Responding to the new International Classification of Diseases-11 prolonged grief disorder during the COVID-19 pandemic: a new bereavement network and three-tiered model of care

The field of bereavement research and care is at a tipping point. The introduction of prolonged grief disorder (PGD) in the International Classification of Diseases (ICD-11) has ignited clinical interest in this new disorder, along with debate over challenges in validating and implementing these new criteria. At the same time, the global COVID-19 pandemic has launched several local and international efforts to provide urgent support and comfort for individuals and communities suffering from grief. Recently, grief experts have called for a collective response to these complicated bereavements and possible increase in PGD due to COVID-19. Here we outline a new European network that aims to unite a community of grief researchers and clinicians to provide accessible, evidence-based support particularly during times of unprecedent crisis. The Bereavement Network Europe (BNE) has been developed with two main aims. Firstly, to develop expert agreed, internationally acceptable guidelines for bereavement care through a three-tiered approach. Secondly, to provide a platform for researchers and clinicians to share knowledge, collaborate, and develop consensus protocols to facilitate the introduction of PGD to diverse stakeholders. This article outlines the current status and aims of the BNE along with the plans for upcoming network initiatives and the three-tiered bereavement care guidelines in response to the COVID-19 pandemic. Keywords: Bereavement network Europe; COVID-19; ICD-11; Prolonged grief disorder; Three-tiered bereavement care

Environmental and nutrient conditions influence fucoxanthin productivity of the marine diatom Phaeodactylum tricornutum grown on palm oil mill effluent

Palm oil mill effluent (POME) is a type of wastewater posing large problems when discharged in the environment. Yet, due to its high nutrient content, POME may offer opportunities for algal growth and subsequent harvesting of high-value products. The marine diatom Phaeodactylum tricornutum is a potential feedstock diatom for bioactive compounds such as the carotenoid fucoxanthin, which has been shown to have pharmaceutical applications. The aim of this paper was to evaluate the growth and fucoxanthin productivity of P. tricornutum grown on POME, as a function of light intensity, temperature, salinity, and nutrient enrichment. High-saturating irradiance (300molphotonsm(-2)s(-1)) levels at 25 degrees C showed highest growth rates but decreased the fucoxanthin productivity of P. tricornutum. Box-Behnken response surface methodology revealed that the optimum fucoxanthin productivity was influenced by temperature, salinity, and the addition of urea. Nutrient enrichment by phosphorus did not enhance cell density and fucoxanthin productivity, while urea addition was found to stimulate both. We conclude that POME wastewater, supplemented with urea, can be considered as the potential medium for P. tricornutum to replace commercial nutrients while producing high amounts of fucoxanthin.</p

Online treatment of persistent complex bereavement disorder, posttraumatic stress disorder, and depression symptoms in people who lost loved ones during the COVID-19 pandemic:study protocol for a randomized controlled trial and a controlled trial

Background: Losing a loved one during the COVID-19 pandemic is a potentially traumatic loss that may result in symptoms of persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression. To date, grief-specific cognitive-behavioural therapy (CBT) has mostly been delivered through individual face-to-face formats, while studies have shown that online treatment also yields promising results. Offering treatment online is now more than ever relevant during the pan demic and may offer important benefits compared with face-to-face CBT, such as lower costs and higher accessibility. Our expectation is that grief-specific online CBT is effective in reducing PCBD, PTSD, and depression symptoms. Objective: Our aim is to evaluate the short-term and long-term effectiveness of grief-specific online CBT in reducing PCBD, PTSD, and depression symptom-levels for adults who lost a loved one during the COVID-19 pandemic. Method: This study consists of two parts. In part 1, a two-armed (unguided online CBT versus waitlist controls) randomized controlled trial will be conducted. In part 2, a two-armed (guided online CBT versus unguided online CBT) controlled trial will be conducted. Symptoms of PCBD, PTSD, and depression will be assessed via telephone interviews at pre-treatment/pre-waiting period, post-treatment/post-waiting period, and six months post-treatment. Potential participants are people who lost a loved one at least three months earlier during the COVID-19 pandemic with clinically relevant levels of PCBD, PTSD, and/or depression. Analysis of covariance and multilevel modelling will be performed. Discussion: This is one of the first studies examining the effectiveness of online grief-specific CBT. More research is needed before implementing online grief-specific CBT into clinical practice

Trajectories of grief, depression, and posttraumatic stress in disaster-bereaved people

Background: Previous latent trajectory studies in adult bereaved people have identified individual differences in reactions postloss. However, prior findings may not reflect the complete picture of distress postloss, because they were focused on depression symptoms following nonviolent death. We examined trajectories of symptom-levels of persistent complex bereavement disorder (PCBD), depression, and posttraumatic stress disorder (PTSD) in a disaster-bereaved sample. We also investigated associations among these trajectories and background and loss-related factors, psychological support, and previous mental health complaints. Methods: Latent class growth modeling was used to identify distinct trajectories of PCBD, depression, and PTSD symptoms in people who lost loved ones in a plane disaster in 2014. Participants (N = 172) completed questionnaires for PCBD, depression, and PTSD at 11, 22, 31, and 42 months postdisaster. Associations among class membership and background and loss-related variables, psychological support, and previous mental health complaints were examined using logistic regression analyses. Results: Two PCBD classes emerged: mild (81.8%) and chronic (18.2%) PCBD. For both depression and PTSD, three classes emerged: mild (85.6% and 85.2%), recovered (8.2% and 4.4%), and chronic trajectory (6.2% and 10.3%). People assigned to the chronic PCBD, depression, or PTSD class were less highly educated than people assigned to the mild/recovered classes. Conclusions: This is the first latent trajectory study that offers insights in individual differences in longitudinal symptom profiles of PCBD, depression, and PTSD in bereaved people. We found support for differential trajectories and predictors across the outcomes

Assessing DSM-5-TR and ICD-11 prolonged grief disorder in children and adolescents:development of the Traumatic Grief Inventory - Kids - Clinician-Administered

BACKGROUND: Around 10% of bereaved youths experience symptoms of prolonged grief disorder (PGD). Recently, PGD was included in the two main classification systems for mental disorders: the ICD-11 and DSM-5-TR. Assessing PGD symptoms in youth is currently hindered by the lack of instruments for ICD-11 and DSM-5-TR criteria. To fill this gap, we developed an instrument to assess PGD symptoms in children and adolescents, the Traumatic Grief Inventory - Kids - Clinician-Administered (TGI-K-CA), based on input of grief experts and bereaved children.METHODS: Five experts rated the items on alignment with DSM-TR and ICD-11 PGD symptoms and comprehensibility. The adjusted items were then presented to seventeen bereaved youths ( Mdn age  = 13.0 years, range = 8-17 years). Using the Three-Step Test Interview (TSTI), children were asked to verbalize their thoughts while answering the items. RESULTS: Issues raised by experts were mostly related to alignment with the DSM-5-TR/ICD-11 symptom, ambiguous formulation of the items, or low comprehensibility for children and adolescents. Items raising fundamental issues according to experts were adjusted. The TSTI showed that children encountered relatively few problems with the items. Frequently reported problems with some of the items (e.g. regarding comprehensibility) led to final adjustments.CONCLUSION: With input from grief experts and bereaved youths, an instrument to assess PGD symptoms as defined in DSM-5-TR and ICD-11 in bereaved youths was finalized. Further quantitative research is currently undertaken to evaluate the instrument's psychometric qualities.</p

Enhancement of C-phycocyanin productivity by Arthrospira platensis when growing on palm oil mill effluent in a two-stage semi-continuous cultivation mode

Palm oil mill effluent (POME) is well known as agricultural wastewater that has a high potential as a medium for microalgal growth due to its high macro- and micronutrient content. The cyanobacterium Arthrospira platensis is considered as a species with a high C-phycocyanin (C-PC) content which is important for fine chemical and pharmaceutical applications. However, cultivation of A. platensis on POME to produce economically feasible amounts of C-PC has not been well explored. For this, environmental, nutritional, and cultivation modes (batch, semi-continuous) were varied to optimize C-PC productivity when cultivated at various POME concentrations. Arthrospira platensis was found to grow well on POME. Highest biomass and C-PC concentrations were found on 30–100% POME. Central composite rotatable design (CCRD) response surface methodology demonstrated that C-PC productivity was influenced by urea addition at the optimum salinity. The highest C-PC productivity was found on 100% POME during semi-continuous cultivation, while the addition of phosphorus and urea did not significantly improve C-PC productivity. By applying semi-continuous cultivation with 50% POME at the first stage and 100% POME at the second stage, a similarly high C-PC productivity (4.08 ± 1.3 mg L−1 day−1) was achieved as compared with (artificial) Zarrouk medium during batch cultivation. We conclude that, when using a two-stage semi-continuous cultivation process, A. platensis can produce economically feasible amounts of C-PC when cultivated on 100% POME

Building blocks for social accountability: a conceptual framework to guide medical schools

Background: This paper presents a conceptual framework developed from empirical evidence, to guide medical schools aspiring towards greater social accountability. Methods: Using a multiple case study approach, seventy-five staff, students, health sector representatives and community members, associated with four medical schools, participated in semi-structured interviews. Two schools were in Australia and two were in the Philippines. These schools were selected because they were aspiring to be socially accountable. Data was collected through on-site visits, field notes and a documentary review. Abductive analysis involved both deductive and inductive iterative theming of the data both within and across cases. Results: The conceptual framework for socially accountable medical education was built from analyzing the internal and external factors influencing the selected medical schools. These factors became the building blocks that might be necessary to assist movement to social accountability. The strongest factor was the demands of the local workforce situation leading to innovative educational programs established with or without government support. The values and professional experiences of leaders, staff and health sector representatives, influenced whether the organizational culture of a school was conducive to social accountability. The wider institutional environment and policies of their universities affected this culture and the resourcing of programs. Membership of a coalition of socially accountable medical schools created a community of learning and legitimized local practice. Communities may not have recognized their own importance but they were fundamental for socially accountable practices. The bedrock of social accountability, that is, the foundation for all building blocks, is shared values and aspirations congruent with social accountability. These values and aspirations are both a philosophical understanding for innovation and a practical application at the health systems and education levels. Conclusions: While many of these building blocks are similar to those conceptualized in social accountability theory, this conceptual framework is informed by what happens in practice - empirical evidence rather than prescriptions. Consequently it is valuable in that it puts some theoretical thinking around everyday practice in specific contexts; addressing a gap in the medical education literature. The building blocks framework includes guidelines for social accountable practice that can be applied at policy, school and individual levels

Valid measurement of DSM-5 persistent complex bereavement disorder and DSM-5-TR and ICD-11 prolonged grief disorder:The Traumatic Grief Inventory-Self Report Plus (TGI-SR+)

Introduction: When grief reactions after bereavement are so intense that they impair daily functioning, a diagnosis of disturbed grief may apply. Slightly differing criteria-sets for disturbed grief are included in the ICD-11, the DSM-5, and its forthcoming text revision, DSM-5-TR. We examined psychometric properties of a new self-report measure, the 22-item Traumatic Grief Inventory-Self Report Plus (TGI-SR+), that assesses these criteria sets for Persistent Complex Bereavement Disorder (PCBD) as per DSM-5, and Prolonged Grief Disorder (PGD) as defined in ICD-11 and DSM-5-TR. Material and methods: We examined the: i) factor structure, ii) internal consistency, iii) temporal stability, iv) convergent validity, v) known-groups validity, vi) probable caseness, and vii) optimal clinical cut-off scores in two Dutch bereaved samples. Sample 1 consisted of 278 adults, bereaved by various causes. Sample 2 included 270 adults who lost loved ones in a traffic accident. Results: We found support for a 3-factor PCBD model, 1-factor DSM-5-TR model, and 1-factor ICD-11 PGD model. The DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD items demonstrated good internal consistency and temporal stability. Associations between disturbed grief symptoms and posttraumatic stress and depression levels supported convergent validity. Associations between demographic/loss-related variables and disturbed grief symptoms supported known-groups validity. Optimal clinical cut-offs for the TGI-SR+ total score were ≥ 75, ≥71, and ≥ 75 for probable caseness of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD, respectively. Discussion: While replication of our findings in diverse bereaved samples is needed, we conclude that the TGI-SR+ is a reliable and valid measure to assess symptoms of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD

How can medical schools contribute to bringing about health equity?

The role of medical schools is in a process of change. The World Health Organization has declared that they can no longer be ivory towers whose primary focus is the production of specialist physicians and cutting edge laboratory research. They must also be socially accountable and direct their activities towards meeting the priority health concerns of the areas they serve. The agenda must be set in partnership with stakeholders including governments, health care organisations and the public.&lt;p&gt;&lt;/p&gt; The concept of social accountability has particular resonance for the Bar Ilan Faculty of Medicine in the Galilee, Israel’s newest medical school, which was established with a purpose of reducing health inequities in the Region. As a way of exploring and understanding the issues, discussions were held with international experts in the field who visited the Galilee. A symposium involving representatives from other medical schools in Israel was also held to extend the discourse. Deliberations that took place are reported here.&lt;p&gt;&lt;/p&gt; The meaning of social accountability was discussed, and how it could be achieved. Three forms of action were the principal foci – augmentation of the medical curriculum, direct action through community engagement and political advocacy. A platform was set for taking the social accountability agenda forward, with the hope that it will impact on health inequalities in Israel and contribute to discussions elsewhere