Tag: public health

Categories : Diseases, Syndromes and Conditions GeneticsTags :

Gene Drive to Control Mosquito-borne Disease a Step Closer

On By ModernMedia
Image source: Ekamalev at Unsplash

Scientists have developed a set of tools that will help create a gene drive to control mosquito-borne diseases such as the West Nile virus, which has received less attention than controlling mosquitoes that transmit malaria.

Since the advent of CRISPR genetic editing revolution, scientists have been working to use the technology to develop gene drives that target pathogen-spreading mosquitoes such as Anopheles and Aedes species, which spread malaria, dengue and other life-threatening diseases.

Much less genetic engineering work has focused on Culex genus mosquitoes, which spread devastating afflictions stemming from West Nile virus, as well as other viruses such as the Japanese encephalitis virus (JEV). Culex mosquitoes are a significant health risk in Africa and Asia, where they transmit the worm causing filariasis, a disease that can lead to a chronic debilitating condition known as elephantiasis.

University of California San Diego scientists have now developed a number of genetic editing tools that will help create a gene drive designed to stop Culex mosquitoes from spreading disease. Gene drives are designed to spread modified genes, in this case those that disable the ability to transmit pathogens, throughout the targeted wild population. The new study is published in the journal Nature Communications,

The researchers developed a Cas9/guide-RNA expression ‘toolkit’ designed for Culex mosquitoes. Since so little genetic engineering work has been done on Culex mosquitoes, the researchers were required to develop their toolkit from scratch, starting with a careful examination of the Culex genome.

“My coauthors and I believe that our work will be impactful for scientists working on the biology of the Culex disease vector since new genetic tools are deeply needed in this field,” said Gantz, an assistant research scientist in the Division of Biological Sciences at UC San Diego. “We also believe the scientific community beyond the gene drive field will welcome these findings since they could be of broad interest.”

The researchers also demonstrated the applicability of their tools in other insects.

“These modified gRNAs can increase gene drive performance in the fruit fly and could potentially offer better alternatives for future gene drive and gene-editing products in other species,” said Gantz.

Gantz and his colleagues have now tested their new tools to ensure proper genetic expression of the CRISPR components and are now on the verge of applying them to a gene drive in Culex mosquitoes. This could be used to stop pathogen transmission by Culex mosquitoes, or alternatively employed to suppress the mosquito population to prevent biting.

Source: University of California San Diego

Categories : Metabolic DisordersTags :

Only 1 in 10 Getting Full Diabetes Care in Developing Countries

On By ModernMedia

 Only 1 in 10 people with diabetes in low- and middle-income countries are getting evidence-based, low-cost comprehensive care proven to reduce diabetes-related problems, according to a study published in Lancet Healthy Longevity. 

That comprehensive package of care – low-cost medicines to reduce blood sugar, blood pressure and cholesterol levels; and counseling on diet, exercise and weight – can help lower the health risks of under-treated diabetes. Those risks include future heart attacks, strokes, nerve damage, blindness, amputations and other disabling or fatal conditions.

The authors analysed data from recent surveys, examinations and tests of over 680 000 people between 25 and 64 worldwide. More than 37 000 had diabetes; more than half of them had a key biomarker of elevated blood sugar but had not yet received a diagnosis.

The researchers have provided their findings to the World Health Organization, which is developing efforts to scale up delivery of evidence-based diabetes care globally as part of an initiative known as the Global Diabetes Compact. The forms of diabetes-related care used in the study are all included in the 2020 WHO Package of Essential Noncommunicable Disease Interventions.

“Diabetes continues to explode everywhere, in every country, and 80% of people with it live in these low- and middle-income countries,” said lead author David Flood, MD, MSc, a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation. “It confers a high risk of complications such as including heart attacks, blindness, and strokes. We can prevent these complications with comprehensive diabetes treatment, and we need to make sure people around the world can access treatment.”

Flood worked with senior author Jennifer Manne-Goehler, MD, ScD, of Brigham and Women’s Hospital and the Medical Practice Evaluation Center at Massachusetts General Hospital, to lead the analysis of detailed global data.

In addition to the main finding that 90% of the people with diabetes studied weren’t getting access to all six components of effective diabetes care, the study also finds major gaps in specific care.

For instance, while about half of all people with diabetes were taking a drug to lower their blood sugar, and 41% were taking a drug to lower their blood pressure, only 6.3% were receiving cholesterol-lowering medications. Less than a third had access to counseling on diet and exercise.

These findings show the need to scale-up proven treatment not only to lower glucose but also to address cardiovascular disease risk factors, such as hypertension and high cholesterol, in people with diabetes.

“Diabetes continues to explode everywhere, in every country, and 80% of people with it live in these low- and middle-income countries. We need to make sure people around the world can access treatment.” David Flood, MD, MSc.

Even when the authors focused on the people who had already received a formal diagnosis of diabetes, they found that 85% were taking a medicine to lower blood sugar, 57% for blood pressure, but only 9% for cholesterol. Nearly 74% had received diet-related counseling, and just under 66% had received exercise and weight counseling.

Taken together, less than one in five people with previously diagnosed diabetes were getting the full package of evidence-based care.

Economy and availability of care

The researchers found that generally, the lower the average income of the country and region,  the less evidence-based diabetes care was available.

The nations in the Oceania region of the Pacific had the highest prevalence of diabetes – both diagnosed and undiagnosed – but the lowest rates of diabetes-related care.

However some low-income countries had higher-than-expected rates of good diabetes care, said Dr Flood. The Latin America and Caribbean region had the second highest diabetes prevalence, but had much higher levels of care than Oceania.

Finding out what the countries with high-performing achievements in diabetes care are doing well could provide valuable insights for improving care elsewhere, the authors said. That even extends to informing care in high-income countries like the United States, which does not consistently deliver evidence-based care to people with diabetes.

The study also highlights differences in diabetes diagnoses in different regions and countries. Access to diagnosis enables people to receive diabetes care.

Women, people with higher levels of education and higher personal wealth, and people who are older or had high body mass index were more likely to be receiving evidence-based diabetes care. Diabetes in people with ‘normal’ BMI is not uncommon in low- and middle-income countries, suggesting more need to focus on these individuals, the authors noted.

The fact that cheap diabetes-related medications are available, and that people can cut risk through lifestyle changes, mean that cost should not be a major barrier, said Flood. In fact, studies have shown that the medications are cost-effective as a preventative measure.

Source: University of Michigan

Journal information: David Flood et al, The state of diabetes treatment coverage in 55 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 680 102 adults, The Lancet Healthy Longevity (2021). DOI: 10.1016/S2666-7568(21)00089-1

Categories : COVIDTags :

School Closures in NC and All School Contact Sports Suspended

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As South Africa awaits an impending third wave, twenty-eight schools in the Northern Cape have had to close as a result of COVID cases this month, while all school contact sports are being suspended.

While infections are on the rise in most provinces, Northern Cape has 314 patients in hospital with COVID, according to information from the National Institute for Communicable diseases.

“Since 1 May we can report that 28 schools in the Province have been directly affected due to COVID-19 cases,” the department said in a statement on Wednesday.

The department said that those schools were closed for disinfecting and those who were infected with COVID were isolated.

“To date, 13 schools still remain closed and will reopen once it is safe to do so. The department also recorded from 1 May to date, 124 positive cases that were reported at schools thus impacting on valuable learning and teaching time being lost.”

Four schools in the small town of Calvinia were also closed earlier this year to contain rapidly spreading COVID infections.

The provincial education department’s Geoffrey van der Merwe called on communities to be even more vigilant and follow COVID safety protocols.

“District offices developed recovery plans for these schools to ensure that the academic performance of learners are not negatively affected,” he said.

Since the second phase of the programme kicked off this week, a mere 329 people in the province have so far received a COVID vaccine shot. So far approximately 9500 healthcare workers in the Northern Cape have been vaccinated.

No more rugby

Meanwhile, all contact sport at South African schools has been suspended with immediate effect.

This was decided on by the Council of Education Ministers  in a virtual meeting held on Wednesday morning .

However, the Department of Basic Education said non-contact sport training in schools could continue, on the condition that all social distancing, hygiene and safety measures would be adhered to and that there was no physical contact between participants during training.

Source: Eyewitness News

Categories : Diseases, Syndromes and ConditionsTags :

SA Study Finds That Influenza is Widely Spread by Asymptomatic Cases

On By ModernMedia
Image by Arek Socha from Pixabay

A new study investigated the prevalence and transmission of influenza in rural and urban South Africa communities.

The study was conducted by the National Institute for Communicable Diseases (NICD), Perinatal HIV Research Unit (PHRU), WITS Agincourt HDSS in partnership with the US Centers for Disease Control and Prevention (CDC), who also funded the study. 

Influenza, a communicable viral disease caused by a spectrum of influenza viruses, affects the upper respiratory tract, including upper and lower respiratory passages. The virus can be transmitted in droplets from coughing, talking or sneezing, and through touching contaminated surfaces.

Researchers enrolled 100 rural and urban households in South Africaeach year and observed them for 10 months. Systematic twice-weekly nasopharyngeal sampling of all household members were conducted, with samples tested by polymerase chain reaction (PCR) for influenza. A total of 81 430 samples were collected from 1116 participants in 225 households, out of which 917 (1%) tested positive for influenza and 79% of households (178/225) had ≥1 influenza-positive individual.

The burden of was high in a rural and an urban African setting, the study revealed, with over three-quarters of households and more than one in three individuals experiencing at least one flu infection each year. It is important to note that the flu incidence risk was similar between the rural and urban areas who participated in the study. The study also showed that recurring flu infections in the same annual flu epidemic, particularly in children, were a common occurrence, accounting for 15% of those infected. Young children also experienced the highest burden of flu infection and symptomatic illness — and compared to other age groups, they were more likely to spread the flu to others in their household.

In addition, the study also revealed that slightly over half of the flu infections were symptomatic. Asymptomatic individuals were also able to spread flu, transmitting the flu to approximately 6% of household contacts. For this reason, authors of the study believe asymptomatic infections to be an important driver of flu transmission.

Medically attended influenza-associated influenza like illness (ILI), defined as a fever and cough as captured by the World Health Organization-recommended flu surveillance programs, suggests the prevalence of flu within communities may be much higher than observed at healthcare facilities. Understanding the community burden and transmission of seasonal influenza is crucial for vaccination programmes and non-pharmaceutical interventions, as well as pandemic preparedness.

In conclusion, the study provides important data on the community burden of flu and transmission thereof in an African setting, a topic that hasn’t been adequately explored. It also contributes important findings relating to symptomatic and asymptomatic flu transmissions, and has implications for the use of non-pharmaceutical interventions and vaccination strategies that target children.

A similar study to examine the burden and transmission of SARS-CoV-2 in the same communities including the role of asymptomatic infections in the spread of SARS-CoV-2 was initiated in July 2020 and results of this study are expected in the coming months.

Source: National Institute for Communicable Diseases

Categories : Hospitals Substance UseTags :

Only Total Alcohol Bans Relieve Pressure on SA Hospitals

On By ModernMedia

A new study found that alcohol bans could be a sensible policy to help South Africa through new health crises, according to a study published on Monday.

Based on local hospital admission data, the authors said that their work demonstrates that “alcohol prohibition correlates with a decrease in health seeking behaviour for injury”.

Several organisations in the liquor industry have started pre-emptive lobbying in the face of possible new alcohol bans as COVID infections are rising in a third wave. At the same time, The Southern African Alcohol Policy Alliance is pressuring the government to institute tougher alcohol controls to pre-empt the new wave of infections. 

The study was published in the journal Drug and Alcohol Review.

The authors, all associated with Stellenbosch University or the South African Medical Research Council, which helped fund their work, compared data from Worcester Regional Hospital for 2020 with the same from 2019, across trauma admissions, trauma operations, and stab wound admissions, “as a proxy for intentional injury”.

A pattern of decreased hospital use was observed in 2020 when there were bans and partial bans, and a resurgence following even the partial lifting of bans.

“Each time a complete ban was instituted, there was a significant drop in trauma volume which was lost by allowing alcohol (even partial sales),” the researchers wrote.

Specifically, there was a 59–69% decrease in trauma volume between pre-Covid-19 and the first complete ban period. When alcohol sales were partially rein-stated, trauma volume significantly increased by 83–90% then dropped again by 39–46% with the second alcohol ban.”

The study “demonstrates a clear trend of decreased trauma admissions and operations during complete alcohol prohibition compared to when alcohol sales were allowed or only partially restricted,” the authors wrote.

They concluded that an alcohol ban is an effective way to reduce strain on healthcare infrastructure.

“These findings suggest that temporary, complete bans on alcohol sales can be used to decrease health facility traffic during national emergencies.”

The authors considered the possibility other measures such as the curfew could have affected the result, but argued that it was unlikely.

Source: Business Insider

Categories : Cardiovascular DiseaseTags :

WHO Says Overwork is Killing 745 000 People a Year

On By ModernMedia
Exhausted man looking at laptop in a restaurant. Photo by Tim Gouw from Pexels

Long working hours led to 745 000 deaths from stroke and ischaemic heart disease in 2016, a 29% increase from 2000, according to a report by the World Health Organization and the International Labour Organization.

Published in Environment International, this is the first global analysis of the loss of life and health associated with working long hours. The global analysis drew on 37 studies on ischaemic heart disease with over 768 000 participants and 22 studies on stroke with more than 839 000 participants.
The WHO and ILO estimate that, in 2016, 398 000 people died from stroke and 347 000 from heart disease as a result of having worked at least 55 hours a week. Between 2000 and 2016, the number of deaths from heart disease due to working long hours rose by 42%, and those from stroke by 19%.

This burden of work-related disease is particularly significant in men (72% of deaths were males), people living in the Western Pacific and South-East Asia regions, and middle-aged or older workers. Most of these deaths were among people aged 60-79 years, who had worked for 55 hours or more per week between the ages of 45 and 74 years.

Long work hours are now known to cause about one-third of the total estimated work-related burden of disease, and so is now the risk factor with the largest occupational disease burden. This shifts thinking towards a relatively new and more psychosocial occupational risk factor to human health.

Compared to a 35-40 hour work week, a 55 hour or more work week is associated with an estimated 35% higher risk of a stroke and a 17% higher risk of dying from ischaemic heart disease, concluded the study.

Increasing numbers of people are working long hours, currently standing at 9% of the world’s population. Even more people are being put at risk of work-related disability and early death by this trend.

This report comes just as the COVID pandemic is feeding a trend towards increased work hours. In China, 18 health workers died from overwork-related illnesses in the pandemic.

“The COVID pandemic has significantly changed the way many people work,“ said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Teleworking has become the norm in many industries, often blurring the boundaries between home and work. In addition, many businesses have been forced to scale back or shut down operations to save money, and people who are still on the payroll end up working longer hours. No job is worth the risk of stroke or heart disease. Governments, employers and workers need to work together to agree on limits to protect the health of workers.”

“Working 55 hours or more per week is a serious health hazard,” added Dr Maria Neira, Director, Department of Environment, Climate Change and Health, at the WHO. “It’s time that we all, governments, employers, and employees wake up to the fact that long working hours can lead to premature death”.

The WHO pointed out the following actions that governments, employers and workers can take protect workers’ health:  

  • governments can introduce, implement and enforce laws, regulations and policies that ban mandatory overtime and ensure maximum limits on working time;
  • bipartite or collective bargaining agreements between employers and workers’ associations can arrange working time to be more flexible, while at the same time agreeing on a maximum number of working hours;
  • employees could share working hours to ensure that numbers of hours worked do not climb above 55 or more per week.  

Source: World Health Organization

Journal information: Pega, F., et al. 2021. Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. Environment International, p.106595.

Categories : COVIDTags :

At Long Last, Phase 2 of Vaccinations Gets Under Way

On By ModernMedia
Nurse administering a vaccine. Photo by National Cancer Institute on Unsplash

Coming just days after a third wave was officially declared in Gauteng, and months of delays, frustration and confusion, South Africa’s COVID vaccination programme is at last rolling out on Monday.

The vaccination programme will start off mostly on old age homes, at 87 sites across 9 provinces. 

Fanned out across nine provinces and 87 sites, healthcare workers and those licensed to administer vaccines will start the mammoth task, which will kick off mostly at old age homes.

Those who are registered and eligible will receive a vaccination date and site to visit where they will either receive the once-off Johnson and Johnson vaccination – or the first dose of the Pfizer vaccine with another to be taken a fortnight later.

A vaccine site such as a pharmacy may charge up to R354.75 per dose of Pfizer, and R330 for a dose of Johnson and Johnson, according to a memo released by the department of health.

Additionally, a R70 fee for administering the vaccine will be billed to the recipient’s health insurance company or the government if uninsured.

The programme will also cover the hundreds of thousands of healthcare workers who have not yet received their vaccinations.

Health Minister Zweli Mkhize, health MECs and other representatives described their plans for the nation on Sunday night.

Dr Mkhize is under no illusion about what lies ahead and what it will take to get it all done.

“Five million senior citizens are targeted to be completed by the end of June, provided that the supply of vaccines flow as anticipated.”

To put this into context, that’s just 44 days for this target to be met and given some of the setbacks experienced during the Sisonke implementation study, the government will face many sceptics.

“We know that everyone has been very anxious to know what will happen and how we will start to vaccinate our most vulnerable citizens and then move onto vaccinating the general population,” Dr Mkhize said.

According to the minister, over 1.2 million senior citizens have registered to be inoculated thus far. Officials are also hoping to vaccinate an additional 700 000 health workers during this time.

Text messages are being sent out to citizens aged 60 years and over, to get help them prepare.

As the campaign begins, there should be over 975 000 doses of Pfizer vaccines in stock, which have stringent, ultra-cold storage requirements.

Dr Mkhize emphasised that Monday or this week is not open to all senior citizens 60 year and above, rather that old age homes will be the priority.

“We recommend that as many people as possible register beforehand. We will not accommodate people walking into the vaccination sites, the program has been designed to avoid long queues, that’s why we want to keep people on going in based on the message inviting them for vaccination.”

However, some provinces with smaller populations,such as Mpumalanga and the North West, have stated they would try to accommodate senior citizens who would have travelled long distances to vaccination sites.

Dr Mkhize underscored the difficulty of conducting such a programme.

“This is just to know how many vaccines you will get out of a vial and how you draw out the requisite amount, to allow us a few days to iron out teething problems and we expect there will be many teething problems so we are expected to start slow.”

Source: Eyewitness News

Categories : HospitalsTags :

Cyber Attack Cripples Ireland’s Health Services

On By ModernMedia
Photo by Nahel Abdul Hadi on Unsplash

A “significant ransomware attack” caused widespread disruption to Ireland’s health service, forcing cancellations and blocking services.

Paul Reid, Ireland’s Health Service Executive chief executive, told RTÉ there had been a “human-operated” attempt to access data for a likely ransom. “There has been no ransom demand at this stage. The key thing is to contain the issue. We are in the containment phase.”

Reid said the HSE was working with police, the defence forces and third-party cybersecurity experts to respond to the cyber attack. He apologised to patients and the public for the disruption.

The attack has affected national and local systems that provide core services. However COVID vaccinations and ambulance services were unaffected.

Several hospitals cancelled outpatient visits or asked patients with appointments to not attend. The Rotunda, a Dublin maternity hospital, said it was experiencing a “critical emergency”, cancelling all outpatients visits save for women over 35 weeks pregnant.

At Cork university hospital, the oncology department was reportedly brought to a halt. The child and family agency Tusla said its IT systems, including the portal through which child protection referrals are made, were offline.

In the US earlier this week, the Colonial petrochemical pipeline was crippled in a major cyberattack by a cybercriminal group called Darkside, resulting in fuel shortages and states of emergency being declared. The pipeline company reportedly paid a ransom fee of $5 million to get control back of their systems.

Master of the Rotunda Hospital Professor Fergal Malone told Morning Ireland that accessing patient records and data was the reason for the cancellations.

There was a backup plan to use an “old-fashioned” paper-based system, he said, but added that “throughput would be much slower” this way.

Malone said the hospital discovered unusual activity in its IT systems at about 2am and later detected what appeared to be a ransomware virus. “We use a common system throughout the HSE in terms of registering patients and it seems that must have been the entry point or source,” he told RTÉ. “It means we have had to shut down all our computer systems.”

However, all patients were safe. “We have systems in place to revert back to old-fashioned record-keeping.” Lifesaving equipment was not affected. “Patients will come in in labour over the weekend and we will be well able to look after them.”

Source: The Guardian

Categories : Cancer Metabolic DisordersTags :

Rise in Obesity Impeding Cancer Fight

On By ModernMedia

Though cancer death rates have fallen dramatically in the United States, those from obesity-related cancers are falling much more slowly.

In a study published this week in JAMA Network Open, researchers found that obesity-related cancer deaths are improving, but at a slowing pace.

Researchers at the University of North Carolina Gillings School of Global Public Health drew on mortality data for 50 million people, cancer deaths not associated with obesity — such as lung or skin cancer – are declining at a rate almost three times faster than obesity-related cancers, such as stomach, colorectal, uterine, thyroid and postmenopausal breast cancer.

“These are cancers where we could see even larger mortality improvements with creative and practical tools to combat obesity,” said study senior author Hazel B Nichols, PhD, associate professor in the Department of Epidemiology at the UNC Gillings School.

Most Americans are over the recommended body weight, and being overweight or obese puts them at risk for certain cancers.  

Extra body fat can lead to changes in the body that can contribute to cancer development, such as long-lasting inflammation and higher than normal levels of insulin and hormones that can fuel cell growth, according to the U.S. Centers for Disease Control and Prevention.

Discordant progress

Researchers use cancer death rates to track progress against cancer over time. The study authors set out to find out if obesity was stalling progress against cancer the way it did against heart disease. After 2011, heart disease mortality rates slowed their decline, a phenomenon which may be due to obesity.

“What was puzzling was that we didn’t see the same pattern of slower improvements when looking at cancer overall, which is surprising because obesity contributes to both cancer risk and heart disease risk,” said Dr Nichols. “When we focused on the differences between obesity-related cancers and non-obesity related cancers, we saw that improvements for obesity cancers were not as impressive — consistent with the pattern for heart disease.”

For example, the study showed that in 2011, 110 people out of 100 000 died from cancers not related to obesity. In 2018, the mortality rate for those cancers fell to 93.8 deaths per 100 00 people — a 2.29% annual decline.

During the same period, the decline for obesity-related cancers was much slower, changing from 58.4 to 54.9 deaths per 100 000 people, a rate of .83% — a rate one-third the decrease in non-obesity related cancers.

Obesity may also be contributing to more of the cancer deaths in the US. The study found that cancers not associated with obesity accounted for 66.8% of cancer deaths in 1999, decreasing to 62.6% in 2018.
The good news is that if we’re able to make these changes as a society, we will be able to improve the health of a nation. Christy Leigh Avery, PhD

Falls in cancer deaths are the result of fewer smokers, along with better screening and treatments, according to the American Cancer Society.

But the findings by UNC researchers reinforce the impact of obesity on cancer. 

“Obesity is a risk factor for many, but not all, types of cancer,” Nichols Dr said. “We need to make maintaining a healthy weight an obtainable goal for everyone in terms of safe public spaces, the availability and affordability of nutritious foods, and other structural factors. The good news is that if we’re able to make these changes as a society, we will be able to improve the health of a nation.”

Source: University of North Carolina

Journal information: Avery CL, Howard AG, Nichols HB. Comparison of 20-Year Obesity-Associated Cancer Mortality Trends With Heart Disease Mortality Trends in the US. JAMA Netw Open. 2021;4(5):e218356. doi:10.1001/jamanetworkopen.2021.8356

Categories : Expert Opinion Mental HealthTags :

Is PTSD Underdiagnosed or Overdiagnosed?

On By ModernMedia
Photo by Alex Green from Pexels

In an article published in the BMJ, experts debated as to whether diagnoses of post-traumatic stress disorder (PTSD) are surging in Western society due to real trauma, or whether it is simply being overdiagnosed. 

Some clinicians are concerned that diagnoses of PTSD have increased throughout Western society since the late 1980s.

PTSD is a serious and uncommon condition resulting from severe trauma, but is has come to mean an umbrella term encompassing other disorders and normal reactions to stress, argued John Tully at the University of Nottingham and Dinesh Bhugra at King’s College London’s Institute for Psychiatry, Psychology & Neuroscience (IoPPN).

Estimates of lifetime population prevalence are now around 7% in the US (26 million cases) and at 5% in other high income countries. In the UK, PTSD is estimated to be in 1 in 13 youths and in mothers after 4% of all births.

In military settings, there may be an underdiagnosis of PTSD, they acknowledged, as well as in the developing world due to limited psychiatric resources. 
But in other settings, they argue that PTSD is often conflated with normal responses to difficult situations, which has led to increased pressure on services to make this diagnosis. 

“The conflation of stress with trauma—and of trauma with PTSD—has become rife. This is the most convincing explanation for overdiagnosis,” they wrote.

This “concept creep” they argue, may also involve “compensation culture” and vested interests of the “trauma industry” as factors, they said. Am alternative explanation could be that psychiatry and society have become more accepting of trauma, and so give more leeway to diagnosis and treatment.

At a public health level however, they believe this approach is problematic as, “resources are finite, and a line must be drawn somewhere as to what level of symptoms meets criteria.”

PTSD misdiagnosis also risks other more common conditions, such as depression, anxiety disorder, and personality disorders, not being appropriately treated, while trivialising PTSD risks the medicalisation of everyday life, devaluing resilience and protective social factors, they warn.

“On this basis, we must reclaim the diagnosis of PTSD for what it is—a profound and severe response to catastrophic events—and not a spectrum of reactions to trauma or everyday life,” they conclude.

However Stephanie Lewis, Sarah Markham and Gerard Drennan at King’s IoPPN and the South London and Maudsley NHS Foundation Trust, contend that there is compelling evidence showing that PTSD is much more commonly underdiagnosed, which has concerning implications.

They say that PTSD has clear guidelines for diagnosis, and there is no evidence to suggest that it is being overdiagnosed – and rather the opposite.

“Large epidemiological studies representative of the population have found that less than half of adults and two fifths of young people who meet criteria for PTSD have sought help from any health professional,” they wrote.

“These findings fit with our professional experience that people with PTSD often find it difficult to seek help—for example, because of avoidance symptoms, concerns about stigma, or fear that there may be no effective treatment,” they write.

Additionally, only a fraction of people with PTSD who access health services receive a diagnosis, they added.

They warned that underdiagnosis is concerning because, compared to those without PTSD adults who meet the criteria are over six times more likely to attempt suicide, and 10 times for young people with PTSD. However, treatment can be effective.

They argued that underdiagnosis to PTSD should be reduced, and access increased to service for diagnosis and treatment.

“Prioritising these actions now may prove particularly timely because the COVID-19 pandemic may have exacerbated the underdiagnosis of PTSD,” they concluded.

Source: Medical Xpress

Journal information: Is PTSD overdiagnosed? BMJ (2021). www.bmj.com/content/373/bmj.n787