detonation of a nuclear device will be implementing a strategy to assess the severity of radiation exposure among survivors and to triage them appropriately. Those found to be at significant risk for radiation injury can be prioritized to receive potentially lifesaving myeloid cytokines and to be evacuated to other communities with intact health care infrastructure prior to the onset of severe complications of bone marrow suppression. Currently, the most efficient and accessible triage method is the use of sequential complete blood counts to assess lymphocyte depletion kinetics that correlate with estimated whole-body dose radiation exposure. However, even this simple test will likely not be available initially on the scale required to assess the at-risk population. Additional variables such as geographic location of exposure, sheltering, and signs and symptoms may be useful for initial sorting. An interdisciplinary working group composed of federal, state, and local public health experts proposes an Exposure And Symptom Triage (EAST) tool combining estimates of exposure from maps with clinical assessments and single lymphocyte counts if available. The proposed tool may help sort survivors efficiently at assembly centers near the damage and fallout zones and enable rapid prioritization for appropriate treatment and transport. (Disaster Med Public Health Preparedness. 2018; 12: 386–395)
The dietary inflammatory index (DIITM) is a novel composite score based on a range of nutrients and foods known to be associated with inflammation. DII scores have been linked to the risk of a number of cancers, including oesophageal squamous cell cancer and oesophageal adenocarcinoma (OAC). Given that OAC stems from acid reflux and that the oesophageal epithelium undergoes a metaplasia-dysplasia transition from the resulting inflammation, it is plausible that a high DII score (indicating a pro-inflammatory diet) may exacerbate risk of OAC and its precursor conditions. The aim of this analytical study was to explore the association between energy-adjusted dietary inflammatory index (E-DIITM) in relation to risk of reflux oesophagitis, Barrett’s oesophagus and OAC. Between 2002 and 2005, reflux oesophagitis (n 219), Barrett’s oesophagus (n 220) and OAC (n 224) patients, and population-based controls (n 256), were recruited to the Factors influencing the Barrett’s Adenocarcinoma Relationship study in Northern Ireland and the Republic of Ireland. E-DII scores were derived from a 101-item FFQ. Unconditional logistic regression analysis was applied to determine odds of oesophageal lesions according to E-DII intakes, adjusting for potential confounders. High E-DII scores were associated with borderline increase in odds of reflux oesophagitis (OR 1·87; 95 % CI 0·93, 3·73), and significantly increased odds of Barrett’s oesophagus (OR 2·05; 95 % CI 1·22, 3·47), and OAC (OR 2·29; 95 % CI 1·32, 3·96), when comparing the highest with the lowest tertiles of E-DII scores. In conclusion, a pro-inflammatory diet may exacerbate the risk of the inflammation-metaplasia-adenocarcinoma pathway in oesophageal carcinogenesis.
A recent quantitative review in the area of stigma and help seeking in the armed forces has questioned the association between these factors (Sharp et al. 2015). To date, the contribution of qualitative literature in this area has largely been ignored, despite the value this research brings to the understanding of complex social constructs such as stigma. The aim of the current systematic review of qualitative studies was to identify appropriate literature, assess the quality and synthesize findings across studies regarding evidence of stigma-related barriers and facilitators to help seeking for mental health issues within the armed forces. A multi-database text word search incorporating searches of PsycINFO, MEDLINE, Social Policy and Practice, Social Work Abstracts, EMBASE, ERIC and EBM Review databases between 1980 and April 2015 was conducted. Literature was quality assessed using the Critical Appraisal Skills Programme tool. Thematic synthesis was conducted across the literature. The review identified eight studies with 1012 participants meeting the inclusion criteria. Five overarching themes were identified across the literature: (1) non-disclosure; (2) individual beliefs about mental health; (3) anticipated and personal experience of stigma; (4) career concerns; and (5) factors influencing stigma. The findings from the current systematic review found that unlike inconsistent findings in the quantitative literature, there was substantial evidence of a negative relationship between stigma and help seeking for mental health difficulties within the armed forces. The study advocates for refinement of measures to accurately capture the complexity of stigma and help seeking in future quantitative studies.