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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 (coronavirus disease 2019), which is associated with high morbidity and mortality, especially in elder patients. Acute respiratory distress syndrome (ARDS) is a life-threatening complication of COVID-19 and has been linked with severe hyperinflammation. Dexamethasone has emerged as standard of care for COVID-19 associated respiratory failure. In a non-randomized prospective phase II multi-center study, we asked whether targeted inhibition of Janus kinase-mediated cytokine signaling using ruxolitinib is feasible and efficacious in SARS-CoV-2- induced ARDS with hyperinflammation. Sixteen SARS-CoV-2 infected patients requiring invasive mechanical ventilation for ARDS were treated with ruxolitinib in addition to standard treatment. Ruxolitinib treatment was well tolerated and 13 patients survived at least the first 28 days on treatment, which was the primary endpoint of the trial. Immediate start of ruxolitinib after deterioration was associated with improved outcome, as was a lymphocyte-to-neutrophils ratio above 0.07. Together, treatment with the janus-kinase inhibitor ruxolitinib is feasible and might be efficacious in COVID-19 induced ARDS patients requiring invasive mechanical ventilation. The trial has been registered under EudraCT-No.: 2020-001732-10 and NCT04359290.

Motivated by the cooperative breeding hypothesis, we investigate the effect of having kin on the mortality of reproductive women based on family reconstitutions for the Krummhörn region (East Frisia, Germany, 1720–1874). We rely on a combination of Cox clustered hazard models and hazard models stratified at the family level. In order to study behavior-related effects, we run a series of models in which only kin who lived in the same parish are considered. To investigate structural, non-behavior-related effects, we run a different model series that include all living kin, regardless their spatial proximity. We find that women of reproductive age who had a living mother had a reduced mortality risk. It appears that having living sisters had an ambivalent impact on women’s mortality: i.e., depending on the socioeconomic status of the family, the effect of having living sisters ranged between representing a source of competition and representing a source of support. Models which are clustered at the family level suggest that the presence of a living mother-in-law was associated with reduced mortality among her daughters-in-law especially among larger-scale farm families. We interpret this finding as a consequence of augmented consanguineous marriages among individuals of higher social strata. For instance, in first cousin marriages, the mother-in-law could also be a biological aunt. Thus, it appears that among the wealthy elite, the genetic in-law conflict was neutralized to some extent by family solidarity. This result further suggests that the tipping point of the female trade-off between staying with the natal family and leaving the natal family to join an economically well-established in-law family might have been reached very quickly among women living under the socioeconomic conditions of the Krummhörn region.

: Complex posttraumatic stress disorder (cPTSD) was recently added to the ICD-11. Refugees might be particularly vulnerable to develop this disorder, due to key risk factors including trauma history, comorbid symptoms, and post-migration stressors. However, most prevalence estimates rely on self-report questionnaires, which are less reliable than clinical interviews. This study aimed to assess PTSD and cPTSD prevalence in treatment-seeking refugees using clinician ratings, and to examine risk factors influencing diagnostic status and symptom severity. :  = 104 treatment-seeking refugees were assessed for cPTSD and PTSD , as well as symptom severity and single symptom endorsement using a new clinical interview, the Complex PTSD Item Set Additional to the CAPS. Trauma history, comorbid symptoms (dissociation, sleep problems, somatic symptoms, anxiety, depression, social impairment), and post-migration stressors were investigated as predictors for cPTSD diagnostic status and symptom severity using Wilcoxon Rank sum tests, logistic and linear regression. : Prevalences for cPTSD and PTSD were 14.42% (  = 15) and 63.46% (  = 66), respectively. Participants with and without cPTSD did not differ regarding the frequency of traumatic events experienced. However, cPTSD symptom severity was significantly positively associated with the frequency of experienced traumatic events. In regression analyses, comorbid symptoms were significantly associated with cPTSD diagnostic status and symptom severity with depressive symptoms being a significant predictor. Post-migration stressors were associated with cPTSD diagnostic status and symptom severity, and the perception of the present financial situation was a significant predictor for cPTSD severity. : The prevalence of cPTSD was relatively low in this refugee sample. This discrepancy to earlier prevalence estimates could be due to the assessment since we used a clinical interview instead of a self-report questionnaire. More investigations into cPTSD diagnostic assessments are needed, and clinical interviews should be used more often.

IntroductionDespite high levels of mental distress, accessing psychological treatment is difficult for asylum seekers in Western host countries due to a lack of knowledge about mental disorders, and the health system, as well as due to cultural and language barriers. This study aims to investigate whether brief culturally sensitive and transdiagnostic psychoeducation is effective in increasing mental health literacy.Methods and analysisThe study is a parallel two-group randomised controlled trial with 1:1 individual allocation to either culturally sensitive, low-threshold psychoeducation (‘Tea Garden’ (TG)) or a waitlist (WL) control group. It takes place at four study sites in Germany. A total of 166 adult asylum seekers who report at least mild mental distress will be randomly assigned. The TG consists of two 90 min group sessions and provides information about mental distress, resources and mental health services in a culturally sensitive manner. The primary outcome is the percentage of participants in the TG, as compared with the WL, achieving an increase in knowledge concerning symptoms of mental disorders, individual resources and mental healthcare from preintervention to postintervention. The further trajectory will be assessed 2 and 6 months after the end of the intervention. Secondary outcomes include changes in mental distress, openness towards psychotherapy and resilience. Furthermore, healthcare utilisation and economics will be assessed at all assessment points.Ethics and disseminationThe study has been approved by the Ethics Commission of the German Psychological Society (ref: WeiseCornelia2019-10-18VA). Results will be disseminated via presentations, publication in international journals and national outlets for clinicians. Furthermore, intervention materials will be available, and the existing network will be used to disseminate and implement the interventions into routine healthcare.Trial registration numberDRKS00020564; Pre-results.Protocol version2020-10-06, version number: VO2F.

Background: Many refugees have experienced multiple traumatic events in their country of origin and/or during flight. Trauma-related disorders such as posttraumatic stress disorder (PTSD) or complex PTSD (CPTSD) are prevalent in this population, which highlights the need for accessible and effective treatment. Imagery Rescripting (ImRs), an imagery-based treatment that does not use formal exposure and that has received growing interest as an innovative treatment for PTSD, appears to be a promising approach. Objective: This randomized-controlled trial aims to investigate the efficacy of ImRs for refugees compared to Usual Care and Treatment Advice (UC+TA) on (C)PTSD remission and reduction in other related symptoms. Method: Subjects are 90 refugees to Germany with a diagnosis of PTSD according to DSM-5. They will be randomly allocated to receive either UC+TA (n = 45) or 10 sessions of ImRs (n = 45). Assessments will be conducted at baseline, post-intervention, three-month follow-up, and 12-month follow-up. Primary outcome is the (C)PTSD remission rate. Secondary outcomes are severity of PTSD and CPTSD symptoms, psychiatric symptoms, dissociative symptoms, quality of sleep, and treatment satisfaction. Economic analyses will investigate health-related quality of life and costs. Additional measures will assess migration and stress-related factors, predictors of dropout, therapeutic alliance and session-by-session changes in trauma-related symptoms. Results and Conclusions: Emerging evidence suggests the suitability of ImRs in the treatment of refugees with PTSD. After positive evaluation, this short and culturally adaptable treatment can contribute to close the treatment gap for refugees in high-income countries such as Germany. Trial registration: German Clinical Trials Register under trial number DRKS00019876, registered prospectively on 28 April 2020. * Many refugees have experienced traumatic events. * This trial investigates the efficacy of imagery rescripting, a short and culturally adaptable treatment that can contribute to close the treatment gap for refugees with posttraumatic stress disorder in high-income countries.

Based on historical data pertaining to the Krummhörn population (eighteenth and nineteenth centuries, Germany), we compared reproductive histories of mothers according to whether the maternal grandmother (MGM) or the paternal grandmother (PGM) or neither of them was resident in the parents’ parish at the time of the mother’s first birth. In contrast to effects of PGMs, we discovered conditional differences in the MGM’s effects between landless people and wealthier, commercial farmers. Our data indicate that the presence of the MGM only lowers the woman’s age at marriage (AAM) and her age at the birth of her first child (AFB) in the case of landless families. However, among commercial farmers, who can generally be characterized by a lower AAM and AFB, we found opposite tendencies for the MGM’s effect leading to a relatively small delay in AAM and AFB. Moreover, we also analyzed differences in the completed fertility (i.e., children ever born: CEB). Results indicate that landless families in general do have fewer CEB compared with commercial farmers except for those families in which the MGM has been present. Emphasizing that the adaptiveness of investment decisions should depend on the interaction of genetic, lineage-specific (intrinsic) and ecologically imposed (extrinsic) constraints, we conclude that kin strategies consequently address different fitness components under different conditions.

When considering inclusive fitness, it is expected that individuals will provide more care towards those with whom they are more closely related. Thus, if a selfish X-linked genetic element influenced care giving, we would expect care giving to vary with X-relatedness. Recent studies have shown that X-chromosome inheritance patterns may influence selection of traits affecting behavior and life-history. Sexually antagonistic (SA) zygotic drive could encourage individuals to help those with whom they are more likely to share genetic material at the expense of other relatives. We reanalyze previously reported data in light of this new idea. We also evaluate the effects of paternity uncertainty on SA-zygotic drive. Our evidence suggests that human paternal discrepancy is relatively low. Using published models, we find the effects of paternal discrepancy do not override opportunity for selection based on X-relatedness. Based on these results, longevity and grandmothering behaviors, including favoritism, may be more heavily influenced by selection on the X-chromosome than by paternity uncertainty.