Public Health Prevention Measures Research Articles

Hair steroid before and after COVID-19 in preschoolers: the moderation of family characteristics

BackgroundFrequent or prolonged exposure to stressors may jeopardize young children’s health. The onset of the COVID-19 pandemic, coupled with disruptions in daily routines and social isolation resulting from public health preventive measures, have raised concerns about its potential impact on children’ experienced stress, particularly for young children and vulnerable families. However, whether the pandemic was accompanied by changes in physiological stress remains unknown as perceived stress is not a good proxy of physiological stress. This study examined if preschoolers showed increasing hair steroid concentrations following the onset of the COVID-19 pandemic and whether family characteristics may have exacerbated or buffered these changes. Methods136 preschoolers (2–4 years) provided hair for steroid measurement (cortisol, dehydroepiandrosterone (DHEA), cortisone, cortisol-to-DHEA ratio, cortisol-to-cortisone ratio) in October-November 2019 (T0) and in July-August 2020 (T1). A 2-centimeter hair segment was analyzed, reflecting steroid production over the two months leading up to collection. Family income, conflict resolution and lack of cohesion, as well as parents’ COVID-19 stress were reported by parents. Linear mixed models for repeated measures and Bayes factors were used. ResultsNo significant changes were noted from before to after the onset of the COVID-19 pandemic for most hair steroids. However, a moderating role of family conflict resolution was noted. Children living with parents with a better ability to resolve conflicts had lower levels of DHEA compared to those who had more difficulty managing conflicts. Additionally, lower levels of family cohesion and income were linked to some steroids, especially DHEA, suggesting that these factors may relate to children’s physiological stress. Finally, boys had higher DHEA levels than girls. ConclusionOur findings suggest that stress biomarkers were comparable from before to during the COVID-19 pandemic. This observation holds true despite the pandemic being perceived by many as a novel, unpredictable, and potentially threatening event. Findings further suggest that family characteristics are associated with hair steroid, especially DHEA, which deserves further investigation.

Total worker health® based Helicobacter pylori public health prevention strategy

Purpose of review This review aims to explore the public health approach for Helicobacter pylori Infection Prevention within the Total Worker Health (TWH) framework strategy. Recent findings The review identifies certain occupations considered high-risk groups for H. pylori infection. It underscores primary, secondary, and tertiary public health preventive measures align with the TWH approach. Within this framework, the role of raising awareness, emphasizing infection control, worker hygiene, risk assessment, and ensuring healthcare accessibility is emphasized. The importance of early detection, treatment, eradication, and a TWH approach emerges as a central theme. The TWH approach offers a holistic perspective, intertwining occupation-related health risks with overall health and well being. Summary Adopting the TWH approach, coupled with household-based infection control and eradication strategies, can significantly reduce H. pylori prevalence, fostering a healthier workforce and diminishing long-term healthcare costs. The review underscores the importance of recognizing H. pylori as an occupational disease. It calls for further research into the “one-health” perspective on H. pylori transmission dynamics.

IJCM_234A: Malaria Surveillance System Assessment in Jashpur district, Chhattisgarh State, India, January - March 2023

Background: Globally in 2021, 247 million malaria cases were reported from 84 malaria endemic countries. India is committed to eliminate malaria by year 2030. India reported >160,000 malaria cases in 2021 and 2022; 65% cases from four states-West Bengal, Chhattisgarh, Orrisa and Jharkhand. Objectives: We assessed malaria surveillance system in Jashpur district to describe epidemiology of reported malaria cases, for its strengths and weaknesses and to provide evidence-based recommendations. Methodology: We analyzed surveillance data for the year 2022. We assessed timeliness and completeness attributes of the system using US CDC guidelines for evaluating the surveillance system of the five randomly selected reporting units (RUs) for January-March 2023. We reviewed surveillance data reporting portal, hospital records and interviewed key informants. We analyzed data using MS Excel and calculated frequencies and proportion Results: Jashpur reported 269 cases in 2022; 51% female, 58% among tribal community, 89% above 15 years and 90% were of plasmodium falciparum. The maximum number of cases were reported during July to November with peak in the month of August. The annual parasite index (API) per 1000 population was 0.3 for the district, however two blocks had API of >0.5. All the five RUs submitted monthly reports timely. Of the ten reporting formats reviewed, 48% critical blank fields were not filled. Conclusion: Malaria surveillance system in Jashpur detected cases largely among tribal community, identified high burden blocks with good timeliness but require improvement in complete information. We recommended district to focus preventive public health measures in high burden blocks and orient the laboratory technicians for complete data entry in line list of cases.

Stochastic near-optimal controls for treatment and vaccination in a COVID-19 model with transmission incorporating Lévy jumps

The COVID-19 pandemic has triggered a groundbreaking reliance on mathematical modelling as an important tool for studying and managing the spread of the virus since its emergence. Public health preventive measures such as vaccination and therapeutics can effectively reduce or eradicate an infectious disease. This work investigates these two strategies for controlling the COVID-19 epidemic through a stochastic epidemiological modelling approach. The existence and uniqueness of a positive solution of the stochastic system is studied. A priori estimates of the vaccination and treatment controls are established. Sufficient and necessary conditions are obtained for the near-optimal control problem of the stochastic model using the maximum condition of the Hamiltonian function and the Ekeland principle. Finally, to support our theoretical results, numerical simulations for a combination of optimized vaccination and treatment strategies were presented to understand the challenges posed by COVID-19 in Brazil.

SARS-CoV-2 infection during pregnancy and the risk of adverse maternal outcomes in the Republic of Georgia: a national birth registry-based cohort study.

Georgia experienced an increase in maternal deaths (MD) during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which warrants further investigation. This study aimed to assess associations between timing of SARS-CoV-2 infection during pregnancy and MD, post-delivery intensive care unit (ICU) admission, and caesarean section (CS) delivery. We performed a national birth registry-based cohort study of pregnant women who had completed 22 weeks of gestation and delivered between February 28, 2020, and August 31, 2022. The data were linked to coronavirus disease 2019 (COVID-19) testing, vital, and immunization registries. Pregnant women were classified into three groups: confirmed SARS-CoV-2 infection from conception through 31 days before delivery; confirmed infection within 30 days before or at delivery; and women negative for SARS-CoV-2 infection or without any test results (reference group). Multivariable logistic regression was used to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Among 111,493 pregnant women, 16,751 had confirmed infection during pregnancy, and 7,332 were fully vaccinated against COVID-19 before delivery. Compared to the reference group, those with confirmed infection within 30 days before or at delivery experienced increased odds of MD (aOR: 43.11, 95% CI, 21.99-84.55), post-delivery ICU admission (aOR: 5.20, 95% CI, 4.05-6.67), and CS delivery (aOR: 1.11, 95% CI, 1.03-1.20). Pregnant women in Georgia with confirmed SARS-CoV-2 infection within 30 days before or at delivery experienced a considerably higher risk of MD and post-delivery ICU admission and a slightly higher risk for CS delivery. Additionally, the results highlighted that most pregnant women were not vaccinated against COVID-19. These findings should alert stakeholders that adherence to public health preventive measures needs to be improved.

COVID-19 and COVID-19 vaccination experiences and perceptions and their predictors among community members during the COVID-19 pandemic in Ebonyi state, Nigeria: an analytical cross-sectional study

BackgroundCOVID-19 is still a disease of global public health importance which requires long term application of control measures as millions of new infections or re-infections and thousands of related deaths still occur worldwide and the risk of an upsurge from new strains of the virus continues to be a threat. The decrease in the use of and non-use of preventive public health measures are among the factors fuelling the disease. The (previous) experiences and perceptions of people regarding the COVID-19 pandemic, COVID-19 vaccination, and the vaccination process are factors that will influence subsequent use of preventive/control measures. We explored the COVID-19 and COVID-19 vaccination and the vaccination process experiences and perceptions, and their predictors, among the community members in Ebonyi state, Nigeria.MethodsWe conducted an analytical cross-sectional study between March 12 and May 9, 2022 among all consenting/assenting community members aged 15 years and above in 28 randomly selected geographical clusters. A structured interviewer-administered electronic questionnaire in KoBoCollect installed in android devices was used to collect data which was analysed using descriptive statistics and bivariate and multivariate generalized estimating equations.ResultsOf the 10,825 community members surveyed: only 31.6% had strong COVID-19 experience and perception, 72.2% had good COVID-19 vaccination expectation and perception, and only 54.2% had positive COVID-19 vaccination process experience and perception. The most important predictors of the extent/level of COVID-19 and COVID-19 vaccination and the vaccination process experiences and perceptions were level of attitude towards COVID-19 and COVID-19 vaccination and level of knowledge about COVID-19. Other important predictors were marital status, educational level, and main occupation.ConclusionsThis study’s evidence, including the identified predictors, will inform subsequent policy actions regarding COVID-19 in the strategies to improve the COVID-19 and COVID-19 vaccination and the vaccination process experiences and perceptions of community members (and their use of preventive/control measures) in Ebonyi state and Nigeria, and other similar contexts. It will also inform future policy actions/strategies regarding similar diseases.

The prevalence of alcohol references in music and their effect on people's drinking behavior: A systematic review and meta-analysis.

Understanding the prevalence of alcohol references in music and their impact on alcohol drinking behavior is important given the increased accessibility to daily music listening with the proliferation of smart devices. In this review, we estimate the pooled prevalence of alcohol references in music and its association with drinking behavior. Systematic searches were conducted across four major databases (MEDLINE, PsycINFO, EMBASE, and CINHAL). Articles were selected following duplicate checking, title and abstract screening, and full-text review. Studies reporting the prevalence of alcohol-referencing music and/or investigating its association with drinking behavior were included. Pooled prevalence with 95% confidence intervals (CIs) were computed using a random effects model. Of 1007 articles identified, 26 met inclusion criteria and 23 studies comprising 12,224 songs were eligible for meta-analysis. The overall pooled prevalence of alcohol references in music (including lyrics and videos) was 24.0% (95% CI: 19.0%-29.0%). The pooled prevalence was 22.0% (95% CI: 16.0%-29.0%) for only lyrics, 25.0% (95% CI: 18.0%-33.0%) for only the visual elements of music videos, and 29.0% (95% CI: 21.0%-38.0%) for both the lyrical content and the visual components. Only three studies assessed the relationship between listening to music with alcohol references and drinking behavior, and all three reported a positive association. Whereas almost a quarter of all songs included references to alcohol, public health preventive measures are needed to reduce alcohol exposure from music. Future research is needed to understand fully the effect of music with alcohol references on drinking behavior.

Mental health and risk of death and hospitalization in COVID-19 patients. Results from a large-scale population-based study in Spain.

The COVID-19 pandemic has created unprecedented challenges for health care systems globally. This study aimed to explore the presence of mental illness in a Spanish cohort of COVID-19-infected population and to evaluate the association between the presence of specific mental health conditions and the risk of death and hospitalization. This is a retrospective cohort study including all individuals with confirmed infection by SARS-CoV-2 from the PRECOVID (Prediction in COVID-19) Study (Aragon, Spain). Mental health illness was defined as the presence of schizophrenia and other psychotic disorders, anxiety, cognitive disorders, depression and mood disorders, substance abuse, and personality and eating disorders. Multivariable logistic regression models were used to examine the likelihood of 30-day all-cause mortality and COVID-19 related hospitalization based on baseline demographic and clinical variables, including the presence of specific mental conditions, by gender. We included 144,957 individuals with confirmed COVID-19 from the PRECOVID Study (Aragon, Spain). The most frequent diagnosis in this cohort was anxiety. However, some differences were observed by sex: substance abuse, personality disorders and schizophrenia were more frequently diagnosed in men, while eating disorders, depression and mood, anxiety and cognitive disorders were more common among women. The presence of mental illness, specifically schizophrenia spectrum and cognitive disorders in men, and depression and mood disorders, substance abuse, anxiety and cognitive and personality disorders in women, increased the risk of mortality or hospitalization after COVID-19, in addition to other well-known risk factors such as age, morbidity and treatment burden. Identifying vulnerable patient profiles at risk of serious outcomes after COVID-19 based on their mental health status will be crucial to improve their access to the healthcare system and the establishment of public health prevention measures for future outbreaks.

Impact of community mask mandates on SARS-CoV-2 transmission in Ontario after adjustment for differential testing by age and sex.

Mask use for prevention of respiratory infectious disease transmission is not new but has proven controversial during the SARS-CoV-2 pandemic. In Ontario, Canada, irregular regional introduction of community mask mandates in 2020 created a quasi-experiment useful for evaluating the impact of such mandates; however, Ontario SARS-CoV-2 case counts were likely biased by testing focused on long-term care facilities and healthcare workers. We developed a regression-based method that allowed us to adjust cases for under-testing by age and gender. We evaluated mask mandate effects using count-based regression models with either unadjusted cases, or testing-adjusted case counts, as dependent variables. Models were used to estimate mask mandate effectiveness, and the fraction of SARS-CoV-2 cases, severe outcomes, and costs, averted by mask mandates. Models using unadjusted cases as dependent variables identified modest protective effects of mask mandates (range 31-42%), with variable statistical significance. Mask mandate effectiveness in models predicting test-adjusted case counts was higher, ranging from 49% (95% CI 44-53%) to 76% (95% CI 57-86%). The prevented fraction associated with mask mandates was 46% (95% CI 41-51%), with 290,000 clinical cases, 3,008 deaths, and loss of 29,038 quality-adjusted life years averted from 2020 June to December, representing $CDN 610 million in economic wealth. Under-testing in younger individuals biases estimates of SARS-CoV-2 infection risk and obscures the impact of public health preventive measures. After adjustment for under-testing, mask mandates emerged as highly effective. Community masking saved substantial numbers of lives, and prevented economic costs, during the SARS-CoV-2 pandemic in Ontario, Canada.

Healthcare utilization and associated factors during the first wave of COVID-19 pandemic in Ghana: A cross-sectional survey.

Understanding healthcare utilization during the coronavirus disease 2019 (COVID-19) pandemic is crucial to inform policy and to prepare health systems for future pandemics. We examined self-reported healthcare utilization and associated factors, including public health preventive practices, perceptions, and coping strategies among the general public in Ghana during the first wave of the COVID-19 pandemic. We adopted a cross-sectional study design using a public survey to recruit 643 respondents between May 23, and July 11, 2020 during the first wave of confirmed COVID-19 cases and after the fifth week of a partial lockdown in Ghana. Descriptive, bivariate, and binary logistic regression analyses were carried out in Stata version 15. Overall, there was a high level of compliance with COVID-19 public health preventive measures. In terms of perception, 357 (55.5%) of respondents stated unnecessary worry was created about the disease. In relation to coping strategies, 376 (58.5%) of respondents stayed home for more than 6 h, while 35 (5%) reported drinking alcohol to overcome the fear created by the disease. The results showed that 176 (27.4%) of the respondents utilized healthcare while 44 (9.4%) did not utilized healthcare for fear of contracting the disease at the health facility. Marital status (adjusted odds ratio [aOR] = 0.63; 95% confidence interval [CI] = 0.409, 0.963), religion (aOR = 2.34; 95% CI = 1.10, 4.98), and possession of valid health insurance (aOR = 1.51; 95% CI = 1.020, 2.235) were associated with healthcare utilization. There was low healthcare utilization coupled with fear of contracting the COVID-19 disease at the health facilities among the respondents. The findings suggest the need for effective public education that ensures that future pandemics' prevention information and recommendations are easily understandable by the general public. Additionally, investment in health insurance coverage may contribute to healthcare utilization during future pandemics.

Governmentality, Science and the Media. Examining the “Pandemic Reality” with Foucault, Lyotard and Baudrillard

This article examines the legitimization process of the public health preventive measures implemented in many Western countries following the SARS-CoV-2 outbreak. Through concepts such as governmentality, disciplinarization and security mechanisms proposed by Foucault, we trace some of the basic principles and implications of the relationship between biopower and medicine, as well as the media dissemination of an official narrative on scientific truth. These reflections are complemented by the contributions of Francois Lyotard and Jean Baudrillard. Lyotard reflects on the relationship between science and a “performative game”, whose own staging is the core of its criteria of truth. Baudrillard shows the relevance of a “hyperreality” in which the signs presented by the media take precedence over the experience of the subjects. We argue that a mediatized version of science, defined through a strong disciplinarization of knowledge and the censorship of dissident voices, played a key role in the establishment of consensus and the legitimization of policies that granted extraordinary power to governments and transnational elites. Although the work of Foucault in this demonstration is essential, the contributions of Lyotard and Baudrillard provide additional elements to understand a fundamental problem: the public acceptance of “truth” as an instrument of governmentality on a global scale.

Assessing the Health Security Responsiveness of the Caribbean Public Health Agency (CARPHA) and the Government of Trinidad and Tobago: The Zika and COVID-19 Outbreaks

This article examines the response of the Caribbean Public Health Agency and the government of Trinidad and Tobago against the Zika and COVID-19 outbreaks. These contrasting diseases were chosen to examine the surveillance systems and responses and the preventative public health measures that were implemented to protect the population. Health experts were interviewed and the data were analyzed using thematic analysis. The findings revealed that the Caribbean Public Health Agency and the government of Trinidad and Tobago were prepared to respond to the Zika outbreak. However, there is much to be improved in the case of COVID-19. Concrete policy recommendations are discussed.

Perceptions and Knowledge of Public Towards Emerging Human Monkeypox in Yemen: A Cross-Sectional Study.

The spread of monkeypox (mpox) worldwide poses a severe threat to human life. This virus leads to a disease with symptoms similar to smallpox in humans. To combat this threat, improving public knowledge and perception toward mpox is vital for public health preventive measures. A cross-sectional survey was carried out in Yemen from December 2022 to March 2023 to investigate public perception and knowledge of mpox. Individuals were approached through social media platforms using a convenient sampling approach. Linear regression was used to determine the association between participants' knowledge (dependent variable) and explanatory variables. A total of 853 individuals consented to take part in the study. A significant proportion of respondents had a low knowledge level (N=572, 67.06%). Most participants knew about the nature of the diseases (75%, n=641), transmission mode (78.1%, n=668), hand sanitizer preventive measures, and skin- related symptoms. However, only 20.8% (n= 178) knew that diarrhea is not a symptom, and 25.4% (n= 217) knew antibiotics are unnecessary for mpox management. A proportion of 57.7% (n=492) of the participants feared human mpox, and 47.7% (n= 407) thought it was a conspiracy. Most participants had a good perception of local and international health authorities controlling the disease. Age, education level, having a health-related certificate, and receiving a 2-dose vaccination for COVID-19 had statistically significant associations with mpox knowledge level (P < 0.05). Social media platforms were the most often used information source about mpox (78.3%, n= 668), followed by articles (41.1%, n=351). The study reveals a low public knowledge about mpox in Yemen, emphasizing the need for targeted educational campaigns, especially via social media, to strengthen public health measures and disease control. Addressing Knowledge gaps and correcting misconceptions is crucial for improving preparedness and response to the disease.

SARS-CoV-2 incidence and hospitalisation in South Tyrol (Italy): a population-based ecological study

Abstract Background Literature associating SARS-CoV-2 spread to environmental variables such as altitude, tourism, vaccination adherence and demographics, is inconclusive and contrasting. This study aimed at studying these relationships during the first unrestricted winter in South Tyrol, a multicultural Italian alpine province. Methods An ecological study was performed, based on the 20 districts of the area. Data about incidence and hospitalization between November ’21 and February ’22 was collected and associated to geographical, demographic and health-related characteristics via bivariate analyses. Results Incidence (range: 15% - 22%) and hospitalization (range: overall = 0.09% - 0.26%/ intensive care unit (ICU) = 0 - 0.06%) varied widely among districts. Incidence showed positive correlations with average altitude (Rho=0.62, p &amp;lt; 0.001), tourist amount (0.54, p &amp;lt; 0.04) and average family size (0.66, p &amp;lt; 0.005); whereas negative ones with vaccination coverage (-0.62, p &amp;lt; 0.04) and population density (-0.44, p &amp;lt; 0.05). Similar trends were observed for ICU admissions. Incidence was significantly higher in Ladin speaking districts and lower in Italian ones, while ordinary wards admission appeared lowest in Ladin districts and higher in the Italian ones, as well as close to main cities and hospitals. Conclusions Living in urban districts, geographically and linguistically closer to the Health Authorities, may have played a protective role against infection and severe disease, through an increased adherence to public health preventive measures. The concomitant higher rate of admissions might be due to the easier access to the structures. By contrast, infection spread was higher in rural and sparsely populated districts, associated with greater winter tourism and family sizes, but also characterized by lower herd immunity and institutional closeness. More attention should be paid to communities with special needs (geographical and cultural) to ensure equitable means for future pandemics. Key messages • Living in urban districts may protect against infection spread through increased adherence to public health preventive measures, and facilitate hospitalisations due to easier access to the structures. • More attention should be paid to communities geographically and culturally distant from Public Health Institutions to ensure equitable means for future pandemics.

The impact of urban green space on the health of middle-aged and older adults.

Urban green space is one of the most closely related ecosystem services to residents' lives, and it can be regarded as a preventive public health measure. Residents living in parks and other green environments can help improve their physical and mental health, reduce stress and even prevent crime and violence. Therefore, based on the actual situation in China, this paper analyzes the relationship between urban green space and the health of middle-aged and older adults and its mechanisms. This study used multiple linear regression, based the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015, and 2018, to explore the relationship between urban green space and the health of middle-aged and older adults. At the same time, group regression was conducted to identify the heterogeneity of health effects of urban green space. The research shows that the increase of urban green space areas can significantly improve the health status of middle-aged and older adults. After a series of robustness tests, the results are still valid. In addition, the health effects of urban green space are different because of gender, age, education level, marital status residence, geographical location of the respondents and park quantity distribution. Further research found that reducing hot weather and optimizing air quality are the potential mechanisms of urban green space affecting the health of middle-aged and older adults, providing new evidence for the causal mechanism between urban green space and the health of middle-aged and older adults. This study expanded the research scope of the impact of urban green space on the health of middle-aged and older adults, covering a representative sample in China. The results show that urban green space has an important impact on the health of middle-aged and older adults. Policy suggestions are made to help cities optimize the landscape and residents to enjoy ecology.

Utilizing Mobility Tracking to Identify Hotspots for Contagious Disease Spread

A significant global health problem nowadays is the incidence of serious infectious illnesses. An extraordinary humanitarian crisis has been brought on by the current COVID-19 pandemic, which has spread around the world. The spread of new viruses has put established healthcare institutions under tremendous strain and created a number of pressing problems. It is important to predict the future movement and pattern of the illness in order to decrease infectious instances and maximize recovered cases. This research paper aims to utilize mobility tracking as a means to identify hotspots for contagious disease spread. The study focuses on collecting and analyzing mobility data from UNITEN students using Google Map data over a period of two weeks. The paper describes the data collection process, data pre-processing steps, and the application of the HDBSCAN algorithm for hotspot clustering. The results demonstrate the effectiveness of HDBSCAN in identifying hotspots based on the mobility data. The findings highlight the potential of mobility tracking for disease surveillance and provide insights for public health interventions and preventive measures.

Predicting the Adoption of COVID-19 Public Health Preventive Measures in Ethiopia: Application of Health Belief Model

In the face of coronavirus disease pandemic, adherence to public health measures largely influences their effectiveness in containing the spread. Four specific objectives guided this study: (i) Assess whether individuals are adhering to the COVID-19 preventive measures promoted by Ethiopian government; (ii) Examine the heterogeneity in adoption of preventive measures in Ethiopia; (iii) Identify the factors affecting adherence to preventive measures-based health belief model; and (iv) Examine the moderating effects of socio-economic factors on the relationship between adherence to preventive measures and HBM factors. The study relied on a nationally representative cross-sectional survey commissioned by the World Health Organization in 2021 for Ethiopia. Data was collected from 895 individuals aged 18 years of age or older. Analysis applied several methods including the Multiple Correspondence Analysis, Univariate analysis, hierarchical cluster analysis, cluster analysis and multiple regression analysis. Using face masks and washing hands were the most frequently practiced preventive measures. The regression analysis indicated that perceived severity, perceived barriers, and cues to action showed a significant association with adherence at p &gt;0.05. Furthermore, socio-economic factors have a moderating role on adherence to preventive measures and HBM factors. Effective promotion and adoption of preventive measures require addressing individuals' perceptions of severity and benefits while minimizing barriers and providing clear cues to action. Additionally, specific preventive measures that require ongoing effort and habit development may face challenges in adoption. Tailoring interventions can help overcome these challenges and encourage the widespread adoption of preventive measures to curtail the spread. Keywords: Coronavirus disease - 2019, Prevention, Health belief model.

2 Excessive Exercise among Youth with a New Diagnosis of Restrictive Eating Disorder before and during the COVID-19 Pandemic

Abstract Background During the COVID-19 pandemic, Canadian youth with anorexia nervosa (AN) and atypical anorexia nervosa (AAN) presented at higher rates with more severe illness. This trend was found to be more pronounced in Canadian jurisdictions where public health measures included full school closures and confinement. Disease severity in AN is multifactorial, however, excessive exercise can be associated with more severe illness. Due to closures, many adolescents turned to unregulated exercise regimes within their homes. The contribution of excessive exercise to the rise of new onset AN during the pandemic remains unknown. Objectives To determine the rate of excessive exercise among newly diagnosed adolescents with AN/AAN during the COVID-19 pandemic compared to the five preceding years. Design/Methods This was a secondary analysis of a prospectively collected intake registry of all new diagnoses of AN and AAN completed between January 1st, 2015, and November 30th, 2020 at two large, urban, tertiary paediatric hospitals in Quebec. Baseline demographic information and clinical assessment variables were collected based on standardized assessment forms. Excessive exercise was self-reported and defined as &amp;gt;10 hours per week of moderate or vigorous physical activity at the time of diagnosis. Medical hospitalization within 1 week of assessment was used as a marker of medical severity. The primary outcome of excessive exercise was compared between the period of pandemic public health preventive measures (March 2020 to November 2020) and the pre-pandemic period (January 2015 to February 2020). Variables were compared before and during the pandemic using Chi square testing. Results Overall, 817 patients with new diagnoses of AN/AAN met inclusion criteria during the study period (pre=647; during=170), with 40 patients (pre=34/647 and during =6/170) excluded due to missing data on exercise frequency. Overall, median patient age was 15.9 (IQR 13.8-16.9) years; 93% female; and 59% diagnosed with AAN. During the pandemic, mean hospitalization rate increased from 2.2 to 7.2 patients per month (p=0.001). Hospitalization within one week of diagnosis increased from 23% to 40% (136/613 vs. 65/16; p=0.001). The rate of excessive exercise did not differ before versus during the pandemic overall (27% vs. 24%; p=0.48) nor in patients requiring admission (40/136 [29%] vs. 23/65[36%]; p=0.39). Conclusion Excessive exercise in isolation does not appear to explain the increased rate and severity of new AN/AAN diagnoses since the pandemic in this cohort. Further studies are needed to better elucidate other drivers which may have contributed to the severity of eating disorders during this period.

Falls among older adults in Nigeria; public health implications and preventive measures

Falls among older adults in Nigeria; public health implications and preventive measures

Why Mourning for Minks Matters: Rebellious Grief as Practice of Solidarity

The paper advocates the idea of grief as a key emotion for transformation. Following Judith Butler’s concept of grievability, it agues that a critical reflection on who (or what) is mourned reveals the normative orders of a society as well as its possible blind spots. As a particularly telling case, the mass culling of Danish minks that took place in 2020 as a preventive public health measure in the Covid-19 pandemic is examined. The response to the case sheds light on the various barriers of broadening the moral community. The paper explores some of the reasons for the practical disability to mourn for animals bred for use and argues that it is part misleading to focus on the species-line. Rather, it is a question of selective moral responsiveness which is dependent on the specific cultural context and way of life. In the last part of the paper, it is suggested that ecological grief work is a means to move from grief to empathy and solidarity and finally resistance. When others are discovered as grievable, they are acknowledged as vulnerable fellow beings which have to be morally considered. Grief, then, can be understood as a disruptive emotion which questions the current understanding of normality.