Increased antibiotic use (AU) has been reported globally during the COVID-19 pandemic despite low rates of bacterial co-infection. We assessed changes in AU during the COVID-19 pandemic in Indonesia and the Philippines.

We evaluated hospital-wide AU over 36 months in six hospitals, 3 in Indonesia and 3 in the Philippines. Intravenous antibiotics commonly used for respiratory conditions were selected and grouped for analysis. AU rates were calculated as monthly defined daily dose per 1000 patient-days or patient discharges. Median AU rates were compared from the pre-pandemic (March 2018–February 2020) and pandemic periods (March 2020–February 2021) using quantile regression to assess for statistical significance. Changes in AU during the COVID-19 pandemic were analyzed using interrupted time series analysis.

Significant increases were noted in the median AU rate from the pre-pandemic to pandemic period of all antibiotics combined in 3/6 hospitals (percentage change, Δ, 12.5%–63.6%) and anti-pseudomonal antibiotics in 3/6 hospitals (Δ 51.5%–161.5%). In the interrupted time series analysis, an immediate increase (range: 125.40–1762) in the use of all included antibiotics combined was observed in 3/6 hospitals at the onset of the COVID-19 pandemic. One of these 3 hospitals experienced a statistically significant sustained increase, while another experienced a decrease over time.

We observed significant increases in facility-wide inpatient AU during the COVID-19 pandemic in our participating hospitals in Indonesia and the Philippines. These findings reinforce the importance of antibiotic stewardship practices to optimize AU, especially during infectious disease pandemics.

The majority of studies of mental health interventions for young adolescents have only evaluated short-term benefits. This study evaluated the longer-term effectiveness of a non-specialist delivered group-based intervention (Early Adolescent Skills for Emotions; EASE) to improve young adolescents’ mental health.

In this single-blind, parallel, controlled trial, Syrian refugees aged 10-14 years in Jordan who screened positive for psychological distress were randomised to receive either EASE or enhanced usual care (EUC). Primary outcomes were scores on the Paediatric Symptom Checklist (PSC) assessed at Week 0, 8-weeks, 3-months, and 12 months after treatment. Secondary outcomes were disability, posttraumatic stress, school belongingness, wellbeing, and caregivers’ reports of distress, parenting behaviour, and their perceived children’s mental health.

Between June, 2019 and January, 2020, 185 adolescents were assigned to EASE and 286 to EUC, and 149 (80.5%) and 225 (78.7%) were retained at 12 months, respectively. At 12 months there were no significant differences between treatment conditions, except that EASE was associated with less reduction in depression (estimated mean difference -1.6, 95% CI –3.2 to -0.1; p=.03; effect size, -0.3), and a greater sense of school belonging (estimated mean difference -0.3, 95% CI –5.7 to -0.2; p=.03; effect size, 5.0).

Although EASE led to significant reductions in internalising problems, caregiver distress, and harsh disciplinary parenting at 3-months, these improvements were not maintained at 12 months relative to EUC. Scalable psychological interventions for young adolescents need to consider their ongoing mental health needs. Prospectively registered: ACTRN12619000341123.

Studies have shown an association between workplace safety climate scores and patient outcomes. This study aimed to investigate (1) performance of the hospital safety climate scale that was adapted to assess acute respiratory illness safety climate, (2) factors associated with safety climate scores, and (3) whether the safety scores were associated with following recommended droplet and contact precautions.

A survey of Canadian healthcare personnel participating in a cohort study of influenza during the 2010/2011–2013/2014 winter seasons. Factor analysis and structural equation modeling were used for analyses.

Of the 1359 participants eligible for inclusion, 88% were female and 52% were nurses. The adapted items loaded to the same factors as the original scale. Personnel working on higher risk wards, nurses, and younger staff rated their hospital’s safety climate lower than other staff. Following guidelines for droplet and contact precautions was positively associated with ratings of management support and absence of job hindrances.

The adapted tool can be used to assess hospital safety climates regarding respiratory pathogens. Management support and the absence of job hindrances are associated with hospital staff’s propensity and ability to follow precautions against the transmission of respiratory illnesses.

Knowledge of sex differences in risk factors for posttraumatic stress disorder (PTSD) can contribute to the development of refined preventive interventions. Therefore, the aim of this study was to examine if women and men differ in their vulnerability to risk factors for PTSD.

As part of the longitudinal AURORA study, 2924 patients seeking emergency department (ED) treatment in the acute aftermath of trauma provided self-report assessments of pre- peri- and post-traumatic risk factors, as well as 3-month PTSD severity. We systematically examined sex-dependent effects of 16 risk factors that have previously been hypothesized to show different associations with PTSD severity in women and men.

Women reported higher PTSD severity at 3-months post-trauma. Z-score comparisons indicated that for five of the 16 examined risk factors the association with 3-month PTSD severity was stronger in men than in women. In multivariable models, interaction effects with sex were observed for pre-traumatic anxiety symptoms, and acute dissociative symptoms; both showed stronger associations with PTSD in men than in women. Subgroup analyses suggested trauma type-conditional effects.

Our findings indicate mechanisms to which men might be particularly vulnerable, demonstrating that known PTSD risk factors might behave differently in women and men. Analyses did not identify any risk factors to which women were more vulnerable than men, pointing toward further mechanisms to explain women's higher PTSD risk. Our study illustrates the need for a more systematic examination of sex differences in contributors to PTSD severity after trauma, which may inform refined preventive interventions.

To examine neurocognitive correlates of oculomotor performance among U.S. military personnel with history of mild traumatic brain injury (mTBI).

A series of studies (total n=356) were conducted to examine saccadic eye movements and manual button presses collected in response to attention stimuli, and to compare these findings to the results of standardized neuropsychological tests. Study 1 included n=27 with remote mTBI and n=54 controls who completed the Bethesda Eye and Attention Measure (BEAM), an eye tracking task that was designed to measure visual attention and executive function. In Study 2, n=51 with chronic mTBI and n=33 controls completed the Fusion n-Back task, an eye tracking task that was designed to assess the impact of working memory load on visual attention performance. Study 3 examined psychometric characteristics of BEAM among n=191 military personnel with remote mTBI. In all studies, participants completed eye tracking tasks, a structured TBI diagnostic interview, and a brief battery of standardized neuropsychological tests.

In Study 1, BEAM saccadic and manual metrics demonstrated strong reliability and high sensitivity to multiple cognitive cues designed to elicit spatial orienting, temporal alerting, executive interference, perceptual release (gap) and inhibition (n2p=.76, p<.001). However, corresponding saccadic and manual measurements were weakly related to each other, and only manual (not saccadic) measurements were related to estimated verbal intelligence or years of education. Standardized neuropsychological measures did not differ between groups, but mTBI participants were more likely to be impaired on saccadic metrics than controls.

In Study 2, Standardized cognitive measures and estimated premorbid intelligence were positively associated with all manual metrics from the Fusion n-Back test, but were not associated with mTBI history or with saccadic metrics. Fusion n-Back saccadic and manual metrics had strong reliability and complementary sensitivity to chronic mTBI, with combined predictive power of PPV=.78, NPV=.72, r2=.44 for classification of remote mild TBI vs. controls on the more cognitively-challenging 1-back task condition.

In Study 3, BEAM metrics including manual RT latency and consistency, saccadic RT consistency, and saccadic inhibition errors showed consistent correlations with standardized measures of visual attention, processing speed, task switching, working memory, and executive functions. Hierarchical regressions showed that BEAM saccadic and manual metrics were independently predictive of cognitive test performance, above and beyond effects of demographic factors and clinical characteristics.

Results demonstrated some surprising findings related to neurocognitive influences on oculomotor performance. While both saccadic and manual performance were strongly and similarly influenced by attention cues, these two modalities were only weakly correlated to one another. Additionally, manual metrics were more strongly and consistently related to standardized cognitive test performance and premorbid intelligence than saccadic metrics. However, saccadic metrics demonstrated superior sensitivity to remote/chronic mTBI relative to manual metrics and standardized neuropsychological measures. Overall, these results suggest that saccadic eye tracking measures may provide unique value in assessment of mTBI and neurocognitive functions that is complementary with more common forms of assessment relying upon somatomotor response modalities.

White matter hyperintensity (WMH) burden is greater, has a frontal-temporal distribution, and is associated with proxies of exposure to repetitive head impacts (RHI) in former American football players. These findings suggest that in the context of RHI, WMH might have unique etiologies that extend beyond those of vascular risk factors and normal aging processes. The objective of this study was to evaluate the correlates of WMH in former elite American football players. We examined markers of amyloid, tau, neurodegeneration, inflammation, axonal injury, and vascular health and their relationships to WMH. A group of age-matched asymptomatic men without a history of RHI was included to determine the specificity of the relationships observed in the former football players.

240 male participants aged 45-74 (60 unexposed asymptomatic men, 60 male former college football players, 120 male former professional football players) underwent semi-structured clinical interviews, magnetic resonance imaging (structural T1, T2 FLAIR, and diffusion tensor imaging), and lumbar puncture to collect cerebrospinal fluid (CSF) biomarkers as part of the DIAGNOSE CTE Research Project. Total WMH lesion volumes (TLV) were estimated using the Lesion Prediction Algorithm from the Lesion Segmentation Toolbox. Structural equation modeling, using Full-Information Maximum Likelihood (FIML) to account for missing values, examined the associations between log-TLV and the following variables: total cortical thickness, whole-brain average fractional anisotropy (FA), CSF amyloid ß42, CSF p-tau181, CSF sTREM2 (a marker of microglial activation), CSF neurofilament light (NfL), and the modified Framingham stroke risk profile (rFSRP). Covariates included age, race, education, APOE z4 carrier status, and evaluation site. Bootstrapped 95% confidence intervals assessed statistical significance. Models were performed separately for football players (college and professional players pooled; n=180) and the unexposed men (n=60). Due to differences in sample size, estimates were compared and were considered different if the percent change in the estimates exceeded 10%.

In the former football players (mean age=57.2, 34% Black, 29% APOE e4 carrier), reduced cortical thickness (B=-0.25, 95% CI [0.45, -0.08]), lower average FA (B=-0.27, 95% CI [-0.41, -.12]), higher p-tau181 (B=0.17, 95% CI [0.02, 0.43]), and higher rFSRP score (B=0.27, 95% CI [0.08, 0.42]) were associated with greater log-TLV. Compared to the unexposed men, substantial differences in estimates were observed for rFSRP (Bcontrol=0.02, Bfootball=0.27, 994% difference), average FA (Bcontrol=-0.03, Bfootball=-0.27, 802% difference), and p-tau181 (Bcontrol=-0.31, Bfootball=0.17, -155% difference). In the former football players, rFSRP showed a stronger positive association and average FA showed a stronger negative association with WMH compared to unexposed men. The effect of WMH on cortical thickness was similar between the two groups (Bcontrol=-0.27, Bfootball=-0.25, 7% difference).

These results suggest that the risk factor and biological correlates of WMH differ between former American football players and asymptomatic individuals unexposed to RHI. In addition to vascular risk factors, white matter integrity on DTI showed a stronger relationship with WMH burden in the former football players. FLAIR WMH serves as a promising measure to further investigate the late multifactorial pathologies of RHI.

Stress and depression have a reciprocal relationship, but the neural underpinnings of this reciprocity are unclear. We investigated neuroimaging phenotypes that facilitate the reciprocity between stress and depressive symptoms.

In total, 22 195 participants (52.0% females) from the population-based UK Biobank study completed two visits (initial visit: 2006–2010, age = 55.0 ± 7.5 [40–70] years; second visit: 2014–2019; age = 62.7 ± 7.5 [44–80] years). Structural equation modeling was used to examine the longitudinal relationship between self-report stressful life events (SLEs) and depressive symptoms. Cross-sectional data were used to examine the overlap between neuroimaging correlates of SLEs and depressive symptoms on the second visit among 138 multimodal imaging phenotypes.

Longitudinal data were consistent with significant bidirectional causal relationship between SLEs and depressive symptoms. In cross-sectional analyses, SLEs were significantly associated with lower bilateral nucleus accumbal volume and lower fractional anisotropy of the forceps major. Depressive symptoms were significantly associated with extensive white matter hyperintensities, thinner cortex, lower subcortical volume, and white matter microstructural deficits, mainly in corticostriatal-limbic structures. Lower bilateral nucleus accumbal volume were the only imaging phenotypes with overlapping effects of depressive symptoms and SLEs (B = −0.032 to −0.023, p = 0.006–0.034). Depressive symptoms and SLEs significantly partially mediated the effects of each other on left and right nucleus accumbens volume (proportion of effects mediated = 12.7–14.3%, p < 0.001−p = 0.008). For the left nucleus accumbens, post-hoc seed-based analysis showed lower resting-state functional connectivity with the left orbitofrontal cortex (cluster size = 83 voxels, p = 5.4 × 10−5) in participants with high v. no SLEs.

The nucleus accumbens may play a key role in the reciprocity between stress and depressive symptoms.

Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians.

In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance.

Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12.

Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.

Postpartum depression (PPD) affects up to one in five mothers and birthing parents, yet as few as 10% access evidence-based treatment. One-day cognitive behavioral therapy (CBT)-based workshops for PPD have the potential to reach large numbers of sufferers and be integrated into stepped models of care.

This randomized controlled trial of 461 mothers and birthing parents in Ontario, Canada with Edinburgh Postnatal Depression Scale (EPDS) scores ⩾10, age ⩾18 years, and an infant <12 months of age compared the effects of a 1-day CBT-based workshop plus treatment as usual (TAU; i.e. care from any provider(s) they wished) to TAU alone at 12-weeks post-intervention on PPD, anxiety, the mother–infant relationship, offspring behavior, health-related quality of life, and cost-effectiveness. Data were collected via REDCap.

Workshops led to meaningful reductions in EPDS scores (m = 15.77 to 11.22; b = −4.6, p < 0.01) and were associated with three times higher odds of a clinically significant decrease in PPD [odds ratio (OR) 3.00, 95% confidence interval (CI) 1.93–4.67]. Anxiety also decreased and participants had three times the odds of clinically significant improvement (OR 3.20, 95% CI 2.03–5.04). Participants reported improvements in mother–infant bonding, infant-focused rejection and anger, and effortful control in their toddlers. The workshop plus TAU achieved similar quality-adjusted life-years at lower costs than TAU alone.

One-day CBT-based workshops for PPD can lead to improvements in depression, anxiety, and the mother–infant relationship and are cost-saving. This intervention could represent a perinatal-specific option that can treat larger numbers of individuals and be integrated into stepped care approaches at reasonable cost.