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Paterson A, Olliaro PL, Rojek A. Addressing stigma in infectious disease outbreaks: a crucial step in pandemic preparedness. Front Public Health 2023; 11:1303679. [PMID: 38186713 PMCID: PMC10768929 DOI: 10.3389/fpubh.2023.1303679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
There is a complex interplay between infectious disease outbreaks and the stigmatization of affected persons and communities. Outbreaks are prone to precipitating stigma due to the fear, uncertainty, moralisation, and abatement of freedoms associated with many infectious diseases. In turn, this stigma hampers outbreak control efforts. Understanding this relationship is crucial to improving coordinated outbreak response. This requires valid and reliable methods for assessing stigma towards and within impacted communities. We propose adopting a cross-outbreak model for developing the necessary assessment tools. A stigma-informed approach must then be integrated into outbreak preparedness and response efforts to safeguard public health and promote inclusivity and compassion in future outbreaks.
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Affiliation(s)
- Amy Paterson
- Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Piero L. Olliaro
- Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
| | - Amanda Rojek
- Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
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Kavanagh E. Long Covid brain fog: a neuroinflammation phenomenon? OXFORD OPEN IMMUNOLOGY 2022; 3:iqac007. [PMID: 36846556 PMCID: PMC9914477 DOI: 10.1093/oxfimm/iqac007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/12/2022] [Accepted: 09/13/2022] [Indexed: 11/14/2022] Open
Abstract
Neuroinflammation is a process triggered by an attack on the immune system. Activation of microglia in response to an immune system challenge can lead to a significant impact on cognitive processes, such as learning, memory and emotional regulation. Long Covid is an ongoing problem, affecting an estimated 1.3 million people within the UK alone, and one of its more significant, and as yet unexplained, symptoms is brain fog. Here, we discuss the potential role of neuroinflammation in Long Covid cognitive difficulties. Inflammatory cytokines have been found to play a significant role in reductions in LTP and LTD, a reduction in neurogenesis, and in dendritic sprouting. The potential behavioural consequences of such impacts are discussed. It is hoped that this article will allow for greater examination of the effects of inflammatory factors on brain function, most particularly in terms of their role in chronic conditions.
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Shantha JG, Canady D, Hartley C, Cassedy A, Miller C, Angeles-Han ST, Harrison-Williams LC, Vandy MJ, Weil N, Bastien G, Yeh S. Ophthalmic sequelae and psychosocial impact in pediatric ebola survivors. EClinicalMedicine 2022; 49:101483. [PMID: 35747182 PMCID: PMC9167858 DOI: 10.1016/j.eclinm.2022.101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/22/2022] Open
Abstract
Background Ebola virus disease (EVD) outbreaks in West Africa (2013-2016) and the Democratic Republic of Congo (2018-2020) have resulted in thousands of EVD survivors who remain at-risk for survivor sequelae. While EVD survivorship has been broadly reported in adult populations, pediatric EVD survivors are under-represented. In this cross-sectional study, we investigated the prevalence of eye disease, health-related quality-of-life, vision-related quality-of-life, and the burden of mental illness among pediatric EVD survivors in Sierra Leone. Methods Twenty-three pediatric EVD survivors and 58 EVD close contacts were enrolled. Participants underwent a comprehensive ophthalmic examination and completed the following surveys: Pediatric Quality of Life Inventory Version 4.0, Effect of Youngsters Eyesight on Quality-of-Life, and the Revised Child Anxiety and Depression Scale. Findings A higher prevalence of uveitis was observed in EVD survivor eyes (10·8%) cohort compared to close contacts eyes (1·7%, p=0·03). Overall, 47·8% of EVD survivor eyes and 31·9% of close contact eyes presented with an eye disease at the time of our study (p=0·25). Individuals diagnosed with an ocular complication had poorer vision-related quality-of-life (p=0·02). Interpretation Both health related quality-of-life and vision-related quality-of-life were poor among EVD survivors and close contacts. The high prevalence of eye disease associated with reduced vision health, suggests that cross-disciplinary approaches are needed to address the unmet needs of EVD survivors. Funding National Institutes of Health R01 EY029594, K23 EY030158; National Eye Institute; Research to Prevent Blindness (Emory Eye Center); Marcus Foundation Combating Childhood Illness; Emory Global Health Institute; Stanley M. Truhlsen Family Foundation.
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Affiliation(s)
- Jessica G. Shantha
- University of California San Francisco, F.I. Proctor Foundation, San Francisco, CA, United States
| | | | - Caleb Hartley
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Amy Cassedy
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, United States
| | - Chris Miller
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sheila T. Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, United States
| | | | - Matthew J. Vandy
- Ministry of Health and Sanitation Sierra Leone, Freetown, Sierra Leone
| | - Natalie Weil
- Children's Hospital New Orleans, New Orleans, LA, United States
| | | | - Steven Yeh
- Truhlsen Eye Institute, Department of Ophthalmology, University of Nebraska Medical Center, Omaha, NE, United States
- Child Health Research Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
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COVID-19 Pandemisi Sırasında Türk Toplumunun Ruh Sağlığı. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1057608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Giriş: Yeni koronavirüs hastalığı (COVID-1 tüm dünyaya hızla yayılarak tüm dünyada olduğu gibi Türkiye'de de çok sayıda ölüme neden olmuştur. COVID-19 potansiyel olarak öldürücüdür ve insanların ruh sağlığını etkiler. Potansiyel psikolojik sorunları tespit etmek önemlidir. Türkiye'de COVID-19 sürecinde toplumun kaygı düzeylerini ve ilişkili risk faktörlerini belirlemeyi amaçladık.
Yöntemler: Bu, pandemi sırasında Türkiye genelinde gerçekleştirilen kesitsel bir çalışmadır. Anketler katılımcılara Google Formlar aracılığıyla ulaştırılmıştır. Anket ilk olarak 15 Nisan 2020 tarihinde yayınlanmış ve 30 günlük bir süre boyunca veriler toplanmıştır.
Bulgular: Türk toplumu tarafından doldurulan 8.917 anket formu çalışmaya dahil edildi. Yaşlılarda, kadınlarda, anne-babalarda, sigara içenlerde, ek hastalığı olanlarda, sosyal medya kullananlarda ve eğitim düzeyi yüksek olanlarda kaygı düzeyi ve ölüm korkusu daha yüksekti.
Sonuç: Bu çalışma, katılımcı sayısı açısından Türkiye'de yapılmış en kapsamlı çalışma olup, Türk toplumunun pandemi sürecindeki ruhsal durumuna ışık tutmaktadır. Türkiye'de COVID-19'un nüfusun ruh sağlığını olumsuz yönde etkilediği, kaygı düzeylerini ve ölüm korkusunu artırdığı belirlendi. Kaygı düzeyi ve ölüm korkusu yüksek olan kişiler belirlenmeli ve bu kişilere psikolojik destek sağlanmalıdır.
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Bond NG, Grant DS, Himmelfarb ST, Engel EJ, Al-Hasan F, Gbakie M, Kamara F, Kanneh L, Mustapha I, Okoli A, Fischer W, Wohl D, Garry RF, Samuels R, Shaffer JG, Schieffelin JS. Post-Ebola Syndrome Presents With Multiple Overlapping Symptom Clusters: Evidence From an Ongoing Cohort Study in Eastern Sierra Leone. Clin Infect Dis 2021; 73:1046-1054. [PMID: 33822010 PMCID: PMC8442780 DOI: 10.1093/cid/ciab267] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Following the 2013-2016 West African Ebola outbreak, distinct, persistent health complaints were recognized in Ebola virus disease (EVD) survivors. Here we provide an in-depth characterization of post-Ebola syndrome >2.5 years after resolution of disease. Additionally, we report subphenotypes of post-Ebola syndrome with overlapping symptom clusters in survivors from Eastern Sierra Leone. METHODS Participants in Eastern Sierra Leone were identified by the Sierra Leone Association of Ebola survivors. Survivors and their contacts were administered a questionnaire assessing self-reported symptoms and a physical examination. Comparisons between survivors and contacts were conducted using conditional logistic regression. Symptom groupings were identified using hierarchical clustering approaches. Simplified presentation of incredibly complex evaluations (SPICE), correlation analysis, logistic regression, and principal component analysis (PCA) were performed to explore the relationships between symptom clusters. RESULTS Three hundred seventy-five EVD survivors and 1040 contacts were enrolled into the study. At enrollment, EVD survivors reported significantly more symptoms than their contacts in all categories (P < .001). Symptom clusters representing distinct organ systems were identified. Correlation and logistic regression analysis identified relationships between symptom clusters, including stronger relationships between clusters including musculoskeletal symptoms (r = 0.63, P < .001; and P < .001 for correlation and logistic regression, respectively). SPICE and PCA further highlighted subphenotypes with or without musculoskeletal symptoms. CONCLUSIONS This study presents an in-depth characterization of post-Ebola syndrome in Sierra Leonean survivors >2.5 years after disease. The interrelationship between symptom clusters indicates that post-Ebola syndrome is a heterogeneous disease. The distinct musculoskeletal and non-musculoskeletal phenotypes identified likely require targeted therapies to optimize long-term treatment for EVD survivors.
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Affiliation(s)
- Nell G Bond
- Tulane University, New Orleans, Louisiana, USA
| | | | | | | | | | | | | | | | | | | | - William Fischer
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - David Wohl
- University of North Carolina, Chapel Hill, North Carolina, USA
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Assessing anxiety, depression and insomnia symptoms among Ebola survivors in Africa: A meta-analysis. PLoS One 2021; 16:e0246515. [PMID: 33544772 PMCID: PMC7864444 DOI: 10.1371/journal.pone.0246515] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background During health disaster events such as the current devastating havoc being inflicted on countries globally by the SARS-CoV-19 pandemic, mental health problems among survivors and frontline workers are likely concerns. However, during such health disaster events, stakeholders tend to give more precedence to the socio-economic and biomedical health consequences at the expense of mental health. Meanwhile, studies show that regardless of the kind of disaster/antecedent, all traumatic events trigger similar post-traumatic stress symptoms among survivors, families, and frontline workers. Thus, our study investigated the prevalence of anxiety, depression and insomnia symptoms among survivors of the 2014–2016 Ebola virus disease that plagued the West African sub-region. Methods We systematically retrieved peer-reviewed articles published between 1970 and 2019 from seven electronic databases, including Google Scholar, MEDLINE, PsychInfo, PubMed, Scopus, Springer Link, Web of Science on Ebola and post-traumatic stress disorder symptoms. A comprehensive hand search complemented this literature search. Of the 87 articles retrieved, only 13 met the inclusion criteria for this meta-analysis. Results After heterogeneity, influence, and publication bias analysis, our meta-analysis pooled proportion effects estimates showed a moderate to a high prevalence of anxiety (14%; 99% CI: 0.05–0.30), depression (15%; 99% CI: 0.11–0.21), and insomnia (22%; 99% CI: 0.13–0.36). Effect estimates ranging from (0.13; 99% CI: 0.05, 0.28) through to (0.11; 99% CI: 0.05–0.22), (0.15; 99% CI: 0.09–0.25) through to (0.13; 99% CI: 0.08–0.21) and (0.23; 99% CI: 0.11–0.41) to (0.23; 99% CI: 0.11–0.41) were respectively reported for anxiety, depression and insomnia symptoms. These findings suggest a significant amount of EVD survivors are struggling with anxiety, depression and insomnia symptoms. Conclusion Our study provided the first-ever meta-analysis evidence of anxiety, depression, and insomnia symptoms among EVD survivors, and suggest that the predominant biomedical health response to regional and global health disasters should be complemented with trauma-related mental health services.
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Wang S, Zhang Y, Guan Y, Ding W, Meng Y, Hu H, Liu Z, Zeng X, Wang M. A nationwide evaluation of the prevalence of and risk factors associated with anxiety, depression and insomnia symptoms during the return-to-work period of coronavirus disease 2019 in China. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2275-2286. [PMID: 33616693 PMCID: PMC7898251 DOI: 10.1007/s00127-021-02046-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/12/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the prevalence of and risk factors associated with anxiety, depression, and insomnia symptoms during the return-to-work period of coronavirus disease 2019 in China. METHODS The authors conducted a large-scale, nationwide, multicenter, cross-sectional study in China. A population-based quota and snowball sampling were designed to recruit a representative sample. Online questionnaires and telephone reviews were used to collect characteristics and assess psychological and sleep problems. Anxiety, depression, and insomnia symptoms were measured by the generalized anxiety disorder-7, patient health questionnaire-9, and insomnia severity index tools. RESULTS A total of 42,000 participants were recruited from 15 centers, and 36,795 valid questionnaires were received. Generally, 18.3, 14.9, and 17.9% of the participants had anxiety, depression, and insomnia symptoms, respectively, and 2.2-2.7% had severe symptoms. Engaging in outside activity once in ≥ 30 days (OR = 2.719, OR = 2.074, OR = 2.225) and age 50-64 years (OR = 2.431, OR = 1.936, OR = 2.036) were common risk factors for anxiety, depression and insomnia symptoms. Living in Hubei Province (OR = 1.304, OR = 1.242) was a common risk factor for anxiety and insomnia symptoms. Working as frontline medical staff (OR = 2.150) was another risk factor for anxiety symptoms. The health education rate of the samples reached 98.9%. However, the psychological intervention rate was only 16.2%, and 2.5% received targeted interventions. CONCLUSIONS An increasing number of people might have psychological and sleep problems. However, the current psychological interventions are not sufficient. Efforts should be made to strengthen interventions for high-risk populations.
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Affiliation(s)
- Shu Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, 100093 China
| | - Yuan Zhang
- Dalian Medical University, Dalian, 116044 Liaoning China
- Department of Pediatric Hematology-Oncology, Dalian Municipal Women and Children’s Medical Center, Dalian, 116037 Liaoning China
| | - Yuguang Guan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, 100093 China
- Beijing Key Laboratory of Epilepsy, Beijing, 100093 China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, 100093 China
| | - Wei Ding
- Department of Neurology, Liaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Yao Meng
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250014 Shandong China
| | - Huiting Hu
- Department of Neurology, Heze Mudan People’s Hospital, Heze, 274000 Shandong China
| | - Zhenhua Liu
- Sleep Medicine Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Xianwei Zeng
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, 250012 Shandong China
| | - Minzhong Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
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Prevalence of anxiety and depression symptoms, and association with epidemic-related factors during the epidemic period of COVID-19 among 123,768 workers in China: A large cross-sectional study. J Affect Disord 2020; 277:495-502. [PMID: 32882506 PMCID: PMC7448744 DOI: 10.1016/j.jad.2020.08.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND COVID-19 has gained intense attention globally. However, little is known about the COVID-19-ralated mental health status among workers. METHODS The cross-sectional online survey with 123,768 workers was conducted from February 2, 2020 to February 7, 2020 on a mega-size labor-intensive factory in Shenzhen, China. Oral consent was obtained prior to the questionnaire survey. The information collected in the survey included demographic characteristics, psychological symptoms, COVID-19-related information, and demands for psychological education and interventions. Symptoms of anxiety and depression were measured by the Zung's Self-Rating Anxiety Scale and Self-Rating Depression Scale. Logistic regression models were performed to determine the association between related factors and mental health status. RESULTS The prevalence of anxiety and depression symptoms was 3.4% and 22.8%, respectively. The dominant epidemic-related factors were having confirmed cases in the community (odds ratio [OR], 2.75, 95% CI, 2.37-3.19) and having confirmed friends (OR, 2.44; 95% CI, 1.69-3.52) for the increased risk of anxiety and depression symptoms, respectively. Nevertheless, major traditional risk factors such as general or poor health status and always drinking alcohol were still the dominant factors associated with the increased risk of anxiety and depression symptoms. Overall, 67.3% and 26.8% workers reported desire for psychological education and interventions, respectively. LIMITATIONS All assessments were self-reported, resulting in a risk of method bias. CONCLUSIONS Our findings show a relatively low prevalence of anxiety symptoms, a relatively high prevalence of depression symptoms, and urgent demand for psychological education and interventions among workers during the COVID-19 outbreak.
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Dar SA, Khurshid SQ, Wani ZA, Khanam A, Haq I, Shah NN, Shahnawaz M, Mustafa H. Stigma in coronavirus disease-19 survivors in Kashmir, India: A cross-sectional exploratory study. PLoS One 2020; 15:e0240152. [PMID: 33253177 PMCID: PMC7703941 DOI: 10.1371/journal.pone.0240152] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/21/2020] [Indexed: 01/31/2023] Open
Abstract
Background Coronavirus disease-19 (COVID-19) has not only spawned a lot of stigma and discrimination towards its survivors but also to their corpses. We aimed to assess the magnitude and correlates of stigma in these survivors, on return to their communities. Methods This was a cross-sectional, hospital-based, exploratory study conducted by the postgraduate department of psychiatry, in collaboration with the postgraduate department of chest medicine, Govt. medical college, Srinagar. The study was performed among COVID-19 survivors, who attended the outpatient department after their discharge from the hospital. Socio-demographic characteristics were recorded through semi-structured proforma. Stigma was measured by the stigma questionnaire. Data was analyzed using descriptive statistics and regression analysis. Results A total of 91 survivors consented to participate in the study. Almost half (46.2%) of them were in the age group of 30–49 years and close to two-thirds (68.1%) were males. About three–fourths (74.7%) were from the urban background. The mean time from hospital discharge to study entry was 11.7±5.1 [Range(R) = 7–21] days. 98% of survivors provided at least one stigma endorsing response and the total mean stigma score was 28.5±7.1[R = 6–39]. The mean stigma sub-scores were highest for enacted stigma (7.6±1.8) [R = 2–9] and externalized stigma (15.0±4.1) [R = 1–20]. Enacted stigma was significantly high in males as compared to females. Enacted stigma and internalized stigma were both associated with education. Enacted stigma, externalized stigma, disclosure concerns, and total stigma was significantly associated with the occupation. Being unemployed and time since discharge were identified as independent predictors of total stigma. Conclusion Our study results showed high levels of enacted and externalized stigma among COVID-19 survivors. Enacted stigma was more among males and in those who were highly educated. Survivor centered and community-driven anti-stigma programs are the need of the hour to promote the recovery and community re-integration of these survivors.
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Affiliation(s)
- Shabir Ahmad Dar
- Department of Psychiatry, Government Medical College, Srinagar, India
- * E-mail:
| | | | - Zaid Ahmad Wani
- Department of Psychiatry, Government Medical College, Srinagar, India
| | - Aaliya Khanam
- Department of Psychiatry, Government Medical College, Srinagar, India
| | - Inaamul Haq
- Department of Social and Preventive Medicine, Government Medical College, Srinagar, India
| | - Naveed Nazir Shah
- Department of Chest Medicine, Government Medical College, Srinagar, India
| | - Mir Shahnawaz
- Department of Chest Medicine, Government Medical College, Srinagar, India
| | - Hena Mustafa
- Department of Chest Medicine, Government Medical College, Srinagar, India
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Zhang Y, Wang S, Ding W, Meng Y, Hu H, Liu Z, Zeng X, Guan Y, Wang M. Status and influential factors of anxiety depression and insomnia symptoms in the work resumption period of COVID-19 epidemic: A multicenter cross-sectional study. J Psychosom Res 2020; 138:110253. [PMID: 32979696 PMCID: PMC7500335 DOI: 10.1016/j.jpsychores.2020.110253] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE In this study, the authors analyzed the status of anxiety depression and insomnia symptoms and influential factors in the work resumption period of Coronavirus disease 2019 (COVID-19). METHODS A multicenter cross-sectional survey was conducted from March 2, 2020 to March 8, 2020 in Shandong Province, China, using quota sampling combined with snowball sampling. The Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Insomnia Severity Index (ISI) were used to assess the anxiety, depression, and insomnia symptoms. The multivariate logistic regression analysis was used to explore the influential factors. RESULTS A total of 4000 invitations were sent from three centers, 3237 valid questionnaires were received. Based on GAD-7, PHQ-9, and ISI scales, 19.5%-21.7% of the participants had anxiety, depression, or insomnia symptoms; 2.9%-5.6% had severe symptoms. Besides, 2.4%, 4.8%, and 4.5% of the participants had anxiety-depression, anxiety-insomnia, or depression-insomnia combined symptoms. The scores of anxiety and insomnia symptoms, along with scores of depression and insomnia symptoms were positively correlated in these samples. Aged 50-64 years and outside activities once in ≥30 days were risk factors of anxiety, depression, and insomnia symptoms in common. During the epidemic, 17.4% of the participants had received psychological interventions, and only 5.2% had received individual interventions. CONCLUSIONS The incidence of psychological distress increased during the outbreak of COVID-19 in the work resumption period than the normal period. Current psychological interventions were insufficient; target psychological interventions should be conducted in time.
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Affiliation(s)
- Yuan Zhang
- Dalian Medical University, Dalian, Liaoning 116044, China,Department of Pediatric Hematology-Oncology, Dalian Municipal Women and Children's Medical Center, Dalian, Liaoning 116037, China
| | - Shu Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China.
| | - Wei Ding
- Department of Neurology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, China
| | - Yao Meng
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, China
| | - Huiting Hu
- Department of Neurology, Heze Mudan People's Hospital, Heze, Shandong 274000, China
| | - Zhenhua Liu
- Sleep Medicine Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Xianwei Zeng
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Yuguang Guan
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing 100093, China,Beijing Key Laboratory of Epilepsy, Beijing 100093, China,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing 100093, China
| | - Minzhong Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
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Wang S, Zhang Y, Ding W, Meng Y, Hu H, Liu Z, Zeng X, Wang M. Psychological distress and sleep problems when people are under interpersonal isolation during an epidemic: A nationwide multicenter cross-sectional study. Eur Psychiatry 2020; 63:e77. [PMID: 32854786 PMCID: PMC7503168 DOI: 10.1192/j.eurpsy.2020.78] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background. During the outbreak of coronavirus disease 2019 (COVID-19), people are under the dual pressure of interpersonal isolation and concerns about infection. An evaluation of people’s psychological status and risk factors is needed to conduct target interventions. Methods. This was a nationwide, multicenter, cross-sectional study using quota and snowball sampling methods during the COVID-19 epidemic in China. Participants’ characteristics and experiences were obtained by an online questionnaire and telephone review. Psychological distress and sleep problems were measured by the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Insomnia Severity Index. Results. A total of 23,500 participants were recruited, and 19,372 valid questionnaires were received from 11 centers. Overall, 11.0–13.3% of the participants had anxiety, depression, or insomnia symptoms, and 1.9–2.7% had severe symptoms. The prevalence of psychological and sleep problems has increased. Working as frontline medical staff (Odds Ratio OR = 3.406), living in Hubei Province (OR = 2.237), close contacts with COVID-19 (OR = 1.808), and age 35–49 years (OR = 1.310) were risk factors for anxiety symptoms; no outside activity for 2 weeks (OR = 2.167) and age 35–49 years (OR = 1.198) were risk factors for depression symptoms; and living in Hubei Province (OR = 2.376), no outside activity for 2 weeks (OR = 1.927), and age 35–49 years (OR = 1.262) were risk factors for insomnia symptoms. Only 1.9% of participants received counseling during the epidemic. Conclusions. Psychological and sleep problems increased during interpersonal isolation due to COVID-19. Current psychological interventions are far from sufficient.
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Affiliation(s)
- Shu Wang
- Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China
| | - Yuan Zhang
- Dalian Medical University, Dalian, China.,Department of Pediatric Hematology-Oncology, Dalian Municipal Women and Children's Medical Center, Dalian, China
| | - Wei Ding
- Department of Neurology, Liaocheng People's Hospital, Liaocheng, China
| | - Yao Meng
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Huiting Hu
- Department of Neurology, Heze Mudan People's Hospital, Heze, China
| | - Zhenhua Liu
- Sleep Medicine Center, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xianwei Zeng
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
| | - Minzhong Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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12
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Albott CS, Wozniak JR, McGlinch BP, Wall MH, Gold BS, Vinogradov S. Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for Health Care Workers During the COVID-19 Pandemic. Anesth Analg 2020; 131:43-54. [PMID: 32345861 PMCID: PMC7199769 DOI: 10.1213/ane.0000000000004912] [Citation(s) in RCA: 233] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The outbreak of the coronavirus disease 2019 (COVID-19) and its rapid global spread have created unprecedented challenges to health care systems. Significant and sustained efforts have focused on mobilization of personal protective equipment, intensive care beds, and medical equipment, while substantially less attention has focused on preserving the psychological health of the medical workforce tasked with addressing the challenges of the pandemic. And yet, similar to battlefield conditions, health care workers are being confronted with ongoing uncertainty about resources, capacities, and risks; as well as exposure to suffering, death, and threats to their own safety. These conditions are engendering high levels of fear and anxiety in the shortterm, and place individuals at risk for persistent stressexposure syndromes, subclinical mental health symptoms, and professional burnout in the longterm. Given the potentially wide-ranging mental health impact of COVID-19, protecting health care workers from adverse psychological effects of the pandemic is critical. Therefore, we present an overview of the potential psychological stress responses to the COVID-19 crisis in medical providers and describe preemptive resilience-promoting strategies at the organizational and personal level. We then describe a rapidly deployable Psychological Resilience Intervention founded on a peersupport model (Battle Buddies) developed by the United States Army. This intervention—the product of a multidisciplinary collaboration between the Departments of Anesthesiology and Psychiatry & Behavioral Sciences at the University of Minnesota Medical Center—also incorporates evidence-informed “stress inoculation” methods developed for managing psychological stress exposure in providers deployed to disasters. Our multilevel, resource-efficient, and scalable approach places 2 key tools directly in the hands of providers: (1) apeersupport Battle Buddy; and (2) adesignated mental health consultant who can facilitate training in stress inoculation methods, provide additional support, or coordinate referral for external professional consultation. In parallel, we have instituted a voluntary research data-collection component that will enable us to evaluate the intervention’s effectiveness while also identifying the most salient resilience factors for future iterations. It is our hope that these elements will provide guidance to other organizations seeking to protect the well-being of their medical workforce during the pandemic. Given the remarkable adaptability of human beings, we believe that, by promoting resilience, our diverse health care workforce can emerge from this monumental challenge with new skills, closer relationships, and greater confidence in the power of community.
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Affiliation(s)
| | | | - Brian P McGlinch
- Anesthesiology, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Michael H Wall
- Anesthesiology, School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Barbara S Gold
- Anesthesiology, School of Medicine, University of Minnesota, Minneapolis, Minnesota
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13
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Ficenec SC, Schieffelin JS, Emmett SD. A Review of Hearing Loss Associated with Zika, Ebola, and Lassa Fever. Am J Trop Med Hyg 2020; 101:484-490. [PMID: 31333155 PMCID: PMC6726950 DOI: 10.4269/ajtmh.18-0934] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The neglected tropical diseases Zika, Ebola, and Lassa fever (LF) have all been noted to cause some degree of hearing loss (HL). Hearing loss is a chronic disability that can lead to a variety of detrimental effects, including speech and language delays in children, decreased economic productivity in adults, and accelerated cognitive decline in older adults. The objective of this review is to summarize what is known regarding HL secondary to these viruses. Literature for this review was gathered using the PubMed database. Articles were excluded if there were no data of the respective viruses, postinfectious complications, or conditions related to survivorship. A total of 50 articles were included in this review. Fourteen articles discussing Zika virus and subsequent complications were included. Across these studies, 56 (21.2%) of 264 Zika-infected individuals were found to have HL. Twenty-one articles discussing Ebola virus and subsequent complications were included, with 190 (5.7%) of 3,350 Ebola survivors found to have HL. Fifteen additional articles discussing LF and subsequent complications were included. Of 926 individuals with LF, 79 (8.5%) were found to have HL. These results demonstrate a relationship between HL and infection. The true prevalence is likely underestimated, however, because of lack of standardization of reporting and measurement. Future studies of viral sequelae would benefit from including audiometric evaluation. This information is critical to understanding pathophysiology, preventing future cases of this disability, and improving quality of life after survival of infection.
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Affiliation(s)
| | | | - Susan D Emmett
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina.,Duke Global Health Institute, Durham, North Carolina.,Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina
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14
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James PB, Wardle J, Steel A, Adams J. An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross-sectional study. BMC Public Health 2020; 20:182. [PMID: 32020858 PMCID: PMC7001224 DOI: 10.1186/s12889-020-8279-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/27/2020] [Indexed: 12/17/2022] Open
Abstract
Background We examined the magnitude and correlates of Ebola virus disease (EVD)-related stigma among EVD survivors in Sierra Leone since their return to their communities. In addition, we determined whether EVD-related stigma is a predictor of informal health care use among EVD survivors. Methods We conducted a cross-sectional study among 358 EVD survivors in five districts across all four geographic regions (Western Area, Northern Province, Eastern Province and Southern Province) of Sierra Leone. Ebola-related stigma was measured by adapting the validated HIV related stigma for people living with HIV/AIDS instrument. We also measured traditional and complementary medicine (T&CM) use (as a measure of informal healthcare use). Data were analysed using descriptive statistics and regression analysis. Results EVD survivors report higher levels of internalised stigma (0.92 ± 0.77) compared to total enacted stigma (0.71 ± 0.61). Social isolation (0.96 ± 0.88) was the highest reported enacted stigma subscale. Ebola survivors who identified as Christians [AOR = 2.51, 95%CI: 1.15–5.49, p = 0.021], who perceived their health to be fair/poor [AOR = 2.58, 95%CI: 1.39–4.77. p = 0.003] and who reside in the northern region of Sierra Leone [AOR = 2.80, 95%CI: 1.29–6.07, p = 0.009] were more likely to experience internalised stigma. Verbal abuse [AOR = 1.95, 95%CI: 1.09–3.49, p = 0.025] and healthcare neglect [AOR = 2.35, 95%CI: 1.37–4.02, p = 0.002] were independent predictors of T&CM use among EVD survivors. Conclusion Our findings suggest EVD-related stigma (internalised and enacted) is prevalent among EVD survivors since their return to their communities. Religiosity, perceived health status and region were identified as independent predictors of internalised stigma. Verbal abuse and healthcare neglect predict informal healthcare use. EVD survivor-centred and community-driven anti-stigma programs are needed to promote EVD survivors’ recovery and community re-integration.
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Affiliation(s)
- Peter Bai James
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, 2007, Australia. .,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Jonathan Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, 2007, Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, 2007, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, 2007, Australia
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15
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Ebola virus disease: An emerging and re-emerging viral threat. J Autoimmun 2019; 106:102375. [PMID: 31806422 DOI: 10.1016/j.jaut.2019.102375] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022]
Abstract
The genus Ebolavirus from the family Filoviridae is composed of five species including Sudan ebolavirus, Reston ebolavirus, Bundibugyo ebolavirus, Taï Forest ebolavirus, and Ebola virus (previously known as Zaire ebolavirus). These viruses have a large non-segmented, negative-strand RNA of approximately 19 kb that encodes for glycoproteins (i.e., GP, sGP, ssGP), nucleoproteins, virion proteins (i.e., VP 24, 30,40) and an RNA dependent RNA polymerase. These viruses have become a global health concern because of mortality, their rapid dissemination, new outbreaks in West-Africa, and the emergence of a new condition known as "Post-Ebola virus disease syndrome" that resembles inflammatory and autoimmune conditions such as rheumatoid arthritis, systemic lupus erythematosus and spondyloarthritis with uveitis. However, there are many gaps in the understanding of the mechanisms that may induce the development of such autoimmune-like syndromes. Some of these mechanisms may include a high formation of neutrophil extracellular traps, an uncontrolled "cytokine storm", and the possible formation of auto-antibodies. The likely appearance of autoimmune phenomena in Ebola survivors suppose a new challenge in the management and control of this disease and opens a new field of research in a special subgroup of patients. Herein, the molecular biology, pathogenesis, clinical manifestations, and treatment of Ebola virus disease are reviewed and some strategies for control of disease are discussed.
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James PB, Wardle J, Steel A, Adams J. Post-Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review. Trop Med Int Health 2019; 24:671-691. [PMID: 30843627 DOI: 10.1111/tmi.13226] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE A myriad of physical and psychosocial sequelae have been reported among Ebola survivors from previous Ebola virus disease (EVD) outbreaks, including the most recent in West Africa. This review examines the various forms of psychological distress experienced by EVD survivors, family and community reactions to EVD survivors and EVD survivors' coping mechanisms. METHODS We conducted a literature search of original articles employing Medline (Ovid), PubMed, Web of Science, Scopus, CINAHL, EBSCO host academic search complete, PsycINFO (EBSCO) and Embase databases. RESULTS Our search identified 1890 articles of which 24 met our inclusion criteria. Various forms of psychological distress were prevalent among EVD survivors including depression, anxiety, anger, grief, guilt, flashbacks, sadness, worthlessness, substance addiction, suicidal tendencies and self-stigmatisation. Family and community responses to EVD survivors ranged from acceptance to rejection, isolation, stigmatisation and discrimination. EVD survivors' coping strategies included engagement with religious faith, EVD survivors associations and involvement in EVD prevention and control interventions. CONCLUSION Psychological distress, including that resulting from family and community stigma and discrimination, appears common among EVD survivors. Community-based mental health and psychosocial interventions integrated within a broader package of care for EVD survivors that also recognises the physical health challenges are required. Well-designed longitudinal studies can provide clear insights on the nature and trajectory of the psychosocial issues currently experienced by EVD survivors.
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Affiliation(s)
- P B James
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - J Wardle
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - A Steel
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - J Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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