Objectives Shiga toxin–producing Escherichia coli (STEC) are an important cause of foodborne disease, yet global estimates of disease burden do not exist. Our objective was to estimate the global annual number of illnesses due to pathogenic STEC, and resultant hemolytic uremic syndrome (HUS), end-stage renal disease (ESRD), and death. Materials We searched Medline, Scopus, SIGLE/OpenGrey, and CABI and World Health Organization (WHO) databases for studies of STEC incidence in the general population, published between January 1, 1990 and April 30, 2012, in all languages. We searched health institution websites for notifiable disease data and reports, cross-referenced citations, and consulted international knowledge experts. We employed an a priori hierarchical study selection process and synthesized results using a stochastic simulation model to account for uncertainty inherent in the data. Results We identified 16 articles and databases from 21 countries, from 10 of the 14 WHO Sub-Regions. We estimated that STEC causes 2,801,000 acute illnesses annually (95% Credible Interval [Cr.I.]: 1,710,000; 5,227,000), and leads to 3890 cases of HUS (95% Cr.I.: 2400; 6700), 270 cases of ESRD (95% Cr.I.: 20; 800), and 230 deaths (95% Cr.I.: 130; 420). Sensitivity analyses indicated these estimates are likely conservative. Conclusions These are the first estimates of the global incidence of STEC-related illnesses, which have not been explicitly included in previous global burden of disease estimations. Compared to other pathogens with a foodborne transmission component, STEC appears to cause more cases than alveolar echinococcosis each year, but less than typhoid fever, foodborne trematodes, and nontyphoidal salmonellosis. Applications Given the persistence of STEC globally, efforts aimed at reducing the burden of foodborne disease should consider the relative contribution of STEC in the target population.

Indigenous Peoples globally are among those who are most acutely experiencing the mental health impacts of climate change; however, little is known about the ways in which Indigenous Peoples globally experience climate-sensitive mental health impacts and outcomes, and how these experiences may vary depending on local socio-cultural contexts, geographical location, and regional variations in climate change. Thus, the goal of this study was to examine the extent, range, and nature of published research investigating the ways in which global Indigenous mental health is impacted by meteorological, seasonal, and climatic changes. Following a systematic scoping review protocol, three electronic databases were searched. To be included, articles had to be empirical research published since 2007 (i.e. since the Intergovernmental Panel on Climate Change's Fourth Assessment Report); explicitly discuss Indigenous Peoples and describe factors related to climatic variables and mental health. Descriptive data from relevant articles were extracted, and the articles were thematically analyzed. Fifty articles were included for full review. Most primary research articles described research in Canada (38%), Australia (24%), and the United States of America (10%), with the number of articles increasing over time. Mental health outcomes such as strong emotional responses, suicide, depression, and anxiety were linked to changes in meteorological factors, seasonality, and exposure to both acute and chronic weather events. The literature also reported on the ways in which the emotional and psychological impacts of climate were connected to changing place attachment, disrupted cultural continuity, altered food security and systems, forced human mobility, and intangible loss and damages. This review highlights global considerations for Indigenous mental health in relation to climate change, which can support Indigenous-driven initiatives and decisionmaking to enhance mental wellness in a changing climate.

D espite the many benefits of veterinary work, 1 concerns have been raised regarding the relatively higher risk, compared with the risk for the general population, of poor mental health outcomes among veterinarians. 2-4 A relatively high rate of death by suicide among veterinarians was first described in 1980 5 and has since been corroborated by data from Canada and the United States. [6][7][8] Early work by Bartram et al 2,9 proposed a model linking the prevalence of

Purpose To estimate the prevalence of stress, anxiety, depression, and resilience amongst Canadian farmers. Methods An online cross-sectional survey using validated psychometric scales [Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale, Connor-Davidson Resilience Scale] conducted with farmers in Canada between September 2015 and February 2016. Results 1132 farmers participated in the study. The average PSS score was 18.9. Approximately 57% and 33% of participants were classified as possible and probable cases for anxiety, respectively; the respective proportions for depression were 34% and 15%. The average resilience score was 71.1. Scores for stress, anxiety, and depression were higher, and resilience lower, than reported normative data. Females scored less favorably on all mental health outcomes studied, highlighting important gender disparities. Conclusions These results highlight a significant public health concern amongst farmers, and illustrate a critical need for research and interventions related to farmer mental health. These findings are important for policymakers, physicians, and public and mental health service providers, and can help to inform decision-making, policy recommendations, resource allocation, and development and delivery of training programs for farmers.

BackgroundMental health issues among farmers are identified population health concerns. While one systematic review focused on suicide in farming populations in the United States, there have been no scoping studies examining mental health in farming communities worldwide. The objectives of this scoping review were to: provide a descriptive analysis of the literature pertaining to mental health outcomes in farming populations; describe the international scope of the research; and highlight published mental health services and interventions that have been evaluated.MethodsFollowing Arksey and O’Malley’s scoping review framework, five major health and science platforms were used to identify studies examining mental health outcomes in farming populations, worldwide. Studies that met a priori inclusion criteria that were published prior to December 31, 2017 were included in this review. Data synthesis and descriptive statistics were conducted using STATA 15® software; proportions were calculated by country.ResultsThe initial literature search yielded 9,906 records. After title and abstract screening, 676 articles were reviewed in-full. Of these, 341 met a priori inclusion criteria. Studies included were conducted between 1979 and 2017; the majority (265; 77.7%) were published between 2002–2017. The most frequently measured outcomes were stress (41.9%), suicide (33.1%), and depression (32.6%). Over 70% of studies that examined stress described using quantitative research methods, most predominantly, cross-sectional designs (42.7%). Approximately 64% of studies that measured suicide reported using a quantitative approach; the largest proportion of included suicide studies (33.6%) described using cohort designs. Approximately 84% of studies that measured depression described using quantitative approaches; sixty percent of these studies reported using a cross-sectional study design. Twenty included studies described a mental health service or intervention (5.9%).ConclusionsThis scoping review provides a critical overview of the literature examining mental health outcomes in farming populations worldwide. Given the importance of farming and agriculture, this review can be used to ensure future research complements existing work, avoids unnecessary overlap, and begins to tackle the less-studied mental health outcomes amongst farmers. These results can guide researchers to identified gaps in research and services, leading to a more informed approach to future work, and ultimately, a more comprehensive understanding of mental health among farmers worldwide.