H5N1

Canada: Mental health issues linger from Fort McMurray fire, says study

Via CBC News, a report from The Canadian Press: Mental health issues linger from Fort McMurray fire, says study. Excerpt:

For many of the residents who fled for their lives as a ferocious wildfire ripped through Fort McMurray in 2016, the psychological scars still linger.   

Newly published research suggests the fire cast a lasting shadow over the lives of many residents who are still experiencing elevated rates of depression and related mental-health problems.  

"There's been a big jump," said Vincent Agyapong, a psychiatrist and University of Alberta professor whose paper was published Saturday in the International Journal of Mental Health and Addiction. 

But the research also revealed a way to help dispel the darkness. 

Agyapong was working in Fort McMurray when the fire that came to be known as "The Beast" hit the city that May. He helped patients in the hospital get to safety before fleeing himself. 

When he returned to his clinical practice in the city, after the immediate chaos subsided, he realized he had a chance to learn something about resilience.  

"We thought it was an opportune time to change the focus to actually looking at the mental-health impacts of the Fort McMurray wildfire," he said.

Agyapong and his colleagues developed an extensive survey that included questions about age, employment, where people were before the fire, how exposed they were, how much media they followed and their clinical history.  

The team received 486 completed responses. 

Previously reported results found the rate of probable post-traumatic stress disorder was 12.8 per cent — more than 10 times the normal rate for Alberta. 

Agyapong's research used standard psychiatric tests to conclude the fire correlated to a much broader set of problems. 

The survey found that six months after flames tore through parts of the city, almost 15 per cent of respondents were suffering from some type of major depressive disorder. The rate was 17 per cent for women and 10 per cent for men. The average Alberta rate is 3.3 per cent.  

Those disorders were also associated with substance abuse. "We found that those that presented with (depressive disorder) were far more likely to present with alcohol use disorder and substance use disorder as well as nicotine dependence," Agyapong said.

The survey found those with depression symptoms were roughly twice as likely to abuse drugs and alcohol. 

Preliminary results from further studies suggest those problems persist.

Higher temperatures increase suicide rates in the United States and Mexico

Via Nature Climate Change, an unfortunately timely report: Higher temperatures increase suicide rates in the United States and Mexico. The abstract:

Linkages between climate and mental health are often theorized but remain poorly quantified. In particular, it is unknown whether the rate of suicide, a leading cause of death globally, is systematically affected by climatic conditions. 

Using comprehensive data from multiple decades for both the United States and Mexico, we find that suicide rates rise 0.7% in US counties and 2.1% in Mexican municipalities for a 1 °C increase in monthly average temperature. This effect is similar in hotter versus cooler regions and has not diminished over time, indicating limited historical adaptation. Analysis of depressive language in >600 million social media updates further suggests that mental well-being deteriorates during warmer periods. 

We project that unmitigated climate change (RCP8.5) could result in a combined 9–40 thousand additional suicides (95% confidence interval) across the United States and Mexico by 2050, representing a change in suicide rates comparable to the estimated impact of economic recessions, suicide prevention programmes or gun restriction laws.

Case series of severe neurologic sequelae of Ebola virus disease during epidemic, Sierra Leone

Via Emerging Infectious Diseases: Ahead of Print -Case Series of Severe Neurologic Sequelae of Ebola Virus Disease during Epidemic, Sierra Leone. The abstract:

We describe a case series of 35 Ebola virus disease (EVD) survivors during the epidemic in West Africa who had neurologic and accompanying psychiatric sequelae. 

Survivors meeting neurologic criteria were invited from a cohort of 361 EVD survivors to attend a preliminary clinic. Those whose severe neurologic features were documented in the preliminary clinic were referred for neurology specialist evaluation, ophthalmology examination, and psychiatric assessment. 

Of 35 survivors with neurologic sequelae, 13 had migraine headache, 2 stroke, 2 peripheral sensory neuropathy, and 2 peripheral nerve lesions. Of brain computed tomography scans of 17 patients, 3 showed cerebral and/or cerebellar atrophy and 2 confirmed strokes. 

Sixteen patients required mental health followup; psychiatric disorders were diagnosed in 5. The 10 patients who experienced greatest disability had co-existing physical and mental health conditions. 

EVD survivors may have ongoing central and peripheral nervous system disorders, including previously unrecognized migraine headaches and stroke.

MSF: A year on from battle, Mosul’s healthcare system is still in ruins

Via MSF.org: A year on from battle, Mosul’s healthcare system is still in ruins. Excerpt:

One year since the battle between the so-called Islamic State (IS) group and the Iraqi forces officially ended in Mosul, Iraq, the healthcare system is still in ruins and struggling to cope as thousands of people continue to return to the city, Médecins Sans Frontières (MSF) said.  

During the conflict, nine out of 13 public hospitals were damaged in Mosul, slashing healthcare capacity and the number of hospital beds by 70 per cent. The reconstruction of health facilities has been extremely slow and there are still less than 1,000 hospital beds for a population of 1.8 million people. This is half of the internationally-recognised minimum standard for health service delivery in a humanitarian context.  

“Accessing healthcare services is a daily challenge for thousands of children and adults in Mosul,” said Heman Nagarathnam, MSF’s head of mission in Iraq. “The city’s population is increasing by the day. In May 2018 alone, almost 46,000 people returned to Mosul. But the public health system is not recovering and there is a huge gap between the available services and the needs of the growing population.”   

“Emergency room services and surgical, oncology and burns facilities are urgently required, as well as medical equipment and a steady and affordable supply of medication”, Nagarathnam added.   

“Other needs include mental health services for people coping with the trauma of violence and losing loved ones, and follow-up surgery, pain management and physiotherapy for war-wounded patients who have been suffering for months because they have not been able to access the healthcare they need to recover from their injuries.” 

Forty-two-year-old Nashwan [not his real name] was shot in the leg and back by a sniper in Mosul in March 2017 when he was buying food. Since then, he has lived in agony with his injury and has been unable to access adequate healthcare.  

“When I was at home… the pain started to grow in my leg and hip, and eventually it was unbearable,” Nashwan said. “So I went to the general hospital in October 2017 in west Mosul. They did x-rays and tests and they said I needed a huge operation and they didn't have the capacity to do the operation. 

“Life has been really hard. My injury has impacted negatively on my life - my family, the way I interact with my kids. I can’t play with them. I can't work and we haven’t had an income. I've been really depressed.”   

The dangerous living conditions in Mosul – poor hygiene due to a lack of water and electricity, damaged buildings and the presence of improvised explosive devices and booby traps – also pose a risk to people’s health and increase the need for healthcare facilities. 

At MSF’s hospital in west Mosul, the team saw in the past 12 months a shift from war-related wounds, to mine injuries, and more recently, injuries and medical issues related to poor living conditions as more people return to the city. For example, in May this year, 95 per cent of trauma cases received in the emergency room were related to the unsafe living conditions – such as falling rubble, buildings collapsing or people falling from unstable structures.

US: After rescuing victims of gun violence, first responders face their own trauma

Via NPR's Shots blog: After Rescuing Victims Of Gun Violence, First Responders Face Their Own Trauma. Excerpt:

Research shows that emergency first responders suffer from the accumulation of stress and trauma. First responders report feeling depression, job burnout, substance abuse, troubled relationships — even suicide. Many studies have found elevated rates of post-traumatic stress disorder among nurses, firefighters and paramedics. A 2016 report by the International Association of Fire Fighters found that firefighters and paramedics are exhibiting levels of PTSD similar to that of combat veterans. 

Yet there's a dearth of research on treatment, insufficient preparation by employers for traumatic events and significant stigma associated with seeking care for the emotional fallout of those events, says Jeff Dill, a counselor and founder of the Firefighter Behavioral Health Alliance in Anthem, Ariz.  

"When we have these national disasters or have a guy take a truck and run people over ... those are added stressors we aren't prepared for," says Dill, who is a former firefighter. 

Dill says the emotional toll of these large-scale horrific events is magnified because everyone is talking about them. They are inescapable and become emotional "trigger points."  

But a slow change in culture is also catching on, Dill says. 

Dill travels the country teaching mental health awareness workshops for firefighters and other emergency personnel. Some employers are working on developing greater peer support, he says, but it often comes after the fact rather than proactively.  

"We met a lot of resistance early on because of the [stoic] culture," says Dill.  

Now, he says, emergency workers are starting to talk more openly about their PTSD and depression from the trauma they see at work. More first responders are reaching out to him and attending his workshops, he says. 

"When I started in the fire service way back when, we didn't have to worry about those things," Dill says. But now, "out of those horrific incidents comes the conversation. They're talking about it instead of keeping it buried deep inside."

Gigantic study of Chinese babies yields slew of health data

Via Nature News & Comment: Gigantic study of Chinese babies yields slew of health data. Excerpt:

An ambitious Chinese study tracking tens of thousands of babies and their mothers has begun to bear fruit — just six years after the study’s leaders recruited their first sets of mothers and babies. 

Researchers have already published results based on the cohort study, which collects biological, environmental and social data, some with important public-health implications. And many more investigations are under way. One, in particular, will examine infants’ microbiomes, the collections of bacteria and other microorganisms that inhabit their bodies — a hot topic in health research and a key goal of the cohort study. 

The Born in Guangzhou Cohort Study has recruited about 33,000 babies and their mothers since 2012. The study’s leaders are hoping to reach 50,000 baby–mother sets by 2020. And this year, investigators started recruiting 5,000 maternal grandmothers to the project, enabling studies across multiple generations. 

“The data is vast, and there is space for many different groups globally to mine this information,” says Maria Gloria Dominguez-Bello, a microbiologist at Rutgers, The State University of New Jersey, in New Brunswick, who is not involved in the study. “I really admire this effort from the Chinese team. Very few countries can achieve this scale.” 

Ezra Susser, an epidemiologist from Columbia University in New York City, says the cohort is also important because it is tracking mothers and babies during a period of rapid economic development and social change in China, where previous studies of this type have been limited in scale. 

The Guangzhou project aims to set itself apart from previous large birth cohort studies in Norway and Denmark by enabling detailed investigations of the links between the microbiome and disease. Two other large birth-cohort studies, in the United States and United Kingdom, had planned to include microbiome data, but both were cancelled because of trouble recruiting participants. The US study also struggled with excessive costs and management issues.  

The Chinese team has so far avoided similar problems. Its rich collection of 1.6 million biological samples includes specimens of stools, blood, placental tissue and umbilical cords. Extensive surveys also record participants’ eating habits, mental health, and other lifestyle factors, such as the amount of mould in their house. 

The cohort’s leaders recruit babies born at the Guangzhou Women and Children’s Medical Center. Only families planning to live in the southern Chinese city for a long time have been recruited, says Xia Huimin, a surgeon at the centre and one of the project’s co-founders. That’s because it is hoped that children will remain in the study from the time they are babies until they are 18 years old. 

First results  

Researchers are already publishing results. Incense burning is common in southern China, and one study found that exposure to the resulting fumes increases the risk of hypertension in expectant mothers. 

Another study found that progesterone, a drug used around the world to reduce the risk of a preterm birth, was prescribed too early in pregnancy in more than 40% of women studied. The researchers found that giving women the drug before 14 weeks of gestation did not reduce their chances of a preterm birth, but put them at higher risk of needing a caesarean section and developing post-partum depression. The authors consider the findings “an urgent public-health concern”.

MSF in Mexico: An unsafe country for thousands of refugees fleeing violence in Central America

MSF.org has published Mexico: An unsafe country for thousands of refugees fleeing violence in Central America. Excerpt (but you'd better read the whole report):

Migrants and refugees fleeing danger in Central America are trapped and exposed to more violence in Mexico due to ever tighter and more callous United States border control policies, said Médecins Sans Frontières (MSF) on World Refugee Day. 

The violence in Honduras, Guatemala and El Salvador continues to force thousands of people to head north in search of refuge, even as the Trump administration imposes cruel practices intended to deter them from seeking asylum. 

Last week, US Attorney General Jeff Sessions ruled that people submitting claims related to domestic or gang violence will not qualify for asylum—a decision that effectively closes the door to many Central Americans fleeing for their lives. In recent weeks, authorities have stepped up criminal prosecutions of people attempting to cross the border, going so far as to forcibly separate children from their families. 

Mexico is effectively becoming a final destination for thousands of vulnerable refugees and migrants, left exposed to further violence by criminal gangs who prey on them.  

"We are seeing a population that is increasingly trapped in Mexico. They can´t return to the countries they escaped from for fear of violence. And now they can’t find safety in the US as the administration punishes those who try to cross the border with increasingly harsh and cruel measures,” says Marc Bosch, MSF's Operations Manager for Latin America. 

“We are alarmed by the terrible policy of separating children from their parents. This is compounded by the recent US decision not to accept gang violence or sexual violence as the basis for asylum claims.”  

Initial talks between the US and Mexican governments in May considered the possibility of converting Mexico into a “safe third country”. This would force asylum seekers to apply in Mexico, preventing them from reaching the US to demand refuge. 

Mexico is not a safe country for people fleeing violence in the Northern Triangle of Central America (NTCA) 

More than 20,000 migrants or refugees are kidnapped in NTCA countries – Guatemala, Honduras and El Salvador – every year, according official sources (CNDH). Sixty-eight per cent of the migrants and refugees interviewed by MSF in places along the transit route in Mexico had been exposed to violence. Nearly one-third of the women surveyed were sexually abused. Central American gangs are operating in the south of Mexico and are responsible of some of the attacks against migrants. 

MSF medical data shows that a quarter of our medical consultations for migrants and refugees in Mexico are related to injuries from intentional violence. Ninety per cent of our mental health consultations are related to violence. Our patients are suffering from anxiety, depression, and post-traumatic stress disorder, among other conditions, which have severe consequences on their ability to function. Women, children, and members of the Lesbian-Gay-Bisexual-Transgender-Queer (LGBTQ) community are more vulnerable to certain types of violence and require specific protection measures that are not effectively in place in Mexico.

Two years after end of Ebola crisis, survivors sue to receive promised aid

Via NPR's Goats and Soda blog: Two Years After End Of Ebola Crisis, Survivors Sue To Receive Promised Aid. Excerpt:

"Cellal alaa cogu — health has no price," sighs Haja Bah, looking out on a dusty street in the sprawling eastern suburbs of Freetown, Sierra Leone's capital. "But they have forgotten us ... and many are still really suffering."  

Between 2013 and 2016, the Ebola virus claimed more than 11,000 lives across West Africa. Bah is one of about 4,000 Ebola survivors in Sierra Leone. Four years after the outbreak began devastating West Africa and two years after the World Health Organization (WHO) declared the end of the last flare-up, Bah and other survivors still cope with an array of physical and mental issues. They have channeled their frustration into a lawsuit that seeks to hold the government accountable for the support they were promised — and say they have not received.  

Mariatu Kargbo contracted Ebola while working as a nurse. She survived and is now chairperson of the branch of the Sierra Leone Association of Ebola Survivors (SLAES) in the northern city of Makeni. While grateful to be alive, she says she tires easily and feels weaker than before.  

She still counts herself lucky as she rattles off a list of post-Ebola complications that trouble survivors: "There are some [who] have had miscarriages. There are the joint pains. Some of them are not walking properly. Some became deaf. Some are blind, others are partially blind. There are many health complications."

Dr. Robert Musoke, technical officer for emergency preparedness and response at WHO's Freetown office, says these are common issues among survivors. According to a 2016 WHO report, between 50 and 75 percent of survivors report joint and muscle pain. Many experience a range of eye problems caused by uveitis, an inflammation that can lead to blindness. Around a quarter of survivors report losing their hearing. Mental health problems such as anxiety, depression and PTSD — stemming from the trauma of the virus itself and conditions in treatment centers — are pervasive.

MSF: Isolated, angry, anxious and stressed - mental health in Iraq

Via MSF.org: Iraq: Isolated, angry, anxious and stressed - mental health in Iraq. Excerpt:

The psychological and emotional scars of war in Iraq are immense and thousands of people need mental health assistance. Mental health is a key component of many Médecins Sans Frontières (MSF) projects in Iraq. We have teams of qualified medical doctors, psychologists and counsellors who provide vital care and support for moderate and severe cases, including post-traumatic stress syndrome (PTSD), depression, schizophrenia and severe anxiety. 

Jasim Hammed, 32, fled his home in Muqdadiyah in 2014 and eventually settled in Alwand 1 Camp, Diyala governorate, where he now works for MSF as counsellor.  

Why did you leave your home and come to Alwand 1 Camp?  

In July 2014, there was a lot of shooting and bombing near my home in Muqdadiyah and a lot of people were dying. My mother said it wasn't safe and we should go. I left with my family. 

As we were fleeing, we saw fighting and bombing happening in the area, and we saw families get killed. A whole family in the two cars behind us got killed by an airstrike. 

My youngest child, Othman, was only 10 days old at the time and I didn't think he was going to live. But thankfully he is here and still alive – he’s three years old now. My younger brother was kidnapped when he went back to our home town to try and complete his studies. He was taken from my mother’s house. We still don't know where he is.  

We went from camp to camp until we reached here, to Alwand 1 Camp. Some of the camps where we stayed didn’t have water or electricity. I worked for some other NGOs in the camp and then applied for a job with MSF in Alwand 1 Camp.  

What is the situation in Alwand 1 Camp and what are the challenges facing people in the camp?  

There are more than 3,000 internally displaced people living in Alwand 1 Camp. Most people in the camp come the from the surrounding area, from towns such as Sadiyah, Jalawla and Muqdadiyah. Most people fled the conflict with the Islamic State (IS) group. People in the camp live in caravans with shared bathrooms. There is a school in the camp, as well as a health centre, run by MSF.   

People living in the camp face many challenges. The main challenge is their financial situation, and this often impacts on their psychology. Some of them have given up and say: “My life is finished. I’m done”. 

In additional to financial concerns, there is the additional fear of an unknown future. There has been some renewed conflict in the region and people’s fear has increased. There are people who cannot communicate with family members, and others have ruined houses from the conflict and they cannot return home. 

Some of the families say they don't feel comfortable living in the containers and that it doesn’t feel like a house to them, it feels like a prison. We have seen people become isolated, angry, anxious and stressed. Some of the children show signs of aggressive behaviour, incontinence and anxiety. 

The mental health of refugees and asylum seekers on Manus Island

Via The Lancet, a comment: The mental health of refugees and asylum seekers on Manus Island. Excerpt:

On Oct 31, 2017, the Governments of Australia and Papua New Guinea ended support for the Manus Island Regional Processing Centre, an Australian immigration detention facility on Manus Island, Papua New Guinea. 

Instead, currently incomplete and substandard facilities without adequate service provision have been hastily constructed to accommodate people. 379 refugees and asylum seekers refused to leave the centre stating fears for their security. They managed to survive for several weeks with no provision of food and water or electricity and in poor hygienic circumstances. However, on Nov 23–24, 2017, the Papua New Guinea police went into the centre moving people out on buses to these incomplete facilities. 

The physical and mental health of these people is precarious.4 Since 2013, an estimated 3000 refugees and asylum seekers have been forcibly transferred by Australia to so-called offshore facilities in Papua New Guinea and Nauru where asylum claims of people who entered Australian territories by boat are processed. Around 1200 refugees and asylum seekers remain in Nauru and 900 in Papua New Guinea. 

The office of the United Nations High Commissioner for Refugees (UNHCR) has repeatedly spoken out against this practice that does not provide international protection to those who need it but is driven by the desire to deter future asylum seekers and deny any possibility of settlement in Australia. At the former detention facilities people had been placed for indefinite periods without external freedom of movement and no prospects for resettlement in Australia or family reunification. 

Such an environment is wholly inappropriate for the housing of refugees and asylum seekers, violates their basic rights, and has associated social and health costs. The punitive conditions and absence of realistic long-term solutions cause harm to asylum seekers, particularly related to their mental health. 

During a monitoring visit by UNHCR to Manus Island in 2016, one of us (SS) with other medical colleagues held individual interviews with 181 of the detainees in the Manus Island Regional Processing Centre. Most (90%) of the detainees met criteria for severe mental health conditions such as major depression, severe anxiety disorder, and probable post-traumatic stress disorder. Diagnoses could not be confirmed against Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) or International Classification of Diseases, Tenth Revision (ICD-10) criteria and therefore cannot be seen as evidence of the presence of a true mental disorder but indicate high rates of psychological distress. Most interviewees (71%) had experienced torture or traumatic events before seeking asylum and most reported not having symptoms of mental disorders before detention. 

The UNHCR team concluded that the lengthy, arbitrary, and indefinite nature of immigration detention on Manus Island, together with hopelessness in the absence of durable settlement options, had corroded the resilience of the detainees, and made them vulnerable to mental illness.