Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 11 de 11
Filter
1.
Brain Behav Immun ; 87: 8-9, 2020 07.
Article in English | MEDLINE | ID: covidwho-1719343

ABSTRACT

The COVID-19 pandemic has led to high levels of psychological distress in the general public, including symptoms of anxiety and depression. Such distress is associated with alterations in immune function, including an elevated risk of viral respiratory tract infections. In this light, the possible effects of Ayurveda, a traditional system of medicine promoted by the Indian government as an "immune booster", are examined from the point of view of psychoneuroimmune mechanisms as well as the "meaning response" described by Moerman. It was found that many of the measures advocated in their guidelines could positively influence immunity either by direct effects on symptoms of depression or anxiety, or through their symbolic significance. Therefore, it is possible that such traditional practices could be beneficial both in terms of psychological quality of life, and in terms of moderating the risk of infection.


Subject(s)
Anxiety/immunology , Coronavirus Infections/epidemiology , Depression/immunology , Medicine, Ayurvedic , Pneumonia, Viral/epidemiology , Psychoneuroimmunology , Stress, Psychological/immunology , Anxiety/epidemiology , Anxiety/psychology , Betacoronavirus , COVID-19 , Coriandrum , Cuminum , Curcuma , Depression/epidemiology , Depression/psychology , Garlic , Guidelines as Topic , Humans , India/epidemiology , Pandemics , Plant Preparations , Psychological Distress , SARS-CoV-2 , Spices , Stress, Psychological/epidemiology , Stress, Psychological/psychology , Teas, Herbal , Yoga
2.
Brain Behav Immun ; 87: 34-39, 2020 07.
Article in English | MEDLINE | ID: covidwho-1719335

ABSTRACT

The coronavirus disease 19 (COVID-19) pandemic is a significant psychological stressor in addition to its tremendous impact on every facet of individuals' lives and organizations in virtually all social and economic sectors worldwide. Fear of illness and uncertainty about the future precipitate anxiety- and stress-related disorders, and several groups have rightfully called for the creation and dissemination of robust mental health screening and treatment programs for the general public and front-line healthcare workers. However, in addition to pandemic-associated psychological distress, the direct effects of the virus itself (several acute respiratory syndrome coronavirus; SARS-CoV-2), and the subsequent host immunologic response, on the human central nervous system (CNS) and related outcomes are unknown. We discuss currently available evidence of COVID-19 related neuropsychiatric sequelae while drawing parallels to past viral pandemic-related outcomes. Past pandemics have demonstrated that diverse types of neuropsychiatric symptoms, such as encephalopathy, mood changes, psychosis, neuromuscular dysfunction, or demyelinating processes, may accompany acute viral infection, or may follow infection by weeks, months, or longer in recovered patients. The potential mechanisms are also discussed, including viral and immunological underpinnings. Therefore, prospective neuropsychiatric monitoring of individuals exposed to SARS-CoV-2 at various points in the life course, as well as their neuroimmune status, are needed to fully understand the long-term impact of COVID-19, and to establish a framework for integrating psychoneuroimmunology into epidemiologic studies of pandemics.


Subject(s)
Coronavirus Infections/psychology , Cytokine Release Syndrome/psychology , Mental Disorders/psychology , Nervous System Diseases/psychology , Pneumonia, Viral/psychology , Acute Disease , Anxiety/etiology , Anxiety/immunology , Anxiety/psychology , Bacterial Translocation , Betacoronavirus , COVID-19 , Chronic Disease , Coronavirus Infections/complications , Coronavirus Infections/immunology , Coronavirus Infections/therapy , Cytokine Release Syndrome/immunology , Cytokine Release Syndrome/therapy , Demyelinating Diseases/etiology , Demyelinating Diseases/immunology , Demyelinating Diseases/physiopathology , Demyelinating Diseases/psychology , Depression/etiology , Depression/immunology , Depression/psychology , Humans , Immunologic Factors/adverse effects , Mental Disorders/etiology , Mental Disorders/immunology , Mental Health , Nervous System Diseases/etiology , Nervous System Diseases/immunology , Nervous System Diseases/physiopathology , Neurodegenerative Diseases/etiology , Neurodegenerative Diseases/immunology , Neurodegenerative Diseases/physiopathology , Neurodegenerative Diseases/psychology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/immunology , Pneumonia, Viral/therapy , Psychoneuroimmunology , Psychotic Disorders/etiology , Psychotic Disorders/immunology , Psychotic Disorders/psychology , Public Health , SARS-CoV-2 , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/immunology , Stress Disorders, Post-Traumatic/psychology
3.
Ann Allergy Asthma Immunol ; 127(4): 446-450.e1, 2021 10.
Article in English | MEDLINE | ID: covidwho-1230347

ABSTRACT

BACKGROUND: The coronavirus disease 2019 pandemic has highlighted the importance of accurate capture of vaccine, and vaccine component, allergy. There remains a gap in the prevalence literature from the perspective of direct primary care provider (PCP) reporting at a population level. OBJECTIVE: To determine the prevalence of PCP-documented vaccine and polyethylene glycol (PEG) allergy using electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network. METHODS: Retrospective cohort study using the Canadian Primary Care Sentinel Surveillance Network repository. Machine learning algorithms were applied to evaluate for vaccine allergy documentation, and Anatomic Therapeutic Chemical codes were used for PEG allergy or allergy to common injectable medications containing PEG (CIMCP). RESULTS: The prevalence of PCP-documented vaccine allergy in Canada was 0.037% (395/1,055,677) and of PEG allergy was 0.0009% (10/1,055,677). In total, 0.01% of patients had a documented allergy to either PEG or CIMCP (135/1,055,677). None of the patients with PEG allergy had a documented allergy to a CIMCP. Patients with vaccine allergy and PEG allergy were significantly more likely to have other atopic comorbidities, including asthma (P < .001 for both), eczema (P < .001 and P = .001, respectively), rhinitis (P = .002 and P < .001, respectively), and food allergy (P < .001 for both). Significantly higher rates of depression (P < .001 and P < .001, respectively) and anxiety (P = .003 and P < .001, respectively) were found in those with vaccine allergy, or PEG allergy, than those without vaccine allergy or PEG allergy. CONCLUSION: This is the first study to estimate the prevalence of vaccine and PEG allergy in a national cohort that uses PCP documentation, revealing a low reported rate of vaccine allergy and PEG allergy.


Subject(s)
Hypersensitivity, Immediate/epidemiology , Hypersensitivity, Immediate/immunology , Hypersensitivity/immunology , Polyethylene Glycols/adverse effects , Vaccines/adverse effects , Adult , Algorithms , Anxiety/immunology , Asthma/epidemiology , Asthma/immunology , COVID-19/immunology , Canada/epidemiology , Documentation/methods , Eczema/epidemiology , Eczema/immunology , Electronic Health Records , Female , Health Personnel , Humans , Male , Middle Aged , Pandemics/prevention & control , Prevalence , Primary Health Care/methods , Retrospective Studies , SARS-CoV-2/immunology , Vaccines/immunology
4.
Cogn Behav Ther ; 50(3): 191-203, 2021 05.
Article in English | MEDLINE | ID: covidwho-1083280

ABSTRACT

Excessive fear and worry in response to the COVID-19 pandemic (e.g., COVID stress syndrome) is prevalent and associated with various adverse outcomes. Research from the current and past pandemics supports the association between transdiagnostic constructs-anxiety sensitivity (AS), disgust, and intolerance of uncertainty (IU)-and pandemic-related distress. Recent research suggests a moderating effect of disgust on the relationship of AS-physical concerns and COVID-19-related distress, suggesting that transdiagnostic constructs underlie individual differences in activation of the behavioral immune system (BIS). No previous study has examined the independent and conjoint effects of pre-COVID-19 AS-physical concerns, disgust propensity (DP), disgust sensitivity (DS), and IU in this context; thus, we did so using longitudinal survey data (N = 3,062 Canadian and American adults) with simple and moderated moderations controlling for gender, mental health diagnosis, and COVID-19 diagnosis. Greater AS-physical concerns, DP, and DS predicted more severe COVID stress syndrome assessed one month later. Either DP or DS further amplified the effect of AS-physical concerns on COVID stress syndrome, except danger and contamination fears. IU did not interact with AS-physical concerns and DS or DP. Theoretical and clinical implications pertaining to delivery of cognitive behavioural therapy for pandemic-related distress are discussed.


Subject(s)
Anxiety/psychology , Disgust , Fear/psychology , Stress, Psychological/psychology , Uncertainty , Adult , Aged , Anxiety/immunology , Anxiety Disorders/immunology , Anxiety Disorders/psychology , COVID-19 , COVID-19 Testing , Canada , Female , Humans , Immune System/immunology , Male , Middle Aged , Pandemics , Stress, Psychological/immunology
5.
Ann Allergy Asthma Immunol ; 126(1): 83-88.e1, 2021 01.
Article in English | MEDLINE | ID: covidwho-962732

ABSTRACT

BACKGROUND: Food allergy has a known effect on quality of life (QoL), but this has not been extensively studied during the coronavirus disease 2019 pandemic. OBJECTIVE: To characterize the levels of anxiety of mothers of children aged 0 to 8 years with food allergy compared with families of children without a food allergy and the health-related QoL among children with food allergy during the coronavirus disease 2019 pandemic. METHODS: In a mixed-methods study, Canadian mothers of children aged 0 to 8 years with (cases) and without (controls) food allergy provided demographic data and completed age-appropriate anxiety questionnaires between April 14, 2020, and April 28, 2020. The cases also provided food allergy-related data and completed the Food Allergy Quality of Life Questionnaire. In-depth interviews were subsequently conducted with purposefully selected cases. RESULTS: In a total of 580 participants, 5.5% were cases and 94.5% were controls. For mothers of children aged 0 to 1.5 years, anxiety levels did not differ between cases and controls. For mothers of children aged 1.5 to 8 years, anxiety levels were higher in cases vs controls (P < .05). Among the cases, neither overall nor domain-specific Food Allergy Quality of Life Questionnaire scores differed between age groups (0-3 vs 4-7 years), even after adjustment for confounding variables, including childcare during the pandemic. Qualitatively, the following 3 themes were identified: unexpected challenges of food shopping; less food-related food anxiety during the pandemic; and differences and delays in food allergy testing and therapy. CONCLUSION: Mothers of children with food allergy reported high anxiety and poor health-related QoL. Yet, qualitatively, day-to-day food allergy management was better during the pandemic.


Subject(s)
Anxiety/psychology , COVID-19/epidemiology , Food Hypersensitivity/psychology , Pandemics , Quality of Life/psychology , Adult , Anxiety/diagnosis , Anxiety/etiology , Anxiety/immunology , COVID-19/immunology , COVID-19/psychology , COVID-19/virology , Canada/epidemiology , Case-Control Studies , Child , Child, Preschool , Female , Food Hypersensitivity/complications , Food Hypersensitivity/diagnosis , Food Hypersensitivity/immunology , Humans , Infant , Infant, Newborn , Male , Mothers/psychology , SARS-CoV-2/pathogenicity , Surveys and Questionnaires
7.
Prostaglandins Leukot Essent Fatty Acids ; 161: 102177, 2020 10.
Article in English | MEDLINE | ID: covidwho-796199

ABSTRACT

As the infected cases of COVID-19 reach more than 20 million with more than 778,000 deaths globally, an increase in psychiatric disorders including anxiety and depression has been reported. Scientists globally have been searching for novel therapies and vaccines to fight against COVID-19. Improving innate immunity has been suggested to block progression of COVID-19 at early stages, while omega-3 polyunsaturated fatty acids (n-3 PUFAs) have been shown to have immunomodulation effects. Moreover, n-3 PUFAs have also been shown to improve mood disorders, thus, future research is warranted to test if n-3 PUFAs may have the potential to improve our immunity to counteract both physical and mental impact of COVID-19.


Subject(s)
Anxiety/prevention & control , Coronavirus Infections/prevention & control , Depression/prevention & control , Dietary Supplements , Fatty Acids, Omega-3/administration & dosage , Immunologic Factors/administration & dosage , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Anxiety/immunology , Anxiety/metabolism , Anxiety/virology , Betacoronavirus/immunology , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/immunology , Coronavirus Infections/metabolism , Coronavirus Infections/virology , Cytokines/biosynthesis , Cytokines/immunology , Dendritic Cells/drug effects , Dendritic Cells/immunology , Dendritic Cells/virology , Depression/immunology , Depression/metabolism , Depression/virology , Epithelial Cells/drug effects , Epithelial Cells/immunology , Epithelial Cells/virology , Fatty Acids, Omega-3/immunology , Fatty Acids, Omega-3/metabolism , Host-Pathogen Interactions/drug effects , Host-Pathogen Interactions/immunology , Humans , Immunity, Innate/drug effects , Immunologic Factors/immunology , Immunologic Factors/metabolism , Lymphocytes/drug effects , Lymphocytes/immunology , Lymphocytes/virology , Macrophages/drug effects , Macrophages/immunology , Macrophages/virology , Pneumonia, Viral/immunology , Pneumonia, Viral/metabolism , Pneumonia, Viral/virology , SARS-CoV-2
8.
Brain Behav Immun ; 89: 594-600, 2020 10.
Article in English | MEDLINE | ID: covidwho-688835

ABSTRACT

Infection-triggered perturbation of the immune system could induce psychopathology, and psychiatric sequelae were observed after previous coronavirus outbreaks. The spreading of the Severe Acute Respiratory Syndrome Coronavirus (COVID-19) pandemic could be associated with psychiatric implications. We investigated the psychopathological impact of COVID-19 in survivors, also considering the effect of clinical and inflammatory predictors. We screened for psychiatric symptoms 402 adults surviving COVID-19 (265 male, mean age 58), at one month follow-up after hospital treatment. A clinical interview and a battery of self-report questionnaires were used to investigate post-traumatic stress disorder (PTSD), depression, anxiety, insomnia, and obsessive-compulsive (OC) symptomatology. We collected sociodemographic information, clinical data, baseline inflammatory markers and follow-up oxygen saturation levels. A significant proportion of patients self-rated in the psychopathological range: 28% for PTSD, 31% for depression, 42% for anxiety, 20% for OC symptoms, and 40% for insomnia. Overall, 56% scored in the pathological range in at least one clinical dimension. Despite significantly lower levels of baseline inflammatory markers, females suffered more for both anxiety and depression. Patients with a positive previous psychiatric diagnosis showed increased scores on most psychopathological measures, with similar baseline inflammation. Baseline systemic immune-inflammation index (SII), which reflects the immune response and systemic inflammation based on peripheral lymphocyte, neutrophil, and platelet counts, positively associated with scores of depression and anxiety at follow-up. PTSD, major depression, and anxiety, are all high-burden non-communicable conditions associated with years of life lived with disability. Considering the alarming impact of COVID-19 infection on mental health, the current insights on inflammation in psychiatry, and the present observation of worse inflammation leading to worse depression, we recommend to assess psychopathology of COVID-19 survivors and to deepen research on inflammatory biomarkers, in order to diagnose and treat emergent psychiatric conditions.


Subject(s)
Anxiety Disorders/epidemiology , Coronavirus Infections/epidemiology , Depressive Disorder, Major/epidemiology , Pneumonia, Viral/epidemiology , Survivors/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety/epidemiology , Anxiety/immunology , Anxiety/psychology , Anxiety Disorders/immunology , Anxiety Disorders/psychology , Betacoronavirus , C-Reactive Protein/immunology , COVID-19 , Coronavirus Infections/immunology , Coronavirus Infections/psychology , Depression/epidemiology , Depression/immunology , Depression/psychology , Depressive Disorder/epidemiology , Depressive Disorder/immunology , Depressive Disorder/psychology , Depressive Disorder, Major/immunology , Depressive Disorder, Major/psychology , Emergency Service, Hospital , Female , Humans , Inflammation , Italy/epidemiology , Length of Stay/statistics & numerical data , Leukocyte Count , Lymphocyte Count , Male , Mental Disorders/epidemiology , Mental Disorders/immunology , Mental Disorders/psychology , Middle Aged , Monocytes , Neutrophils , Obsessive-Compulsive Disorder/epidemiology , Obsessive-Compulsive Disorder/immunology , Obsessive-Compulsive Disorder/psychology , Pandemics , Pneumonia, Viral/immunology , Pneumonia, Viral/psychology , SARS-CoV-2 , Severity of Illness Index , Sex Factors , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/immunology , Sleep Initiation and Maintenance Disorders/psychology , Stress Disorders, Post-Traumatic/epidemiology
9.
Brain Behav Immun ; 89: 587-593, 2020 10.
Article in English | MEDLINE | ID: covidwho-652159

ABSTRACT

OBJECTIVE: To evaluate the mental health status of hospitalized patients with coronavirus disease 2019 (COVID-19) and to explore the related factors. METHOD: This was a cross-sectional survey among COVID-19 inpatients in two isolation wards of a designated hospital in Wuhan, China, from March 7, 2020, to March 24, 2020. Participants' demographic data, clinical data and levels of circulating inflammatory markers were collated. Mental health symptoms were evaluated with questionnaires, which included the Insomnia Severity Index (ISI) scale, the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7) scale, and questions about patients' self-perceived illness severity. Multivariate linear regression analysis was performed to explore factors that associated with mental symptoms, and a structural equation model (SEM) was used to assess the possible relationships between those factors and the patients' mental health. RESULTS: Among the 85 participants, 45.9% had symptoms of depression (PHQ-9 ≥ 5), 38.8% had anxiety (GAD-7 ≥ 5), and 54.1% had insomnia (ISI ≥ 8). According to multivariate regression analysis, female sex, a higher level of interleukin (IL)-1ß and greater self-perceived illness severity were all significantly associated with a higher PHQ-9 score, higher GAD-7 score and higher ISI score. In addition, the disease duration and the neutrophil to lymphocyte ratio (NLR) were positively related to patients' self-perceived illness severity. The results of the SEM analyses suggested that sex (ß = 0.313, P < 0.001), self-perceived illness severity (ß = 0.411, P < 0.001) and levels of inflammatory markers (ß = 0.358, P = 0.002) had direct effects on patients' mental health. The disease duration (ß = 0.163, P = 0.003) and levels of inflammatory markers (ß = 0.101, P = 0.016) also indirectly affected patients' mental health, with self-perceived illness severity acting as a mediator. CONCLUSION: A majority of COVID-19 infected inpatients reported experiencing mental health disturbances. Female sex, disease duration, levels of inflammatory markers and self-perceived illness severity are factors that could be used to predict the severity of patients' mental symptoms.


Subject(s)
Anxiety/psychology , Coronavirus Infections/psychology , Depression/psychology , Hospitalization , Pneumonia, Viral/psychology , Sleep Initiation and Maintenance Disorders/psychology , Adult , Anxiety/epidemiology , Anxiety/immunology , Betacoronavirus , COVID-19 , China/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Cross-Sectional Studies , Depression/epidemiology , Depression/immunology , Female , Humans , Inflammation , Leukocyte Count , Lymphocyte Count , Male , Mental Health , Middle Aged , Neutrophils , Pandemics , Patient Health Questionnaire , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , SARS-CoV-2 , Severity of Illness Index , Sex Factors , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/immunology , Time Factors
10.
Expert Rev Anti Infect Ther ; 18(12): 1195-1200, 2020 12.
Article in English | MEDLINE | ID: covidwho-646853

ABSTRACT

INTRODUCTION: The COVID-19 pandemic is causing devastating global morbidity and mortality. Worldwide measures are taken to prevent human to human transmission and improve general health. Public lifestyle and health are affected by social distancing and isolation. A strong host immune response to the novel coronavirus is a key factor, for protection against infection and avoiding reaching severe stages of the disease. AREAS COVERED: Pathophysiology and the human immune response of similar coronaviruses have been previously described. The novel coronavirus has distinct clinical stages related to the immune response. Exercise improves host innate immunity and affords protection to viral infections. Exercise also mitigates the negative effects of isolation including stress, anxiety, and sedentarism, all of which further reduces immunity and increases non-communicable disease risk. EXPERT OPINION: Improving host immunity and mitigating the negative effects of isolation via physical activity is strongly justified. Exercise should be done in moderate intensities and volumes during the current pandemic, which is a nutritionally, psychologically, socially challenging environment in the presence of a virulent viral organism. Proactively creating innovative health promotion models with technology and government involvement with the best available evidence should be encouraged to reduce physical inactivity during the current COVID-19 pandemic and after.


Subject(s)
COVID-19/prevention & control , Exercise/physiology , Immunity/immunology , Physical Distancing , Sedentary Behavior , Social Isolation , Anxiety/immunology , Anxiety/psychology , COVID-19/immunology , Exercise/psychology , Guidelines as Topic , Humans , Noncommunicable Diseases , Quarantine , Risk Factors , Stress, Psychological/immunology , Stress, Psychological/psychology
11.
Brain Behav Immun ; 88: 17-27, 2020 08.
Article in English | MEDLINE | ID: covidwho-270288

ABSTRACT

Since the end of 2019, Corona Virus Disease 2019 (COVID-19) has been the cause of a worldwide pandemic. The mental status of patients with COVID-19 who have been quarantined and the interactions between their psychological distress and physiological levels of inflammation have yet to be analyzed. Using a mixed-method triangulation design (QUAN + QUAL), this study investigated and compared the mental status and inflammatory markers of 103 patients who, while hospitalized with mild symptoms, tested positive with COVID-19 and 103 matched controls that were COVID-19 negative. The severity of depression, anxiety, and post-traumatic stress symptoms (PTSS) was measured via an on-line survey. Using a convenience sampling technique, qualitative data were collected until the point of data saturation. In addition, a semi-structured interview was conducted among five patients with COVID-19. Peripheral inflammatory markers were also collected in patients, both at baseline and within ± three days of completing the on-line survey. Results revealed that COVID-19 patients, when compared to non-COVID controls, manifested higher levels of depression (P < 0.001), anxiety (P < 0.001), and post-traumatic stress symptoms (P < 0.001). A gender effect was observed in the score of "Perceived Helplessness", the subscale of PSS-10, with female patients showing higher scores compared to male patients (Z = 2.56, P = 0.010), female (Z = 2.37, P = 0.018) and male controls (Z = 2.87, P = 0.004). Levels of CRP, a peripheral inflammatory indicator, correlated positively with the PHQ-9 total score (R = 0.37, P = 0.003, Spearman's correlation) of patients who presented symptoms of depression. Moreover, the change of CRP level from baseline inversely correlated with the PHQ-9 total score (R = -0.31, P = 0.002), indicative of improvement of depression symptoms. Qualitative analysis revealed similar results with respect to patient reports of negative feelings, including fear, guilt, and helplessness. Stigma and uncertainty of viral disease progression were two main concerns expressed by COVID-19 patients. Our results indicate that significant psychological distress was experienced by hospitalized COVID-19 patients and that levels of depressive features may be related to the inflammation markers in these patients. Thus, we recommend that necessary measures should be provided to address depression and other psychiatric symptoms for COVID-19 patients and attention should be paid to patient perceived stigma and coping strategies when delivering psychological interventions.


Subject(s)
Anxiety/psychology , C-Reactive Protein/immunology , Coronavirus Infections/psychology , Depression/psychology , Inflammation/immunology , Pneumonia, Viral/psychology , Psychological Distress , Quarantine/psychology , Stress, Psychological/psychology , Adult , Aged , Anxiety/immunology , Betacoronavirus , Blood Sedimentation , COVID-19 , Case-Control Studies , Coronavirus Infections/immunology , Cross-Sectional Studies , Depression/immunology , Female , Hospitalization , Humans , Leukocyte Count , Male , Middle Aged , Pandemics , Patient Health Questionnaire , Pneumonia, Viral/immunology , Procalcitonin/immunology , SARS-CoV-2 , Sex Factors , Stress Disorders, Post-Traumatic/immunology , Stress Disorders, Post-Traumatic/psychology , Stress, Psychological/immunology
SELECTION OF CITATIONS
SEARCH DETAIL