Estudiar y trabajar como factores de riesgo en estudiantes de enfermería, Universidad Nacional Formosa, 2022 / Study and work as risk factors in nursing students, National University of Formosa,2022

Objetivo: Correlacionar la variable principal sostén del hogar con las variables género, edad, horas de trabajo, horas de sueño y factores de riesgo cardiovascular (índice de masa corporal, hipertensión arterial, dislipemia y diabetes mellitus), en estudiantes de 3º, 4 y 5º año de la Licenciatura en Enfermería, Universidad Nacional de Formosa. Metodología: estudio descriptivo, correlacional, transversal realizado en 214 estudiantes, durante el año 2022, utilizándose un cuestionario on-line autoadministrado, estructurado y medición de peso y talla. Resultados: el 76% fueron mujeres; 64%, principal fueron principal sostén del hogar, 57% refirió dormir menos de 6 horas al día, 15 % trabaja más de 41 horas semanales; 67% tuvo respuestas no saludables a la variable estrés, para la variable actividad física este valor ascendió a 71% y el 53,8% presentó exceso de peso. Se encontró asociación significativa entre ser el principal sostén del hogar con exceso de peso, trabajar 41 horas o más semanalmente, dormir menos de 6 horas al día y con la presencia de 3 o más factores de riesgo cardiovascular. Conclusiones: Las condiciones de vida que afrontan los estudiantes que de manera simultánea estudian, trabajan y son principal sostén del hogar pueden generar estrés, el cual es un factor de riesgo para las enfermedades cardiovasculares[AU]

Objetive: to correlate the main variable of primary income earner or primary breadwinner with gender, age, working hours, sleep hours, and cardiovascular disease risk factors (body mass index, hypertension, dyslipidemia, and diabetes mellitus) in 3rd, 4th, and 5th-year nursing students at the Nursing Program at the National University of Formosa. Methodology: The study was a descriptive, correlational, cross-sectional, conducted with 214 students during 2022 using a self-administered structured online questionnaire and measurement of weight and height. Results: 76% were women, 64% were the main breadwinner, 57% reported sleeping less than 6 hours a day, 15% working more than 41 hours per week; 67% had unhealthy responses to the stress variable, this value rose to 71% for the physical activity variable, and 53.8% were overweight. A significant association was found between the main variable of primary breadwinner and being overweight, working 41 or more hours weekly, and the presence of 3 or more cardiovascular risk factors. Conclusions: The living conditions faced by students who simultaneously study and work, and being the main breadwinner in the household can generate stress, which is a risk factor for cardiovascular diseases[AU]

Objetivo:: correlacionar a variável principal de sustento econômico do lar com as variáveis gênero, idade, horas de trabalho, horas de sono e fatores de risco cardiovascular (índice de massa corporal,hipertensão arterial, dislipidemia e diabetes mellitus) em estudantes do 3º, 4º e 5º ano do curso de graduação em Enfermagem, Universidade Nacional de Formosa. Metodologia: O estudo foi descritivo, correlacional e transversal, realizado em 214 estudantes durante o ano de 2022. Foi utilizado um questionário online autoadministrado e estruturado, e a medição de peso e altura dos estudantes foi realizada. Resultados: 76% dos estudantes eram mulheres; 64% eram o principal sustento econômico do lar; 57% relataram dormir menos de 6 horas por dia, 15% responderam que trabalham mais de 41 horas por semana; em relação aos fatores de risco cardiovascular, 67% tiveram respostas não saudáveis para a variável estresse, para a variável atividade física esse valor aumentou para 71% e 53,8% apresentaram excesso de peso. Foi encontrada uma associação significativa entre a variável principal de sustento econômico do lar com as variáveis excesso de peso, trabalhar 41 horas ou mais por semana, dormir menos de 6 horas al día e a presença de 3 ou mais fatores de risco cardiovascular. Conclusões: As condições de vida enfrentadas pelos estudantes que simultaneamente estudam, trabalham e são o principal sustento do lar podem gerar estresse, que é um fator de risco para doenças cardiovasculares[AU]

Feasibility of a trauma-focused internet- and mobile-based intervention for youth with posttraumatic stress symptoms.

Background: Many youth with posttraumatic stress symptoms (PTSS) do not receive evidence-based care. Internet- and Mobile-Based Interventions (IMIs) comprising evidence-based trauma-focused components can address this gap, but research is scarce. Thus, we investigated the feasibility of a trauma-focused IMI for youth with PTSS.Methods: In a one-arm non-randomized prospective proof-of-concept study, 32 youths aged 15-21 years with clinically relevant PTSS (CATS ≥ 21) received access to a trauma-focused IMI with therapist guidance, comprising nine sessions on an eHealth platform accessible via web-browser. We used a feasibility framework assessing recruitment capability, sample characteristics, data collection, satisfaction, acceptability, study management abilities, safety aspects, and efficacy of the IMI in PTSS severity and related outcomes. Self-rated assessments took place pre-, mid-, post-intervention and at 3-month follow-up and clinician-rated assessments at baseline and post-intervention.Results: The sample mainly consisted of young adult females with interpersonal trauma and high PTSS levels (CATS, M = 31.63, SD = 7.64). The IMI sessions were found useful and comprehensible, whereas feasibility of trauma processing was perceived as difficult. Around one-third of participants (31%) completed the IMI's eight core sessions. The study completer analysis showed a significant reduction with large effects in self-rated PTSS at post-treatment [t(21) = 4.27; p < .001; d = 0.88] and follow-up [t(18) = 3.83; p = .001; d = 0.84], and clinician-rated PTSD severity at post-treatment [t(21) = 4.52; p < .001; d = 0.93]. The intention-to-treat analysis indicated significant reductions for PTSS at post-treatment and follow-up with large effect sizes (d = -0.97- -1.02). All participants experienced at least one negative effect, with the most common being the resurfacing of unpleasant memories (n = 17/22, 77%).Conclusion: The study reached highly burdened young adults. The IMI was accepted in terms of usefulness and comprehensibility but many youths did not complete all sessions. Exploration of strategies to improve adherence in trauma-focused IMIs for youth is warranted, alongside the evaluation of the IMI's efficacy in a subsequent randomized controlled trial.

Youth often lack access to evidence-based care after trauma. This study assessed the feasibility of a trauma-focused internet- and mobile-based intervention with therapist guidance.The intervention was accepted by youths, and the preliminary evaluation of participant responses suggests its efficacy.Future studies should examine strategies to improve adherence and the IMI's efficacy in a RCT.

Exogenous glucocorticoids to improve extinction learning for post-traumatic stress disorder patients with hypothalamic-pituitary-adrenal-axis dysregulation: a study protocol description.

Background: Trauma-focused treatments for post-traumatic stress disorder (PTSD) are effective for many patients. However, relapse may occur when acquired extinction memories fail to generalize beyond treatment contexts. A subgroup of PTSD patients - potentially with substantial exposure to early-life adversity (ELA) - show dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which results in lower cortisol levels. Glucocorticoids, including cortisol, appear to facilitate strength and generalization of emotional memories.Objective: We describe the protocol of an integrated PTSD study. We investigate (A) associations between HPA-axis dysregulation, ELA, epigenetic markers, and PTSD treatment outcome (observational study); and (B) effects of exogenous glucocorticoids on strength and generalization of extinction memories and associated neural mechanisms [pharmacological intervention study with functional magnetic resonance imaging (fMRI)]. The objective is to provide proof of concept that PTSD patients with HPA-axis dysregulation often experienced ELA and may show improved strength and generalization of extinction learning after glucocorticoid administration.Method: The observational study (n = 160 PTSD group, n = 30 control group) assesses ELA, follow-up PTSD symptoms, epigenetic markers, and HPA-axis characteristics (salivary cortisol levels during low-dose dexamethasone suppression test and socially evaluated cold-pressor test). The pharmacological intervention study (n = 80 PTSD group, with and without HPA-axis dysregulation) is a placebo-controlled fMRI study with a crossover design. To investigate strength and generalization of extinction memories, we use a differential fear acquisition, extinction, and extinction recall task with spatial contexts within a virtual environment. Prior to extinction learning, 20 mg hydrocortisone or placebo is administered. During next-day recall, strength of the extinction memory is determined by recovery of skin conductance and pupil dilation differential responding, whereas generalization is assessed by comparing responses between different spatial contexts.Conclusion: The integrated study described in the current protocol paper could inform a personalized treatment approach in which these PTSD patients may receive glucocorticoids as a treatment enhancer in trauma-focused therapies.Trial registration: The research project is registered in the European Union Drug Regulating Authorities Clinical Trials (EudraCT) database, https://eudract.ema.europa.eu/, EudraCT number 2020-000712-30.

This protocol reports a proof-of-concept study for glucocorticoids as an enhancer for PTSD treatment.The study examines whether glucocorticoids enhance the strength and generalization of extinction memory.A further aim is to identify HPA-axis-related PTSD subgroups that may particularly benefit.

Trauma care in crisis: war trauma and mental health funding.

Background: Israel is currently under a state of continued unrest and state of war. There has been an influx of financial aid to treat the mental health fallout both from within Israel and abroad. Despite increased research into resilience, treatment and wide-scale interventions, there is a concern that this is not significantly influencing mental health aid allocation.Objective: This letter to the editor aims to describe the current situation and address current difficulties in regard to the relevant literature from recent conflicts and national traumatic events.Method: A consortium of national and international trauma experts pooled together their knowledge to produce a working statement based on evidence from clinical and research findings.Results: As opposed to wider, short-term psychological interventions which have limited long-term proven efficacy, lessons from previous war zones, wide-scale exposure to trauma and current war-torn countries highlight the importance of targeting and assessment, addressing barriers to care, strengthening existing systems and promoting community resilience and care.Conclusions: In addition to acute care, funding should be allocated to long-term care, enhancing treatment accessibility and community follow-up and additionally support long-term research to assess effectiveness and contribute to international knowledge.

Immediately following widescale attacks, national disasters and outbreaks of war there is a tendency for an outpouring of aid, and in recent years, mental health aid.Despite an increase in research in the field there are still significant gaps in the literature and a disconnect between the evidence and economic and philanthropic policy with short-term initiatives often favoured over long-term strategic planning.It is recommended that greater attention be paid to targeting and assessment, addressing barriers to care, strengthening existing systems and promoting community care.

Consequences of the COVID-19 pandemic on the mental health of nurses in the Spanish out-of-hospital Emergency Service.

OBJECTIVE: To analyse the impact of the COVID-19 pandemic on the mental health of nurses in Spanish out-of-hospital Emergency Services, identifying predictor factors of greater severity. METHOD: A multicentre cross-sectional descriptive study was designed, including all nurses working in any Spanish out-of-hospital Emergency Services between 01/02/2021 and 30/04/2021. The main outcomes were the level of depression, anxiety and stress assessed through the DASS-21 scale. Sociodemographic, clinical, and occupational information was also collected. Univariate and multivariate analyses were conducted to determine possible associations between variables. RESULTS: The sample included 474 nurses. 32.91%, 32.70% and 26.33% of the participants had severe or extremely severe levels of depression, anxiety and stress, respectively. Professionals with fewer competencies to handle stressful situations, those who had used psychotropic drugs and/or psychotherapy on some occasion before the pandemic onset, or those who had changed their working conditions presented more likelihood of developing more severe levels of depression, anxiety and/or stress. CONCLUSION: Nurses in Spanish out-of-hospital Emergency Services have presented medium levels of depression, anxiety and stress during the pandemic. Clinical and occupational factors have been associated with a higher degree of psychological distress. It is necessary to adopt strategies that promote professionals' self-efficacy and mitigate the triggers of negative emotional states.

Traumatic loss: a systematic review of potential risk factors differentiating between posttraumatic stress disorder and prolonged grief disorder.

Background: When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief.Objective: This systematic review investigates which characteristics differentiate between the development of the respective disorders or are associated with comorbidity.Method: A systematic literature search using Medline, PubMed, APA PsycInfo and Web of Science yielded 46 studies which met the inclusion criteria. In these studies, PTSD was assessed using 17 and pathological grief using 16 different validated instruments. In the quality assessment, 12 studies were classified as average, 30 as above average, and 4 as excellent. The investigated risk factors were categorized into 19 superordinate clusters and processed using narrative synthesis.Results: The relationship to the deceased, mental health issues, and religious beliefs seem to be associated specifically with pathological grief symptoms compared to PTSD symptoms. Social support and social emotions emerged as significant correlates and potential risk factors for both PTSD and pathological grief. Included studies had mainly cross-sectional designs.Conclusions: Differentiating factors between pathological grief and PTSD appear to exist. The results should be considered within the limitations of the heterogeneity of the included studies and the research field. There is a lack of studies (1) using a longitudinal study design, (2) starting data collection early following the traumatic loss, (3) using standardized, up-to-date measurement instruments and (4) including comorbidity in their analyses. Further research is urgently needed for more accurate (acute) screenings, prognoses, and interventions following traumatic loss.

When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief. This systematic review investigates which characteristics can differentiate between the development of the respective disorders or are associated with comorbidity.The relationship to the deceased, mental health issues, and religious beliefs seem to be specific characteristics for predicting pathological grief. Social support and social emotions were frequently reported as significant correlates of both PTSD and pathological grief.The studies to date have been very heterogeneous and mainly cross-sectional. Further research considering both disorders after traumatic loss in longitudinal study designs is urgently indicated for better (acute) screenings, prognoses, and interventions.

The nature and impacts of deployment-related encounters with children among Canadian military Veterans: a qualitative analysis.

Background: As armed conflict grows increasingly complex, the involvement of children in armed violence across diverse roles is rising. Consequently, military personnel are more likely to encounter children during deployment. However, little is known about deployment-related encounters with children and their impact on the mental health of military personnel and Veterans.Objective: This study qualitatively examines the nature and impacts of deployment-related encounters with children.Methods: We conducted semi-structured interviews with 16 Canadian Armed Forces Veterans, eliciting rich information on the nature of child encounters on deployment, the psycho-social-spiritual impacts of these encounters, and perceptions of support. Interview transcripts were analysed using thematic analysis.Results: Six primary themes were identified: types of encounters (i.e. factual aspects of deployment-related encounters with children), contextual factors (i.e. aspects of the mission, environment, and personal context relevant to one's experience of the encounter), appraisals of encounters (i.e. sensory or sense-making experiences relevant to the encounter), impacts of encounters (i.e. psycho-social, existential, and occupational impacts), coping strategies engaged in both during and after deployment, and support experiences, describing both formal and informal sources of support.Conclusions: Encounters with children are diverse and highly stressful, resulting in impacts pertinent to mental health, including psychological and moral distress, and difficulties with identity, spirituality, and relationships. These impacts are prompted by complex interactions among appraisals, expectations of morality, cultural norms, and professional duties and are amplified by various personal factors (e.g. childhood maltreatment history, parenthood), feelings of unpreparedness, and lack of post-deployment support. Implications for prevention, intervention, and policy are discussed with the aim of informing future efforts to safeguard and support military personnel facing a high likelihood of encounters with children.

Deployment-related encounters with children result in diverse impacts, including psychological and moral distress, along with disruptions in identity, spirituality, and interpersonal relationships.Encounters with children during military deployments are diverse and highly stressful, characterized by complex interactions among appraisals and expectations of morality, cultural norms, and professional duties.Emphasis on feeling unprepared for encounters with children highlights the need for future efforts to safeguard and support military personnel facing such situations.

Combined effect of compassionate and uncompassionate self-responding on Chinese college students' mental health during the initial wave of the COVID-19 pandemic: a response surface analysis.

Background: The initial wave of the COVID-19 pandemic significantly deteriorated mental health, especially among college students. Self-compassion has demonstrated benefits for psychological outcomes such as depressive symptoms, life satisfaction, posttraumatic stress symptoms (PTSS), and posttraumatic growth (PTG). Notably, existing literature suggests that the protective and vulnerable aspects within the Self-Compassion Scale, namely, compassionate and uncompassionate self-responding (CSR and USR), can coexist within individuals and influence their mental health through various coexisting patterns. However, this process has not been sufficiently explored.Objective: This study aimed to explore the combined effects of CSR and USR on college students' depressive symptoms, life satisfaction, PTSS, and PTG during the initial wave of the pandemic.Method: In this cross-sectional study, 4450 Chinese college students (51.9% females, Mage = 20.58 years, SD = 1.49) completed self-report measures amid the COVID-19 pandemic's initial wave in 2020. Response surface analyses were utilised to investigate the combined effects of CSR and USR.Results: Simultaneously increased CSR and USR were associated with a slight increase in depressive symptoms, PTSS, and life satisfaction, but a substantial increase in PTG. Conversely, increased CSR and decreased USR were associated with a considerable decrease in depressive symptoms and PTSS, a significant increase in life satisfaction, and a moderate increase in PTG.Conclusions: CSR and USR demonstrated protective and vulnerable impacts, respectively. It is imperative to analyse their combined effects as an interactive system and consider the specific characteristics of different psychological responses.

Increased CSR and decreased USR were associated with less depressive symptoms and PTSS as well as more life satisfaction.CSR mitigated the negative effects of USR on depressive symptoms, life satisfaction, and PTSS.Simultaneously increased CSR and USR were associated with a substantial increase in PTG.

Social capital as a moderator of the relationship between violent community environment and psychological distress.

OBJECTIVE: To evaluate the modifying effect of social capital on the relationship between living in violent communities and the presence of psychological distress in adolescents and youth in Mexico. METHOD: The analysis of the Social Cohesion Survey for the Prevention of Violence and Crime (ECOPRED, by its acronym in Spanish) was conducted. The analytic sample consisted of 39,639 participants aged 12 to 29 years. Community violence and social capital were measured at the census tract level using the average answers of a household's head sample. These environmental variables were independent of the experiences of the participants. Social capital variables included structural (social ties, recreational participation, collaborative participation, and social cohesion), and cognitive (trust in neighbors) dimensions. Multilevel structural equation models were used. RESULTS: Recreational participation, collaborative participation, and social cohesion modified the relationship between community environments and psychological distress. In females who lived in places with less recreational participation or less social cohesion, the higher the social disorder, the higher the psychological distress. A similar relationship between vandalism and psychological distress was identified, but only in males who lived in places with less collaborative participation, and in females with less social cohesion. CONCLUSIONS: Our results suggest that dimensions of the structural social capital (organization and interest in the community and its members) were the ones that had the buffering effect of the exposure to disordered community environments on psychological distress.

Types of childhood maltreatment as predictors of posttraumatic stress disorder severity and complex posttraumatic stress disorder in patients with substance use disorders.

Background: Childhood maltreatment (CM) can be divided into: emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). CM is associated with (Complex)Posttraumatic stress disorder (PTSD/CPTSD) and substance use disorder (SUD).Objective: This cross-sectional study examined the relationships between CM-subtypes with PTSD-severity and CPTSD in patients with SUD-PTSD.Method: Participants (N = 209) were treatment-seeking SUD-PTSD patients who completed the Childhood Trauma Questionnaire-short form, the Clinician-Administered PTSD Scale for DSM-5 and the International Trauma Questionnaire. Regression analyses and a model selection procedure to select an optimal model were used to examine CM-subtypes as predictors of (C)PTSD, adjusted for sex and age.Results: Total CM and all CM-types significantly predicted PTSD-severity in the univariate regression analysis, with EA begin the strongest predictor. In the multiple regression only SA predicted PTSD-severity. Subsequently, model selection indicated that the optimal model to predict PTSD-severity included EA and SA. In the univariate analyses total CM, EA, and PN significantly predicted CPTSD-classification, and total CM and all CM-types significantly predicted CPTSD-severity. In the multiple regression for CPTSD-classification only EA and PA were significant predictors and for CPTSD-severity EA, PA and SA were significant predictors. In post-hoc multiple regression analyses, only EA was a significant predictor of CPTSD-classification and CPTSD-severity. Finally, in the model selection the most parsimonious model only included EA for both CPTSD-classification and CPTSD-severity. Sex was not a moderator in the relationship between CM and PTSD, nor in CM and CPTSD.Conclusions: These findings indicate that for SUD-PTSD patients, several CM-types have predictive value for (C)PTSD-severity, however SA and especially EA appear to contribute to these complaints. Since EA does not constitute an A-criterion, it is generally more overlooked in PTSD treatment. Its impact should therefore be underlined, and clinicians should be attentive to EA in their treatment.

All types of Childhood Maltreatment are associated with PTSD severity.Emotional Abuse and Sexual Abuse are most predictive for PTSD severity.Emotional Abuse is most predictive for CPTSD classification and symptom severity.

Moral injury appraisals and posttraumatic stress symptoms in trauma-exposed police officers: a latent class analysis.

Background: Police officers encounter various potentially traumatic events (PTEs) and may be compelled to engage in actions that contradict their moral codes. Consequently, they are at risk to develop symptoms of Posttraumatic Stress Disorder (PTSD), but also moral stress or moral injury (MI). To date, MI in police officers has received limited attention.Objective: The present study sought to identify classes of MI appraisals and PTSD symptoms among police officers exposed to PTEs, while also investigating potential clinical differences between these classes.Method: For this study, 421 trauma-exposed police officers were assessed on demographics and several clinical measurements including MI appraisals (self-directed and other-directed), PTSD severity, and general psychopathology. Latent class and regression analyses were conducted to examine the presence of different classes among trauma-exposed police officers and class differentiation in terms of demographics, general psychopathology, PTSD severity, mistrust, guilt, self-punishment, and feelings of worthlessness.Results: The following five classes were identified: (1) a 'Low MI, high PTSD class' (28%), (2) a 'High MI, low PTSD class' (11%), (3) a 'High MI, high PTSD class' (17%), (4) a 'Low MI, low PTSD class' (16%), and (5) a 'High MI-other, high PTSD class' (27%). There were significant differences between the classes in terms of age, general psychopathology, PTSD severity, mistrust, guilt, and self-punishment but no differences for gender and feelings of worthlessness.Conclusion: In conclusion, we identified five classes, each exhibiting unique patterns of cognitive MI appraisals and PTSD symptoms. This underscores the criticality of measuring and identifying MI in this particular group, as it allows for tailored treatment interventions.

This study identified classes differing in terms of endorsement of MI appraisals and posttraumatic stress disorder (PTSD) symptoms among police officers exposed to potentially traumatic events.Five classes were identified, each exhibiting unique patterns of MI appraisals and PTSD symptoms.It is important to measure the presence of MI appraisals in addition to PTSD symptoms in traumatized police officers as it can inform treatment interventions.

Effect of trauma on asylum seekers and refugees receiving a WHO psychological intervention: a mediation model.

Background: Scalable psychological interventions such as the WHO's Self-Help Plus (SH+) have been developed for clinical and non-clinical populations in need of psychological support. SH+ has been successfully implemented to prevent common mental disorders among asylum seekers and refugees who are growing in number due to increasing levels of forced migration. These populations are often exposed to multiple, severe sources of traumatisation, and evidence of the effect of such events on treatment is insufficient, especially for non-clinical populations.Objective: We aim to study the effect of potentially traumatic experiences (PTEs) and the mediating role of symptoms of posttraumatic stress disorder (PTSD) on the improvement following SH+.Method: Participants allocated to SH+ who received at least three sessions (N = 345) were extracted from two large, randomised, European prevention trials involving asylum seekers and refugees. Measures of distress, depression, functional impairment, and post-traumatic stress symptoms were administered at baseline and 6 months post-intervention, together with measures of well-being and quality of life. Adjusted models were constructed to examine the effect of PTEs on post-intervention improvement. The possible mediating role of PTSD symptoms in this relationship was then tested.Results: Increasing numbers of PTEs decreased the beneficial effect of SH+ for all measures. This relationship was mediated by symptoms of PTSD when analysing measures of well-being and quality of life. However, this did not apply for measures of mental health problems.Conclusions: Exposure to PTEs may largely reduce benefits from SH+. PTSD symptomatology plays a specific, mediating role on psychological well-being and quality of life of participants who experienced PTE. Healthcare professionals and researchers should consider the role of PTEs and PTSD symptoms in the treatment of migrants and refugees and explore possible feasible add-on solutions for cases exposed to multiple PTEs.

Increasing numbers of potentially traumatic experiences can decrease the beneficial effect of a manualized group psychotherapeutic intervention in migrants and refugees across multiple countries.In absence of a full threshold diagnosis of post-traumatic stress disorder, post-traumatic stress symptoms still mediate the relation between potentially traumatic experiences and some outcome improvements at follow-up.While the moderating role of number of potentially traumatic experiences applies to all outcomes (depression symptoms, psychological distress, functional impairment, well-being, and quality of life), the mediating role of post-traumatic stress symptoms in this relation only applies to well-being and quality of life.

Occurrence, co-occurrence and persistence of symptoms of depression and post-traumatic stress disorder in survivors of COVID-19 critical illness.

Background: Intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) are associated with psychological distress and trauma. The COVID-19 pandemic brought with it a series of additional long-lasting stressful and traumatic experiences. However, little is known about comorbid depression and post-traumatic stress disorder (PTSD).Objective: To examine the occurrence, co-occurrence, and persistence of clinically significant symptoms of depression and PTSD, and their predictive factors, in COVID-19 critical illness survivors.Method: Single-centre prospective observational study in adult survivors of COVID-19 with ≥24 h of ICU admission. Patients were assessed one and 12 months after ICU discharge using the depression subscale of the Hospital Anxiety and Depression Scale and the Davidson Trauma Scale. Differences in isolated and comorbid symptoms of depression and PTSD between patients with and without IMV and predictors of the occurrence and persistence of symptoms of these mental disorders were analysed.Results: Eighty-nine patients (42 with IMV) completed the 1-month follow-up and 71 (34 with IMV) completed the 12-month follow-up. One month after discharge, 29.2% of patients had symptoms of depression and 36% had symptoms of PTSD; after one year, the respective figures were 32.4% and 31%. Coexistence of depressive and PTSD symptoms accounted for approximately half of all symptomatic cases. Isolated PTSD symptoms were more frequent in patients with IMV (p≤.014). The need for IMV was associated with the occurrence at one month (OR = 6.098, p = .005) and persistence at 12 months (OR = 3.271, p = .030) of symptoms of either of these two mental disorders.Conclusions: Comorbid depressive and PTSD symptoms were highly frequent in our cohort of COVID-19 critical illness survivors. The need for IMV predicted short-term occurrence and long-term persistence of symptoms of these mental disorders, especially PTSD symptoms. The specific role of dyspnea in the association between IMV and post-ICU mental disorders deserves further investigation.Trial registration: ClinicalTrials.gov identifier: NCT04422444.

Clinically significant depressive and post-traumatic stress disorder symptoms in survivors of COVID-19 critical illness, especially in patients who had undergone invasive mechanical ventilation, were highly frequent, occurred soon after discharge, and persisted over the long term.

Clonidine for post-traumatic stress disorder: a systematic review of the current evidence.

Background: Clonidine is a centrally acting anti-adrenergic agent that may have applications in post-traumatic stress disorder (PTSD), particularly for sleep.Objective: In this systematic review, we aimed to summarize the effect of clonidine on sleep quality and duration, nightmares, and PTSD symptom severity in adults with PTSD.Method: PubMed (Medline), Embase, PsycINFO, CINAHL, and clinicaltrials.gov were searched up to April 2023. Studies on clonidine use in adult PTSD patients reporting data on the effect on sleep, nightmares, and PTSD symptoms were included. A narrative summary and a meta-analysis of the study findings are presented.Results: Ten reports, accounting for N = 569 patients with PTSD (145 on clonidine and 436 controls), were included in the final selection. There were four case reports, four observational studies, one non-blind clinical trial, and one crossover randomized controlled trial (RCT). Median clonidine dose was 0.15 mg/day (range: 0.1-0.5 mg/day). Median follow-up time was 31 days (range: 3 days to 19 months). The quality of the evidence was rated from very low to low. There was marked between-study heterogeneity and low power in the individual studies, but many reported improved sleep quality, nightmare reduction, and improvement of PTSD symptoms for patients treated with clonidine. Meta-analysis was only possible for two studies reporting the effect of clonidine on nightmares, and showed no difference from the comparator (i.e. prazosin or terazosin) (odds ratio: 1.16; 95% confidence interval: 0.66 to 2.05), potentially pointing towards non-inferiority between these medications.Conclusions: Future research, such as well-powered RCTs, is needed to identify the efficacy in the lower dose range and the most suitable treatment group, and to obtain good evidence on the effects of clonidine in the treatment of sleep disorders related to PTSD.

Post-traumatic stress disorder (PTSD) is associated with hyperarousal and sleep disorders, reflecting adrenergic nervous system involvement.The use of anti-adrenergic drugs to target the sympathetic activation in PTSD is rational. However, previous reports on prazosin, a peripherally acting agent, yielded weak evidence.Clonidine, a central adrenergic antagonist, shows promise in improving sleep, nightmares, and PTSD symptoms, but further research is needed because the quality of the current evidence is low.

Voice Disorder, Job Stress, and COVID-19 in Teachers: Impacts in Times of Pandemic

Introduction: The conditions of teachers' work during the COVID-19 pandemic affected teachers' lives regarding voice disorder and stress, even in emergency remote classroom situation. Objective: To analyze the relationship between the presence of voice disorder, job stress, and COVID-19 in teachers when in emergency remote classroom teaching situation at the time of the pandemic. Method: This is a primary, exploratory, observational cross-sectional study with the use of survey forwarded online during the period of emergency classes after the arrival of COVID-19 pandemic in Brazil. The teachers answered the sociodemographic questions about the presence of COVID-19 and the following instruments: Condition of Vocal Production-Teacher [Condição de Produção Vocal - Professor (CPV-P)], Screening Index for Voice Disorder (SIVD), and Job Stress Scale (JSS). Results: Of the 118 teachers analyzed, 94.1% were female; the average age was 44 years. The SIVD recorded the presence of voice disorder in 66.9% of the participants. Regarding the JSS, which are the findings related to stress at work in the demand domain, the teachers showed high levels, a fact which presupposes the existence of pressure of psychological nature to perform their work. Conclusion: The teachers self-reported the presence of voice disorder even in remote class situation, on the occasion of COVID-19, which were more common in older teachers. When comparing the presence of voice disorders, coronavirus symptoms, and stress domains in relation to demand, control, and social support, there was no significance. It is hoped that this study will help to reflect on the need to improve teachers' working conditions, strengthening work-related voice disorder actions and guiding actions for vocal care and well-being.

Introducción: Las condiciones de trabajo de los profesores durante la pandemia de COVID-19 afectaron sus vidas en lo que respecta al trastorno de la voz y el estrés, incluso en situaciones de emergencia en aulas remotas. Objetivo: Analizar la relación entre la presencia de trastorno de la voz, estrés laboral y COVID-19 en profesores cuando se encontraban en situación de emergencia de enseñanza en aulas remotas en la época de la pandemia. Método: Se trata de un estudio primario, exploratorio, observacional de tipo transversal, con el uso de encuesta remitida online durante el periodo de clases de emergencia tras la llegada de la pandemia de COVID-19 en Brasil. Los profesores respondieron a las preguntas sociodemográficas sobre la presencia de COVID-19 y a los siguientes instrumentos: Condición de Producción Vocal-Profesor (CPV-P), Índice de Detección de los Trastornos de la Voz (SIVD) y Escala de Estrés Laboral (JSS). Resultados: De los 118 profesores analizados, el 94,1% eran mujeres; la mediana de edad era de 44 años. El (SIVD) registró la presencia de trastorno de la voz en el 66,9% de los participantes. En cuanto a la JSS, que son los hallazgos relacionados con el estrés laboral en el dominio de la demanda, los profesores mostraron niveles elevados, hecho que presupone la existencia de presiones de naturaleza psicológica para realizar su trabajo. Conclusión: Los profesores autoinformaron de la presencia de trastornos de la voz incluso en situación de clase a distancia, con ocasión del COVID-19, que fueron más frecuentes en los profesores de más edad. Al comparar la presencia de trastornos de la voz, los síntomas del coronavirus y los dominios de estrés en relación con la demanda, el control y el apoyo social, no hubo resultados significativos. Se espera que este estudio ayude a reflexionar sobre la necesidad de mejorar las condiciones de trabajo de los docentes, fortaleciendo las acciones de Trastorno de la voz relacionado con el trabajo (WRVD) y orientando acciones para el cuidado y bienestar vocal.

Ajuste fino de un modelo de producción vocal para estimar el estrés de impacto utilizando un método metaheurístico

Introducción: En modelos de producción vocal que emplean estructuras de resorte-masa-amortiguador, la precisión en la determinación de coeficientes de amortiguamiento que se asemejen a las características fisiológicas de las cuerdas vocales es crucial, teniendo en cuenta posibles variaciones en la representación de la viscoelasticidad. Objetivo: Este estudio tiene como objetivo realizar un ajuste paramétrico de un modelo de producción vocal basado en un sistema de resorte-masa-amortiguador que incorpora interacción con la presión subglótica, con el fin de modelar de manera precisa las fuerzas de colisión ejercidas por las cuerdas vocales durante la fonación. Método: Se utilizó un algoritmo de búsqueda metaheurística para la síntesis paramétrica. El algoritmo se aplicó a los coeficientes de elasticidad c1 y c2, así como a los coeficientes de amortiguamiento ε1 y ε2, que se correlacionan directamente con las matrices de masa del modelo. Esto facilita el ajuste de la composición de las cuerdas para lograr un comportamiento fisiológico deseado. Resultados: El comportamiento del sistema vocal para cada ciclo de simulación se comparó con un estándar predefinido en condiciones normales. El algoritmo determinó el punto final de la simulación evaluando las discrepancias entre características clave de las señales obtenidas y las deseadas. Conclusión: El ajuste paramétrico permitió la aproximación del comportamiento fisiológico de la producción vocal, proporcionando estimaciones de las fuerzas de impacto experimentadas por las cuerdas vocales durante la fonación.

Introduction: In vocal production models employing spring-mass-damper frameworks, precision in determining damping coefficients that align with physiological vocal fold characteristics is crucial, accounting for potential variations in the representation of viscosity-elasticity properties. Objective: This study aims to conduct a parametric fitting of a vocal production model based on a mass-spring-damper system incorporating subglottic pressure interaction, with the purpose of accurately modeling the collision forces exerted by vocal folds during phonation. Method: A metaheuristic search algorithm was employed for parametric synthesis. The algorithm was applied to elasticity coefficients c1 and c2, as well as damping coefficients ε1 and ε2, which directly correlate with the mass matrices of the model. This facilitates the adjustment of fold composition to achieve desired physiological behavior. Results: The vocal system's behavior for each simulation cycle was compared to a predefined standard under normal conditions. The algorithm determined the simulation endpoint by evaluating discrepancies between key features of the obtained signals and the desired ones. Conclusion: Parametric fitting enabled the approximation of physiological vocal production behavior, providing estimates of the impact forces experienced by vocal folds during phonation.

Salud mental en estudiantes de la Carrera de Kinesiología y Fisioterapia de la Universidad Nacional de Asunción

Introducción: la salud mental es crucial para el bienestar y el rendimiento académico de los estudiantes universitarios. Los estudiantes de Kinesiología y Fisioterapia enfrentan desafíos únicos que pueden afectar su salud mental. Objetivo: determinar la frecuencia de trastornos mentales comunes en estudiantes de kinesiología y fisioterapia de la Universidad Nacional de Asunción. Metodología: se trata de un estudio observacional, descriptivo y transversal. La muestra no probabilística estuvo compuesta por 150 estudiantes de Kinesiología y Fisioterapia de la Universidad Nacional de Asunción. Se recogieron datos sociodemográficos, académicos, ocupacionales, de estilo de vida y psicopatológicos mediante la Escala de Depresión, Ansiedad y Estrés - 21 (DASS-21). El análisis se realizó mediante Jamovi con regresión logística binomial multivariada. Resultados: la frecuencia de depresión, ansiedad y estrés fue del 61,3 %, 72 % y 54,7 %, respectivamente. Los factores importantes para la depresión incluyeron ser un estudiante irregular, trabajar y no realizar actividad física. Para la ansiedad, fueron significativos ser estudiante irregular y ser mujer. Respecto al estrés, se encontraron relevantes ser estudiante irregular, trabajar y no realizar actividad física. Los modelos resultantes tuvieron clasificaciones correctas del 90,2 %, 88 % y 72 % para depresión, ansiedad y estrés, respectivamente. Conclusión: Este estudio reveló una alta frecuencia de depresión, ansiedad y estrés entre estudiantes de kinesiología y fisioterapia, lo que se asoció significativamente con irregularidad académica, empleo y falta de actividad física. Estos hallazgos subrayan la necesidad de implementar estrategias de intervención y programas de apoyo que aborden estos factores de riesgo para promover la salud mental y el bienestar de los futuros profesionales de la salud.

Introduction: mental health is crucial for university students' well-being and academic performance. Kinesiology and Physical Therapy students face unique challenges that can affect their mental health. Objective: to determine the frequency of common mental disorders in kinesiology and physical therapy students at the Universidad Nacional de Asunción. Methodology: this was an observational and descriptive cross-sectional study. The nonprobabilistic sample included 150 Kinesiology and Physiotherapy students from the Universidad Nacional de Asunción. Sociodemographic, academic, occupational, lifestyle, and psychopathological data were collected using the Depression, Anxiety and Stress Scale - 21 (DASS-21). The analysis was performed using Jamovi with multivariate binomial logistic regression. Results: the frequency of depression, anxiety, and stress was 61.3 %, 72 %, and 54.7 %, respectively. The significant factors for depression included being an irregular student, working, and not engaging in physical activity. For anxiety, being an irregular student and being a woman were significant. Regarding stress, being an irregular student, working, and not engaging in physical activity were found to be relevant. The resulting models had correct classifications of 90.2 %, 88 %, and 72 % for depression, anxiety, and stress, respectively. Conclusion: this study revealed a high frequency of depression, anxiety, and stress among kinesiology and physical therapy students, which was significantly associated with academic irregularity, employment, and a lack of physical activity. These findings underscore the need to implement intervention strategies and support programs that address these risk factors in order to promote the mental health and well-being of future health professionals.

Medicolegal assessment of human trafficking victims. Descriptive study of a series of forensic cases in Catalonia (Spain). / Valoración médico-legal de las víctimas de trata de seres humanos. Estudio descriptivo de una serie de casos forenses en Cataluña (España).

BACKGROUND AND OBJECTIVE: Human trafficking or contemporary slavery is the recruitment and transfer of people by force or deception for sexual, labour or other types of exploitation. Although the violence, abuse and deprivation that trafficking entails are a threat to the health of its victims, in Spain the clinical or forensic data available in this regard is scarce. At the Institute of Legal Medicine and Forensic Sciences of Catalonia (IMLCFC), a unit specialized in the forensic assessment of these victims was created. The objective of this work was to describe a series of forensic cases of trafficking victims. MATERIAL AND METHOD: Retrospective study of victims in judicial cases opened for an alleged crime of human trafficking registered in the IMLCFC until 06/30/2023. RESULTS: 57 different victims were registered. The majority were women (71.9%). The average age was 30.5 years (s.d. 10.31). All the victims were foreigners, mostly from Latin America (45.5%). The exploitation was mainly sexual (61.4%). There were some sociodemographic differences and in the conditions and consequences of trafficking between victims of sexual exploitation and the rest. Mental health problems were very common in all victims at the time of the assessment (87.5%). CONCLUSIONS: The consequences of trafficking on health, especially mental health, are notable and the forensic assessment of victims is valuable in judicial proceedings. It is necessary to deepen our knowledge of the phenomenon in our environment.

Complex posttraumatic stress disorder and dissociation in trauma-exposed Chinese adolescents: a latent class analysis.

Background: Preliminary evidence provides support for the proposition that there is a dissociative subtype of Complex posttraumatic stress disorder (CPTSD). Research on this proposition would extend our knowledge on the association between CPTSD and dissociation, guide contemporary thinking regarding placement of dissociation in the nosology of CPTSD, and inform clinically useful assessment and intervention.Objectives: The present study aimed to investigate the co-occurring patterns of CPTSD and dissociative symptoms in a large sample of trauma exposed adolescents from China, and specify clinical features covariates of such patterns including childhood trauma, comorbidities with major depressive disorder (MDD) and generalized anxiety disorder (GAD), and functional impairment.Methods: Participants included 57,984 high school students exposed to the coronavirus disease 2019 (COVID-19) pandemic. CPTSD and dissociative symptoms, childhood traumatic experience, and functional impairment were measured with the Global Psychotrauma Screen for Teenagers (GPS-T). Major depressive disorder (MDD) and generalized anxiety disorder (GAD) symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Latent class analysis (LCA) was employed to test the co-occurring patterns of CPTSD and dissociative symptoms. Analysis of covariance (ANCOVA) and chi-square tests were respectively used to examine between-class differences in continuous and categorical clinical covariates.Results: A 5-class model emerged as the best-fitting model, including resilience, predominantly PTSD symptoms, predominantly disturbances in self-organization (DSO)symptoms, predominantly CPTSD symptoms, and CPTSD dissociative subtype classes. The CPTSD dissociative subtype class showed the lowest level of functioning and the highest rates of MDD, GAD and childhood trauma.Conclusions: Our findings provide initial empirical evidence supporting the existence of a dissociative subtype of CPTSD, and inform for further research and clinical practice on traumatized individuals.

The present study identified a dissociative subtype of ICD-11 CPTSD among trauma exposed youth.The dissociative subtype of ICD-11 CPTSD was associated with poorer mental health outcomes.Findings of this study provide initial empirical evidence supporting the existence of a dissociative subtype of CPTSD.

Do multigenerational homes moderate the intergenerational transmission of maternal adverse childhood experiences?

ABSTRACTBackground: Maternal adverse childhood experiences (ACEs) may lead to increased behavioural problems in children. However, the mediating roles of psychological distress and corporal punishment, two common mechanisms underlying the intergenerational transmission of maternal ACEs, in these relations have not been examined in Chinese samples. Multigenerational homes (MGH) are the dominate living arrangement in China; however, limited research focuses on the effects of MGHs on the intergenerational transmission of maternal ACEs.Objective: This study explored the parallel mediating effects of corporal punishment and psychological distress on the association between maternal ACEs and children's behaviour and whether MGHs can strengthen or weaken the relationship between maternal ACEs and corporal punishment or psychological distress.Participants and setting: Participants were 643 three-year-old children and their mothers (mean age of 32.85 years, SD = 3.79) from Wuhu, China.Methods: Mothers completed online questionnaires measuring ACEs, psychological distress, corporal punishment, their family structure, and children's behavioural problems. This study used a moderated mediation model.Results: The findings suggest that psychological distress and corporal punishment mediate the association between maternal ACEs and children's behavioural problems. The mediating role of corporal punishment was found depend on whether mothers and their children reside in MGHs. MGHs were not found to have a moderating role in the indirect relationship between maternal ACEs and children's behaviour problems via psychological distress.Conclusion: Our findings highlight the importance of addressing psychological distress and corporal punishment when designing interventions targeted Chinese mothers exposed to ACEs and their children, especially those living in MGHs.

Psychological distress and corporal punishment have parallel mediating roles in the associations between maternal adverse childhood experiences and offspring behavioural problems.Mothers with more adverse childhood experiences and in multigenerational homes were more likely to use corporal punishment.Multigenerational homes did not moderate the indirect relationship via psychological distress.