MENTAL HEALTH WORKSHOPS DELIVERED BY MEDICAL STUDENTS IN CAMBRIDGE SECONDARY SCHOOLS: AN EVALUATION OF LEARNING

Aims: For a group of medical students to design and deliver a mental health workshop in Cambridge secondary schools. Subsequently, to evaluate any improvements in pupils’ knowledge of mental health issues, including knowledge of common mental illnesses, stigma and where to access help with mental health problems. Method: A group of three medical students undertook a five week Student Selected Component to develop a mental health workshop in Spring 2013. The workshop was designed to include interactive components, such as role play, models and video. It was delivered to eight classes of 12-13 year old pupils across two local secondary schools, a total of 230 students. Questionnaires were completed before and after each workshop to test knowledge acquisition of mental health issues, stigma and where pupils could get help with mental health problems. Comparisons between data from the pre- and post-workshop questionnaires were made to assess learning. Results: The responses from the questionnaires showed a global improvement in knowledge of mental health. This is highlighted by the increase in awareness of the prevalence of mental health problems amongst young people from 47.0% before the workshops to 97.8% after the workshops. The ability to identify symptoms of anxiety rose from 21.7% to 44.8% and the ability to identify depression rose from 29.0% to 53.5% respectively. Whilst only 15.2% pupils disagreed with a stigmatising statement about mental illness before the workshops, 61.3% pupils disagreed afterwards. The students were also better informed about how to access help and identified areas that they found useful to learn about. Conclusion: Comparison of the pre- and post-workshop questionnaires indicate that medical student-led workshops are an effective method for improving knowledge of mental health topics amongst 12-13 year old school pupils, as well as encouraging positive attitudes towards mental health. The project highlights a demand for mental health education in schools and brings to light topics that could be covered in future sessions or similar projects

MENTAL HEALTH WORKSHOPS DELIVERED BY MEDICAL STUDENTS IN CAMBRIDGE SECONDARY SCHOOLS: AN EVALUATION OF LEARNING

Aims: For a group of medical students to design and deliver a mental health workshop in Cambridge secondary schools. Subsequently, to evaluate any improvements in pupils’ knowledge of mental health issues, including knowledge of common mental illnesses, stigma and where to access help with mental health problems. Method: A group of three medical students undertook a five week Student Selected Component to develop a mental health workshop in Spring 2013. The workshop was designed to include interactive components, such as role play, models and video. It was delivered to eight classes of 12-13 year old pupils across two local secondary schools, a total of 230 students. Questionnaires were completed before and after each workshop to test knowledge acquisition of mental health issues, stigma and where pupils could get help with mental health problems. Comparisons between data from the pre- and post-workshop questionnaires were made to assess learning. Results: The responses from the questionnaires showed a global improvement in knowledge of mental health. This is highlighted by the increase in awareness of the prevalence of mental health problems amongst young people from 47.0% before the workshops to 97.8% after the workshops. The ability to identify symptoms of anxiety rose from 21.7% to 44.8% and the ability to identify depression rose from 29.0% to 53.5% respectively. Whilst only 15.2% pupils disagreed with a stigmatising statement about mental illness before the workshops, 61.3% pupils disagreed afterwards. The students were also better informed about how to access help and identified areas that they found useful to learn about. Conclusion: Comparison of the pre- and post-workshop questionnaires indicate that medical student-led workshops are an effective method for improving knowledge of mental health topics amongst 12-13 year old school pupils, as well as encouraging positive attitudes towards mental health. The project highlights a demand for mental health education in schools and brings to light topics that could be covered in future sessions or similar projects

Urban expansion and forest reserves: Drivers of change and persistence on the coast of São Paulo State (Brazil)

Landscapes changes are a result of a wide range of interactions between actors and driving forces (DFs). In this study, we quantify the contribution of different types of DFs to processes of land change in the Northern Coast of São Paulo State (NCSP), Brazil, an important region for tourism and the energy sector. We analysed the relationship between DFs and the processes of land change from 1985 to 2000 and from 2000 to 2015 with partial least squares path modelling. The political and technological DFs were the most important groups of drivers for explaining the observed processes, especially the most dominant ones: policies on land use and environment (political DF), distances to the main transportation infrastructure (technological DF), and the presence of steep slopes in Serra do Mar (natural DF) influenced forest persistence and were also determinants for urban settlement distribution. The State Parks and the zones for nature conservation (political DF) were important for the maintenance of forest cover and overall the importance of political DF increased after 2000. In general, the DFs in NCSP were similar to those observed in other coastal and tourist regions, but surprisingly, despite a rapid population increase, demography did not explain urban and peri-urban growth. Urban growth was happening foremost in the zones for urban development and was accompanied by increases in water provision services and waste collection, whereas peri-urban sprawl was concentrated in conservation and agricultural zones, without investments in basic services. We conclude that an increasing demand for housing must be considered in future policies in NCSP, instead of solely focussing on economic interests in tourism and the energy sectors

Helminth burden and ecological factors associated with alterations in wild host gastrointestinal microbiota

Infection by gastrointestinal helminths of humans, livestock and wild animals is common, but the impact of such endoparasites on wild hosts and their gut microbiota represents an important overlooked component of population dynamics. Wild host gut microbiota and endoparasites occupy the same physical niche spaces with both affecting host nutrition and health. However, associations between the two are poorly understood. Here we used the commonly parasitized European shag (Phalacrocorax aristotelis) as a model wild host. Forty live adults from the same colony were sampled. Endoscopy was employed to quantify helminth infection in situ. Microbiota from the significantly distinct proventriculus (site of infection), cloacal and faecal gastrointestinal tract microbiomes were characterised using 16S rRNA gene-targeted high-throughput sequencing. We found increasingly strong associations between helminth infection and microbiota composition progressing away from the site of infection, observing a pronounced dysbiosis in microbiota when samples were partitioned into high- and low-burden groups. We posit this dysbiosis is predominately explained by helminths inducing an anti-inflammatory environment in the proventriculus, diverting host immune responses away from themselves. This study, within live wild animals, provides a vital foundation to better understand the mechanisms that underpin the three-way relationship between helminths, microbiota and hosts

Clinical Characteristics and Predictors of Outcomes of Hospitalized Patients With Coronavirus Disease 2019 in a Multiethnic London National Health Service Trust: A Retrospective Cohort Study.

BACKGROUND: Emerging evidence suggests ethnic minorities are disproportionately affected by coronavirus disease 2019 (COVID-19). Detailed clinical analyses of multicultural hospitalized patient cohorts remain largely undescribed. METHODS: We performed regression, survival, and cumulative competing risk analyses to evaluate factors associated with mortality in patients admitted for COVID-19 in 3 large London hospitals between 25 February and 5 April, censored as of 1 May 2020. RESULTS: Of 614 patients (median age, 69 [interquartile range, 25] years) and 62% male), 381 (62%) were discharged alive, 178 (29%) died, and 55 (9%) remained hospitalized at censoring. Severe hypoxemia (adjusted odds ratio [aOR], 4.25 [95% confidence interval {CI}, 2.36-7.64]), leukocytosis (aOR, 2.35 [95% CI, 1.35-4.11]), thrombocytopenia (aOR [1.01, 95% CI, 1.00-1.01], increase per 109 decrease), severe renal impairment (aOR, 5.14 [95% CI, 2.65-9.97]), and low albumin (aOR, 1.06 [95% CI, 1.02-1.09], increase per gram decrease) were associated with death. Forty percent (n = 244) were from black, Asian, and other minority ethnic (BAME) groups, 38% (n = 235) were white, and ethnicity was unknown for 22% (n = 135). BAME patients were younger and had fewer comorbidities. Although the unadjusted odds of death did not differ by ethnicity, when adjusting for age, sex, and comorbidities, black patients were at higher odds of death compared to whites (aOR, 1.69 [95% CI, 1.00-2.86]). This association was stronger when further adjusting for admission severity (aOR, 1.85 [95% CI, 1.06-3.24]). CONCLUSIONS: BAME patients were overrepresented in our cohort; when accounting for demographic and clinical profile of admission, black patients were at increased odds of death. Further research is needed into biologic drivers of differences in COVID-19 outcomes by ethnicity

Effects of a fishery closure and prey abundance on seabird diet and breeding success: Implications for strategic fisheries management and seabird conservation

Industrial forage fish fisheries may reduce prey availability affecting diet and breeding success of marine predators. However, evidence for fisheries effects on predator demography remains rare, hindering evaluation of their impact on populations. Using 25 years of data on the commercial lesser sandeel fishery in the north-western North Sea, we evaluated the effectiveness of the closure in safeguarding breeding success of four seabird species - black-legged kittiwake, common guillemot, Atlantic puffin and razorbill. We also tested for effects of a scientific fishery in the closed area on breeding success. We quantified how changes in the diet of chicks for the four seabird species were influenced by the abundance of sandeels and the alternative prey species, European sprat, and the potential prey behavioural disturbance effects of sandeel fishing on the prey. Finally, we examined how changes in chick diet and prey abundance have shaped long-term variation in seabird breeding success. The period of fishery operation was associated with a decline in kittiwake breeding success in colonies with foraging ranges overlapping the closed area, from 52 % of young fledged pre-fishery to 23 % during fishery operation. Breeding success increased by approximately 10 % in the period following fishery closure to 2018. We document wide uncertainty around this increase in breeding success, partly driven by variation in the responses of individual colonies. For guillemot, razorbill and puffin we found no evidence for negative effects of the fishery on breeding success, nor for positive effects arising from its closure. We found no evidence for an impact on breeding success of the scientific fishery. The proportion of sandeel in chick diet was positively associated with breeding success in the four species, albeit with only weak evidence for puffin. Fishing effort was associated with a decreased proportion of sandeel in puffin diet, a lower proportion of the sandeel component of the diet consisting of 0-group in kittiwake, razorbill and puffin, and with decreased kittiwake breeding success. Our findings provide quantitative evidence for how forage fish fisheries may impact seabird demography, highlighting the species-specific nature of responses, and the difficulties in teasing apart drivers amongst ongoing environmental change. Time-area fisheries closures show promise as a tool for positively affecting productivity in some seabird species. However, we identify important caveats around its effectiveness for strategic seabird conservation and aspirations of net gain

Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series

OBJECTIVE: To characterise the clinical features of monkeypox infection in humans. DESIGN: Descriptive case series. SETTING: A regional high consequences infectious disease centre with associated primary and secondary care referrals, and affiliated sexual health centres in south London between May and July 2022. PARTICIPANTS: 197 patients with polymerase chain reaction confirmed monkeypox infection. RESULTS: The median age of participants was 38 years. All 197 participants were men, and 196 identified as gay, bisexual, or other men who have sex with men. All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%). 170 (86.3%) participants reported systemic illness. The most common systemic symptoms were fever (n=122, 61.9%), lymphadenopathy (114, 57.9%), and myalgia (n=62, 31.5%). 102/166 (61.5%) developed systemic features before the onset of mucocutaneous manifestations and 64 (38.5%) after (n=4 unknown). 27 (13.7%) presented exclusively with mucocutaneous manifestations without systemic features. 71 (36.0%) reported rectal pain, 33 (16.8%) sore throat, and 31 (15.7%) penile oedema. 27 (13.7%) had oral lesions and 9 (4.6%) had tonsillar signs. 70/195 (35.9%) participants had concomitant HIV infection. 56 (31.5%) of those screened for sexually transmitted infections had a concomitant sexually transmitted infection. Overall, 20 (10.2%) participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling. CONCLUSIONS: These findings confirm the ongoing unprecedented community transmission of monkeypox virus among gay, bisexual, and other men who have sex with men seen in the UK and many other non-endemic countries. A variable temporal association was observed between mucocutaneous and systemic features, suggesting a new clinical course to the disease. New clinical presentations of monkeypox infection were identified, including rectal pain and penile oedema. These presentations should be included in public health messaging to aid early diagnosis and reduce onward transmission