Mental health in Germany in the first weeks of the Russo-Ukrainian war

Background In the connected world, although societies are not directly involved in a military conflict, they are exposed to media reports of violence. Aims We assessed the effects of such exposures on mental health in Germany during the military conflict in Ukraine. Method We used the German population-based cohort for digital health research, DigiHero, launching a survey on the eighth day of the Russo-Ukrainian war. Of the 27 509 cohort participants from the general population, 19 444 (70.7%) responded within 17 days. We measured mental health and fear of the impact of war compared with other fears (natural disasters or health-related). Results In a subsample of 4441 participants assessed twice, anxiety in the population (measured by the Generalised Anxiety Disorder-7 screener) was higher in the first weeks of war than during the strongest COVID-19 restrictions. Anxiety was elevated across the whole age spectrum, and the mean was above the cut-off for mild anxiety. Over 95% of participants expressed various degrees of fear of the impact of war, whereas the percentage for other investigated fears was 0.47–0.82. A one-point difference in the fear of the impact of war was associated with a 2.5 point (95% CI 2.42–2.58) increase in anxiety (11.9% of the maximum anxiety score). For emotional distress, the increase was 0.67 points (0.66–0.68) (16.75% of the maximum score). Conclusions The population in Germany reacted to the Russo-Ukrainian war with substantial distress, exceeding reactions during the strongest restrictions in the COVID-19 pandemic. Fear of the impact of war was associated with worse mental health

Anxiety, depressive symptoms, and distress over the course of the war in Ukraine in three federal states in Germany

IntroductionThe Russian invasion of Ukraine and the resulting consequences are in the center of political discussions, media, and likely individual thinking of the population in Germany. Yet, the impact of this prolonged exposure on mental health is not known hitherto.MethodsUsing the population based cohort study DigiHero from three federal states (Saxony-Anhalt, Saxony, and Bavaria), we assessed anxiety levels (GAD-7), depressive symptoms (PHQ-9), and distress (modified PDI) in the first weeks of war and 6 months later.ResultsOf those 19,432, who responded in the first weeks of war, 13,934 (71.1%) responded also 6 months later. While anxiety and emotional distress decreased during the 6 months, their average scores were still elevated, and a substantial fraction of respondents displayed clinically relevant sequelae. Persons from low-income households were especially affected, specifically by fears related to the personal financial situation. Those who reacted with a particularly strong fear in the beginning of war were more likely to have persistent clinically relevant symptoms of depression and anxiety also 6 months later.DiscussionThe Russian invasion of Ukraine is accompanied by continuing impairment of mental health in the German population. Fears surrounding the personal financial situation are a strong determinant

Das Mikrobiom bei bakterieller Vaginose - klinische Studien und Biofilm-Modelle

This work focuses on different aspects of the vaginal disorder bacterial vaginosis (BV). After (i) the identification of a new compound against BV, and (ii) the in vivo application of this compound and vaginal and urinary microbiota analyses, (iii) metatranscriptomics were applied on the vaginal microbiome, (iv) ending with a new in vitro multispecies biofilm model. First, different compounds were tested on a Gardnerella vaginalis biofilm model. Amphoteric tensides were effective either alone or in combination with the antibiotic metronidazole. Second, the amphoteric tenside sodium cocoamphopropionate (SCAP) was formulated into a pessary and its safety, tolerability and effectiveness was evaluated in a randomized controlled clinical trial. Patients with BV were included into the study and received the pessary after they had been treated with the antibiotic metronidazole. WO 3191 was safe and tolerated well but was not able to reduce BV recurrence. Vaginal fluid and urine samples were obtained from BV patients and from healthy women and were analysed using Illumina 16S rRNA gene sequencing. Vaginal microbial profiles of BV patients were more diverse than those of healthy women and the most common species in BV were Lactobacillus iners, Prevotella bivia, Sneathia amnii and P. amnii. The L. crispatus dominated vaginal microbial community observed in health could not be restored after metronidazole treatment and L. iners was the most abundant species after treatment. Most urinary microbial community profiles (urotypes) were similar in health and BV. However, the L. crispatus urotype was only identified in healthy women and was not restored after metronidazole treatment. These findings suggest that supporting L. crispatus in the vaginal and urinary microbiota after incidents of BV may have beneficial health outcomes. Third, metatranscriptomic analyes were performed on vaginal fluid samples. G. vaginalis was the most active species in BV and upregulated functional pathways related to biofilm formation. After metronidazole treatment, either L. crispatus or L. iners dominated the community and covered different functional patterns. Lastly, a multispecies biofilm model containing G. vaginalis, A. vaginae and L. crispatus was developed. Metronidazole promoted L. crispatus growth whereas SCAP promoted the growth of G. vaginalis and A. vaginae thus highlighting the importance of multispecies biofilm models in compound research against polymicrobial diseases.Diese Arbeit beschäftigt sich mit Bakterieller Vaginose (BV). Sie beginnt mit (i) der Identifikation einer Substanz gegen BV, gefolgt von (ii) deren in vivo Anwendung und der Mikrobiomanalyse der Vaginalflüssigkeit und des Urins. Danach wird (iii) das vaginale Metatranskriptom beschrieben, bevor am Ende (iv) die Substanz einem in vitro Multispezies-Biofilm-Modell getestet wird. Zuerst wurden verschiedene Substanzen an Gardnerella vaginalis-Biofilmen getestet. Dabei waren amphotere Tenside wirksam. Dann wurde das amphotere Tensid Natriumcocoamphopropionat (SCAP) als Vaginalzäpfchen (WO 3191) formuliert und in einer klinischen Studie auf seine Sicherheit, Verträglichkeit und Wirksamkeit geprüft. BV-Patienten erhielten WO 3191, nachdem sie mit Metronidazol behandelt worden waren. WO 3191 erwies sich als sicher und verträglich, konnte rezidivierende BV aber nicht reduzieren. Vaginalsekret- und Urinproben von BV-Patienten und einer gesunden Kontrollgruppe wurden mittels der Illumina 16S rRNA Gen Sequenzierung analysiert. Die bakteriellen Gemeinschaften der BV-Patienten hatten eine größere Diversität als die von gesunden Frauen. Am häufigsten kamen Lactobacillus iners, Prevotella bivia, Sneathia amnii und P. amnii vor. Nach der Behandlung mit Metronidazol konnte die bei gesunden Frauen beobachtete, von L. crispatus dominierte bakterielle Gemeinschaft, nicht wiederhergestellt werden und L. iners war die häufigste Spezies. Bakterielle Gemeinschaften im Urin (Urotypen) waren bei erkrankten und gesunden Probanden ähnlich. Der von L. crispatus dominierte Urotyp wurde nur bei gesunden Frauen und nie nach Metronidazol-Behandlung beobachtet. Demnach könnte sich eine erhöhte Abundanz von L. crispatus in Vagina und Urin nach einer BV-Erkrankung positiv auf die Gesundung auswirken. Im Anschluss wurden Metatranskriptomanalysen des Vaginalsekrets durchgeführt. G. vaginalis war die aktivste Spezies in der BV. Nach der Behandlung mit Metronidazol dominierten entweder L. crispatus oder L. iners und zeigten unterschiedliche Funktionsprofile. G. vaginalis Biofilme könnten eine Rolle bei der Entstehung von rezidiver BV spielen. Zuletzt wurde ein Multispezies-Biofilm-Modell mit G. vaginalis, A. vaginae und L. crispatus entwickelt. Metronidazol förderte das Wachstum von L. crispatus. SCAP hingegen förderte das Wachstum von G. vaginalis und A. vaginae. Diese Ergebnisse zeigen die Bedeutung von Multispezies-Biofilm-Modellen für polymikrobielle Biofilm-Erkrankungen

Knowledge, Vaccination Status, and Reasons for Avoiding Vaccinations against Hepatitis B in Developing Countries: A Systematic Review

(1) Background: The coverage of hepatitis B vaccination remains low in developing countries to date. This systematic review thus analyzes the determinants of people’s knowledge and vaccination status as well as the reasons why people in developing countries chose not to receive the hepatitis B vaccination. (2) Methods: We searched four databases to identify all studies from developing countries published within the past 10 years. Both low-risk and high-risk populations aged older than 15 years old were eligible for the study. The quality of studies was assessed by the Newcastle–Ottawa Scale assessment. (3) Results: This study identified 2443 articles, 89 of which were included in the analysis. Monthly income, occupational status, and profession as a health-care worker were the strongest predictive factors for both knowledge of hepatitis B and vaccination status. In addition, strong predictor variables of hepatitis B knowledge were knowing an infected person and level of education, while health insurance, management’s protection at workplace, infection training, and experience of hepatitis B exposure were strong influencing factors for vaccine uptake. (4) Conclusions: Exposure to information, support from institutions, and financial support related to vaccination cost have a positive impact on the knowledge about hepatitis B infection and vaccination coverage

Barriers to and Facilitators of Hepatitis B Vaccination among the Adult Population in Indonesia: A Mixed Methods Study

To reach the goals of the Global Hepatitis Elimination 2030 program, Indonesia is now preparing a new regulation for hepatitis B vaccinations for adult population. This study aimed to determine the factors influencing vaccine uptake for hepatitis B in the adult population, and identify barriers to, and facilitators of, hepatitis B vaccination programmes. An explanatory sequential mixed methods design was implemented in this study. We conducted a survey involving 893 participants in the general population followed by 14 in-depth interviews with health providers. The survey found that only 15% (95% confidence interval 13–18%) of participants received at least one dose of the hepatitis B vaccine. Factors associated with vaccine uptake were, living in Yogyakarta compared to living in Aceh, having secondary and higher education compared to primary education, working as a health worker compared to working in other sectors, and having health insurance that covered hepatitis B vaccination compared to not having such health insurance. Our qualitative study also identified several barriers to the adult hepatitis B vaccination programme in Indonesia such as the high cost of vaccination, lack of vaccine availability in certain areas, limited human resources to implement the hepatitis B vaccination programme, and the ineffective dissemination of hepatitis B vaccination. This study highlights that accessibility and affordability of vaccinations are important determinants of vaccination uptake that should be taken into account when planning vaccination campaigns

Metatranscriptome Analysis of the Vaginal Microbiota Reveals Potential Mechanisms for Protection against Metronidazole in Bacterial Vaginosis

Bacterial vaginosis is a serious issue for women in their reproductive years. Although it can usually be cured by antibiotics, the recurrence rate is very high, and some women do not respond to antibiotic therapy. The reasons for that are not known. Therefore, we undertook a study to detect the activity of the complete microbiota in the vaginal fluid of women who responded to antibiotic therapy and compared it to the activity of the microbiota in women who did not respond. We found that one of the most important pathogens in bacterial vaginosis, Gardnerella vaginalis, has activated genes that can repair the DNA damage caused by the antibiotic in those women that do not respond to therapy. Suppressing these genes might be a possibility to improve the antibiotic therapy of bacterial vaginosis.Bacterial vaginosis (BV) is a prevalent multifactorial disease of women in their reproductive years characterized by a shift from the Lactobacillus species-dominated microbial community toward a taxonomically diverse anaerobic community. For unknown reasons, some women do not respond to therapy. In our recent clinical study, among 37 women diagnosed with BV, 31 were successfully treated with metronidazole, while 6 still had BV after treatment. To discover possible reasons for the lack of response in those patients, we performed a metatranscriptome analysis of their vaginal microbiota, comparing them to the patients who responded. Seven of 8 clustered regularly interspaced short palindromic repeat (CRISPR)-associated (Cas) genes of Gardnerella vaginalis were highly upregulated in nonresponding patients. Cas genes, in addition to protecting against phages, might be involved in DNA repair, thus mitigating the bactericidal effect of DNA-damaging agents such as metronidazole. In the second part of our study, we analyzed the vaginal metatranscriptomes of four patients over 3 months and showed high in vivo expression of genes for pore-forming toxins in L. iners and of genes encoding enzymes for the production of hydrogen peroxide and d-lactate in L. crispatus

Screening of Compounds against Gardnerella vaginalis Biofilms.

Bacterial vaginosis (BV) is a common infection in reproductive age woman and is characterized by dysbiosis of the healthy vaginal flora which is dominated by Lactobacilli, followed by growth of bacteria like Gardnerella vaginalis. The ability of G. vaginalis to form biofilms contributes to the high rates of recurrence that are typical for BV and which unfortunately make repeated antibiotic therapy inevitable. Here we developed a biofilm model for G. vaginalis and screened a large spectrum of compounds for their ability to prevent biofilm formation and to resolve an existing G. vaginalis biofilm. The antibiotics metronidazole and tobramycin were highly effective in preventing biofilm formation, but had no effect on an established biofilm. The application of the amphoteric tenside sodium cocoamphoacetate (SCAA) led to disintegration of existing biofilms, reducing biomass by 51% and viability by 61% and it was able to increase the effect of metronidazole by 40% (biomass) and 61% (viability). Our data show that attacking the biofilm and the bacterial cells by the combination of an amphoteric tenside with the antibiotic metronidazole might be a useful strategy against BV

The urinary microbiota of men and women and its changes in women during bacterial vaginosis and antibiotic treatment.

The urinary microbiota is similarly complex as the vaginal and penile microbiota, yet its role as a reservoir for pathogens and for recurrent polymicrobial biofilm diseases like bacterial vaginosis (BV) is not clear

Treatment of biofilms in bacterial vaginosis by an amphoteric tenside pessary-clinical study and microbiota analysis.

Bacterial vaginosis (BV) is the most common vaginal syndrome among women in their reproductive years. It is associated with an increased risk of acquiring sexually transmitted infections and complications like preterm labor. BV is characterized by a high recurrence rate for which biofilms frequently found on vaginal epithelial cells may be a reason

Effect of pH on growth of <i>G</i>. <i>vaginalis</i> in planktonic and biofilm culture.

<p>(A) Planktonic growth in media adjusted to pH 7, 5.5, 5 or 4.5 measured via OD_600nm (B) Biofilm formation after 20 h at pH 7 (20 h, pH 7) and after 40 h with a medium change after 20 h. After the medium change, the pH was either kept at pH 7 (40 h, pH 7), changed to pH 4.5 (40 h, pH 4.5) or buffered with citrate phosphate buffer (CPB) to pH 4.5 (40 h, pH 4.5 CPB). Biofilm formation was measured using colony forming units (CFUs). Mean and standard deviation from triplicate cultures are shown.</p