112 What's your emergency? Overview of mental health and sleep disorders among emergency medical dispatchers in a French 112 call center.

BACKGROUND: Emergency medical dispatchers (EMD) experience significant occupational stress. Medical dispatching includes call-taking, triage, dispatch, and providing callers gesture guidance to the victims. Every decision has a major impact on the patient's outcome. Chronic exposure to stress and potentially traumatic situations, combined with night shifts can impact the stress response and physical health of staff. OBJECTIVES: To evaluate the prevalence of mental health and sleep disorders among EMD personnel working in a 112-call center, prior to an evidence-based prevention intervention (primary outcome); and to assess the relationship between health outcomes and DM (secondary outcome). METHODS: We conducted a descriptive, monocentric study with 109 EMD. HAD Anxiety (HAD-A) and Depression (HAD-D) scores, and the PTSD checklist for DSM-5 (PCL-5) were used to explore mental health disorders. The Epworth Sleepiness Scale, and other analog scales were used to explore sleep disorders. DM resources were assessed using the Freiburg Mindfulness Inventory (FMI), and its Presence and Acceptance subscales. RESULTS: A total of 72% of the EMD working in the call center were included. Of these, 16.6% had moderate anxiety disorder, and 6.4% had an anxiety disorder (Mean HAD-A: 6.05 ± 2.88). Furthermore, 16.6% had a moderate depression disorder, and 6.4% had a depression disorder (Mean HAD-D: 4.28 ± 3.28), and 16% had symptoms of PTSD (Mean PCL-5: 17.57 ± 13.67). Turning to sleep, 39% may suffer from excessive daytime sleepiness (EDS), and 10% had confirmed EDS (Mean Epworth score 10.47 ± 4.41). Finally, 39% had moderate insomnia, and 59% had severe insomnia (Mean insomnia: 13.84 ± 5.77.). Medium-strength negative correlations were found between mental health and DM (FMI scores and sub-scores: -0.48 < r < - 0.29; 0.001 < p < 0.004); and a positive correlation was found between DM and daytime awareness (0.22 < r < 0.26; 0.01 < p < 0.03). CONCLUSION: The prevalence of depression, symptoms of PTSD, and sleep disorders in our sample of EMD is significant, and confirms findings reported in the literature. The EMD population may benefit from specific, multi-level interventions that target mindfulness, sleep, and ergonomics to improve their mental and physical health.

Mental health care utilization by first responders after Paris attacks.

BACKGROUND: First responders (FRs) are frequently exposed to potentially traumatic events, including terror attacks, and may consequently be at risk of developing mental health disorders. Prior research suggests that FRs with mental health disorders often do not receive appropriate treatment. More knowledge is needed about their use of mental health care (MHC). AIMS: This study aimed to identify factors associated with receiving immediate support, post-immediate support and engagement in MHC among FRs of the November 2015 terror attacks in Paris. METHODS: A web-based study was conducted 8-12 months after the attacks on 663 FRs who were mobilized during the night and/or the aftermath of the attacks. Logistic regression was performed to analyse factors associated with MHC. RESULTS: Overall, 44 FRs sought MHC. Among FRs with post-traumatic stress disorder (PTSD), partial PTSD or depression (n = 60), 38% sought MHC (n = 23). Post-immediate support was associated with immediate support, and both were associated with knowing someone who could help regarding the potential psychological risks following a traumatic event. MHC engagement was associated with a history of MHC, post-immediate support and the presence of PTSD, partial PTSD or depression. CONCLUSIONS: Among FRs with PTSD, partial PTSD or depression, few sought MHC. Improved access to MHC for FRs after terror attacks is essential. Knowing someone who could help regarding potential psychological risks may facilitate immediate and/or post-immediate support. Furthermore, post-immediate support could encourage engagement in MHC. Efforts should be made before and after potentially traumatic events to ensure mental health education for FR.

The role of veterinarians in the farm-to-fork food chain and the underlying legal framework.

While the metaphor 'farm to fork' is a simple way of describing the chain that starts with the animal and follows through to the food delivered to consumers, there is a danger it could convey the idea that it only covers the food chain. The author believes that the expression should be understood to refer to a broader field--which he calls the 'veterinary domain' - which includes all aspects of animal use and management and the goals of veterinary public health, which is itself defined. Within the veterinary domain, it is veterinarians who are the guarantors of animal health and protectors of animal resources, providing a vital component of food security and public safety. Historical and geographical references show that this role is vulnerable and must be protected to ensure its existence and quality, not only for the benefit of those involved, but above all for society as a whole. As the organisation of such protection involves granting monopolies, special attention must be paid to the conditions governing veterinary training and practice. Protection brings duties and requires control mechanisms, which are generally entrusted to veterinary statutory bodies. The entire mechanism must therefore be covered by specific legislation, which is now embodied in Article 3.4.6. of the TerrestrialAnimal Health Code of the World Organisation for Animal Health. However, there is a danger of destroying a system, which has evolved over many years and has proven its worth, by an insistence on free-trade dogma that rejects the relationship between the health and veterinary professions.

Governance, veterinary legislation and quality.

This review of governance distinguishes between ends and means and, by highlighting the complexity and differing definitions of the concept, defines its scope and focuses discussion on its characteristics in order to establish an interrelationship between veterinary legislation and governance. Good governance must be backed by legislation, and good legislation must incorporate the principles and instruments of good governance. This article lists some of the main characteristics of governance and then reviews them in parallel with the methodology used to draft veterinary legislation, emphasising the importance of goal-setting and stakeholder participation. This article describes the criteria developed by the Veterinary Legislation Support Programme (VLSP) of the World Organisation for Animal Health (OIE) for assessing the quality of veterinary legislation. It then makes a comparison between the quality assurance process and the good governance process in order to demonstrate that the introduction and proper use of the tools for developing veterinary legislation offered by the OIE VLSP leads to a virtuous circle linking legislation with good governance. Ultimately, the most important point remains the implementation of legislation. Consequently, the author points out that satisfactory implementation relies not only on legislation that is technically and legally appropriate, acceptable, applicable, sustainable, correctly drafted, well thought through and designed for the long term, but also on the physical and legal capacity of official Veterinary Services to perform their administrative and enforcement duties, and on there being the means available for all those involved to discharge their responsibilities.

Economic analysis and costing of animal health: a literature review of methods and importance.

Myriads of data, a host of methods, but no single universal indicator. The Performance of Veterinary Services (PVS) Gap Analysis helps to quantify the needs of national Veterinary Services. In a world of scarce public financial resources and heightened transparency and accountability, official Veterinary Services (national Veterinary Authorities) must be able to justify their needs in economic and budgetary terms to their line minister, national parliament and the public at large, or in negotiations with donors. Animal health and Veterinary Service activities are a global public good. It is the responsibility of governments to maintain animal health systems, including networks for the surveillance and control of animal diseases to ensure the early detection of suspected animal disease outbreaks, a rapid response and, where possible, eradication of animal disease outbreaks 'at source'. The establishment of animal health systems is a core responsibility of the State, and it requires the use of public funds, although it does not preclude public-private partnerships and strategies for ensuring complementarity between the partners concerned. The PVS Gap Analysis mission of the World Organisation for Animal Health (OIE) is a method for analysing and quantifying disparities between a baseline situation (determined by PVS Evaluation using the OIE PVS Tool) and the target levels set by the country itself in accordance with its priorities. An added advantage is that the method can be used for training and awareness raising.

Progesterone releases dopamine in male and female rat striatum: a behavioral and microdialysis study.

1. The acute effect of progesterone at a physiological dose (50 micrograms) was investigated behaviorally by measuring postural deviation of rats bearing a unilateral lesion of the entopeduncular nucleus and biochemically by in vivo microdialysis in the striatum. 2. Ovariectomized female and intact male rats displayed a significant increase of postural deviation to the lesioned side 30-65 min after the subcutaneous injection of progesterone with a return to control values thereafter. 3. In addition, rats of both sexes had increased dopamine (DA) in the first 20-40 min dialysate collection following the progesterone injection. The metabolites of DA dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) in the dialysate were also increased after the progesterone injection and HVA levels remained elevated for a longer time than DA, up to 120 min after progesterone. 4. Progesterone, at a physiological dose and independently of estrogens can therefore rapidly increase DA release in the striatum of rats of both sexes as revealed in vivo behaviorally and biochemically.

Descriptive study of prognostic factors influencing survival of compensated silicotic patients.

The objective of this study was to assess survival and the prognostic influencing survival of compensated silicotic patients. All workers compensated for silicosis in the Province of Quebec from 1938 to 1985 (n = 1,165) were included. Clinical data were those collected during the exam that led to a compensation decision. Due to missing data, a subcohort of 961 patients was used for multivariate analysis of clinical prognostic factors with the Cox proportional hazards model. The following factors made an independent contribution to survival: age at compensation, smoking, dyspnea, expectoration, abnormal breath sounds, radiographic appearance, and vital capacity. On the basis of the model, patients with small opacities alone on their chest radiograph and who did not have dyspnea, expectoration, or abnormal breath sounds had a survival similar to the average Quebec man; other patients had a poorer survival. We conclude that it is possible to identify at the time of compensation, silicotic patients who are likely to have a life expectancy similar to that of the general population. Symptoms and physical signs as well as radiographic and lung function abnormalities appear to be useful prognostic indicators in compensated silicotic patients.

Lung cancer mortality and silicosis in Québec, 1938-85.

Men who had received compensation for silicosis in Québec between 1938 and 1985 were studied up to the end of 1986 to estimate risk of lung cancer mortality. Particular attention was paid to selection biases inherent in the study of such workers. Age-specific and calendar-year-specific mortality rates of Québec men from 1931 to 1985 were used for comparison. Risk of death from lung cancer in men who had received compensation for silicosis was more than 3 times higher than expected; silicosis may be a strong risk factor for lung cancer mortality.

A telephone support service to reduce medical care use among the elderly.

A randomized controlled trial was performed to determine whether a telephone support system could reduce the frequency of ambulatory physician encounters. A total of 182 elderly persons were enrolled in the study. The experimental group was regularly called by a public health nurse and could call the nurse every weekday during normal working hours. The control group received no intervention. A year later, the experimental group reported 7.40 ambulatory encounters with a physician (SD = 4.94) and the control group reported 8.61 encounters (SD = 6.85). The difference between the groups, after adjusting for various prognostic factors, was 1.20 (95% confidence interval, -0.84 to 3.24). Although the difference did not achieve statistical significance, the results suggest that telephone support may bring about a substantial decrease in medical care utilization. Further research assessing the cost-advantage ratio for this type of intervention is recommended.

Sensitivity and specificity of first screen mammography in the Canadian National Breast Screening Study: a preliminary report from five centers.

Sensitivity and specificity of first screen mammography in a randomized screening trial at five centers are reported. A total of 23,101 women underwent mammography; in 139, breast cancer was detected at first screening; in 20, less than 12 months after first screening; and in 47, at second screening. All 206 cancer cases were histologically confirmed, and 174 were defined as being detectable at first screening. Average length of follow-up for all women was 3.2 years. Interpretations of first screen mammograms by the center radiologists were matched to known outcomes. Simultaneous blind review was performed by a single reference radiologist with mammograms from all 206 cancer cases and those of a random sample of 739 women not known to have breast cancer at 15 months or more after initial screening. Overall, the five screening centers achieved a sensitivity of 69% (range, 60%-78%), a specificity of 94% (range, 93%-96%), a positive predictive value of 8.6% (range, 3%-16%), and a negative predictive value of 99.7% (range, 99.6%-99.9%).

Observer variation in the interpretation of xeromammograms.

We have examined variation in the interpretation of xeromammograms among radiologists designated to take part in a Canadian multicenter randomized controlled trial of screening for breast cancer. Radiologists read 100 xeromammograms comprising 10 histologically proved cancers, 40 benign abnormalities, and 50 normal films. Radiologists' opinions differed widely on the frequency of suspected or identified cancer. The diagnostic category "suspicion of cancer" or "cancer" was selected by radiologists for 10-55% of the films, and biopsy or aspiration was recommended for 21 to 53% of patients whose films were examined. Agreement on specific diagnostic categories was greatest for the diagnosis of cancer; agreement was least for the diagnosis of benign abnormalities and intermediate for the diagnosis of normality. Known cancers were in general correctly identified. These results indicate a need for development of methods to reduce observer variation in a interpretation of xeromammograms while preserving diagnostic sensitivity and validity. Results also emphasize the importance of developing strategies to ensure quality control in multicenter trials.