Preventive psychiatry: a blueprint for improving the mental health of young people

Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon''s, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally‐sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high‐risk for psychosis paradigm has received the most empirical validation, while clinical high‐risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non‐genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi‐endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence‐based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost‐effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.     

National Trends in Main Causes of Hospitalization: A Multi-Cohort Register Study of the Finnish Working-Age Population, 1976–2010

Background

The health transition theory argues that societal changes produce proportional changes in causes of disability and death. The aim of this study was to identify long-term changes in main causes of hospitalization in working-age population within a nation that has experienced considerable societal change.

Methodology

National trends in all-cause hospitalization and hospitalizations for the five main diagnostic categories were investigated in the data obtained from the Finnish Hospital Discharge Register. The seven-cohort sample covered the period from 1976 to 2010 and consisted of 3,769,356 randomly selected Finnish residents, each cohort representing 25% sample of population aged 18 to 64 years.

Principal Findings

Over the period of 35 years, the risk of hospitalization for cardiovascular diseases and respiratory diseases decreased. Hospitalization for musculoskeletal diseases increased whereas mental and behavioral hospitalizations slightly decreased. The risk of cancer hospitalization decreased marginally in men, whereas in women an upward trend was observed.

Conclusions/Significance

A considerable health transition related to hospitalizations and a shift in the utilization of health care services of working-age men and women took place in Finland between 1976 and 2010.     

Societal LCA Methodology and Case Study (12 pp)

Background, Aim and Scope Societal assessment is advocated as one of the three pillars in the evaluation of, and movement toward, sustainability. As is the case with the well established LCA, and the emerging LCC, societal life cycle assessment should be developed in such as way as to permit relative product comparisons, rather than absolute analyses. The development of societal life cycle assessment is in its infancy, and important concepts require clarification including the handling of the more than two hundred social indicators. Therefore, any societal life cycle assessment methodology must explain why it is midpoint- or endpoint-based as well as its reasons to be complimentary with, or included within, life cycle assessment. Materials and Methods: A geographically specific midpoint based societal life cycle assessment methodology, which employs labour hours as an intermediate variable in the calculation has been developed and evaluated against an existing LCA comparing two detergents. The methodology is based on using an existing life cycle inventory and, therefore, has identical system boundaries and functional units to LCA. The societal life cycle assessment methodology, much like LCA, passes from inventory, through characterisation factors, to provide an ultimate result. In analogy to economics and cost estimation, societal life cycle assessment combines, into its statistics, both data as well as estimates, some of which are correlated to elements of the LCI. It focuses on the work hours required to meet basic needs.A geographically specific midpoint based societal life cycle assessment methodology, which employs labour hours as an intermediate variable in the calculation has been developed and evaluated against an existing LCA comparing two detergents. The methodology is based on using an existing life cycle inventory and, therefore, has identical system boundaries and functional units to LCA. The societal life cycle assessment methodology, much like LCA, passes from inventory, through characterisation factors, to provide an ultimate result. In analogy to economics and cost estimation, societal life cycle assessment combines, into its statistics, both data as well as estimates, some of which are correlated to elements of the LCI. It focuses on the work hours required to meet basic needs. Results: The societal life cycle assessment of an appended case study indicates that Detergent 2 generates, relative Detergent 1, approximately 20% less employment in Russia, 35% less in France, and approximately five times more in Canada and South Africa, the latter derived from its higher aluminium content. There is essentially no difference in the employment in the use country (Switzerland) nor in Morocco, where some of the waste disposal was assumed to take place. Discussion: Given that housing is more affordable, in terms of shelter units per labour hour, in South Africa, compared to Europe, it is, therefore, of no surprise that Detergent 2 provides a societal benefit in terms of housing. Detergent 2 does, however, result in dematerialization, in that its environmental impact is lower (LCI). Therefore, as less resources are employed and labour required, in extraction, production and transport, the societal benefits in health care, education and necessities, a grouped variable, are lower for Detergent 2. This is despite the employment shift away from Europe and to less 'developed' regions. Conclusions: The assessment of societal impacts involves several hundred specific indicators. Therefore, aggregation is, if not impossible, at least heavily value laden and, therefore, not recommended. The impact of a societal action, derived from a product purchase or otherwise, is also highly local. Given this, societal life cycle assessment, carried through to the midpoints, and based on an existing LCI, has been developed as a methodology. The results, for an existing LCA-detergent case, illustrate that societal life cycle assessment provides a means to investigate how policy and policy makers can be linked to sustainable development. The sensitivity analyses also clarify the decisions in regards to product improvement. Recommendations and Perspectives: The goal of societal life cycle assessment is not to make decisions, but rather to point out tradeoffs to decision- or policy-makers. This case, and the methodology that it is based on, permit such a comparison. Substituting Detergent 2 for Detergent 1 reduces resource use at the expense of an increase in atmospheric and terrestrial emissions. Access to housing is improved, though at the expense of education, health care and necessities. As a recommendation, one would look at the fact that the majority of indicators are superior for Detergent 2 relative to Detergent 1and seek to improve the aqueous emissions in Detergent 2 via a change in the formulation. An energy or fossil fuel substitution at the site of production could also improve the societal benefits in terms of education and health care. While societal life cycle assessment remains in its infancy, a methodology does exist. The field can, therefore, be viewed in a similar way to LCA in the early 1990s, with a need to validate, consolidate and, ultimately, built toward a standard. The contribution is aimed at contributing to such a discussion and therefore proposes that a societal life cycle assessment be LCI-derived, geographically specific, based on mid-points, and use employment as an intermediate variable.     

Societal Influences on Health and Life-styles

Strong sociocultural forces affect individual attitudes toward health and choice of life-style. Economic deprivation fosters negative health behaviors. Positive health habits are reinforced by discrete societal groups. The news media, particularly television, disseminate much useful health information, though the overall educational value is diminished by the content of commercial messages and programming. The automobile is a major societal influence, but neither individual drivers nor the car manufacturers give enough priority to highway safety, leaving that role to governmental regulation. American industry is becoming a positive influence in the encouragement of good health habits, and fashion is lately an important ally in personal health maintenance.     

Interactive learning and action: realizing the promise of synthetic biology for global health

The emerging field of synthetic biology has the potential to improve global health. For example, synthetic biology could contribute to efforts at vaccine development in a context in which vaccines and immunization have been identified by the international community as being crucial to international development efforts and, in particular, the millennium development goals. However, past experience with innovations shows that realizing a technology’s potential can be difficult and complex. To achieve better societal embedding of synthetic biology and to make sure it reaches its potential, science and technology development should be made more inclusive and interactive. Responsible research and innovation is based on the premise that a broad range of stakeholders with different views, needs and ideas should have a voice in the technological development and deployment process. The interactive learning and action (ILA) approach has been developed as a methodology to bring societal stakeholders into a science and technology development process. This paper proposes an ILA in five phases for an international effort, with national case studies, to develop socially robust applications of synthetic biology for global health, based on the example of vaccine development. The design is based on results of a recently initiated ILA project on synthetic biology; results from other interactive initiatives described in the literature; and examples of possible applications of synthetic biology for global health that are currently being developed.     

Non-canonical aging model systems and why we need them

Aging is one of the greatest challenges for biomedical research in the developed world. The continuing increase in lifespan without accompanying increases in health span has extreme economic and societal implications for an aging society. The majority of adult-onset diseases such as cancer, cardiovascular disease, and Alzheimer's are a direct consequence of aging, and with changing demographics, more and more people are afflicted. If we knew how to slow down the negative effects of aging, we could delay or prevent all of these diseases at once. We therefore need to understand the underlying molecular mechanisms of aging and longevity so as to develop applications that ultimately improve health span.     

Defining and measuring river health

1. Society benefits immeasurably from rivers. Yet over the past century, humans have changed rivers dramatically, threatening river health. As a result, societal well-being is also threatened because goods and services critical to human society are being depleted. 2. ‘Health’— shorthand for good condition (e.g. healthy economy, healthy communities) — is grounded in science yet speaks to citizens. 3. Applying the concept of health to rivers is a logical outgrowth of scientific principles, legal mandates, and changing societal values. 4. Success in protecting the condition, or health, of rivers depends on realistic models of the interactions of landscapes, rivers, and human actions. 5. Biological monitoring and biological endpoints provide the most integrative view of river condition, or river health. Multimetric biological indices are an important and relatively new approach to measuring river condition. 6. Effective multimetric indices depend on an appropriate classification system, the selection of metrics that give reliable signals of river condition, systematic sampling protocols that measure those biological signals, and analytical procedures that extract relevant biological patterns. 7. Communicating results of biological monitoring to citizens and political leaders is critical if biological monitoring is to influence environmental policies. 8. Biological monitoring is essential to identify biological responses to human actions. By using the results to describe the condition, or health, of rivers and their adjacent landscapes and to diagnose causes of degradation, we can develop restoration plans, estimate the ecological risks associated with land use plans in a watershed, or select among alternative development options to minimize river degradation.     

Diminishing returns to aggregate level studies

The idea that the health of individuals depends on the characteristics of the society in which they live and on their own characteristics is important. The aggregate level relation between income inequality and population mortality has been examined by empirical works. However, if the individual level relation between risk of mortality and income is curvilinear, at least part of any association between population mortality and income inequality is artifactual in the sense that it could arise even if individual risk was due only to individual income and not to its distribution. Wolfson et al attempted to estimate how much of the variation in cross-sectional US state-level mortality could be due to the curvature of the relation between individual level mortality and income interacting with differences in the distribution of income within states. They concluded that the artifact is not the main reason for the frequently documented correlations between population mortality and income distribution. However, in the absence of any detailed information on the regressions, it is difficult to determine if the difference between actual and hypothetical mortality is significantly related to income equality. The individual risk of mortality is also affected by other individual characteristics, like climate or public health infrastructure. The authors suggest that investigations of the determinants of individual health test the effect of societal factors and that such testing requires both individual level and aggregate data.     

An Integrated Framework for Risk Management and Population Health

The traditional medical model of health and health policy development has focused on individuals and the role of medical care in preventing and treating disease and injury. Recent attention to health inequities and social determinants of health has raised the profile of population heath and evidence-based strategies for improving the health of whole populations. At the same time, risk science has emerged as an important new discipline for the assessment and management of risks to health. This article reviews historical developments in the fields of risk management and population health and proposes a joint population health risk management framework that integrates the key elements of both fields. Applying this integrated approach to managing population health risks will facilitate the development of evidence-based health policy. It will encourage a more systematic and comprehensive evaluation of population health issues and promote the use of a broader suite of interventions to reduce health risks and enhance population health status.     

Ecological Aging: The Settings Approach in Aged Living and Care Accommodation

As the proportion of older people increases within populations, financial demands related to the cost of health service delivery threaten global stability. This population trend challenges the traditional approach to health service delivery to older populations. This article presents the Australian context as a case study to argue that the application of a health promoting settings approach to aged care may lead to improved well-being for older people to the extent that the periods of chronic morbidity often associated with aging can be compressed into an ever shorter period of time. Promoting an ecological perspective to aged care suggests that there is no need to manage older people in isolation, as is common practice, but as integral to the way society lives, works, and plays. The article maps parallels between characteristics of health promoting settings such as Health Promoting Schools and the aged living and care industry, arguing that the setting encompassing services for the elderly is a prime location for the establishment of a new health promotion setting. Supporting life opportunities for our aged is central to such an approach. More broadly, an ecological approach orients us toward the connection between environment and health, and encourages increased attention and action within the aged living and care sector on reducing environmental impacts of this growing population. As such, the application of this approach to the aged living and care sector has the potential to reduce the threat that a dependant older population has on global sustainability.     

Feeding the world healthily: the challenge of measuring the effects of agriculture on health

Agricultural production, food systems and population health are intimately linked. While there is a strong evidence base to inform our knowledge of what constitutes a healthy human diet, we know little about actual food production or consumption in many populations and how developments in the food and agricultural system will affect dietary intake patterns and health. The paucity of information on food production and consumption is arguably most acute in low- and middle-income countries, where it is most urgently needed to monitor levels of under-nutrition, the health impacts of rapid dietary transition and the increasing ‘double burden’ of nutrition-related disease. Food availability statistics based on food commodity production data are currently widely used as a proxy measure of national-level food consumption, but using data from the UK and Mexico we highlight the potential pitfalls of this approach. Despite limited resources for data collection, better systems of measurement are possible. Important drivers to improve collection systems may include efforts to meet international development goals and partnership with the private sector. A clearer understanding of the links between the agriculture and food system and population health will ensure that health becomes a critical driver of agricultural change.     

Epidemiological aspects of ageing.

A major societal challenge is to improve quality of life and prevent or reduce disability and dependency in an ageing population. Increasing age is associated with increasing risk of disability and loss of independence, due to functional impairments such as loss of mobility, hearing and vision; a major issue must be how far disability can be prevented. Ageing is associated with loss of bone tissue, reduction in muscle mass, reduced respiratory function, decline in cognitive function, rise in blood pressure and macular degeneration which predispose to disabling conditions such as osteoporosis, heart disease, dementia and blindness. However, there are considerable variations in different communities in terms of the rate of age-related decline. Large geographic and secular variations in the age-adjusted incidence of major chronic diseases such as stroke, hip fracture, coronary heart disease, cancer, visual loss from cataract, glaucoma and macular degeneration suggest strong environmental determinants in diet, physical activity and smoking habit. The evidence suggests that a substantial proportion of chronic disabling conditions associated with ageing are preventable, or at least postponable and not an inevitable accompaniment of growing old. Postponement or prevention of these conditions may not only increase longevity, but, more importantly, reduce the period of illnesses such that the majority of older persons may live high-quality lives, free of disability, until very shortly before death. We need to understand better the factors influencing the onset of age-related disability in the population, so that we have appropriate strategies to maintain optimal health in an ageing population.     

Environmental assessment of products

The evaluation of product alternatives in Life Cycle Analysis (LCA) is a critical step on the basis of results as related to their impact category data. Decisions involving several environmental issues are hardly ever straightforward, since one alternative only seldom clearly dominates the others in all aspects. More often, one alternative scores better on some environmental issues and worse on others. A combination of impact data and preferences is then required for evaluation. This can be done using evaluation methods based on fixed societal preferences. However, by applying different evaluation methods to the same data, different “best” alternatives may be chosen. This reduces the credibility of LCA results. Instead of fixed societal preferences an approach has been developed which uses consensus-oriented ranges of societal values for specifying the ranking of the overall environmental attractiveness of alternatives. These ranges may indicate both the uncertainty of decision-makers and the shifting of societal values, e.g. as related to the dynamics of knowledge of environmental problem areas. In this article, an approach is proposed which combines environmental data and uncertain societal values to form a clear statement on alternatives regarding their overall damage. By using a full set of potentially relevant societal preferences, a merely coincidental selection of the best product alternative is ruled out. A step-by-step procedure, narrowing down the feasible range of societal preferences, has been developed. The approach is illustrated using a case study of TV-housing concepts and a survey.     

What the ‘greater good’ excludes: Patients left behind by pre-operative COVID-19 screening in an Ethiopian town

During the coronavirus disease 2019 (COVID-19) pandemic, bioethical analyses often emphasized population health and societal benefit. Hospital policies frequently focused on reducing risk of transmitting SARS-CoV-2 by restricting visitors; requiring protective equipment; and screening staff, patients and visitors. While restrictions can be burdensome, they are often justified as essential measures to protect the whole population against a virus with high rates of transmission, morbidity and mortality. Yet communities are not monolithic, and the impacts of these restrictions affect different groups differently. An ophthalmological unit outreach program in Ethiopia serves to illustrate. Pre-operative screening policies were designed to protect as many patients as possible but had adverse impacts on underserved communities. As this case study demonstrates, creating hospital policies that truly serve the good of the society may require a more holistic review of impacts on inequitably positioned communities.     

Defining "adverse environmental impact" and making paragraph 316(b) decisions: a fisheries management approach

The electric utility industry has developed an approach for decisionmaking that includes a definition of Adverse Environmental Impact (AEI) and an implementation process. The definition of AEI is based on lessons from fishery management science and analysis of the statutory term "adverse environmental impact" and is consistent with current natural resource management policy. The industry has proposed a definition focusing on "unacceptable risk to the population"s ability to sustain itself, to support reasonably anticipated commercial or recreational harvests, or to perform its normal ecological function." This definition focuses not on counting individual fish or eggs cropped by the various uses of a water body, but on preserving populations of aquatic organisms and their functions in the aquatic community. The definition recognizes that assessment of AEI should be site-specific and requires both a biological decision and a balancing of diverse societal values. The industry believes that the definition of AEI should be implemented in a process that will maximize the overall societal benefit of the paragraph 316(b) decision by considering the facility"s physical location, design, and operation, as well as the local biology. The approach considers effects on affected fish and shellfish populations and the benefits of any necessary best technology available (BTA) alternatives. This is accomplished through consideration of population impacts, which conversely allows consideration of the benefits of any necessary BTA modifications. This in turn allows selection of BTAs that will protect potentially affected populations in a cost-effective manner. The process also employs risk assessment with stakeholder participation, in accordance with EPA's Guidelines for Ecological Risk Assessment. The information and tools are now available to make informed decisions about site-specific impacts that will ensure protection of aquatic ecosystems and best serve the public interest.     

Naps and exercise: reinforcing a range of benefits for elderly health

According to the United Nations, in 2017, people aged 60 or over in the world, comprised 13 per cent of the global population. It is a fact that elderly people are keeping a health lifestyle, such as practicing physical exercises and avoiding excessive dosages of medications. However, this population is also more prone to have injuries while practicing exercises. Sleep architecture is physiologically different among elderly, and naps can be very beneficial to improve their mental and physical health. Thus, in this article, we encourage health professionals to recommend regular naps to this population, which could lead to an improve in their well-being and quality of life.     

Ecosystem Approach to Community Health Planning in Ghana

An ecosystem approach to community health seeks to investigate human health concerns from an ecological perspective. The goal is to improve the health of community members by instituting sustainable ecosystem management strategies that will preserve the health of both the ecosystem and its inhabitants. This article reports on a study in a rural community in Ghana that employed an ecosystem approach to community health planning. Adopting a participatory action research approach, a research team comprised of representatives from various local government departments collaborated with local residents to identify major community health problems, their underlying causes, and possible intervention strategies. The findings illustrate the usefulness of the ecosystem approach to mobilizing community-based interventions to addressing environmental determinants of human health.     

The Effectiveness of U.S. Public Health Surveillance Systems for Situational Awareness during the 2009 H1N1 Pandemic: A Retrospective Analysis

Background

The 2009 H1N1 outbreak provides an opportunity to learn about the strengths and weaknesses of current U.S. public health surveillance systems and to identify implications for measuring public health emergency preparedness.

Methodology/Principal Findings

We adopted a “triangulation” approach in which multiple contemporary data sources, each with different expected biases, are compared to identify time patterns that are likely to reflect biases versus those that are more likely to be indicative of actual infection rates. This approach is grounded in the understanding that surveillance data are the result of a series of decisions made by patients, health care providers, and public health professionals about seeking and providing health care and about reporting cases to health authorities. Although limited by the lack of a gold standard, this analysis suggests that children and young adults are over-represented in many pH1N1 surveillance systems, especially in the spring wave. In addition, the nearly two-month delay between the Northeast and the South in the Fall peak in some surveillance data seems to at least partially reflect regional differences in concerns about pH1N1rather than real differences in pH1N1 infection rates.

Conclusions/Significance

Although the extent of the biases suggested by this analysis cannot be known precisely, the analysis identifies underlying problems with surveillance systems – in particular their dependence on patient and provider behavior, which is influenced by a changing information environment – that could limit situational awareness in future public health emergencies. To improve situational awareness in future health emergencies, population-based surveillance systems such as telephone surveys of representative population samples and seroprevalence surveys in well-defined population cohorts are needed.     

肠道菌群与阿尔茨海默病的研究进展

阿尔茨海默病（Alzheimer’s disease,AD）是一种神经退行性疾病,呈进行性发展趋势,严重影响患者的生活质量,给社会和家庭带来了沉重的经济负担。随着人口老龄化进程的不断加剧,AD患者数量不断增加,而其发病原因、发病机制仍不明确,缺乏有效的防治方法。近年来,研究表明肠道菌群通过多种途径参与AD的发生发展,调整肠道菌群有望成为预防和治疗AD的有效措施之一,其可能的作用机制包括减轻AD的病理改变、改善脑内炎症、影响血脑屏障及神经递质的产生。     

A framework for the study of zoonotic disease emergence and its drivers: spillover of bat pathogens as a case study

Many serious emerging zoonotic infections have recently arisen from bats, including Ebola, Marburg, SARS-coronavirus, Hendra, Nipah, and a number of rabies and rabies-related viruses, consistent with the overall observation that wildlife are an important source of emerging zoonoses for the human population. Mechanisms underlying the recognized association between ecosystem health and human health remain poorly understood and responding appropriately to the ecological, social and economic conditions that facilitate disease emergence and transmission represents a substantial societal challenge. In the context of disease emergence from wildlife, wildlife and habitat should be conserved, which in turn will preserve vital ecosystem structure and function, which has broader implications for human wellbeing and environmental sustainability, while simultaneously minimizing the spillover of pathogens from wild animals into human beings. In this review, we propose a novel framework for the holistic and interdisciplinary investigation of zoonotic disease emergence and its drivers, using the spillover of bat pathogens as a case study. This study has been developed to gain a detailed interdisciplinary understanding, and it combines cutting-edge perspectives from both natural and social sciences, linked to policy impacts on public health, land use and conservation.