Inpatient residential treatment program for combat-related posttraumatic stress disorder (PTSD): Results from the 2020 Artsakh (Nagorno-Karabakh) War.

Inpatient residential treatment programs to evaluate active military service members for potential return to service or discharge are considered an integral component of rehabilitation for trauma related conditions. This retrospective study was conducted on combat-exposed military service members who were admitted to an inpatient residential treatment program for evaluation of fitness to serve and treatment of trauma related conditions. The PTSD Checklist for DSM-5 (PCL-5) was used to screen for PTSD, determine symptom severity, and monitor symptom change. At the time of admission, 54.3% of the service members met the provisional PTSD diagnosis, whereas at the time of discharge, 16.28% of the service members met the provisional diagnostic criteria. The most common symptoms rated moderately or higher were sleep troubles, followed by super alert, disturbing memories, feeling upset, disturbing dreams, physical reactions, avoiding memories, and negative feelings. Paired t-test results comparing the PCL-5 five Subscales and Total Score at the time of admission and discharge showed significant reductions. The five symptoms that improved the least were sleep troubles, feeling upset, avoiding memories, difficulty concentrating, and trouble remembering. The successful creation and implementation of an Armenian version of the PCL-5 was realized and, when put to the test, aided in screening, diagnosing, and monitoring PTSD symptoms among Armenian Army Service members. The results suggest that PTSD symptoms in an inpatient residential treatment program decreased over time. The symptoms that bothered the service members at most during the time of admission, however, improved the least at the time of discharge.

How the COVID 19 pandemic will shape influenza public health initiatives: The UK experience.

Although caused by different pathogens, COVID-19 and influenza share many clinical features, as well as the potential for inflammatory, cardiovascular, and other long-term complications. During the 2020-2021 influenza season, COVID-19 mitigation efforts and a robust influenza vaccination campaign led to an unprecedented reduction in influenza cases. The lack of exposure to influenza, along with antigenic changes, may have reduced population immunity to influenza and set the stage for a high severity influenza season in 2021-2022. For the second consecutive season, the UK Department of Health and Social Care has expanded influenza vaccine eligibility to mitigate the impact of both COVID-19 and influenza. Continuation of clear policy decisions, as well as ongoing coordination between manufacturers, distributors, health authorities, and healthcare providers, is key to reducing the burden of influenza and COVID-19 and preventing large numbers of severe cases that can overwhelm the healthcare system.

Development and presentation of an objective risk stratification tool for healthcare workers when dealing with the COVID-19 pandemic in the UK: risk modelling based on hospitalisation and mortality statistics compared with epidemiological data.

OBJECTIVES: Healthcare workers have greater exposure to SARS-CoV-2 and an estimated 2.5-fold increased risk of contracting COVID-19 than the general population. We wished to explore the predictive role of basic demographics to establish a simple tool that could help risk stratify healthcare workers. SETTING: We undertook a review of the published literature (including multiple search strategies in MEDLINE with PubMed interface) and critically assessed early reports on preprint servers. We explored the relative risk of mortality from readily available demographics to identify the population at the highest risk. RESULTS: The published studies specifically assessing the risk of healthcare workers had limited demographics available; therefore, we explored the general population in the literature. Clinician demographics: Mortality increased with increasing age from 50 years onwards. Male sex at birth, and people of black and minority ethnicity groups had higher susceptibility to both hospitalisation and mortality. Comorbid disease. Vascular disease, renal disease, diabetes and chronic pulmonary disease further increased risk. Risk stratification tool: A risk stratification tool was compiled using a white female aged <50 years with no comorbidities as a reference. A point allocated to risk factors was associated with an approximate doubling in risk. This tool provides numerical support for healthcare workers when determining which team members should be allocated to patient facing clinical duties compared with remote supportive roles. CONCLUSIONS: We generated a tool that provides a framework for objective risk stratification of doctors and healthcare professionals during the COVID-19 pandemic, without requiring disclosure of information that an individual may not wish to share with their direct line manager during the risk assessment process. This tool has been made freely available through the British Medical Association website and is widely used in the National Health Service and other external organisations.

The UK approach to COVID-19 vaccination: why was it so different?

The vaccination campaign in the United Kingdom has been extremely successful. Bold decisions were made to order vaccines early, before we knew if they would be effective, and to vary from the manufacturers' recommendations by extending the 'prime-boost' interval between the first and second doses of the AstraZeneca and Pfizer-BioNTech vaccines. These decisions were controversial at the time but have contributed enormously to the effectiveness of the vaccination programme. This is a personal perspective on the approach to COVID-19 vaccination in the United Kingdom.

Associations between MMPI-2-RF Scale scores and institutional violence among patients detained under sexually violent predator laws.

Sexually violent predator (SVP) laws allow the postprison civil commitment of sex offenders to a secure psychiatric hospital because of mental abnormality and posing a serious risk to public safety. Research on predictors of future institutional violence in this population is lacking because adequately sized samples are difficult to obtain. In the current study, we examined psychological predictors of future institutional violence in a sample of 171 psychiatrically hospitalized males detained or civilly committed under an SVP laws. Using the Minnesota Multiphasic-Personality Inventory-2-Restructured Form (Ben-Porath & Tellegen, 2008/2011), we found that scales assessing thought dysfunction, emotional dysregulation, and externalizing behaviors were associated with future physical violence at the hospital. Relative risk ratio analyses indicated that SVPs producing elevations on these scales were at 1.5-2.5 times greater risk of future physical violence than those without elevations. Overall, the results suggest the Minnesota Multiphasic-Personality Inventory-2-Restructured Form is associated with future institutional violence among SVPs. Implications and limitations of these findings are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

National outbreak of Pseudomonas aeruginosa associated with an aftercare solution following piercings, July to September 2016, England.

We report a national Pseudomonas aeruginosa outbreak from a common source following piercings between July and September 2016 in England. The multi-agency outbreak investigation included active case finding, microbiological testing of environmental samples and case specimens including Variable Number Tandem Repeat (VNTR) typing and a retrospective cohort study. Overall, 162 outbreak cases (29 confirmed, 14 probable and 119 possible) and 14 non-outbreak cases were identified; all confirmed cases had ear piercings (93% cartilage). Outbreak cases were predominantly female (95%) and had a median age of 18 years (interquartile range: 13-56 years). Nineteen outbreak cases required surgery under general anaesthetic The same outbreak VNTR type (11,3,5,3,3,3,6,4,7) was isolated from bottles of an aftercare solution from a single manufacturer and in specimens from confirmed cases who attended eight different piercing studios supplied with this product. In the cohort study, use of aftercare solution was associated with becoming a case (aOR: 4.60, 95% confidence interval: 1.65-12.90). Environmental, microbiological and epidemiological investigations confirmed that contamination during production of aftercare solution was the source of this national outbreak; highlighting challenges in the regulation of a cosmetic products used in the piercing industry and that guidance on piercing aftercare may need to be reviewed.

Lessons from an online vaccine communication project.

Most members of the general public use the internet to research health topics. However, the quality of vaccine-related material available online is mixed and internet search engines often bring web users to low-quality anti-vaccine websites. We present a case study of a pro-vaccine information hub launched in 2011. Vaccines Today provides high-quality information about vaccines and diseases, expert interviews, answers to frequently asked questions, parent/patient stories and videos/infographics. Twitter, Facebook, YouTube and Instagram are used to share this content and to engage with various online audiences. This Commentary outlines what works in online communication about vaccines and offers proposals for improving the impact of online vaccine advocacy. The value of networking to boost visibility and search engine ranking is emphasised. Furthermore, we present the case for the sharing and application of best practice in online communication.