The war in Ukraine has had impacts around the world. Supply chains have been disrupted, the cost of living has soared and we’ve seen the fastest-growing refugee crisis since World War II. All of these are in addition to the devastating humanitarian and economic impacts within Ukraine.

Our international team was conducting a global study on wellbeing in the lead up to and after the Russian invasion. This provided a unique opportunity to examine the psychological impact of the outbreak of war.

As we explain in a new study published in Nature Communications, we learned the toll on people’s wellbeing was evident across nations, not just in Ukraine. These effects appear to have been temporary – at least for the average person.

But people with certain psychological vulnerabilities struggled to recover from the shock of the war.

Tracking wellbeing during the outbreak of war

People who took part in our study completed a rigorous “experience-sampling” protocol. Specifically, we asked them to report their momentary wellbeing four times per day for a whole month.

Data collection began in October 2021 and continued throughout 2022. So we had been tracking wellbeing around the world during the weeks surrounding the outbreak of war in February 2022.

We also collected measures of personality, along with various sociodemographic variables (including age, gender, political views). This enabled us to assess whether different people responded differently to the crisis. We could also compare these effects across countries.

Our analyses focused primarily on 1,341 participants living in 17 European countries, excluding Ukraine itself (44,894 experience-sampling reports in total). We also expanded these analyses to capture the experiences of 1,735 people living in 43 countries around the world (54,851 experience-sampling reports) – including in Australia.

A global dip in wellbeing

On February 24 2022, the day Russia invaded Ukraine, there was a sharp decline in wellbeing around the world. There was no decline in the month leading up to the outbreak of war, suggesting the change in wellbeing was not already occurring for some other reason.

However, there was a gradual increase in wellbeing during the month after the Russian invasion, suggestive of a “return to baseline” effect. Such effects are commonly reported in psychological research: situations and events that impact our wellbeing often (though not always) do so temporarily.

Unsurprisingly, people in Europe experienced a sharper dip in wellbeing compared to people living elsewhere around the world. Presumably the war was much more salient for those closest to the conflict, compared to those living on an entirely different continent.

Interestingly, day-to-day fluctuations in wellbeing mirrored the salience of the war on social media as events unfolded. Specifically, wellbeing was lower on days when there were more tweets mentioning Ukraine on Twitter/X.

Our results indicate that, on average, it took around two months for people to return to their baseline levels of wellbeing after the invasion.

Different people, different recoveries

There are strong links between our wellbeing and our individual personalities.

However, the dip in wellbeing following the Russian invasion was fairly uniform across individuals. None of the individual factors assessed in our study, including personality and sociodemographic factors, predicted people’s response to the outbreak of war.

On the other hand, personality did play a role in how quickly people recovered. Individual differences in people’s recovery were linked to a personality trait called “stability”. Stability is a broad dimension of personality that combines low neuroticism with high agreeableness and conscientiousness (three traits from the Big Five personality framework).

Stability is so named because it reflects the stability of one’s overall psychological functioning. This can be illustrated by breaking stability down into its three components:

1. low neuroticism describes emotional stability. People low in this trait experience less intense negative emotions such as anxiety, fear or anger, in response to negative events
2. high agreeableness describes social stability. People high in this trait are generally more cooperative, kind, and motivated to maintain social harmony
3. high conscientiousness describes motivational stability. People high in this trait show more effective patterns of goal-directed self-regulation.

So, our data show that people with less stable personalities fared worse in terms of recovering from the impact the war in Ukraine had on wellbeing.

In a supplementary analysis, we found the effect of stability was driven specifically by neuroticism and agreeableness. The fact that people higher in neuroticism recovered more slowly accords with a wealth of research linking this trait with coping difficulties and poor mental health.

These effects of personality on recovery were stronger than those of sociodemographic factors, such as age, gender or political views, which were not statistically significant.

Overall, our findings suggest that people with certain psychological vulnerabilities will often struggle to recover from the shock of global events such as the outbreak of war in Ukraine.

Luke Smillie, Professor in Personality Psychology, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

You might have heard of something called “cryptosporidiosis” recently, closely followed by warnings to stay away from your local swimming pool if you’ve had diarrhoea.

More than 700 cases of this gastrointestinal disease were reported in Queensland in January, which is 13 times more than in January last year. Just under 500 cases have been recorded in New South Wales this year to-date, while other states have similarly reported an increase in the number of cryptosporidiosis infections in recent months.

Cryptosporidiosis has been listed as a national notifiable disease in Australia since 2001.
But what exactly is it, and should we be worried?

What causes cryptosporidiosis, and who is affected?

Cryptosporidiosis is the disease caused by the parasite Cryptosporidium, of which there are two types that can make us sick. Cryptosporidum hominis only affects humans and is the major cause of recent outbreaks in Australia, while Cryptosporidium parvum can also affect animals.

The infection is spread by spores called oocysts in the stools of humans and animals. When ingested, these oocysts migrate and mature in the small bowel. They damage the small bowel lining and can lead to diarrhoea, nausea, vomiting, fever and abdominal discomfort.

Most people develop symptoms anywhere from one to 12 days after becoming infected. Usually these symptoms resolve within two weeks, but the illness may last longer and can be severe in those with a weakened immune system.

Children and the elderly tend to be the most commonly affected. Cryptosporidiosis is more prevalent in young children, particularly those under five, but the disease can affect people of any age.

So how do we catch it?

Most major outbreaks of cryptosporidiosis have been due to people drinking contaminated water. The largest recorded outbreak occurred in Milwaukee in 1993 where 403,000 people were believed to have been infected.

Cryptosporidium oocysts are very small in size and in Milwaukee they passed through the filtration system of one of the water treatment plants undetected, infecting the city’s water supply. As few as ten oocysts can cause infection, making it possible for contaminated drinking water to affect a very large number of people.

Four days after infection a person with cryptosporidiosis can shed up to ten billion oocysts into their stool a day, with the shedding persisting for about two weeks. This is why one infected person in a swimming pool can infect the entire pool in a single visit.

Cryptosporidium oocysts excreted in the faeces of infected humans and animals can also reach natural bodies of water such as beaches, rivers and lakes directly through sewer pipes or indirectly such as in manure transported with surface runoff after heavy rain.

One study which modelled Cryptosporidium concentrations in rivers around the world estimated there are anywhere from 100 to one million oocysts in a litre of river water.

In Australia, cryptosporidiosis outbreaks tend to occur during the late spring and early summer periods when there’s an increase in recreational water activities such as swimming in natural water holes, water catchments and public pools. We don’t know exactly why cases have seen such a surge this summer compared to other years, but we know Cryptosporidium is very infectious.

Oocysts have been found in foods such as fresh vegetables and seafood but these are not common sources of infection in Australia.

What about chlorine?

Contrary to popular belief, chlorine doesn’t kill off all infectious microbes in a swimming pool. Cryptosporidium oocysts are hardy, thick-walled and resistant to chlorine and acid. They are not destroyed by chlorine at the normal concentrations found in swimming pools.

We also know oocysts can be significantly protected from the effects of chlorine in swimming pools by faecal material, so the presence of even small amounts of faecal matter contaminated with Cryptosporidium in a swimming pool would necessitate closure and a thorough decontamination.

Young children and in particular children in nappies are known to increase the potential for disease transmission in recreational water. Proper nappy changing, frequent bathroom breaks and showering before swimming to remove faecal residue are helpful ways to reduce the risk.

Some sensible precautions

Other measures you can take to reduce yours and others’ risk of cryptosporidiosis include:

• avoid swimming in natural waters such as rivers and creeks during and for at least three days after heavy rain
• avoid swimming in beaches for at least one day after heavy rain
• avoid drinking untreated water such as water from rivers or springs. If you need to drink untreated water, boiling it first will kill the Cryptosporidium
• avoid swallowing water when swimming if you can
• if you’ve had diarrhoea, avoid swimming for at least two weeks after it has resolved
• avoid sharing towels or linen for at least two weeks after diarrhoea has resolved
• avoid sharing, touching or preparing food that other people may eat for at least 48 hours after diarrhoea has resolved
• wash your hands with soap and water after going to the bathroom or before preparing food (Cryptosporidium is not killed by alcohol gels and sanitisers).

Not all cases of diarrhoea are due to cryptosporidiosis. There are many other causes of infectious gastroenteritis and because the vast majority of the time recovery is uneventful you don’t need to see a doctor unless very unwell. If you do suspect you may have cryptosporidiosis you can ask your doctor to refer you for a stool test.

Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

More than 16,000 Australians will be diagnosed with melanoma each year. Most of these will be caught early, and can be cured by surgery.

However, for patients with advanced or metastatic melanoma, which has spread from the skin to other organs, the outlook was bleak until the advent of targeted therapies (that attack specific cancer traits) and immune therapies (that leverage the immune system). Over the past decade, these treatments have seen a significant climb in the number of advanced melanoma patients surviving for at least five years after diagnosis, from less than 10% in 2011 to around 50% in 2021.

While this is great news, there are still many melanoma patients who cannot be treated effectively with current therapies. Researchers have developed two exciting new therapies that are being evaluated in clinical trials for advanced melanoma patients. Both involve the use of immunotherapy at different times and in different ways.

The first results from these trials are now being shared publicly, offering insight into the future of melanoma treatment.

Immunotherapy before surgery

Immunotherapy works by boosting the power of a patient’s immune system to help kill cancer cells. One type of immunotherapy uses something called “immune checkpoint inhibitors”.

Immune cells carry “immune checkpoint” proteins, which control their activity. Cancer cells can interact with these checkpoints to turn off immune cells and hide from the immune system. Immune checkpoint inhibitors block this interaction and help keep the immune system activated to fight the cancer.

Results from an ongoing phase 3 trial using immune checkpoint inhibitors were recently published in the New England Journal of Medicine.

This trial used two types of immune checkpoint inhibitors: nivolumab, which blocks an immune checkpoint called PD-1, and ipilimumab, which blocks CTLA-4.

Some 423 patients (including many from Australia) were enrolled in the trial, and participants were randomly assigned to one of two groups.

The first group had surgery to remove their melanoma, and were then given immunotherapy (nivolumab) to help kill any remaining cancer cells. Giving a systemic (whole body) therapy such as immunotherapy after surgery is a standard way of treating melanoma. The second group received immunotherapy first (nivolumab plus ipilimumab) and then underwent surgery. This is a new approach to treating these cancers.

Based on previous observations, the researchers had predicted that giving patients immunotherapy while the whole tumour was still present would activate the tumour-fighting abilities of the patient’s immune system much better than giving it once the tumour had been removed.

Sure enough, 12 months after starting therapy, 83.7% of patients who received immunotherapy before surgery remained cancer-free, compared to 57.2% in the control group who received immunotherapy after surgery.

Based on these results, Australian of the year Georgina Long – who co-led the trial with Christian Blank from The Netherlands Cancer Institute – has suggested this method of immunotherapy before surgery should be considered a new standard of treatment for higher risk stage 3 melanoma. She also said a similar strategy should be evaluated for other cancers.

The promising results of this phase 3 trial suggest we might see this combination treatment being used in Australian hospitals within the next few years.

mRNA vaccines

Another emerging form of melanoma therapy is the post-surgery combination of a different checkpoint inhibitor (pembrolizumab, which blocks PD-1), with a messenger RNA vaccine (mRNA-4157).

While checkpoint inhibitors like pembrolizumab have been around for more than a decade, mRNA vaccines like mRNA-4157 are a newer phenomenon. You might be familiar with mRNA vaccines though, as the biotechnology companies Pfizer-BioNTech and Moderna released COVID vaccines based on mRNA technology.

mRNA-4157 works basically the same way – the mRNA is injected into the patient and produces antigens, which are small proteins that train the body’s immune system to attack a disease (in this case, cancer, and for COVID, the virus).

However, mRNA-4157 is unique – literally. It’s a type of personalised medicine, where the mRNA is created specifically to match a patient’s cancer. First, the patient’s tumour is genetically sequenced to figure out what antigens will best help the immune system to recognise their cancer. Then a patient-specific version of mRNA-4157 is created that produces those antigens.

The latest results of a three-year, phase 2 clinical trial which combined pembrolizumab and mRNA-4157 were announced this past week. Overall, 2.5 years after starting the trial, 74.8% of patients treated with immunotherapy combined with mRNA-4157 post-surgery remained cancer-free, compared to 55.6% of those treated with immunotherapy alone. These were patients who were suffering from high-risk, late-stage forms of melanoma, who generally have poor outcomes.

It’s worth noting these results have not yet been published in peer-reviewed journals. They’re available as company announcements, and were also presented at some cancer conferences in the United States.

Based on the results of this trial, the combination of pembrolizumab and the vaccine progressed to a phase 3 trial in 2023, with the first patients being enrolled in Australia. But the final results of this trial are not expected until 2029.

It is hoped this mRNA-based anti-cancer vaccine will blaze a trail for vaccines targeting other types of cancer, not just melanoma, particularly in combination with checkpoint inhibitors to help stimulate the immune system.

Despite these ongoing advances in melanoma treatment, the best way to fight cancer is still prevention which, in the case of melanoma, means protecting yourself from UV exposure wherever possible.

Sarah Diepstraten, Senior Research Officer, Blood Cells and Blood Cancer Division, WEHI (Walter and Eliza Hall Institute of Medical Research) and John (Eddie) La Marca, Senior Research Officer, Blood Cells and Blood Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research)

This article is republished from The Conversation under a Creative Commons license. Read the original article.