Pandemic Paradox: Early Life H2N2 Pandemic Influenza Infection Enhanced Susceptibility to Death during the 2009 H1N1 Pandemic.

Recent outbreaks of H5, H7, and H9 influenza A viruses in humans have served as a vivid reminder of the potentially devastating effects that a novel pandemic could exert on the modern world. Those who have survived infections with influenza viruses in the past have been protected from subsequent antigenically similar pandemics through adaptive immunity. For example, during the 2009 H1N1 "swine flu" pandemic, those exposed to H1N1 viruses that circulated between 1918 and the 1940s were at a decreased risk for mortality as a result of their previous immunity. It is also generally thought that past exposures to antigenically dissimilar strains of influenza virus may also be beneficial due to cross-reactive cellular immunity. However, cohorts born during prior heterosubtypic pandemics have previously experienced elevated risk of death relative to surrounding cohorts of the same population. Indeed, individuals born during the 1890 H3Nx pandemic experienced the highest levels of excess mortality during the 1918 "Spanish flu." Applying Serfling models to monthly mortality and influenza circulation data between October 1997 and July 2014 in the United States and Mexico, we show corresponding peaks in excess mortality during the 2009 H1N1 "swine flu" pandemic and during the resurgent 2013-2014 H1N1 outbreak for those born at the time of the 1957 H2N2 "Asian flu" pandemic. We suggest that the phenomenon observed in 1918 is not unique and points to exposure to pandemic influenza early in life as a risk factor for mortality during subsequent heterosubtypic pandemics.IMPORTANCE The relatively low mortality experienced by older individuals during the 2009 H1N1 influenza virus pandemic has been well documented. However, reported situations in which previous influenza virus exposures have enhanced susceptibility are rare and poorly understood. One such instance occurred in 1918-when those born during the heterosubtypic 1890 H3Nx influenza virus pandemic experienced the highest levels of excess mortality. Here, we demonstrate that this phenomenon was not unique to the 1918 H1N1 pandemic but that it also occurred during the contemporary 2009 H1N1 pandemic and 2013-2014 H1N1-dominated season for those born during the heterosubtypic 1957 H2N2 "Asian flu" pandemic. These data highlight the heretofore underappreciated phenomenon that, in certain instances, prior exposure to pandemic influenza virus strains can enhance susceptibility during subsequent pandemics. These results have important implications for pandemic risk assessment and should inform laboratory studies aimed at uncovering the mechanism responsible for this effect

Determinants of Influenza Mortality Trends: Age-Period-Cohort Analysis of Influenza Mortality in the United States, 1959-2016.

This study examines the roles of age, period, and cohort in influenza mortality trends over the years 1959-2016 in the United States. First, we use Lexis surfaces based on Serfling models to highlight influenza mortality patterns as well as to identify lingering effects of early-life exposure to specific influenza virus subtypes (e.g., H1N1, H3N2). Second, we use age-period-cohort (APC) methods to explore APC linear trends and identify changes in the slope of these trends (contrasts). Our analyses reveal a series of breakpoints where the magnitude and direction of birth cohort trends significantly change, mostly corresponding to years in which important antigenic drifts or shifts took place (i.e., 1947, 1957, 1968, and 1978). Whereas child, youth, and adult influenza mortality appear to be influenced by a combination of cohort- and period-specific factors, reflecting the interaction between the antigenic experience of the population and the evolution of the influenza virus itself, mortality patterns of the elderly appear to be molded by broader cohort factors. The latter would reflect the processes of physiological capital improvement in successive birth cohorts through secular changes in early-life conditions. Antigenic imprinting, cohort morbidity phenotype, and other mechanisms that can generate the observed cohort effects, including the baby boom, are discussed

A Systematic Review of Refugee Women’s Reproductive Health

Resettling refugee women may be at greater risk than other women for several harmful reproductive health outcomes as a result of their migration experience. The objective of this study was to determine differences in reproductive health status between refugee women in countries of resettlement and non-refugee counterparts. A systematic review of the literature culled from five electronic databases and web searching of international agencies and academic centres focusing on refugees was conducted. Of the forty-one high quality studies identified, fourteen looked at refugees exclusively; only nine of the fourteen focused on the reproductive health of refugees; six of the nine directly compared refugee to non-refugee women’s health. There is a paucity of populationbased data to support or refute claims of greater reproductive health risks for resettling refugee women.Les femmes réfugiées en situation de réétablissement pourraient bien être plus susceptibles que d’autres femmes de souffrir d’un certain nombre de conséquences néfastes en matière de santé génésique suite à l’expérience de lamigration. Le but de cette étude était de cerner les différences entre le niveau de santé génésique des femmes réfugiées dans les pays de réétablissement et leurs congénères non-réfugiées. Pour ce faire, un examen systématique de la littérature provenant de cinq bases de données électroniques a été entrepris, ainsi que des recherches sur le Web d’agences et de centres académiques internationaux. Des 41 études de haut niveau identifiées, seules 9 de ces études se concentraient sur la santé génésique des réfugiées ; 6 de ces 9 études effectuaient une comparaison directe entre la santé des réfugiées et celle des non-réfugiées. Il existe en fait un manque de données démographiques qui permettraient de soutenir ou de rejeter l’affirmation selon laquelle les risques sont accrus en matière de santé génésique chez les femmes réfugiées en cours de réétablissement

Le FORUM, Vol. 34 No. 1

https://digitalcommons.library.umaine.edu/francoamericain_forum/1025/thumbnail.jp

Parental Anxiety Associated with Summer Camp Experiences: A Comparative Analysis Across Volunteer and Employee-Staffed Camps

Parent anxiety can limit a parent’s willingness to involve their child in out-of-school time experiences such as summer camps. Researchers have studied anxiety within the context of camp, but these studies used narrow frameworks of anxiety. In this exploratory study, we collected open-ended responses about causes of parent anxiety associated with summer camp experiences from 656 parents whose children attended one of two Extension-administered camps. The camps represented different camp staffing models—one primarily staffed by volunteers and the other primarily staffed by employees. The primary purpose of the study was to identify salient categories of anxiety and to examine if anxiety differed based on staffing model. The secondary purpose was to develop a camp-related parent anxiety measure informed by the anxiety categories. Eleven categories were constructed from the data, which both affirmed and expanded existing literature on parent anxiety associated with camp experiences. No differences in parent anxiety were found based on staffing model, suggesting that parents were no more likely to perceive anxiety associated with camp when the program was staffed with volunteers as they were when the program was staffed by employees. Implications for practice and future directions are examined

Tracking postural stability of children and adolescents after a concussion: sport-related versus non-sport-related concussion

Background. Although postural impairments have long been reported following a concussion in the pediatric population, we still know very little about who is more at risk of presenting those balance problems and how the mechanism of injury (sport vs non-sport) could influence balance problems after concussions. The purpose of this study was to compare balance function in children having sustained a sport-related (SRC) or non-sport-related (NSRC) concussion, to that of children with an orthopedic injury (OI) and to non-injured (NI), over a one-year period. Methods. One-hundred and twelve participants were included in this study. Among them, 38 were concussed, with 27 having sustained a SRC; and 11 an NSRC, as well as 38 NI, and 36 OI. Balance function was evaluated at 2 weeks, 3 months, 6 months, and 12 months after a concussion, and at the same time intervals for the control groups. The balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency (BOT2) and Timed Foam Test was used to measure postural instability. Concussion related symptoms were measured by the Post Concussion Symptom Scale (PCSS). Results. There was an improvement in tandem standing on the balance beam (P=.02) and in single-leg standing (SL) on foam surface (P=.02) for all groups over a year. At the 2nd week, NSRC had more postural instability than NI during SL on the balance beam when eyes were closed (P =.01), and performed significantly worse than SRC (P =.01) and NI (P =.01) during SL on the foam surface. NSRC also reported more symptoms than SRC on PCSS (P < 0.001). In the 3rd month, NSRC still had lower performance than SRC in SL on foam surface (P =.01). Conclusions. Children sustaining a concussion outside of a sport seem to have higher levels of postural instability up to 3 months post-injury when compared to those injured in sport

Motivational Interviewing for Smoking Cessation Among College Students

Motivational interviewing has shown some success as an intervention for college student cigarette smokers. We tested the efficacy and process of a two session motivational-interviewing-based smoking intervention compared to an assessment/information session. College student participants assigned to the motivational interviewing condition did not differ significantly from participants in the assessment/information condition on smoking out-come variables one month later. However, both groups reported significant decreases in self-reported smoking over time, suggesting that brief interventions for college student smoking can be efficacious. Consistent with theory, the motivational interviewing group reported a significant increase in self-efficacy over time and reported stronger perceptions of the therapeutic alliance after the first session compared to assessment/information participants

Analyzing the impact of trade and investment agreements on pharmaceutical policy: provisions, pathways and potential impacts

Background: Trade and investment agreements negotiated after the World Trade Organization's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) have included increasingly elevated protection of intellectual property rights along with an expanding array of rules impacting many aspects of pharmaceutical policy. Despite the large body of literature on intellectual property and access to affordable medicines, the ways in which other provisions in trade agreements can affect pharmaceutical policy and, in turn, access to medicines have been little studied. There is a need for an analytical framework covering the full range of provisions, pathways, and potential impacts, on which to base future health and human rights impact assessment and research. A framework exploring the ways in which trade and investment agreements may affect pharmaceutical policy was developed, based on an analysis of four recently negotiated regional trade agreements. First a set of core pharmaceutical policy objectives based on international consensus was identified. A systematic comparative analysis of the publicly available legal texts of the four agreements was undertaken, and the potential impacts of the provisions in these agreements on the core pharmaceutical policy objectives were traced through an analysis of possible pathways. Results: An analytical framework is presented, linking ten types of provisions in the four trade agreements to potential impacts on four core pharmaceutical policy objectives (access and affordability; safety, efficacy, and quality; rational use of medicines; and local production capacity and health security) via various pathways. Conclusions: The analytical framework highlights provisions in trade and investment agreements that need to be examined, pathways that should be explored, and potential impacts that should be taken into consideration with respect to pharmaceutical policy. This may serve as a useful checklist or template for health and human rights impact assessments and research on the implications of trade agreements for pharmaceuticals