FlixBus is growing day by day and continues to introduce various innovations to the Croatian bus market, and what is already standard in all other European countries, is also offered on the Croatian market: a unique FlixBus service for passengers on the spot. FlixBus assistants in recognizable FlixBus colors inform, guide and care for passengers at the bus station and provide an extended hand to customer service and traffic control, while reducing stress for the passenger before the trip.As a support and extended service to customer service and traffic control, FlixBus also employs bus assistants who spend their day at bus stations. In Croatia, FlixBus assistants are currently available at the bus station in Zagreb, 7 days a week, from 6:30 to 23:00, and they are most present during the departures. They are recognizable primarily by FlixBus green jackets and are easy to spot.The role of bus assistants is to guide and inform passengers and communicate with passengers in a foreign or local language. In addition, bus assistants assist drivers in checking tickets and passengers entering the bus. What is important to point out, FlixBus assistants remind each passenger to check their own personal documents. In this way, the aim is to make the passenger aware of the possible forgotten passport and identity card, but also of the possible expiration of the document.Since these are mostly international lines, this eliminates possible problems at the border crossings.Our goal is to offer every passenger the simplest possible stress-free trip. Therefore, a lot is invested in technology, but also in the level of service. Customer service and on-site assistance provide the passenger with a sense of security and justify the trust givenHe points out Petra Milanović, head of public relations for FlixBus CEE, adds that this type of service was offered on the Croatian market for the first time. For now, FlixBus offers this service in Zagreb as the largest hub of all trips.
Pinterest Email Share on Twitter Share on Facebook A ‘gene signature’ that could be used to predict the onset of diseases, such as Alzheimer’s, years in advance has been developed in research published in the open access journal Genome Biology.The study aimed to define a set of genes associated with ‘healthy ageing’ in 65 year olds. Such a molecular profile could be useful for distinguishing people at earlier risk of age-related diseases. This could improve upon the use of chronological age and complement traditional indicators of disease, such as blood pressure.Lead author James Timmons, from King’s College London, UK, said: “We use birth year, or chronological age, to judge everything from insurance premiums to whether you get a medical procedure or not. Most people accept that all 60 year olds are not the same, but there has been no reliable test for underlying ‘biological age’. LinkedIn Share “Our discovery provides the first robust molecular ‘signature’ of biological age in humans and should be able to transform the way that ‘age’ is used to make medical decisions. This includes identifying those more likely to be at risk of Alzheimer’s, as catching those at ‘early’ risk is key to evaluating potential treatments.”The researchers analyzed the RNA of healthy 65 year old subjects, and used the information to develop a signature of 150 RNA genes that indicated ‘healthy ageing’. The signature was found to be a reliable predictor for risk of age-related disease when studying RNA from tissues including human muscle, brain and skin.With this RNA signature, they developed a ‘healthy age gene score’ which they used to test and compare the RNA profiles of different individuals, and demonstrated that a greater score was associated with better health in men and women.The researchers studied RNA from healthy 70 year old subjects and analyzed follow-up health data over two decades. Despite all subjects being born within a year of each other, their RNA at around 70 years of age demonstrated a very wide distribution in ‘healthy age gene score’, varying over a four-fold range. This variation was shown to link to long term health. A greater gene score was also associated with better cognitive health and renal function across a 12 year span – both important determinants of mortality.In particular, they demonstrated that patients diagnosed with Alzheimer’s Disease had an altered ‘healthy ageing’ RNA signature in their blood, and therefore a lower healthy age gene score, suggesting significant association with the disease.Timmons added: “This is the first blood test of its kind that has shown that the same set of molecules are regulated in both the blood and the brain regions associated with dementia, and it can help contribute to a dementia diagnosis. This also provides strong evidence that dementia in humans could be called a type of ‘accelerated ageing’ or ‘failure to activate the healthy ageing program’.”Given that early intervention is important in Alzheimer’s and there is a need to identify those at greatest risk, the authors say that their ‘healthy age gene score’ could be integrated to help decide which middle-aged subjects could be offered entry into a preventative clinical trial many years before the clinical expression of Alzheimer’s.
LinkedIn Share on Facebook Share Email Pinterest Internet-delivered cognitive behavioural therapy (CBT) combined with clinical care has been shown to benefit people with depression, anxiety and emotional distress from illness, according to an evidence-based review in CMAJ (Canadian Medical Association Journal).“In the age of Google, this psychological intervention is empowering, clinically efficient and consistent with the way that, increasingly, patients interact with health care,” write Dr. David Gratzer, attending psychiatrist, and Faiza Khalid-Khan, social worker and Director of Mental Health, The Scarborough Hospital, Toronto, Ontario.The review looks at recent, high quality studies and the growing body of literature on smartphone and tablet applications for mental illness. Some studies showed that patients who used Internet-delivered CBT had better outcomes than placebo controls and equal or better outcomes than those with traditional in-person cognitive behaviour therapy. These outcomes were seen in patients with depression, as well as those with physical illnesses such as cancer and multiple sclerosis. Share on Twitter “There is as much evidence for cognitive behavioural therapy as there is for medications to treat mild and moderate depression, as well as evidence that they have a synergistic effect,” says Dr. Gratzer. “In other words, for the hundreds of thousands of Canadians struggling with depression, Internet-assisted cognitive behavioural therapy offers a cost-effective and empowering way of accessing an important treatment.”Patients may participate in online therapy whenever and wherever they like, which provides the anonymity that may help depressed or shy patients who are reluctant to speak to a health care professional.“[Internet-delivered] CBT has two principal advantages: patient empowerment and increased clinical efficiency,” write the authors. “It allows clinicians to treat more patients effectively in less time. Even with intermittent therapist support, it is less time-consuming and requires fewer resources overall than traditional CBT.”However, this therapy is not recommended for people with severe mental illness.Potential disadvantages to Internet-delivered CBT include the lack of a real human relationship, which prevents direct patient monitoring and the ability to tailor the therapy to the patient’s progress; low adherence by patients and lack of home access to the Internet.“There are compelling data to support the integration of Internet-delivered CBT into clinical psychiatric care. These data indicate that this form of CBT offers numerous benefits to both the patient and the practitioner. It allows treatment of patients with many different psychiatric conditions, at lower cost than traditional CBT,” the authors conclude.They note that more research is needed to determine the ideal demographic for this therapy and that there are challenges in integrating it into clinical practice.
This article originally published by Van Winkle’s, vanwinkles.com, the editorial division of Casper Sleep Pinterest Share LinkedIn Van Winkle’s caught up with Washington to discuss Infectious Madness and rethinking our stance on mental illness.Can you explain the general argument you make in the book with regard to the relationship between mental illness and infectious disease?I used history to illustrate how we tend to take this very binary approach to illness and insist it either be mental or physical, despite abundant evidence that many illnesses are both. I’m simply lobbying to include mental illness in the spectrum of illnesses that are both. The argument is there in history. Now, it’s an issue of readdressing the facts with a more sophisticated understanding of medicine, in particular the relationship between germ theory and medicine that clarifies the fact that we’ve done this for a long time and need to abandon it.Speaking of germ theory, you explain medical history in terms of paradigm shifts, and argue that we’ve already begun a shift towards recognizing infection as an important cause of mental illness, even if most people don’t realize it. How does this thinking fit into the current germ theory paradigm?All I’m saying is that, in many cases, mental illnesses are subject to germ theory. Germ theory doesn’t change at all. It’s just a little more inclusive. The traditional causes of mental illnesses do still apply. The researchers who’ve devoted a lot of time and energy looking into this estimate that 10 to 20 percent of mental illness will turn out to be caused by microbes. What I’m claiming is that we have to include infection alongside stress, trauma, genetics. It’s not so much a total renovation of ideas in the way germ theory was, when we were replacing outmoded theories.Going beyond theory, what does the idea of “catching” mental illness mean in everyday life? How should the average person understand the theory in terms of personal health and hygiene?It’s a scary concept in some ways, but it’s also a hopeful concept. When you think that one out of every 100 people in this country suffers from schizophrenia — half of them don’t get good treatment — the average person should look at it as something we can actually do something about.If it turns out, as I think it will, that some cases of schizophrenia are caused by infection, or by everyday influenza, that means that 10 to 15 percent of cases of schizophrenia can be prevented rather simply. The same things our mom told us growing up, that’s what we ought to do. Avoid pathogens. Wash your hands carefully. Cook your food carefully. Make sure surfaces are clean. Get plenty of sleep.These things are very simple public health actions, which everyone should do for other reasons as well, but now we have the added incentive that they can also prevent against some cases of mental illness, and I think that’s good news.Would the “infectious madness” model, in fact, lessen stigma?Initially, many people had hoped that, as we began to find more evidence for physical triggers of mental illness, it would relieve the stigma. Unfortunately, other types of stigma replaced it. People, as I note in the book, sometimes feel that if there’s actually a physiological substrate to schizophrenia, that means it’s something you have that can never be fixed, and start to think, “I need to avoid you, I don’t want to catch this.” So, unfortunately, we’re very adept at creating stigma, despite the facts. I think that a lot of it will have to rely on education.We’re doing this out of fear and ignorance, I know that one of the things that’s always disturbed me is the misconception that schizophrenics have multiple personalities. That’s just not true. Or that they tend to be violent, which is not true. Treating them as if they are violent unfairly cuts them off from life. So it is important to combat these stigmas whenever we can.A number of chronic illnesses, such as fibromyalgia, and especially Morgellons, have surfaced in conversation a lot in the past few years, particularly through the growth of online patient communities. Some people believe that Morgellons has infectious roots. What’s your reaction to this dialogue?My reaction is that we don’t know enough yet. We need research. We don’t know if it’s a real syndrome yet or not; we don’t know if it is indeed caused by microbes.I noticed something about parents, who were convinced that their children had developed one of a group of diseases, like Tourette’s or obsessive compulsive disorder, as a result of a streptococcal infection. When they were tested and it was found their children did not have it, some became very unhappy.And I thought, “Why are they so upset?” Usually, people are happy not to get a diagnosis, and then I realized, once your child is involved, it’s very difficult not to have a face for the illness, and that was the situation these parents found themselves up against. They thought they had found the culprit. Then they learned that they didn’t and it threw them back into that amorphous situation where their child is sick but they can’t put a face on it.Insomnia fuses the physical and the mental in an interesting way. We treat the disorder both with cognitive therapy and drugs, and recognize both behavioral and physiological causes for its onset. I was wondering how you’d characterize it in the framework you’ve used to look at other disorders that bridge the mental-physical divide, particularly with respect to infection.At the University of Texas sleep center, one doctor did these studies where people who are sleep-deprived have lower levels of T-cells and higher levels of inflammatory cytokines. He theorizes that this makes people more likely to develop the flu, one of the prime infections tied to schizophrenia over decades of studies. So, someone not getting enough sleep could eventually — this is all, of course, very speculative — increase their child’s chance of getting the flu. If they got it while pregnant or when their child is young, and the child catches it, there’s a chance that the influenza infection could increase that child’s risk of schizophrenia.Also, one way our immune system deals with microbial invasions is with a fever, because microbes can only function within a narrow range of temperatures. So, our bodies turn up the heat with a fever in attempts to evict the pathogens. And, actually, fevers tend to rise at night, because you can get a better fever response when you’re sleeping. But people with insomnia can’t get that higher fever going, so they lose one of the tools in fighting microbes, including the microbes that could be implicated in mental illness.While reading the book, I noticed that, in many cases where infection actually did cause a mental disorder, the initial explanation implicated some kind of trauma. If we accept that infection belongs in the mental disorder conversation in a more robust way, are we going to question the significance of trauma?People are uncomfortable with the idea because they think it displaces the prominence of traditional causes. It’s really important to abandon a binary drive. We sometimes have a binary drive where we’re more comfortable when things are either/or. It’s not an either/or case. It’s both. I’m sure there are some disorders more driven by psychosocial factors, like trauma.But, as people become more adept at being inclusive in looking at disease, they’ll understand it better. For example, think about rabies. No one suggests someone with rabies has it because they weren’t breastfed long enough. We understand it was the bite of an infected animal, and we need to expand that understanding to other diseases when those causal connections are drawn.Was there one medical anecdote or study you came across, and included in your book, that you found most surprising?What I didn’t know about sleeping sickness. All I know about is what I’ve seen in the movies, or what I’ve read in medical papers. I thought of it as a disease of irrepressible daytime drowsiness, and that’s actually a bit misleading. Compulsion of sleep is only one feature of it — the one that’s captured our imagination — but a Doctors Without Borders doctor wrote that many of her patients become violent and psychotic, and have attacked doctors and each other.It gripped me so much because it really highlighted what [Johns Hopkins’] Dr. Robert Yolken has said: We don’t know a lot about these organisms or how they affect the brain. Not that I had first-hand knowledge of sleeping sickness, but here I was thinking I know what it is, and then I read the DWB report and realized I had no idea about the scope of this illness, and that it’s largely a mental illness. Email Share on Twitter Philosophers and literary scholars can choose to interpret facts within “the most convincing perspectives, assumptions and causal frameworks,” as Harriet A. Washington explains in the opening chapter of her latest book, Infectious Madness: The Surprising Science of How We Catch Mental Illness. Hard scientists, she says, don’t have the same luxury. They’re bound by a “shared overarching theory,” a worldview that the physicist Thomas Kuhn called Weltanschauung, meaning “what members of a scientific community, and they alone, share.” Biologists couldn’t embrace evolutionary theory, for example, without abandoning creationism.In medical science, we work within the confines of germ theory, the idea that microorganisms cause infectious disease. Scientists only began to accept germ theory in the 18th century. Before then, they blamed infections on sin and demonic influence, to name just two abstract, occult causes. But Washington, a science writer and former public health fellow, says it’s time to expand this theory to include mental illness.It’s well-proven, she states, that infection sometimes lies at the root of psychiatric disorders, including schizophrenia, anorexia and OCD. But, as she argues in her exquisitely written and well-supported book, accepting the notion of “catching” mental illness requires blurring the line between afflictions of the mind and body, a false dichotomy exacerbated by a healthcare system grounded in separating mental and physical disease. “When a man lacks mental balance in pneumonia he is said to be delirious,” physician Martin H. Fischer famously said. “When he lacks mental balance without it, he’s pronounced insane.” Share on Facebook
Share on Facebook LinkedIn Pinterest Share Two new studies suggest that religious media outlets in the United States shape their viewers’ attitudes about same-sex relationships.A longitudinal study published in Sexuality & Culture found that frequently watching or listening to religious media on the television or radio in 2006 predicted increased opposition to same-sex marriage in 2012. (However, this was not true of religious internet-based media.) A second study, to be published in the journal Social Currents, confirmed that religious media had an independent effect on people’s attitudes toward same-sex relationships.Samuel Perry of the University of Oklahoma is the corresponding author of both studies. He was interviewed about his research by PsyPost. Email Share on Twitter PsyPost: Why were you interested in this topic?Perry: I’ve always been interested in how religion shapes our views about what the “ideal” family looks like. Dozens of studies have shown, for example, that people who are either more religious or more theologically conservative tend to be opposed to same-sex romantic and family relationships. Most scholars attribute this consistent finding to either families or religious communities reinforcing moral boundaries around “God’s standard” for marriage and family through socialization and everyday interaction. But we’re influenced by society in lots of other ways too beyond just families, friends, and churches. Since religious groups, and particularly evangelical Christians, have been making strategic use of various media like books, TV, and radio for the past few decades, I began to wonder if certain types of religious media could also be a mechanisms through which religious communities shape consumers attitudes toward same-sex relationships.So I began to play around with a variety of surveys that had measures of religious media use along with measures about Americans’ attitudes toward same-sex romantic and family relationships. These included the General Social Survey, the Portraits of American Life Study, and the Baylor Religion Survey. As I’d suspected, it seemed that the connection between consuming religious media and opposing same-sex relationships was particularly strong.But there was this problem. How can we increase our confidence that we’re not just looking at a selection effect? That is, how can we know that the relationships we’re observing aren’t simply due to the fact that people who consume religious media are already more likely to oppose same-sex relationships? There’s really no way to be certain about this unless we conduct a formal experiment where we randomly assign persons to a treatment (exposure to religious media) and a control (no exposure) and do a pre-test and re-test of attitudes. As an alternative to conducting these experiments, I decided to use two different approaches in different studies. In the study published in Sexuality & Culture, we used longitudinal data from the 2006 and 2012 waves of the Portraits of american Life Study. We used a technique where we predicted the effect of Americans’ religious media use (TV, radio, and internet) in 2006 on their attitudes toward same-sex marriage in 2012, while holding their previous attitudes toward same-sex marriage at 2006 constant. We also controlled for a variety of other religious and sociodemographic characteristics as well as intimate contact with gays and lesbians. The effect was still robust for religious TV and radio. This suggests to us that earlier religious media use does seem to predict later opposition to same-sex marriage, and that this effect is not simply due to those folks already being more opposed to same-sex relationships.In the second study, forthcoming in Social Currents, my colleague and I use data from three surveys (the 1998 General Social Survey, the 2005 Baylor Religion Survey, and the 2012 Portraits of American Life Study) and we examine the effects of religious media use on Americans attitudes toward various same-sex romantic and family relationships. This time we use propensity score matching to simulate random assignment to the “treatment” (religious media exposure) and we find essentially the same thing. Persons who are exposed to various forms of religious media are more likely to oppose same-sex romantic and family relationships, and this finding was consistent for each of the three surveys and with different measures of religious media.What should the average person take away from your study?Our findings suggest that religious media can shape consumers’ attitudes in different ways. Some religious media are more explicit in their message. Take, for example, someone who listens to a Focus on the Family radio show every day or the 700 Club with Pat Robertson. Persons who take in that sort of religious media are likely to get very explicit messages about family formation and sexuality, and thus, religious media can end up shaping their views about same-sex relationships quite directly. However, we also found that there might also be an effect of certain religious media where one might not get explicit messages about sexuality (e.g., devotional Christian books, for example). In this case, religious media can end up shaping Americans’ attitudes toward same-sex relationships by simply connecting them with a religious subculture that tends to be opposed to such relationships. In other words, the effect can be more subtle and indirect. And, of course, all of the religious influences work in conjunction with one another.Are there any major caveats? What questions still need to be addressed?The primary caveat is that we did not conduct randomized experiments here. We were analyzing secondary survey data. While we feel like our analytic techniques allow us to be confident about there being an independent and directional effect of religious media use on opposition to same-sex relationships, causation has not been demonstrated strictly speaking. That needs to be kept in mind until people can replicate our findings with experiments.The first study, “Longitudinal Effects of Religious Media on Opposition to Same-Sex Marriage,” was co-authored by Kara J. Snawder.The forthcoming study, “Seeing is Believing: Religious Media Consumption and Public Opinion toward Same-Sex Relationships,” was co-authored by Landon Schnabel.
First-generation college students are more likely to suffer from imposter syndrome in competitive science, technology, engineering, and mathematics (STEM) classroom environments, according to new research published in Social Psychological and Personality Science.Impostor syndrome (also known as impostor phenomenon or impostorism) describes the unjustified feeling of being someone who is undeserving of their accomplishments.“First-generation college students are inspiring. These students are the first in their families to go to college and are paving the way to higher education for themselves and for their families, all while facing many challenges navigating an often confusing and unwelcoming academy. My goal is to identify and transform harmful contexts that might create barriers for these students,” said study author Elizabeth A. Canning, an assistant professor of psychology at Washington State University. Share LinkedIn Email At the beginning of the study, 818 freshmen and sophomore students at a large U.S. university completed a survey in which they reported their perceptions of classroom competition in their STEM class. The students then received text messages immediately following their specific STEM class during a two-week period, which directed them to complete a survey about their imposter feelings during class. Finally, they completed another survey at the end of the semester.Students who perceived their STEM class to be highly competitive tended to experience greater feelings of being an imposter. Participants who agreed with statements such as “”Students tend to be very competitive with each other in this class” also tended to agree with statements such as “In class, I felt like people might find out that I am not as capable as they think I am.”This was especially pronounced for first-generation university students, who tended to experience more feelings of being an imposter than continuing-generation students in competitive classes. When it came to non-competitive classes, there was no difference between first-generation and continuing-generation students.“We found that when students think their class is competitive, they feel more like an imposter on a day-to-day basis and this is most problematic for first-generation college students. These imposter feelings are associated with less engagement, lower attendance, more thoughts of dropping out, and lower course grades. Our results suggest that perceived classroom competition may be one overlooked barrier for first-generation college students in STEM courses,” Canning told PsyPost.The researchers controlled for socioeconomic status, prior academic achievement, gender, and racial minority status. But as with all research, the study is not without limitations.“One major caveat to this research is that it is correlational in nature. All research methodologies have tradeoffs. By using experience sampling methods, we were able to capture students’ classroom experiences in real time, but it will be important for future research to replicate our findings using other methods,” Canning said.“We still need to understand what behaviors and messages signal to students that a classroom is competitive. Our hope is that such work will lead to useful practice and policy recommendations for faculty and students, which will transform competitive STEM classroom environments into collaborative spaces where all students (and especially FG students) thrive.”“This work was conducted in collaboration with Dr. Mary Murphy and colleagues at Indiana University and was supported by the National Science Foundation,” Canning added.The study, “Feeling Like an Imposter: The Effect of Perceived Classroom Competition on the Daily Psychological Experiences of First-Generation College Students“, was authored by Elizabeth A. Canning, Jennifer LaCosse, Kathryn M. Kroeper, and Mary C. Murphy, Share on Twitter Share on Facebook Pinterest
WHO gains scientists’ support for H1N1 responseSome have accused the World Health Organization (WHO) of hyping novel H1N1 flu, but scientists defended the agency in an Agence France-Presse (AFP) story today. They pointed out that the WHO acted appropriately, given the uncertain nature of the virus. One expert explained, “This virus is not dead yet. It is on a trajectory, and we don’t know where it is going to end up,” adding that H1N1 is still mutating. Another pointed out that in the last pandemic, 70% of deaths occurred in a third wave.http://www.terradaily.com/afp/100224112817.8o9d40zn.htmlFeb 24 AFP articleAlmost 30% of Americans now vaccinatedAt today’s meeting of the Advisory Committee for Immunization Practices (ACIP), Dr. James Singleton of the Centers for Disease Control and Prevention (CDC) said that, as of Feb 13, about 86 million Americans had received the pandemic vaccine, or about 29% of the population. Total vaccine doses administered had reached an estimated 97 million, or about 78% of the doses shipped.http://tinyurl.com/feb2010acip-agendaFeb 24-25 ACIP agendaDefense Department invests in tobacco-based vaccineA Texas-based consortium today announced funding for vaccine technology using tobacco plants instead of chicken eggs to produce H1N1 flu vaccine, according to a news release. The consortium, which comprises G-Con, LLC, and Texas A&M, designed Project GreenVax to eventually produce 100 million doses per month. According to a Wall Street Journal article today, the Defense Advanced Research Projects Agency is providing $40 million of the $61 million cost to produce 10 million initial doses.http://tamunews.tamu.edu/2010/02/24/texas-based-consortium-announces-project-greenvaxFeb 24 Texas A&M releaseCzechs open vaccine to general publicThis week Czech Republic officials opened up the country’s estimated 700,000 doses of novel H1N1 vaccine to the general public free of charge. Although vaccine uptake has been low in that country, officials hope the announcement will spur vaccination, especially in children. The vaccine will be available in vaccination centers, not in doctors’ offices.http://www.radio.cz/en/article/125336Feb 23 Czech Radio report
Dec 7, 2010 (CIDRAP News) – During the 2009 H1N1 pandemic, when colleges faced unique challenges, a group of large US universities found that preparedness paid off and that students were able to play a key role in response efforts, according to a new report.Novel H1N1 influenza emerged in Mexico during the 2009 spring break, putting college students in the early path of the virus, and illness patterns suggested that young people—including those of college age—were at greater risk of flu complications, similar to a pattern seen during the 1918 flu pandemic.The report, released today, details the experience of the “Big 10 + 2″ universities during the pandemic. It was prepared by the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP), the publisher of CIDRAP News, and was sponsored by the Association of State and Territorial Health Officials (ASTHO) with funds from the Centers for Disease Control and Prevention (CDC).The University of Minnesota team based its 60-page report on interviews conducted between March and July 2010, a May 18 online conference for the Big 10 + 2 universities along with federal and state health partners, and follow-up interviews. The report includes best pandemic H1N1 practices from colleges that appear on CIDRAP’s Promising Practices site.Jill DeBoer, MPH, CIDRAP’s associate director and the report’s principal investigator, said that as the group was gathering university pandemic experiences, they were heartened by all the success stories they heard. She said one of the big surprises was the important role students and student leaders played in response activities.”We added an extra chapter to the report just to capture all of that,” DeBoer said. As director of the University of Minnesota’s Academic Health Center emergency response office, she was deeply involved in the school’s pandemic response.The report covers lessons learned on nine main topics: incident management, residence halls, university health services, communication, vaccine distribution, teaching, human resources, student engagement, and collaborations with public health.One of the main lessons is that earlier pandemic planning was useful, not just for the planning documents but for the planning process itself, which produced strong teams that were able to solve problems and adjust quickly. This was especially important because the pandemic turned out to be significantly less severe than the scenario that formed the basis of many schools’ plans.Many colleges took advantage of the summer 2009 lull in pandemic activity to plan for the fall, which brought a surge in flu-like illnesses as soon as students returned to campus.Universities reported that multidisciplinary response teams set up during previous pandemic and emergency planning were successful, because they had strong support from university administrations, represented a broad cross-section of the institutions, and included the health sector.Overall, student health systems were very busy but not overwhelmed, because most successfully streamlined their operations. For example, a group of primary care nurses at the University of Wisconsin-Madison were reassigned as “flu nurses” who advised sick students by phone.Isolating sick students was a challenge for universities, and some had to modify their plans as the pandemic progressed. Some schools had success designating isolation areas, but others had problems, such as when the sick and well students didn’t like the arrangement.Many schools had success with self-isolation systems, which needed support such as communication with sick students and delivery of meals and self-care supplies.Students such as resident advisors, roommates, and health advocates were an invaluable resource when self-isolation was needed. University respondents said they helped care for their peers, suggested alternative housing plans, and helped build community partnerships.The report found that student involvement expanded healthcare surge capacity, provided credible peer messaging, and improved support for university plans. For example, student volunteers at Purdue University rode campus buses for 2 days distributing education materials and hand sanitizer to more than 5,000 of their peers.A big challenge related to self-isolation was managing student absences. Some faculty members were reluctant to adjust student absence policies. The report said school administrators were more successful at navigating self-isolation issues with faculty if provosts and deans supported and communicated the strategy, attendance policies were officially suspended, the media were covering the pandemic, and schools effectively highlighted the CDC’s isolation recommendations.DeBoer said the late arrival of the pandemic vaccine and unpredictable supplies presented the same challenge to universities as to communities, which wasn’t a surprise. However, her team found that colleges rapidly developed online and phone systems to help them identify who should be vaccinated first, maximize available vaccine supplies, and streamline immunization paperwork. They also noted that collaboration between schools and public health agencies was crucial in coping with vaccine supply uncertainties.New technology also helped schools expand their creativity in reaching students with H1N1 information. For example, The Ohio State University added a blog to its H1N1 site to answer student questions and to update information more quickly.Schools represented in the report include the University of Chicago, University of Illinois, Indiana University, University of Iowa, University of Michigan, Michigan State University, University of Minnesota, Northwestern University, The Ohio State University, Pennsylvania State University, Purdue University, and the University of Wisconsin-Madison.See also:H1N1 and higher-ed lessons learned reportMay 18 Big 10 + 2 pandemic lessons learned webinarCIDRAP Promising Practices tools
Sep 1, 2011 (CIDRAP News) – Public health leaders, recalling and reflecting on the anthrax letter attacks of 2001 in a lengthy report released today, say the nation is better prepared to respond to such an emergency than it was 10 years ago, but their confidence is tinged with fear of slipping backward in the current era of budget cutting.The report, titled “Remember 9/11 and Anthrax: Public Health’s Vital Role in National Defense,” includes essays from about 35 federal, state, and local public health officials who were involved in responding to the 2001 attacks, plus a chronology of key events and a summary of the anthrax investigation.The report was prepared by the Trust for America’s Health (TFAH), a nonprofit, nonpartisan advocacy group based in Washington, DC.The report recalls the fear, confusion, and overwhelming workloads that public health agencies faced in the wake of the Sep 11 terrorist attacks and especially the anthrax attacks that surfaced in early October of that year. Envelopes containing Bacillus anthracis spores were mailed to several East Coast media outlets and two US senators’ offices, leading to 22 anthrax cases and 5 deaths.A 7-year investigation led the FBI to conclude that the attacker was Dr. Bruce Ivins of the US Army Medical Research Institute of Infectious Diseases. Ivins committed suicide as the FBI was preparing to formally charge him in 2008, and controversy about the FBI’s conclusion has persisted.In a press release, TFAH says the stories in the report reflect how the 2001 events marked the first time that public health came to be considered central to emergency response and national security on a wide-scale basis, and also show how public health officials were working without adequate resources or training to respond to these types of attacks. A summary of how public health preparedness has evolved in the past 10 years is also included in the report.Most, if not all, of the contributors to the TFAH report say the public health world is better prepared to respond to a biological weapons attack today than it was in 2001. In particular, they say public health laboratories are better equipped to test potentially dangerous samples, communication systems have improved, there are plans in place to distribute countermeasures, and public health has a much closer relationship with law enforcement and emergency response agencies.However, another common theme is that these gains could be lost because of budget cuts and resulting personnel losses.”In 2001, we experienced the unimaginable. In 2011, we know we need to expect the unexpected,” writes Lowell Weicker, Jr., former three-term US senator and former Connecticut governor, in the report’s introduction. Weicker is president of the TFAH board of directors.In the past decade, he writes, “We’ve made smart, strategic investments, and there’s been a lot of progress to show for it. We can be proud of the improvements that have been made. Of course, there is a lot left to be done.”The report includes separate sections on federal, state, local, and laboratory responses to the 2001 crisis.Federal response perspectivesFrom the federal perspective, the report contains personal details and observations that aren’t widely known. Tom Daschle, the former US Senator from South Dakota whose Washington office was targeted in the anthrax attacks, said he remembers a somewhat chaotic environment as the Centers for Disease Control and Prevention (CDC) and other federal agencies struggled to respond.Daschle described the investigation into the attacks as an arduous, frustrating, and controversial experience. He said confidence in the FBI’s assertions is lower than it should be, but he is reasonably satisfied that the agency is correct in its conclusion. “But I must recognize the legitimate concerns and questions posed by many skeptics since the case was officially closed,” he said.Several of the people who contributed their stories credited the CDC for having trained by 2000 a small group of laboratory experts who could isolate and conduct molecular subtyping on Bacillus anthracis, which was critical to the investigation.By then the CDC had also developed and trained the Laboratory Response Network, allowing others to isolate and identify the pathogen.Tanja Popovic, MD, PhD, a CDC lab expert, said the experts completed their training just 6 months before the anthrax letters were mailed. “This did not come from luck. This came from the vision of some dedicated people to whom we all owe a lot,” she writes.”We were ready. I was confident, very confident of our microbiology,” Popovic said. “And we never missed. I never had to come back and say our lab got it wrong.”Current and former federal officials mentioned the unusual experiences they had working under heavy security conditions that followed the terror attacks. Tracee Treadwell, DVM, MPH, reflected how she and her colleagues at the CDC’s main campus in Atlanta met at an alternative site to plan their response the day of the New York City attacks.Immediately after the Sep 11 attacks, she boarded a small CDC jet that had Federal Aviation Administration clearance to fly the agency’s investigators and materials into New York City. During the flight, she saw a black dot moving rapidly toward them, and Treadwell said she feared the CDC plane would be shot down. The fighter plane got so close, she could see the face of the pilot.”They did a wing wave and moved on. We were the only civilian plane in the sky. They called us CDC-1,” Treadwell said in the report.One gap identified in some accounts, including that of James M. Hughes, MD, former director of the CDC’s National Center for Infectious Diseases, was an initial lack of an emergency operations center. He said the need for situational awareness touched many areas, from meeting the demands of the 24-hour news cycle to rapidly providing post-exposure prophylaxis.He said the biggest threat to the nation’s bioterrorism preparedness is complacency, which has led to funding reductions at the state and local levels. “Just in time economy introduces additional preparedness challenges,” he writes.Daniel Jernigan, MD, MPH, who now works as deputy director of the CDC’s Influenza Division, headed its epidemiology team in Atlanta that investigated the anthrax cases. He called the investigation “unprecedented” and observed how the multistate effort began to incorporate the incident-command model of response.”We learned that the outbreak model must persist, but in extraordinary outbreaks, the incident command model is vital too,” he said. “We needed better systems to communicate and interact with partners, elected officials, the media, and the public,”The anthrax experience taught health officials valuable lessons that were useful during the 2009 H1N1 response, Jernigan wrote. “Anthrax taught us the value of having laboratory processes in place, the need for rapid diagnostics, how to communicate uncertainty, and the importance of collaboration with others.”Federal officials also learned the value of regulatory preparedness, he added, noting that response activities involved working with the US Department of Agriculture (USDA) and Food and Drug Administration (FDA) to identify and manage emerging regulatory obstacles.Public health lab storiesThe CDC estimated that the nation’s public health labs processed about 350,000 environmental samples and clinical specimens, an extended effort that led to long hours as lab employees juggled the new tasks with their regular workload, the report says. Sara Beatrice, PhD, assistant commissioner of the New York City Public Health Laboratory, wrote that the public health community is well poised to handle potential bioterror threats, but the lack of sustainable funding makes the system vulnerable.Federal resources drove and supported the response to the attacks, she says. “Unfortunately, these federal grants have consistently been cut so that even service contracts for equipment purchased under the grants can’t be maintained.”Jim Pearson, DrPH, BCLD, deputy director for laboratories with the Virginia Department of General Services, writes that the strong lab infrastructure, with reliable lab testing in every state and major city, at the time of the attacks helped save lives and calm hysteria. He recalled an instance in which a public health lab detected B anthracis within 40 minutes of receiving the sample from the hospital, which resulted in the patient returning to the facility for appropriate antibiotic treatment.Missouri’s public health lab handled massive amounts of samples, including some from the CDC, recalls Eric C. Blank, DrPH, senior director of public health systems for the Association of Public Health Laboratories. He says he was surprised at the roles labs played in helping the public work through tragedies and providing a level of comfort to the public.Given that the lab was considered a potential target, state fire marshals served as security detail, with one officer regularly bringing his Labrador retriever along. “The dog was calming and reassuring—it was something normal during a time that was anything but. We rechristened the dog ‘the Lab’s lab,’ ” Blank writes.Blank said another lesson lab officials learned from the anthrax experience was how to operate in an incident-command setting. Once the flood of samples slowed, federal preparedness funding helped Missouri and other states beef up their emergency response operations to incorporate incident-command principles, he said, adding that the new capabilities helped labs respond to the 2009 H1N1 pandemic.State officials’ struggles In the section on state responses, George DiFerdinando, Jr, MD, MPH, director of the New Jersey Center for Public Health Preparedness at the University of Medicine and Dentistry of New Jersey, recounts struggles he and his colleagues faced at the time of the anthrax attacks, when he was acting commissioner of the New Jersey Department of Health and Senior Services.At the end of a conference call, he writes, it was revealed almost casually that the anthrax letters originated somewhere in New Jersey. Officials on the call were assured that anthrax spores in a sealed letter were not a danger. But at the same time, the state health department got calls from two New Jersey physicians reporting persistent skin illnesses in postal workers who worked at the facility where the letters were processed.A few days later one of the cases was confirmed as cutaneous anthrax, and the postal facility was shut down. It was initially thought that the building could be tested and reopened in 72 hours. But in the end, it took more than 3 years to certify and reopen the building.After another postal worker developed cutaneous anthrax, state officials decided to propose offering prophylactic antibiotics to the staff. But the CDC disagreed that the workers were at risk and didn’t support the state request for antibiotics from the national stockpile, DiFerdinando writes. So New Jersey officials had to scramble to find ciprofloxacin and a place to deliver it, without the legal support of an emergency health powers act. Since then the state has corrected that deficiency.”To me, the biggest change the public health world has seen over the past decade has been our incorporation into the law and public safety community,” DiFerdinando writes. “However, I’d have to be willfully blind not to see that there are fewer people in public health departments in NJ now than there were on 9/11. Today we might respond with a better trained and equipped work force, but there would be many fewer at the front lines.”John R. Lumpkin, former director of the Illinois Department of Public Health (IDPH) and now a senior vice president at the Robert Wood Johnson Foundation, recalls thousands of “white powder” calls after the attacks, forcing the state lab to go into “overdrive” and run its equipment at full capacity.The crisis forced state lab improvements that were helpful when West Nile virus reached Illinois in 2002, sickening 71 and killing 4, he says. The crisis also led to a much stronger relationship between the state health department and the Illinois Emergency Management Agency.Lumpkin remembers the fear and uncertainty of the time, seasoned by satisfaction that IDPH was up to the challenge. “I also look back with regret as I realize that once again our country has forgotten the lessons of the past,” he adds. “Health departments across the nation are being ravaged by budget cuts and layoffs.”Local responses recalledIsaac Weisfuse, MD, MPH, deputy commissioner of the Division of Disease Control in the New York City Department of Health and Mental Hygiene, recalls a difficult day at NBC headquarters at Rockefeller Center, where he had to help respond after an anthrax letter was received. He was “on the firing line for questions on anthrax and many were difficult if not impossible to answer.”Weisfuse said that if a bioterrorist attack occurred now, his agency would be better prepared in three respects:Communication: the department has developed and stockpiled information sheets and frequently asked questions on a variety of emergenciesLab response: the city now has a biosafety-level-3 (BSL-3) lab, a better trained staff, and better computer systems in the labCountermeasures distribution: the department now has a set of sites for distributing countermeasures and pre-staged equipment, and has trained staffIn Charlotte, N.C., the Mecklenburg County Health Department faced a variety of extra burdens in the wake the anthrax attacks, writes Stephen R. Keener, MD, MPH, the department’s medical director.The county was besieged with “white powder” incidents, he recalls. In addition, the health department had to investigate an apartment where the daughter of Robert Stevens, the American Media photo editor and first anthrax victim, lived, since he had visited there shortly before his illness. Public health investigators looked for clues that might point to a natural anthrax source, but none of the samples grew anthrax. Also, the CDC asked hospitals in the county to review lab cultures over the previous 3 months that could’ve been Bacillus species and examine records of patients who had undiagnosed illnesses.Also, the county and state health departments had to run tests at a bank payment processing center in Charlotte that received daily mail deliveries from the Brentwood postal facility in Washington, DC, where several postal workers were sickened by anthrax, Keener writes. Until the samples tested negative, prophylactic antibiotics were offered to the staff. The incident prompted the county to provide funds for an electronic syndromic surveillance system, which was eventually replaced by a statewide system.Segaran P. Pillai, PhD, MSc, who directed the Florida State Public Health Laboratory in Miami at the time of the attacks, writes that the lab operated 24/7 in the first weeks and processed 14,244 samples over 2 years after the attacks. He is now the chief medical and science adviser for the science and technology directorate of the US Department of Homeland Security.In particular, the Miami lab operated 24/7 for 2 weeks in 2003 to test 6,500 samples from the America Media Inc. building in Boca Raton, where the first anthrax victim worked, and there was no overtime pay. “Public health staffs are the unsung national heroes who give time and risk their lives to ensure the safety and security of the public,” Pillai says.He writes that the hardest challenge at the time was the lack of resources and personnel to process the large number of samples. Since then, CDC “focus C” grants have provided for trained scientists who can handle highly complex tests on select agents, and also have been used to create more BSL-3 lab space.Since 2001, 160 labs have joined the CDC’s Laboratory Response Network, Pillai says. In addition, primary care and infectious disease doctors and nurses have been trained, and he’s confident they can rapidly recognize a disease associated with select agents.”My biggest concern is that the country is getting complacent and we might be losing focus on the importance of being prepared,” he writes.See also: Sep 1 TFAH press releaseSep 1 TFAH report “Remembering 9/11 and Anthrax: Public Health’s Vital Role in National Defense”
Saudi Arabia reports MERS in another health workerSaudi Arabia today confirmed one new MERS-CoV case, in a 60-year-old foreign health worker whose illness was detected in the city of Jubail, in the northeastern part of the country, according to a statement from the Ministry of Health (MOH).The man is hospitalized in an intensive care unit, according to the report. He had no pre-existing disease, the MOH said.The case is the first to be reported in 9 days. The last case, reported Aug 29, was also in a non-Saudi health worker in Jubail. The latest case raises Saudi Arabia’s number of MERS-CoV (Middle East respiratory syndrome coronavirus) infections to 727, of which 302 have been fatal.Sep 8 MOH statement Sep 2 CIDRAP News scan “New MERS case raises Saudi count to 726″ Chikungunya case numbers increase by another thousandSuspected and confirmed cases of chikungunya in the Caribbean increased over the past week by 1,088, with no new fatalities, according to numbers from the Pan American Health Organization (PAHO).Given the far larger jump last week (more than 69,000) and the fact that none of this week’s new cases are in the countries with large increases last time, it seems likely that some countries did not report current numbers.The new cases as of Sep 5 occurred mainly in Puerto Rico, with 906 reported. The US Virgin Islands reported 109 more cases, and Barbados had 12. Total reported cases in the outbreak stand at 659,554.Sep 5 PAHO report Sep 2 CIDRAP News scan on last week’s numbers Cameroon, Pakistan report more polio casesTwo new wild poliovirus type 1 (WPV1) cases have been detected in Cameroon’s East Region, signaling continued circulation, surveillance gaps, expansion to new areas, and a heightened threat to other African populations, especially the influx of refugees from the Central African Republic (CAR) into the country, the World Health Organization (WHO) said in a Sep 6 statement.Cameroon’s polio outbreak has been under way since at least October 2013 and has been linked to spread to Equatorial Guinea, one of the factors that led the WHO in May to declare a public health emergency of international concern to address the ongoing spread of the disease. The country’s two new cases involved paralysis onsets of Jun 26 and Jul 9. Cameroon was one of the countries that met the criteria for states currently exporting WPV.The country’s East Region was the target of two recent subnational immunization campaigns, and Cameroon has conducted seven nationwide supplemental vaccination drives so far this year, the WHO said. Neighboring CAR launched a series of five activities in August covering the western half of the nation.Sep 6 WHO statementIn related developments, Pakistan’s National Institute of Health has confirmed 20 polio cases over the past 5 days, raising the country’s total so far this year to 138, the Associated Press of Pakistan (APP) reported yesterday.Among 11 of the newest cases, 8 were from the Federally Administered Tribal Areas and 3 were from Khyber Pakhtunkhwa province. The other recent infections were reported from Sindh and Punjab provinces.Pakistani health officials yesterday launched a 3-day polio immunization campaign in the tribal regions, consisting of 2,000 vaccination teams that will administer drops to 600,000 children, Independent News Pakistan (INP) reported yesterday. Special arrangements have been made to protect the teams from attacks, according to the report.Sep 7 APP story Sep 7 INP story Study: Viral contamination spreads quickly, cleans up easily on fomitesViral contamination of a single fomite in a facility, such as a doorknob, can spread to 40% to 60% of fomites and people in the facility within 2 to 4 hours but can be largely removed just as quickly with disinfectant cleaning, according to a study presented today at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Washington, DC.The researchers applied bacteriophage MS-2, a surrogate of norovirus, to 1 or 2 surfaces early in the morning in office buildings and healthcare facilities. After 2 to 8 hours they sampled 60 to 100 fomites such as knobs, light switches, sink handles, and phones and found that 40% to 60% of them were contaminated with the virus.To test a method of intervention, they provided cleaning personnel and employees with disinfectant wipes containing quaternary ammonium compound (QUAT) and instructions to use them at least once a day on surfaces. The number of fomites on which the virus could be detected was reduced by at least 80% with cleaning, and the concentration of the virus was reduced by at least 99%.Noroviruses are highly infectious agents that spread quickly in facilities and often necessitate their closure for decontamination, according to an ICAAC press release. The QUAT used by the researchers is known to be effective against non-lipid containing viruses, such as norovirus.ICAAC is an annual meeting convened by the American Society of Microbiology.”The results show that viral contamination of fomites in facilities occurs quickly, and that a simple intervention can greatly help to reduce exposure to viruses,” said Charles Gerba, PhD, of the University of Arizona, who presented the study, according to the press release. Proper selection of QUATs is key to control of contaminants, said the study abstract. Sep 8 presentation abstract