The COVID-19 pandemic has precipitated a significant mental health crisis among frontline healthcare workers (FHCWs), with increased reports of depression, anxiety, post-traumatic stress, insomnia, and suicidal thoughts. This letter to the editor responds to a recent study on the psychological burden among FHCWs in Mexico and presents complementary findings from Taiwan. We found that fear of COVID-19, trust in information, and resilience were significant factors contributing to mental health outcomes, including insomnia and suicidal thoughts, among outpatients, healthcare workers, and the general population during the pandemic. These findings suggest that mental health interventions for healthcare workers should consider these factors and include strategies for clear communication, stress management, and resilience building. Particular attention should be given to nurses and residents/fellows who seem to be bearing a disproportionate share of the psychological burden. Ultimately, understanding these contributing factors can guide the development of targeted interventions to support the mental well-being of FHCWs during the pandemic.

Since the tragedy of September 11, 2001 (9/11) there have been a growing awareness and recognition of the expanding threat presented by the transmutation and convergence of international organized crime and terrorist groups. There is a semantic debate on whether these organizations are “converging” or “transforming.” Regardless, this worrisome development is complicated and progressively difficult to combat and calls for law enforcement, intelligence and military interventions. While the United States and other countries have been dealing with the post-9/11 world of persistent problems like Iraq, Afghanistan, al Qaeda, “Islamic State in Iraq and Syria” (ISIS), Syria, and more, the links between organized crime and terrorism could prolong these challenges and generate further disruptions and menace to global security and development. There are strong operational needs and requirements that bring organized crime and terrorists together for collaboration and even seamless transitions within the same general operation. However, there are substantial hurdles that make a total teamwork between the two groups not so easily achievable. For example, organized crime normally avoids the publicity and the indiscriminate killings often used by terrorists. However, it is clear that the merging of international organized crime and terrorist groups is growing and presents unique challenges and opportunities. This paper examines this ongoing transmutation, convergence and cooperation between transnational organized crime and terrorism, and offers examples and recommendations on how to prevent it and defeat it.

Dengue infection in China has increased dramatically in recent years. Guangdong province (main city Guangzhou) accounted for more than 94% of all dengue cases in the 2014 outbreak. Currently, there is no existing effective vaccine and most efforts of control are focused on the vector itself. This study aimed to evaluate different dengue management strategies in a region where this disease is emerging. This work was done by establishing a dengue simulation model for Guangzhou to enable the testing of control strategies aimed at vector control and vaccination. For that purpose, the computer-based dengue simulation model (DENSiM) together with the Container-Inhabiting Mosquito Simulation Model (CIMSiM) has been used to create a working dengue simulation model for the city of Guangzhou. In order to achieve the best model fit against historical surveillance data, virus introduction scenarios were run and then matched against the actual dengue surveillance data. The simulation model was able to predict retrospective outbreaks with a sensitivity of 0.18 and a specificity of 0.98. This new parameterisation can now be used to evaluate the potential impact of different control strategies on dengue transmission in Guangzhou. The knowledge generated from this research would provide useful information for authorities regarding the historic patterns of dengue outbreaks, as well as the effectiveness of different disease management strategies.

The prevalence of obesity in pregnancy is rising exponentially; about 15–20% of pregnant women now enter pregnancy with a BMI which would define them as obese. This paper provides a review of the strong links between obesity and adverse pregnancy outcome which operate across a range of pregnancy complications. For example, obesity is associated with an increased risk of maternal mortality, gestational diabetes mellitus, thromboembolism, pre-eclampsia and postpartum haemorrhage. Obesity also complicates operative delivery; it makes operative delivery more difficult, increases complications and paradoxically increases the need for operative delivery. The risk of the majority of these complications is amplified by excess weight gain in pregnancy and increases in proportion to the degree of obesity, for example, women with extreme obesity have OR of 7·89 for gestational diabetes and 3·84 for postpartum haemorrhage compared to their lean counterparts. The consequences of maternal obesity do not stop once the baby is born. Maternal obesity programmes a variety of long-term adverse outcomes, including obesity in the offspring at adulthood. Such an effect is mediated at least in part via high birthweight; a recent study has suggested that the odds of adult obesity are two-fold greater in babies weighing more than 4 kg at birth. The mechanism by which obesity causes adverse pregnancy outcome is uncertain. This paper reviews the emerging evidence that hyperglycaemia and insulin resistance may both play a role: the links between hyperglycaemia in pregnancy and both increased birthweight and insulin resistance have been demonstrated in two large studies. Lastly, we discuss the nature and rationale for possible intervention strategies in obese pregnant women.

The complex interplay between neural and endocrine responses following food intake regulates ingestive behaviour and ultimately determines subsequent energy intake. These processes include cognitive, gastrointestinal-derived and metabolic mechanisms. Such physiological responses to the ingestion of food initiate short- to medium-term inhibition of intake (satiety). However, in clinical states in which systemic inflammation is evident there is a more profound satiety response and a clear absence of motivation to eat that is evident as loss of appetite. These negative influences on energy intake can contribute to poor nutritional status, and consequently poor physical function, and impact on rehabilitation and recovery. Cytokine mediators of the inflammatory response directly influence feeding behaviour at the hypothalamic nuclei and may explain the lack of motivation and desire for food. However, additional detrimental effects on appetite are brought about because of alterations in intermediary metabolism present in inflammation-induced catabolism. This process forms part of the host response to inflammation and may explain symptoms, such as early satiety, frequently reported in many patient groups. In clinical states, and cancer in particular, pharmacological strategies have been employed to ameliorate the inflammatory response in an attempt to improve energy intake. Some success of this approach has been reported following administration of substrates such as EPA. Novel strategies to improve intake through administration of anti-cytokine drugs such as thalidomide may also be of benefit. However, drugs that oppose the actions of neurotransmitter pathways involved in central induction of satiety, such as 5-hydroxytryptamine, have failed to improve intake but appear to enhance enjoyment of food. Such findings indicate that therapeutic nutritional targets can only be achieved where novel pharmacological therapies can be supported by more innovative and integrated dietary management strategies. Many of these strategies remain to be elucidated.

Development of effective intervention strategies to meet the needs of people with ethnic minority origins is dependent on two factors: an understanding of the modifiable risk factors which can form the basis of intervention; an understanding of the relevant health behaviours so that appropriate strategies can be designed. The present paper briefly reviews the evidence concerning the part that nutritional and dietary factors play in the aetiology of the observed patterns of disease in these groups and the limitations of the data as a basis for intervention. Consideration is also given to the available information concerning factors influencing health behaviour (particularly eating behaviour) and the applicability of commonly-used models of behaviour change to people of ethnic minority origin. Finally, the results of nutrition intervention programmes will be examined with a view to identifying lessons for the future.