Population mental health in Burma after 2021 military coup: online non-probability survey.

BACKGROUND: Humanitarian crises and armed conflicts lead to a greater prevalence of poor population mental health. Following the 1 February 2021 military coup in Burma, the country's civilians have faced humanitarian crises that have probably caused rising rates of mental disorders. However, a dearth of data has prevented researchers from assessing the extent of the problem empirically. AIMS: To better understand prevalence of depressive and anxiety disorders among the Burmese adult population after the February 2021 military coup. METHOD: We fielded an online non-probability survey of 7720 Burmese adults aged 18 and older during October 2021 and asked mental health and demographic questions. We used the Patient Health Questionnaire-4 to measure probable depression and anxiety in respondents. We also estimated logistic regressions to assess variations in probable depression and anxiety across demographic subgroups and by level of trust in various media sources, including those operated by the Burmese military establishment. RESULTS: We found consistently high rates of probable anxiety and depression combined (60.71%), probable depression (61%) and probable anxiety (58%) in the sample overall, as well as across demographic subgroups. Respondents who 'mostly' or 'completely' trusted military-affiliated media sources (about 3% of the sample) were significantly less likely than respondents who did not trust these sources to report symptoms of anxiety and depression (AOR = 0.574; 95% CI 0.370-0.889), depression (AOR = 0.590; 95% CI 0.383-0.908) or anxiety (AOR = 0.609; 95% CI 0.390-0.951). CONCLUSIONS: The widespread symptoms of anxiety and depression we observed demonstrate the need for both continuous surveillance of the current situation and humanitarian interventions to address mental health needs in Burma.

Black Americans demonstrate comparatively low levels of depression and anxiety during the COVID-19 pandemic.

INTRODUCTION: During public health crises like the COVID-19 pandemic, populations can experience worsening mental health. Prior reports have suggested that Black Americans experienced lower rates of anxiety and depression than White Americans before the pandemic; however, during the pandemic, outcomes may be different as Black Americans have been disproportionately affected in terms of mortality, hospitalization, COVID-19 infection, and job loss. We documented the differential mental health impact of COVID-19 on Black and Non-Black Americans. METHODS: We analyzed nationally representative longitudinal data from the Understanding America Study COVID-19 Tracking Survey spanning March through November of 2020 to assess differences over time in prevalence of anxiety and depression between Black and non-Black Americans. RESULTS: We found that Black Americans were significantly less likely to report symptoms for anxiety, depression, or both during the pandemic. In a given month between March through November of 2020, the odds of Black Americans reporting such symptoms was on average about half that of Non-Black Americans. We also found that in September 2020, the gap in reporting symptoms for depression began to widen gradually. Specifically, since that time, prevalence of depression remained stable among non-Black Americans while it declined gradually among Black Americans. Our main results were robust to adjusting for demographics, risk perceptions, and baseline pre-pandemic mental health status. CONCLUSIONS: Black Americans maintained significantly better mental health than Non-Black Americans despite their struggle against economic, health, and racial inequalities during the pandemic. We discuss the significance and implications of our results and identify opportunities for future research.

A noncanonical heme oxygenase specific for the degradation of c-type heme.

Heme oxygenases (HOs) play a critical role in recouping iron from the labile heme pool. The acquisition and liberation of heme iron are especially important for the survival of pathogenic bacteria. All characterized HOs, including those belonging to the HugZ superfamily, preferentially cleave free b-type heme. Another common form of heme found in nature is c-type heme, which is covalently linked to proteinaceous cysteine residues. However, mechanisms for direct iron acquisition from the c-type heme pool are unknown. Here we identify a HugZ homolog from the oligopeptide permease (opp) gene cluster of Paracoccus denitrificans that lacks any observable reactivity with heme b and show that it instead rapidly degrades c-type hemopeptides. This c-type heme oxygenase catalyzes the oxidative cleavage of the model substrate microperoxidase-11 at the ß- and/or δ-meso position(s), yielding the corresponding peptide-linked biliverdin, CO, and free iron. X-ray crystallographic analysis suggests that the switch in substrate specificity from b-to c-type heme involves loss of the N-terminal α/ß domain and C-terminal loop containing the coordinating histidine residue characteristic of HugZ homologs, thereby accommodating a larger substrate that provides its own iron ligand. These structural features are also absent in certain heme utilization/storage proteins from human pathogens that exhibit low or no HO activity with free heme. This study thus expands the scope of known iron acquisition strategies to include direct oxidative cleavage of heme-containing proteolytic fragments of c-type cytochromes and helps to explain why certain oligopeptide permeases show specificity for the import of heme in addition to peptides.

Widespread use of flavored e-cigarettes and hookah tobacco in the United States.

In 2009, the U.S. Food and Drug Administration banned the sale of flavored cigarettes (excluding menthol) in the U.S. However, the sale of flavored e-cigarettes (FE) and flavored hookah tobacco (FHT) is still legal. In this study (conducted in the US in the period from October 2018 to February 2019), we estimated the prevalence of use of FE and FHT across users' sociodemographic characteristics (e.g., age, sex, race/ethnicity) and identified the key characteristics of tobacco users associated with use of FE and FHT. We analyzed the 2014-2015 Tobacco Use Supplement to the Current Population Survey data for current e-cigarette (n = 3691) and hookah tobacco (n = 658) users. Among e-cigarette users, 65.5% used FE; and among hookah tobacco users, 87.3% used FHT. Among e-cigarette users, the prevalence of use of FE was significantly higher for 18-24 year-old than 45+ year-old adults; women than men; Southern than Northeastern residents; and never smokers of regular cigarettes than current smokers of regular cigarettes (all adjusted p's < 0.05). Among hookah tobacco users, the rates of FHT use were significantly higher for women than men, and never smokers of regular cigarettes than current smokers (all adjusted p's < 0.05). Because availability and accessibility of flavored tobacco products may promote tobacco use, revising regulatory guidelines concerning manufacturing and distribution of FE and FHT may help reduce the popularity of emerging tobacco products. IMPLICATIONS: Among users of emerging tobacco products such as e-cigarettes and hookah tobacco, use of flavored products is very common. Among e-cigarette users, 66% consumed flavored e-cigarettes; and among users of hookah tobacco, 87% consumed flavored hookah tobacco. Use of flavored products was especially common among users who were young adults, women, or never and former smokers of regular cigarettes. Availability of emerging tobacco products in many different flavors could be a reason for tobacco use initiation and continued use of tobacco after cessation of regular-cigarette smoking.

Transdiagnostic, internet-delivered cognitive behavior therapy for depression and anxiety: Exploring impact on health anxiety.

Health anxiety is associated with significant personal distress and economic cost; as such, widely available and effective treatment options are crucial. Several studies suggest that Internet-delivered cognitive behavior therapy (ICBT) programs that specifically target health anxiety are efficacious for this condition. However, no known studies have examined the impact of transdiagnostic ICBT, which emphasizes the acquisition of broad coping skills applicable to a variety of mental health concerns, on symptoms of health anxiety. The current study sought to explore changes in health anxiety symptoms by utilizing data available from a previously published study of 8-week transdiagnostic ICBT. Specifically, changes in symptoms of health anxiety in response to a transdiagnostic ICBT program that targeted broad symptoms of depression and anxiety, were examined in a subsample of individuals who endorsed elevated symptom scores on the Short Health Anxiety Inventory at pre-treatment (n = 72). Following treatment, large reductions in health anxiety symptoms (Cohen's d = 0.91; 20% improvement), depression (Cohen's d = 0.85; reduction = 38%), generalized anxiety (Cohen's d = 1.21; reduction = 42%), and disability (Cohen's d = 0.90; reduction = 35%) were reported. Furthermore, results showed that transdiagnostic ICBT was rated as acceptable to people with high health anxiety symptoms. Despite elevated pre-treatment health anxiety scores, email correspondence between clients and their therapist revealed very few mentions of health anxiety. These findings provide preliminary evidence for transdiagnostic ICBT for symptoms of health anxiety and suggest further research is warranted.

Content of client emails in internet-delivered cognitive behaviour therapy: A comparison between two trials and relationship to client outcome.

Many Internet-delivered cognitive behavioural therapy (ICBT) programs include email communication between clients and therapists as a part of treatment; yet relatively little is known about the nature and impact of this communication. Previous research conducted by Svartvatten et al. (2015) has identified 10 themes in written correspondence by clients accessing ICBT for depression. The current study examined: (1) if previously identified themes in client emails would be present in a shorter ICBT program for depression and anxiety; and (2) whether themes in emails similarly correlated with symptom improvement, lesson completion, and perceptions of working alliance. Using 80 randomly selected clients from a published ICBT trial (ISRCTN42729166; Hadjistavropoulos et al., 2016), client emails (average 5.69 per client) were examined for the presence of the themes reported by Svartvatten et al. (2015) and correlated with symptom improvement, lesson completion, perceptions of working alliance. Although most themes developed by Svartvatten et al. (2015) were identified in client emails, the frequency of themes differed between studies. Most notably, emails in the current study were more often coded as involving alliance bolstering (~39% vs. 22% of statements) and identification of patterns and problem behaviours (~25% vs. 6% of statements). Greater frequency of tries alternative behaviour and identifies patterns and problem behaviours were correlated with a greater number of lessons completed. In terms of symptom change, greater frequency of maladaptive repetitive thinking and problems with treatment content in the emails were correlated with smaller improvements in anxiety, whereas observes positive consequences was correlated with larger improvements in anxiety. Similarly, greater frequency of maladaptive repetitive thinking was correlated with smaller improvements in depression. Regarding perceptions of working alliance, more frequent statements of observes positive consequences was correlated with higher alliance. The research provides clinicians and researchers with an improved understanding of the comparability and meaning of client communication in different ICBT programs. Experimental research is needed to better understand the role of client communication in ICBT.

Prevalence and factors associated with use of hookah tobacco among young adults in the U.S.

INTRODUCTION: Among young adults, use of hookah tobacco (HT) is an emerging health-risk behavior. The goals were to demonstrate that (1) the prevalence of ever-use and current use of HT increased among U.S. young adults (18-30 years old) in the period from 2010 to 2015 and (2) the patterns of HT use differed across diverse demographic subpopulations of young adults. METHODS: We merged and analyzed data from the 2010-2011 and 2014-2015 Tobacco Use Supplement to the Current Population Survey. The sample (n = 55,352) was representative of the young adult population in the U.S. Two binary measures were the ever and current use of HT. The significance level was 5%. RESULTS: The rate of current use of HT increased from 1% in 2010-11 to 2% in 2014-15 (CI = 0.6%:1.1%). The rate of ever-use increased from 7% to 12% (CI = 4.2%:5.6%). The over-time increase was not uniform: the increase was most rapid among 26-30 year-old adults, non-Hispanic Black and African American adults, and in Northeastern and Midwestern U.S. regions. HT ever-use, overall, was associated (all p's < 0.001) with many sociodemographic factors and current tobacco-use behaviors. The rate of HT ever-use was 16% for daily and 23% for occasional cigarette smokers, 23% for users of smokeless tobacco products, 37% for cigar smokers, and 55% for smokers of regular pipe (filled with tobacco). DISCUSSION/CONCLUSION: HT use is becoming increasingly more popular among young adults in the U.S. Methods should target not only cessation of cigarette smoking but use of all tobacco products.

The biosynthetic pathway of coenzyme F430 in methanogenic and methanotrophic archaea.

Methyl-coenzyme M reductase (MCR) is the key enzyme of methanogenesis and anaerobic methane oxidation. The activity of MCR is dependent on the unique nickel-containing tetrapyrrole known as coenzyme F430. We used comparative genomics to identify the coenzyme F430 biosynthesis (cfb) genes and characterized the encoded enzymes from Methanosarcina acetivorans C2A. The pathway involves nickelochelation by a nickel-specific chelatase, followed by amidation to form Ni-sirohydrochlorin a,c-diamide. Next, a primitive homolog of nitrogenase mediates a six-electron reduction and γ-lactamization reaction before a Mur ligase homolog forms the six-membered carbocyclic ring in the final step of the pathway. These data show that coenzyme F430 can be synthesized from sirohydrochlorin using Cfb enzymes produced heterologously in a nonmethanogen host and identify several targets for inhibitors of biological methane formation.

Comparative diagnostic performance of volumetric laser endomicroscopy and confocal laser endomicroscopy in the detection of dysplasia associated with Barrett's esophagus.

BACKGROUND AND AIMS: Probe-based confocal laser endomicroscopy (pCLE) and volumetric laser endomicroscopy (VLE) (also known as frequency domain optical coherence tomography) are advanced endoscopic imaging modalities that may be useful in the diagnosis of dysplasia associated with Barrett's esophagus (BE). We performed pCLE examination in ex-vivo EMR specimens and compared the diagnostic performance of using the current VLE scoring index (previously established as OCT-SI) and a novel VLE diagnostic algorithm (VLE-DA) for the detection of dysplasia. METHODS: A total of 27 patients with BE enrolled in a surveillance program at a tertiary-care center underwent 50 clinically indicated EMRs that were imaged with VLE and pCLE and classified into neoplastic (N = 34; high-grade dysplasia, intramucosal adenocarcinoma) and nonneoplastic (N = 16; low-grade dysplasia, nondysplastic BE), based on histology. Image datasets (VLE, N = 50; pCLE, N = 50) were rated by 3 gastroenterologists trained in the established diagnostic criteria for each imaging modality as well as a new diagnostic algorithm for VLE derived from a training set that demonstrated association of specific VLE features with neoplasia. Sensitivity, specificity, and diagnostic accuracy were assessed for each imaging modality and diagnostic criteria. RESULTS: The sensitivity, specificity, and diagnostic accuracy of pCLE for detection of BE dysplasia was 76% (95% confidence interval [CI], 59-88), 79% (95% CI, 53-92), and 77% (95% CI, 72-82), respectively. The optimal diagnostic performance of OCT-SI showed a sensitivity of 70% (95% CI, 52-84), specificity of 60% (95% CI, 36-79), and diagnostic accuracy of 67%; (95% CI, 58-78). The use of the novel VLE-DA showed a sensitivity of 86% (95% CI, 69-96), specificity of 88% (95% CI, 60-99), and diagnostic accuracy of 87% (95% CI, 86-88). The diagnostic accuracy of using the new VLE-DA criteria was significantly superior to the current OCT-SI (P < .01). CONCLUSION: The use of a new VLE-DA showed enhanced diagnostic performance for detecting BE dysplasia ex vivo compared with the current OCT-SI. Further validation of this algorithm in vivo is warranted.

Mid-Level Providers: What Do We Do?

Changes in resident physician work hours have made it increasingly more difficult for physicians to meet the needs of their patients. In many facilities, mid-level providers (MLPs; advanced practice nurses and physician assistants) have become integral members of the medical team in both inpatient and outpatient settings. The purpose of this study was to identify the roles of MLPs in the American Burn Association (ABA) and within burn care teams. There was a 49% return survey response rate. Respondents included 28 (58%) nurse practitioners and 16 (33%) physician assistants. Forty-six percentage of the MLPs had at least 11 years of burn care experience. Forty respondents (87%) worked both inpatient and outpatient settings. Thirty-four (74%) of the providers ran independent clinics. Job responsibilities were in areas of direct patient care, education, and administrative duties. The majority of respondents were members of the ABA, attended annual conferences, and were advanced burn life support instructors. Forty-two (91%) of the MLPs were satisfied with their jobs. In conclusion, MLPs are highly experienced, ABA members and assume direct care of the burn patient.

Educating patients about Internet-delivered cognitive behaviour therapy: Perceptions among treatment seekers and non-treatment seekers before and after viewing an educational video.

Internet-delivered cognitive behaviour therapy (ICBT) is an efficacious, yet novel approach to the treatment of depression and anxiety. It has the potential to improve access to evidenced-based care, but only if potential patients are aware of, understand, and have positive expectations about this treatment. In order to establish whether the use of an educational video could improve favourable expectations of ICBT, two studies were conducted. The goal of the first study was to determine whether an educational video would improve perceptions of ICBT among individuals seeking ICBT treatment and to determine what type of information (client testimonials versus statistical information related to outcomes) facilitates the greatest increase in positive expectations of ICBT. Participants who visited an ICBT service (N = 71) website were invited to first complete brief questionnaires assessing initial perceptions of ICBT. They were then randomly assigned to watch one of two videos containing either client testimonials (n = 32) or statistical information related to outcomes (n = 39). Patient perceptions of ICBT were then reassessed. Perceptions of ICBT were significantly higher post-video than pre-video and the type of information did not impact perceptions of ICBT. In the second study, the research was extended by examining perceptions of ICBT before and after watching an educational video (including both statistical and narrative information as this had no impact on perceptions) in a sample of individuals (N = 94) who were experiencing anxiety and depression but were not specifically seeking ICBT. As with treatment seekers, perceptions of ICBT were significantly higher post-video than pre-video. Comparison of the treatment and non-treatment seekers revealed no differences in perceptions of ICBT between the samples. The findings suggest that educational videos are an effective way to increase expectations of ICBT. Future directions for research are described.

Chinese skullcap in move free arthritis supplement causes drug induced liver injury and pulmonary infiltrates.

Herbal medications are being increasingly used by the American population especially for common conditions like arthritis. They have been reported to cause adverse effects, including significant hepatotoxicity, but reporting remains sporadic. We report here a patient who developed drug induced liver injury following the intake of Move Free, which is an over-the-counter arthritis supplement. We propose that Chinese skullcap, which is one of the herbal ingredients of the medication, is responsible for the adverse event. There was a strong temporal association between the intake of supplement and onset of symptoms, and also there have been a few recent case reports implicating the same component. A unique observation in our case is the occurrence of pulmonary infiltrates simultaneously with the hepatotoxicity, and this side effect has not been well documented before. Both the hepatic and pulmonary complications completely resolved over few weeks after the patient stopped taking the medication. Since these supplements are readily available over the counter, we feel that it is important to document possible adverse outcomes to raise awareness in the medical community and also among patients.

Colonic polyposis and neoplasia in Cowden syndrome.

OBJECTIVE: To identify and describe the frequency, histologic features, and clinical outcome of colon polyposis and neoplasia in Cowden syndrome--a rare familial hamartoma tumor syndrome associated with mutations in the PTEN gene. PATIENTS AND METHODS: Patients with a clinical diagnosis of PTEN hamartoma tumor syndrome-Cowden phenotype were retrospectively identified and studied. Only those who underwent colonoscopy or colon pathologic interpretation were included in the final analysis. RESULTS: From 1994 to 2009, 13 patients met study inclusion criteria. Of the 10 patients who underwent colonoscopy, 9 (90%; 95% confidence interval [CI], 57%-100%) had polyps, and 7 (70%; 95% CI, 39%-90%) were estimated to have more than 50 polyps. Pathologic findings of the colon were reviewed in 11 patients, and the spectrum of tumors included hamartomatous, inflammatory, adenomatous, ganglioneuromatous, hyperplastic, and juvenile polyps. Of the 13 patients, 2 (15%; 95% CI, 3%-43%) had left-sided adenocarcinoma without microsatellite instability. Five (38%) of the 13 patients underwent colectomy secondary to polyp dysplasia. CONCLUSION: Patients with Cowden syndrome have a heavy colon polyp burden with a wide pathologic spectrum, both benign and malignant. The colon polyposis results in a previously unreported morbidity with a high colectomy rate.

Ketamine: a safe and effective agent for painful procedures in the pediatric burn patient.

Ketamine is an effective agent when used for sedation during painful bedside procedures. We developed a ketamine administration protocol for nonanesthesiologists for the purpose of establishing safe monitoring and documentation during ketamine sedation procedures. From June 1, 2002, through June 30, 2003, a total of 522 sedation events using ketamine were performed; 347 of these events were analyzed. Seventeen (4.9%) events contained potentially adverse outcome indicators, 10 (2.9%) of which required intervention. Eight events were airway related and responded to repositioning, supplemental oxygen, or bag-valve-mask ventilation. Two patients had a decrease in blood pressure, which responded to fluid administration. Total doses of ketamine administered were between 6 and 800 mg, for procedures ranging from 1 to 105 minutes, in patients weighing between 3 and 111 kg. The development of a strict protocol ensures the safe administration of ketamine for the pediatric burn patient.