Substantial Health Problems Research Articles

Gut-Brain Axis Microbiota in Stroke Pathogenesis

Stroke is the second cause of death globally and the third cause of global disability, causing substantial health and socioeconomic problems. Clinically, Stroke is defined as brain tissue injury caused by a lack of blood supply to a particular area, resulting in permanent nerve damage or death. Stroke is also frequently associated with metabolic causes, including insulin resistance, obesity, hypertension, and type 2 diabetes mellitus (T2DM), significantly influencing the composition and abundance of the gut microbiota. Therefore, identifying potential risk factors influencing stroke prognosis and underlying pathogenic mechanisms is essential for better management and treatment of Stroke. Several studies show the existence of two-way communication between the gut and the brain through the gut microbiota. Intimate two-way interactions between the gut and the brain occur via neural (central, autonomic, and enteric nervous systems), hormonal (endocrine system), and immunological (innate and acquired immune systems) pathways, commonly referred to as the gut-microbiota axis. Brain or gut-brain axis (Gut-Brain Axis/GBA). Gut microbiota and derived metabolites play an important role in brain function by regulating GBA signaling. Recent evidence also suggests that GBA is critical in regulating immune function post-stroke. Intestinal dysbiosis provides a chronic peripheral and central inflammatory response that accelerates stroke pathology. Gut microbial dysbiosis is a significant risk factor positively correlated with poor post-stroke outcomes. This literature review summarizes the pathogenesis of ischemic Stroke, the description of the gut microbiota, and preclinical and clinical evidence indicating the pathogenic influence of gut dysbiosis in cerebral ischemic Stroke. Keywords: Stroke, Gut-brain axis, dysbiosis

From Crisis to Opportunity: A Qualitative Study on Rehabilitation Therapists' Experiences and Post-Pandemic Perspectives.

Rehabilitation therapists (RTs) have developed substantial mental health problems since the pandemic. Our study aimed to understand the experience of COVID-19 on occupational therapists and physiotherapists practicing in Canada, how the pandemic may have affected care delivery, and to identify new learnings articulated by RTs. A qualitative descriptive study design guided data collection through one-on-one interviews, dyadic interviews, and focus groups. We recruited active RTs across Canada, advertising on professional practice networks and social media platforms and using snowball sampling. Forty-nine RTs representing seven Canadian provinces participated. The four overarching themes developed using thematic analysis were (1) navigating uncertainty along with ever-changing practices, policies, and attitudes, (2) morphing roles within a constrained system, (3) witnessing patients suffering and experiencing moral distress, and (4) recognizing the personal toll of the pandemic on self and others, as well as lessons learned. Our study demonstrated that many RTs suffered moral distress, poor mental health, and some from challenging financial situations, especially those in the private sector. They also expressed a resilient attitude in response to these stressors. Implications in the future include identifying promising communication strategies that could act as protective factors, addressing workforce constraints and diminishing resources through innovative models of care.

Preferences for mHealth Intervention to Address Mental Health Challenges Among Men Who Have Sex With Men in Nepal: Qualitative Study.

Men who have sex with men (MSM) are disproportionately burdened by poor mental health. Despite the increasing burden, evidence-based interventions for MSM are largely nonexistent in Nepal. This study explored mental health concerns, contributing factors, barriers to mental health care and support, and preferred interventions to improve access to and use of mental health support services among MSM in Nepal. We conducted focus groups with MSM in Kathmandu, Nepal, in January 2023. In total, 28 participants took part in 5 focus group sessions. Participants discussed several topics related to the mental health issues they experienced, factors contributing to these issues, and their suggestions for potential interventions to address existing barriers. The discussions were recorded, transcribed, and analyzed using Dedoose (version 9.0.54; SocioCultural Research Consultants, LLC) software for thematic analysis. Participants reported substantial mental health problems, including anxiety, depression, suicidal ideation, and behaviors. Contributing factors included family rejection, isolation, bullying, stigma, discrimination, and fear of HIV and other sexually transmitted infections. Barriers to accessing services included cost, lack of lesbian, gay, bisexual, transgender, intersex, queer, and asexual (LGBTIQA+)-friendly providers, and the stigma associated with mental health and sexuality. Participants suggested a smartphone app with features such as a mental health screening tool, digital consultation, helpline number, directory of LGBTIQA+-friendly providers, mental health resources, and a discussion forum for peer support as potential solutions. Participants emphasized the importance of privacy and confidentiality to ensure mobile apps are safe and accessible. The findings of this study have potential transferability to other low-resource settings facing similar challenges. Intervention developers can use these findings to design tailored mobile apps to facilitate mental health care delivery and support for MSM and other marginalized groups.

Detection and characterization of <i>Listeria monocytogenes</i> from locally processed fermented foods in Ethiope West, Delta State, Nigeria

Outbreaks linked with foodborne pathogens and associated diseases occur regularly and pose substantial health problems to consumer safety globally. Listeriosis is a leading foodborne disease initiated by the consumption of foods contaminated by Listeria monocytogenes (L. monocytogenes ) This study evaluated the presence of . L. monocytogenes in various food samples. Locally fermented food samples (n = 80), which included Garri (n = 30), Kunu (n = 25), and Zobo (n = 25), were obtained from five open local markets in Ethiope West, Delta State, Nigeria. Food samples were screened for L. monocytogenes using standard cultural techniques, biochemical tests including the Analytic Profile Index (API) Listeria kit. The isolates were screened for antimicrobial resistance using the disc diffusion method, and breakpoints were interpreted based on the guidelines of the Clinical Laboratory Standard Institute. Gelatinase and lipase activities, including β-haemolysis, were determined using standard methods. L. monocytogenes was identified in 3 (3.8%) and 4 (5%) samples from Zobo and Kunu, respectively. The Garri samples were negative for L. monocytogenes, and only 7 of the 80 (8.8%) samples were positive for L. monocytogenes. One positive sample each was obtained in the Oghara and Ogharefe markets, two from the Ugbenu market, and three from the Mosogar market. No sample was positive L. monocytogenes. for in the Oghareki market. All the isolates were penicillin-resistant but susceptible to levofloxacin and tetracycline, whereas five were resistant to clindamycin. All isolates were resistant to at least two classes of antibiotics, and the multiple antibiotic resistance (MAR) index was ≥ 0.22. Gelatinase activity was observed in one isolate, β-haemolytic activity in four isolates, and lipase activity in five isolates. This study revealed the importance of proper hygiene practices in food production and continuous surveillance of antibiotic resistance and virulence determinants in food. There is a need to adhere to standard hygiene measures in food processing environments.

Escherichia coli and Salmonella enterica isolated from Egyptian dairy cattle herds: The prevalence and molecular characteristics.

The pathogens Escherichia coli and Salmonella enterica that caused substantial health problems and financial losses were believed to have originated primarily from Egypt's dairy farms. The purpose of this study was to ascertain the occurrence of E. coli and S. enterica in three large dairy farms located in the Egyptian governorate of Sharkia. Furthermore, biochemical and serological characteristics of the isolated isolates were described. Further analysis revealed that several E. coli serovars had the genes stx1, stx2, eaeA, and hylA, while invA, stn, and hilA genes were found in several S. enterica serotypes using a multi-plex PCR. A total of 540 samples of fresh raw cow milk, water, feedstuffs, feces, (108 each), as well as swabs from feeders, milker hands and cattle crushes (36 each ), were gathered and analyzed. The recovery of E. coli from various sampling sources was shown to have an overall prevalence of 62.2% (336/540) in the results. Fecal samples had isolated S. enterica, with a frequency of 0.74% (4/540). The existence of various groups of serovars, such as O26, O44, O55, O78 and O111 for E. coli and Salmonella enteritidis, Salmonella typhimurium and Salmonella inganda for S. enterica was revealed by serological identification of the two species. However, it was discovered that a number of E. coli serovars had much higher percentages of the eaeA and hylA genes as well as shiga-toxin types 1 and 2 (stx1 and stx2). The presence of the invA gene, a diagnostic marker for S. enterica was 100% across all serovars. Salmonella enteritidis possessed both the enterotoxin gene (stn) and the hyper-invasive locus gene (hilA). Salmonella typhimurium had the hilA gene, whereas S. inganda had the stn gene. Escherichia coli and S. enterica recovered in this study have significant genetic risk factors for high pathogenicity and virulence, posing a real threat to dairy population productivity and health, which could spread to the general public through milk.

The Patient Protection and Affordable Care Act and oral health care use among formerly incarcerated people in the United States

BackgroundFormerly incarcerated people report less frequent oral health care use, despite having more substantial oral health problems. This study aimed to determine whether the adoption of the Patient Protection and Affordable Care Act (ACA) has improved oral health care use among formerly incarcerated people in the United States. MethodData were from Wave I (1994-1995), Wave IV (2008), and Wave V (2016-2018) of the National Longitudinal Study of Adolescent to Adult Health (n = 9,108), a nationally representative cohort study in the United States. ResultsOn the basis of the results of multiple logistic regression analysis with interaction terms, the authors found a positive and statistically significant interaction between prior incarceration and living in a state with ACA adoption on past-year oral health care use, net of potential confounding variables (incarceration × ACA: odds ratio, 1.587; 95% CI, 1.043 to 2.414). Substantively, the findings suggest that people with a history of incarceration are less likely to use oral health care, and this disparity is more likely to occur in states without ACA adoption. ConclusionsACA adoption corresponds with improvements in the receipt of oral health care among formerly incarcerated people. Practical ImplicationsThis study builds on prior evidence highlighting that the ACA is beneficial in connecting formerly incarcerated people to health care services and suggests that these benefits may extend to improving access to and use of oral health care.

Functional decline during the COVID-19 pandemic among U.S. military veterans: Results from the National Health and Resilience in Veterans Study.

The coronavirus disease-2019 pandemic has contributed to widespread social and economic stressors, along with substantial health problems, including loss of life. To date, however, relatively few studies have examined the prevalence and correlates of declines in mental and physical functioning in U.S. military veterans, an older and potentially vulnerable segment of the U.S. adult population. Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative, longitudinal study of 3078 veterans. Veterans were surveyed prior to the pandemic (pre-pandemic) and 1year later during the height of the pandemic (peri-pandemic). Multivariable analyses were conducted to identify risk and protective variables associated with pre-to-peri pandemic declines in self-reported physical and mental functioning. The prevalence of veterans who experienced functional decline (≥0.5 standard deviation reductions) pre-to-peri-pandemic was 18.1% (N=541) for physical functioning and 18.3% (N=547) for mental functioning. Older age, greater adverse childhood experiences (ACEs), and pandemic-related posttraumatic stress symptoms were the strongest correlates of physical functional decline, while greater ACEs, loneliness, pandemic-related posttraumatic and social restriction stress symptoms, and lower protective psychosocial characteristics were the strongest correlates of mental functional decline. Although the majority of U.S. Veterans showed functional maintenance or improvement 1year into the pandemic, nearly one-in-five experienced a decline in physical or mental functioning. Results could help inform identification of veterans who may be at risk for functional decline during large-magnitude stressors, such as national or global pandemics.

Physical health of care-experienced young children in high-income countries: a scoping review

BackgroundGood health in the early years lays the foundation for lifelong health. Children with experience of extraparental care (eg, foster, kinship, residential) have poorer outcomes than children without such experience. Common health conditions in high-income countries differ from those in low-income and middle-income countries. Health conditions also vary substantially with age. The literature examining physical health conditions affecting young care-experienced children in high-income countries has not been previously reviewed. This review addresses this gap to better understand the health needs of these children. MethodsIn this scoping review, we used a broad range of search terms in MEDLINE, CINAHL, and Web of Science Core Collection databases to identify studies of (1) care-experienced children, (2) physical health outcomes, and (3) children aged 6 years or younger. Intersecting search results were retained for screening. Results were restricted to peer-reviewed journal articles indexed before Sept 1, 2022, with titles in English. Grey literature was excluded. No restriction was placed on study design. Results were narratively synthesised and categorised by health condition. FindingsSearches yielded 15 639 results, and 33 articles were ultimately included, covering 11 countries. Studies were concentrated in the USA (n=18, 55%) and Europe (including UK; n=10, 30%). Most studies investigated a specific health outcome or set of outcomes (n=23, 70%) with many of the remaining studies carrying out broader health reviews (n=8, 24%). Height and weight were the most frequently reported outcomes (n=10, 30%) followed by vision (n=7, 21%) and dental health (n=7, 21%). Nine studies (27%) compared outcomes in care-experienced children with outcomes in non-care-experienced controls. Synthesis of results identified poor physical development, poor dental health, low rates of immunisation, dermatological conditions, and anaemia to be substantial health problems among young children with care experience. InterpretationPoor physical development and anaemia suggest efforts are required to improve care-experienced children's diet. Dermatological conditions and poor dental health can be managed by additional health-care support to care-experienced children and caregivers. A strength of this work is the standardised methodology. This work is limited by the exclusion of grey literature and restriction to high-income countries. FundingMedical Research Council, Economic and Social Research Council, and Chief Scientist Office (Scotland).

Complex interactions among insect viruses-insect vector-arboviruses.

Insects are the host or vector of diverse viruses including those that infect vertebrates, plants, and fungi. Insect viruses reside inside their insect hosts and are vertically transmitted from parent to offspring. The insect virus-host relationship is intricate, as these viruses can impact various aspects of insect biology, such as development, reproduction, sex ratios, and immunity. Arthropod-borne viruses (arboviruses) that cause substantial global health or agricultural problems can also be vertically transmitted to insect vector progeny. Multiple infections with insect viruses and arboviruses are common in nature. Such coinfections involve complex interactions, including synergism, dependence, and antagonism. Recent studies have shed light on the influence of insect viruses on the competence of insect vectors for arboviruses. In this review, we focus on the biological effects of insect viruses on the transmission of arboviruses by insects. We also discuss the potential mechanisms by which insect viruses affect the ability of hosts to transmit arboviruses, as well as potential strategies for disease control through manipulation of insect viruses. Analyses of the interactions among insect vectors, insect viruses and arboviruses will provide new opportunities for development of innovative strategies to control arbovirus transmission.

Adolescents in therapeutic residential care: treatment needs and characteristics

ABSTRACT Despite the growing body of literature examining the complex needs of adolescents in residential care populations, few studies have investigated the specific treatment needs and characteristics of adolescents in therapeutic residential care (TRC). This study aimed to describe and compare risk, need and responsivity factors in a national sample of 737 juveniles (63% males, mean age = 16.2) who displayed serious behavioural problems. The study utilised comprehensive assessment data, including demographic information, clinical variables, and risk factors assessed with the Youth Level of Service/Case management Inventory (YLS/CMI). Sample characteristics were explored, and three subgroups were compared: adolescents with serious substance abuse, adolescents with a high risk of continued delinquency and adolescents with low/moderate risk. The sample showed complex needs in multiple criminogenic domains and substantial mental health problems. Subgroups were clearly differentiated by the YLS/CMI risk profile and several demographic attributes; however, most clinical variables concerning mental health overlapped between groups. The findings suggest that TRC interventions should be aimed at reducing the risk of persistent delinquency and structured according to the principles of risk, need and responsivity. The study has important clinical implications for how differentiated services can tailor interventions to group-based needs and characteristics.

Prevalence and incidence of health problems and their characteristics in Brazilian para athletes: A one-season single-center prospective pilot study

BackgroundPara athletes experience high prevalence and incidence of health problems related to sport. Despite this, there are few longitudinal studies. ObjectiveTo describe the characteristics, prevalence, incidence, and severity of health problems in para athletes from one of the Brazilian Paralympic Reference Centers during a sports season and to compare the prevalence of health problems between para athletics, para powerlifting, and para swimming. MethodsThis prospective pilot study was conducted from October 2019 to March 2020. The Oslo Sports Trauma Research Center Questionnaire on Health Problems was used to record injuries and illnesses every week for 24 weeks. The characteristics, prevalence, incidence, and severity of health problems were described for each modality. The prevalence of health problems was compared among the three sport modalities. ResultsThirty-five para athletes participated. Most of the injuries occurred in the shoulder, and most illnesses caused respiratory and gastrointestinal symptoms. The average weekly prevalence and the incidence rate of health problems were 40.6% (95% CI 17.0–64.4) and 12.7 (95% CI 9.6–15.9) per 1000 athlete hours, respectively. Para powerlifting had the highest prevalence of all and substantial health problems; para swimming had the lowest prevalence of injuries; and para athletics had the lowest prevalence of illnesses. ConclusionsThis group of Brazilian para athletes showed a high prevalence and incidence of health problems throughout the season. Para athletics, para powerlifting, and para swimming each had a different prevalence of injuries and illnesses.

Effect modification of an effective transdiagnostic cognitive behavioral psychotherapy in youths with common mental health problems: Secondary analyses of the randomized mind-my-mind trial

Mind My Mind (MMM) cognitive behavioral therapy (CBT) manualized treatment is effective in the management of common emotional and behavioral mental health problems in youth, yet not all individuals respond satisfactorily to treatment. This study explored potential effect modifiers, i.e., baseline factors associated with a differential treatment effect. We conducted secondary effect modifier analyses with MMM trial data, which involved randomization of 396 youths aged 6–16 years to either MMM CBT treatment (9–13 sessions) or management as usual in local community settings. We examined sociodemographic- (sex, age, family composition, ethnicity, parental education, and income) and clinical variables (mental disorders and duration of mental health problems) as potential effect modifiers of the a) change in parent-rated impact of mental health problems measured by the Strengths and Difficulties Questionnaire (SDQ) or b) response (reduction of ≥1 on SDQ-impact). In intention-to-treat analyses, superior treatment (net) benefits from the MMM intervention were found among youths who met criteria for any mental disorder at baseline (-1.25 [95%CI: -1.67;-0.82]) compared to youths that did not meet diagnostic criteria (-0.22 [95%CI:-1.09;0.65]). Comorbidity vs no comorbidity (-1.84 [95%CI:-2.58;-1.10] vs -0.72 [95%CI:-1.15;-0.29]) and longer duration of untreated mental health problems, i.e., more vs less than 6 months (-1.16 [95%CI:-1.55;-0.78] vs 0.43 [95%CI:-1.01;1.86]) were also associated with superior treatment benefits. The sociodemographic factors were not associated with differential treatment effects in the intention-to-treat analyses. These findings suggest that community-based programs like the MMM are well-suited for youths with substantial mental health problems. Clinical Trials Identifier: NCT03535805

Risk assessment of combined exposure to lead, cadmium, and total mercury among the elderly in Shanghai, China

Lead (Pb), cadmium (Cd) and total mercury (THg) are toxic heavy metals (THMs) that are widely present in the environment and can cause substantial health problems. However, previous risk assessment studies have rarely focused on the elderly population and have usually targeted a single heavy metal, which might underestimate the long-term accumulative and synergistic effects of THMs in humans. Based on the food frequency questionnaire and inductively coupled plasma mass spectrometry, this study assessed external and internal exposures to Pb, Cd and THg in 1747 elderly people in Shanghai. Probabilistic risk assessment with the relative potential factor (RPF) model was used to assess the neurotoxicity and nephrotoxicity risks of combined THMs exposures. The mean external exposures of Pb, Cd and THg in Shanghai elderly were 46.8, 27.2 and 4.9 μg/day, respectively. Plant-based foods are the main source of Pb and THg exposure, while Cd is mainly from animal-based foods. The mean concentrations of Pb, Cd and THg were 23.3, 1.1 and 2.3 μg/L in the whole blood, and 6.2, 1.0 and 2.0 μg/L in the morning urine, respectively. Combined exposure to THMs leading to 10.0 % and 7.1 % of Shanghai elderly at risk of neurotoxicity and nephrotoxicity. The results of this study have important implications for understanding the profiles of Pb, Cd and THg exposure in the elderly living in Shanghai and provide data support for risk assessment and control of nephrotoxicity and neurotoxicity from combined THMs exposure in the elderly.

Identification of risk factors for post-intensive care syndrome in family members (PICS-F) among adult patients: a systematic review.

Relatives of critically ill patients who either die or survive the intensive care unit (ICU) may develop substantial mental health problems that are collectively defined as post-intensive care syndrome in family (PICS-F). By using a systematised search strategy we included studies that focused on PICS-F in relatives of adult ICU patients and reported the risk factors associated with its development. The search was conducted within PubMed, Embase, SCOPUS, clinicaltrials.gov, and Cochrane Library on the 23 August 2022. PRISMA 2020 guidelines were implemented for appropriate reporting. The objective was to document all possible risk factors associated with the development of PICS-F. We included 51 papers covering 9302 relatives. The frequency of PICS-F varied between 2.5 and 69%. We identified 51 different risk factors of PICS-F, among which we distinguished patient-related ( n = 16), relative-related ( n = 27), and medical staff-related ( n = 8) risk factors. Among 21 studies of the highest quality, we identified the 33 variables associated with the development of PICS-F, of which younger age of a patient, death of a patient, depression in relatives during the ICU stay, history of mental disorders in relatives, being a female relative, being a spouse, and having low satisfaction with communication and care in the ICU were the most commonly reported risk factors. PICS-F is a highly frequent phenomenon that can be exacerbated by several risk factors. Special attention should be paid to relatives of younger patients with worse prognosis and with the following relative-related risk factors: female sex, being a spouse, and history of mental health disorders. Finally, the medical staff play a role in preventing the PICS-F development, not only by maintenance of proper communication, but also by early identification of relatives prone to PICS-F.

Determination of the median lethal dose of indoxacarb pesticide in Wistar rat

Indoxacarb is a novel organophosphate substitute and is considered a “lower risk” pesticide in agriculture. However, in humans and animals, indoxacarb exposure had been linked to substantial health problems. This study was carried out to investigate the acute oral toxicity and histopathological changes of indoxacarb in female Wistar albino rats. The acute oral toxicity of indoxacarb was performed as per the OECD guidelines No. 425, (Acute Oral Toxicity - Up-anddown procedure). The LD50 of indoxacarb was estimated using AOT425StatPgm (version: 1.0) statistical program and found to be 1098 mg/kg. Hence the pesticide is categorized as Type II class of pesticide according to the WHO standards. All the animals dosed at 2000 mg/kg died within 12 h exhibiting clinical signs of intermittent episodes of tremors, incoordination, respiratory distress and open-mouth breathing. Histopathological examination of indoxacarb treated rats at 2000mg/ kg degeneration of hepatocytes and necrosis in haematoxylin and eosin staining.

Health problems in national team cross-country skiers over a competitive season: a 17-week prospective cohort study

ObjectiveFew long-term prospective studies have investigated health problems in elite competitive cross-country (XC) skiers. Hence, our objective was to compare the prevalence of health problems in national team XC skiers...

Distribution of Vibrionaceae in farmed Asian sea bass, Lates calcarifer in Thailand and their high prevalence of antimicrobial resistance

This study describes the etiological agent of Vibriosis along with its distribution and antimicrobial resistance profiles among farmed Asian sea bass (Lates calcarifer) in Thailand. The study isolated 283 Vibrionaceae from 15 Asian sea bass farms located around the provinces of the Andaman Sea and Gulf of Thailand coasts to uncover the distribution and antimicrobial resistance profiles. Bacterial identification based on a combination of the biochemical characteristics, Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry (MS) analysis, and the species-specific PCR demonstrated the predominant Vibrionaceae were Vibrio harveyi (n=56), Photobacterium damselae (n=35), and V. vulnificus (n=31), respectively. According to a laboratory challenge experiment, among the six isolates, only V. harveyi was found to cause clinical signs of muscle necrosis and scale loss in Asian sea bass. Antibiotics resistance test results exhibited high resistance to antibiotics such as metronidazole (100%), streptomycin (97%), clindamycin (96%), colistin sulphate (70%) and amoxicillin (59%). Remarkably, 100% of Vibrionaceae isolates are susceptible to florfenicol. The 28 of 29 resistance profiles were multidrug resistances (MDR), with V. vulnificus having the highest MAR value (0.66). The findings of this study advise that a surveillance program, as well as preventive and control measures, be developed for Vibrionaceae to reduce production loss, pathogen proliferation, and antibiotic abuse, whereas AMR data indicate substantial health problems for aquatic animals and humans.

The prevalence of diabetic retinopathy in the occupied Palestinian territories: a national cross-sectional study

BackgroundDiabetic retinopathy is a complication of diabetes that affects the eyes and can lead to blindness if not adequately managed. No national or population-based estimates of diabetic retinopathy in Palestine exist. High-quality ophthalmic services are not available at the primary health care level for patients with diabetes in all sectors. Specialised eye centres are lacking. St John of Jerusalem Eye Hospital Group, which consists of five facilities in the West Bank and Gaza Strip, is the only provider of expert eye care in Palestine. The aim of this study was to determine the population prevalence of diabetic retinopathy among people with diabetes aged 50 years and older in Palestine. MethodsThis survey was part of a larger population-based survey using the rapid assessment of avoidable blindness (RAAB) methodology to estimate prevalence of vision impairment, blindness, and disability in individuals aged 50 years and older in Palestine. It was a nationally representative, cross-sectional, population-based survey in Gaza Strip and West Bank. Based on an expected prevalence of blindness of 3·4% in individuals aged 50 years and older, 20% precision level, 95% confidence level, 10% non-response rate, and a design effect of 1·4 to account for clustering, a sample size of 4224 participants aged 50 years and older was determined. 69 clusters in the West Bank and 52 clusters in the Gaza Strip were selected with probability proportionate to size from a list of areas from the Palestinian Central Bureau of Statistics population and housing census of 2017. Within each cluster, 35 people aged 50 years or older were randomly selected for examination in their homes. Three teams collected data; each consisted of a nurse and an ophthalmologist. Dilated fundus examination and Scottish diabetic retinopathy grading were done by the ophthalmologist in each team. Participants were classified as having diabetes if they had been diagnosed by a health professional, or if their random blood glucose (RBG) was 200 mg/dL or above on the day of data collection, as measured by a portable glucometer. Ethical approval was obtained from the St John of Jerusalem Eye Hospital Group and the London School of Hygiene & Tropical Medicine ethics committees. Informed oral witnessed consent was obtained from all participants. FindingsThe survey was conducted between July, 2018, and April, 2019. 4224 individuals were asked to participate, of whom 376 did not, leaving 3848 participants. The number of previously diagnosed and newly diagnosed patients with diabetes was 1176 (486 male, 690 female) and 103 (55 male, 48 female), respectively. The overall prevalence of diabetes across West Bank and Gaza was 33·2% (95% CI 31·5–34·9; 1279 of 3848 participants). The prevalence was higher in women (738 of 2047 [36·1%, 95% CI 33·6–38·5]) than in men (541 of 1801 [30·0%, 27·9–32·2), and in Gaza Strip (639 [35·8%] of 1783) than in West Bank (640 [31·0%] of 2065; p=0·002). Only 539 (46·3%) of 1164 patients with diagnosed diabetes who consented to blood blucose measurement had controlled blood glucose (RBG <200 mg/dL). 483 (41·1%) of 1176 patients with previously diagnosed diabetes had never had an eye check-up or had not been checked in the 2 years before the survey. 327 (25·6%) of 1279 patients with diabetes refused dilated fundus examination; 952 patients did undergo this examination, and 457 (48·0%, 95% CI 43·5–52·6) had diabetic retinopathy or maculopathy. Vision impairment was more common in those with diabetes (428 [33·5%] of 1279) than in those without (652 [25·4%] of 2569). 43 (3·4%) of 1279 participants with diabetes had blindness, compared with 65 (2·5%) of 2569 patients without diabetes. The principal cause of blindness in Gaza Strip was diabetic retinopathy (23 [32·4%] of 71) and in West Bank was untreated cataract (19 [51·4%] of 37). Diabetic retinopathy was the main cause of blindness, severe visual impairment, and moderate visual impairment among patients with diabetes. InterpretationDiabetes and diabetic retinopathy are substantial health problems in Palestine. Earlier detection and proper management at primary health care clinics and by outreach clinics for marginalised populations could be key. Referral networks between health-care sectors and specialised eye centres might provide the necessary infrastructure. FundingFred Hollows Foundation, Australia, German Federal Ministry for Economic Cooperation and Development.

A longitudinal comparison of college student mental health under the COVID-19 self-restraint policy in Japan.

BackgroundThe coronavirus-19 (COVID-19) pandemic has resulted in substantial mental health problems. In addition to the fear of infection, prevention policies that result in isolation such as lockdowns or, in Japan, “self-restraint,” are associated with psychological symptoms. University students are vulnerable to emotional disorders because of the psychological challenges associated with the transition to adulthood. Therefore, we investigated changes in the mental health of university students before and during the COVID-19 pandemic.MethodsWe used data from depression screening conducted by the University of Tsukuba, Japan, during student health examinations. Students completed the Patient Health Questionnaire-9 (PHQ-9) and an open-ended question on stress self-coping.ResultsIn 2020, 9.6% of students were depressed, approximately twice as many as in previous years. The paired samples Wilcoxon test showed that PHQ-9 scores were significantly higher in 2020 than in 2019; the largest effect size was for sleep difficulties. Analysis of the open-ended responses for stress coping strategies showed that physical activity and online communication were most frequently used.LimitationsThe 2020 survey was web-based, whereas the surveys in previous years were completed in person. Only approximately one-sixth of participants answered the open-ended question.ConclusionsThe percentage of students with mental health problems has doubled, and more attention to student mental health is needed. However, many students seem to be using appropriate coping measures. Education about best practices and raising awareness about establishing and maintaining sleep–wake rhythms may be useful.

Association Between Preseason Fitness Level and Risk of Injury or Illness in Male Elite Ice Hockey Players: A Prospective Cohort Study.

Background:Little is known about the association between physical fitness and the risk of injury or illness in ice hockey. The least-fit players may be more prone to injury and illness.Purpose:To examine the association between preseason fitness level and injury or illness risk among elite ice hockey players during the regular season.Study Design:Cohort study; Level of evidence, 2.Methods:A total of 133 male ice hockey players in the GET League (the premier professional league in Norway) completed 8 different exercises (40-m sprint, countermovement jump, 3000-m run, squat, bench press, chin-ups, brutal bench, and box jump) at the annual 1-day preseason testing combine. During the 2017-2018 competitive season, the players reported all health problems (acute injuries, overuse injuries, and illnesses) weekly (31 weeks) using the Oslo Sports Trauma Research Center Questionnaire on Health Problems.Results:Overall, the players reported 191 acute injuries, 82 overuse injuries, and 132 illnesses. The least-fit tercile of players did not report more health problems (mean, 3.0; 95% CI, 2.2-3.8) compared with the most-fit (mean, 3.4; 95% CI, 2.6-4.2) or the medium-fit (mean, 2.7; 95% CI, 1.9-3.5) players. The most-fit players reported more substantial health problems (mean, 2.0; 95% CI, 1.6-2.5) compared with the medium-fit (mean, 1.3; 95% CI, 0.8 -1.8) and least-fit (mean, 1.8; 95% CI, 1.3-2.3) (P = .02) players. There was no association between low physical fitness and number of health problems when comparing the least-fit tercile of the players with the rest of the cohort (P > .05); however, there was an association between low physical fitness and greater severity of all health problems when comparing the least-fit tercile of players to the rest of the cohort after adjusting for time on ice per game, playing position, and age (P = .02).Conclusion:Low physical fitness was not associated with increased rate of injury or illness but was associated with greater severity of all health problems after adjusting for time on ice per game, playing position, and age.