Mistrust Among Rescue Workers After the Terrorist Attack in Berlin in 2016 - Gender-Specific Health Inequality

OBJECTIVES

In this single-case-by-group comparison, we examine whether previously found cisgender differences in paranoid ideation after a terror attack are also seen in a transgender male emergency worker.

METHODS

Sixty emergency personnel who were exposed to the 2016 terror attack in Berlin were evaluated 3 to 4 and 21-25 mo after the attack.

RESULTS

On paranoid ideation, the transgender male showed higher scores than cisgender males (+2 standard deviations [SD]) and the overall group (+1 SD).

CONCLUSIONS

This underpins the previously identified gender effects. It would be useful to consider specified pre- and postdeployment modules that take cis- and transgender differences into account.

Gender and occupational differences in post-terrorist mental health outcomes among emergency responders with and without crisis intervention

Introduction

After the Berlin terrorist attack at Breitscheidplatz, the gender-specific evaluation of emergency responders (ER) revealed higher perceived levels of paranoid ideation among females. The occupation-specific evaluation revealed higher hostility among police officers and a lower quality of life among firefighters. The aim of this study was to examine the outcome of crisis intervention (CI) provided for ER deployed to this terrorist attack.

Methods

In total, N = 55 ER were included (n = 37 with and n = 18 w/o CI). Stress, quality of life, post-traumatic stress disorder, and current psychological stress were assessed 4 months after the attack.

Results

ER with and w/o CI were compared. Participants with CI showed lower quality of life in psychological health (t(53)=2.01, p=.050) and higher depressive symptomatology (t(44) = 2.51, p=.016). Females with CI showed lower quality of life in social relationships (t(12)=2.46, p=.030), whereas males showed more posttraumatic stress symptoms (t(39)= .32, p=.026). Emergency responders from NGOs with CI had higher phobic anxiety (t(9.2)=2.72, p=.023). Emergency medical technicians with CI showed more somatic (t(7.5)=2.52, p=.037) and depressive (t(8)=2.30, p=.050) symptoms.

Conclusions

This study provides evidence for differences in the mental health burden for ER with and w/o CI, in general and for subgroups of gender and occupation. There is no conclusive explanation for why ER with CI score worse on certain measures. It is possible that CI had a harmful influence due to the reinforcement of negative emotions in some parts of measures like the Critical Incident Stress Debriefing (CISD). While it is known that ERs are vulnerable to develop mental problems, and appropriate and timely help is recommended, it is important to critical evaluate the methods used and to take also into account the identified gender and occupational differences. Further research is needed to better understand the interaction of risk factors.

Longitudinal Mental Health Effects of the 2016 Terrorist Attack in Berlin on Various Occupational Groups of Emergency Service Personnel

Emergency service personnel who respond to terrorist attacks may experience persistent stress following the event. This occupational stress must be examined in order to develop occupation-specific response preparation and follow-up measures. An explorative pilot study examined the occupational stress-related effects of the 2016 terrorist attack on Breitscheidplatz in Berlin on emergency service personnel. The present study examines whether the results of the pilot study can be replicated and whether the effects changed after 2 years. The participants were 60 emergency personnel (including 11 police officers and 24 firefighters) who were deployed to the attack, and a control group of 60 personnel (including 37 police officers and 21 firefighters) who were not deployed. Data on stress, quality of life, and current mental state were gathered 3 to 4 months after the attack and 18 to 21 months after the first survey. The data showed that police officers who responded to the attack had significantly higher levels of aggression and hostility at both time points, and firefighters had significantly lower levels of environmental quality of life at both time points. Quality of life in terms of physical health for firefighters could not be replicated. Due to the different types of stress experienced by emergency service personnel, a differentiated approach is necessary. More specific preparation and follow-up measures are necessary to counteract persistent stress. Further research in this area could lead to specific predeployment and postdeployment training measures.

Long-term effects of the terror attack in Berlin in 2016 on paranoid ideation in female emergency personnel

In a pilot study, female emergency personnel showed increased paranoid ideation following a terror attack. This newly designed confirmatory study aims to replicate these previously found gender-specific results and investigate the progression of effects after 2 years. Participants were exposed and unexposed emergency personnel (n = 120). Exposed female versus exposed male personnel showed higher paranoid ideation at both time points. There was a group × time interaction effect in paranoid ideation: paranoid ideation increased over time in the exposed versus the unexposed female group. The same effect was observed with exposed female emergency personnel showing a significant 2-year post-deployment increase compared with the total group including unexposed female as well as exposed and unexposed male emergency personnel. There is, as yet, no conclusive explanation for this difference. Sexual harassment in a male-dominated profession may be a vulnerability factor. Differentiated preparation and follow-up for emergency responders is recommended moving towards health-related equality.

Burdens on emergency responders after a terrorist attack in Berlin

Background

Terrorist attacks induce various responses in emergency responders. Addressing this range of responses in individual workers is of central interest.

Aims

To assess the gender- and occupation-specific effects of a terrorist attack, particularly in emergency responders.

Methods

This was a pilot study. Emergency responders present during the 2016 terrorist attack at Breitscheidplatz in Berlin were asked to participate. Measures for crisis management had been previously implemented. Stress (Patient Health Questionnaire [PHQ]), quality of life (The World Health Organization Quality of Life [WHOQOL-BREF]), post-traumatic stress disorder (PTSD Checklist for DSM-5 [PCL-5]) and current psychological symptoms (Brief Symptom Inventory [BSI]) were assessed.

Results

Thirty-seven subjects were included, 11 female and 26 male. The occupational groups included 16 firefighters, six police officers, five psychosocial health care personnel and nine members of aid organizations. Three months after the attack, female workers showed higher scores in stress and paranoid ideation, police officers showed higher scores in hostility and firefighters scored lower quality of life in environment and physical health.

Conclusions

The mental health burden identified in this study plays an important role for emergency responders after terrorist attacks. Differences between occupational groups may be attributable to differences in tasks that responders perform during acute incidents. The presence of these differences 3 months after the incident suggests that these are at least medium-term conditions. This study may inform the development of treatments and policies and it thus recommended to develop a multi-level assessment and treatment programme that is gender- and occupation-specific.

[Barriers to treatment-seeking among German veterans: expert interviews]

BACKGROUND

The number of service members of the German armed forces suffering from deployment-related mental health problems is increasing. However, less than 50 % seek professional help, and there is little knowledge about the barriers to treatment-seeking.

METHODS

The article presents data gathered by the Delphi technique combined with focus groups from 55 health service experts regarding the evaluated barriers to treatment-seeking among German veterans.

FINDINGS

According to the interviewed experts, major contextual barriers to treatment-seeking include: 1) intimidating processes and structures, 2) actual stigmatization and discrimination, and 3) health service deficits. Major individual barriers to treatment were: 4) health beliefs, self-perception and fear of stigmatization, and 5) avoidance behavior related to psychopathology. In addition, there is another both contextual and individual barrier, i.e., 6) information deficits.

INTERPRETATION

Individual internal factors like the soldiers' self-perception and their fear of being stigmatized were considered important barriers to treatment-seeking. The experts' opinion about avoidance behavior related to psychopathology and deficits in health services and information coincides with international findings. Compared to research in other countries, actual stigmatization and discrimination were regarded to be an important barrier in itself. According to our findings daunting/intimidating processes and structures like time-consuming and complex expert medical reports rather seem to be a German phenomenon.

Differences in susceptibility of the European eel (Anguilla anguilla) and the Japanese eel (Anguilla japonica) to the swim-bladder nematode Anguillicola crassus

The swim-bladder nematode Anguillicola crassus originates from the Far East where it is a parasite of the Japanese eel (Anguilla japonica). After A. crassus was introduced to Europe, it became a predominant parasite of the European eel (Anguilla anguilla). A study performed with experimentally infected eels (98 days, 23 degrees C) revealed significant differences in the susceptibility of the two eel species to this parasite. The recovery rate of 30 administered infective A. crassus larvae (L3) from A. japonica was less than half of that from A. anguilla (33.2% and 13.8%, respectively). Almost 60% of the worms recovered from A. japonica were found as dead, encapsulated and necrotic larvae in the swimbladder wall. In contrast, no dead larvae were found in A. anguilla. Additionally, the development of the worms was shown to be significantly slower in A. japonica compared with A. anguilla. The lower survival rate of the worms, together with their slower development, resulted in a significantly lower adult worm burden (11 and 428 mg wet weight, respectively) and in a decreased reproductive success in A. japonica compared with A. anguilla. These results demonstrate that the original host, A. japonica, possesses more effective defence mechanisms against A. crassus than does the non-adapted host, A. anguilla.

Optimization of the anti-(human CD3) immunotoxin DT389-scFv(UCHT1) N-terminal sequence to yield a homogeneous protein

The production and regulatory approval processes for biopharmaceuticals require detailed characterization of potential products. Therapeutic proteins should preferably be homogeneous, although limited, reproducible, heterogeneity may be tolerated. A diphtheria toxin-based anti-(human CD3) immunotoxin, DT389-scFv(UCHT1), was expressed in Escherichia coli and purified following refolding [DT389 corresponds to amino acids 1-389 of diphtheria toxin, scFv is single-chain variable-region antibody fragment and UCHT1is an anti-(human CD3) monoclonal antibody]. Biochemical characterization of this molecule by MS and N-terminal sequencing by Edman degradation revealed that the protein was heterogeneous at the N-terminus, containing species both with (60%) and without (40%) the initiator methionine residue. In an attempt to generate an N-terminally homogeneous molecule, a panel of seven N-terminal variants was designed, based on the published specificity of bacterial methionine aminopeptidase. Following bacterial expression, partial purification and separation on SDS/PAGE, these proteins were subjected to N-terminal sequencing by Edman degradation. Three of the mutants yielded a 100% homogeneous amino acid sequence. By contrast, the original DT389-scFv(UCHT1) protein and four variant proteins yielded two sequences with varying ratios corresponding to species with and without methionine. The N-terminal sequences of the three homogeneous clones were MLADD and MLDD, where the methionine was completely retained, and SADD, where the methionine was completely removed. One of the homogeneous mutants (SADD) was expressed, refolded and purified and found to be equipotent with the parent immunotoxin. Thus, using a rational mutagenesis approach, three N-terminally homogeneous variants of DT389-scFv(UCHT1) have been identified, at least one of which is functionally indistinguishable from the parent immunotoxin. This approach is generally applicable to biopharmaceutical production and immunotoxin development in particular.

Sanglifehrins A, B, C and D, novel cyclophilin-binding compounds isolated from Streptomyces sp. A92-308110. I. Taxonomy, fermentation, isolation and biological activity

A novel class of macrolides for which the name sanglifehrins is proposed, has been discovered from actinomycete strains based on their high affinity binding for cyclophilin A (CypA), an immunophilin originally identified as a cytosolic protein binding cyclosporin A (CsA). The sanglifehrins were produced by Streptomyces sp. A92-308110. They were isolated and purified by extraction and several chromatographic, activity-guided steps. Sanglifehrins A and B exhibit a 10 to approximately 20 fold higher affinity for CypA than CsA, whereas the affinity of sanglifehrins C and D for CypA is comparable to that of CsA. Sanglifehrins exhibit a lower immunosuppressive activity than CsA when tested in the mixed lymphocyte reaction. Their in vitro activity indicates that they belong to a novel class of immunosuppressants.