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BACKGROUND: Human papillomavirus (HPV)-related oropharyngeal cancer screening is being explored in research studies, but strategies to identify an appropriate population are not established. The authors evaluated whether a screening population could be enriched for participants with oncogenic HPV biomarkers using risk factors for oral HPV. METHODS: Participants were enrolled at Johns Hopkins Hospitals and Mount Sinai Icahn School of Medicine. Eligible participants were either men aged 30 years or older who had two or more lifetime oral sex partners and a personal history of anogenital dysplasia/cancer or partners of patients who had HPV-related cancer. Oral rinse and serum samples were tested for oncogenic HPV DNA, RNA, and E6 or E7 antibodies, respectively. Participants with any biomarker were considered at-risk. RESULTS: Of 1108 individuals, 7.3% had any oncogenic oral HPV DNA, and 22.9% had serum antibodies for oncogenic HPV E6 or E7. Seventeen participants (1.5%) had both oral and blood biomarkers. HPV type 16 (HPV16) biomarkers were rarer, detected in 3.7% of participants, including 20 with oral HPV16 DNA and 22 with HPV16 E6 serum antibodies (n = 1 had both). In adjusted analysis, living with HIV (adjusted odds ratio, 2.65; 95% CI, 1.60-4.40) and older age (66-86 vs. 24-45 years; adjusted odds ratio, 1.70; 95% CI, 1.07-2.70) were significant predictors of being at risk. Compared with the general population, the prevalence of oral HPV16 (1.8% vs. 0.9%), any oncogenic oral HPV DNA (7.3% vs. 3.5%), and HPV16 E6 antibodies (2.2% vs. 0.3%) was significantly elevated. CONCLUSIONS: Enrichment by the eligibility criteria successfully identified a population with higher biomarker prevalence, including HPV16 biomarkers, that may be considered for screening trials. Most in this group are still expected to have a low risk of oropharyngeal cancer.
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Neoplasias Orofaríngeas , Infecções por Papillomavirus , Masculino , Humanos , Papillomavirus Humano , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Prevalência , Boca , Papillomavirus Humano 16/genética , Biomarcadores , Fatores de RiscoRESUMO
X-linked agammaglobulinemia (XLA) is a primary immunodeficiency disorder caused by mutations in the Bruton tyrosine kinase (BTK) gene leading to B lymphocyte deficiency and susceptibility to infection. A potential benefit of earlier diagnosis and treatment initiation on morbidity and mortality in XLA is incompletely understood. In the USIDNET Registry, we describe infection frequency and infection-related mortality in patients with XLA and their relationship to age of diagnosis and treatment initiation. Among the 231 XLA patients enrolled in the Registry, respiratory infections (N = 203, 88%) were the most commonly reported. Among those deceased (N = 20) where cause of death was known (N = 17), mortality was attributed to infection in most (N = 12, 71%). Chronic lung disease, often a consequence of repeated lower respiratory tract infection (LRTI), was also a frequent complication associated with mortality (N = 9, 53%). Age of diagnosis in years was lower for those without LRTI compared to those with (median 1.5 [IQR 0.5-3.3] vs. median 3.0 [IQR 1.0-5.0], p = 0.0026) and among living patients compared to deceased (median 1.8 [IQR 0.5-5.0] vs. median 2.7 [IQR 1.6-6.0], p = 0.04). Age at treatment initiation in years was lower among those without LRTIs compared to those with (median 1.0 [IQR 0.4-2.4] vs. median 2.8 [IQR 1.0-5.4], p = 0.0006). For every year increase in age at start of therapy, the odds of experiencing a LRTI was 1.216 (OR 1.216, 95% CI 1.048-1.411, p = 0.01). Given the expected finding of reduced LRTIs and mortality among those with earlier age at diagnosis, our study findings support inclusion of XLA in newborn screening programs.
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Agamaglobulinemia , Doenças Genéticas Ligadas ao Cromossomo X , Infecções Respiratórias , Tirosina Quinase da Agamaglobulinemia/genética , Agamaglobulinemia/complicações , Agamaglobulinemia/diagnóstico , Agamaglobulinemia/epidemiologia , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico , Doenças Genéticas Ligadas ao Cromossomo X/epidemiologia , Doenças Genéticas Ligadas ao Cromossomo X/genética , Humanos , Recém-Nascido , Mutação , Sistema de Registros , Infecções Respiratórias/epidemiologiaRESUMO
PURPOSE: Healthcare workers are at increased risk for mental health problems during disasters such as the COVID-19 pandemic. Identifying resilience mechanisms can inform development of interventions for this population. The current study examined pathways that may support healthcare worker resilience, specifically testing enabling (social support enabled self-efficacy) and cultivation (self-efficacy cultivating support) models. METHODS: Healthcare workers (N = 828) in the Rocky Mountain West completed self-report measures at four time points (once per month from April to July of 2020). We estimated structural equation models to explore the potential mediating effects that received social support and coping self-efficacy had (at time 2 and time 3) between traumatic stress symptom severity (at time 1 and time 4). Models included covariates gender, age, minority status, and time lagged co-variations between the proposed mediators (social support and coping self-efficacy). RESULTS: The full model fit the data well, CFI = .993, SRMR = .027, RMSEA = .036 [90% CIs (0.013, 0.057)]. Tests of sequential mediation supported enabling model dynamics. Specifically, the effects of time 1 traumatic stress severity were mediated through received social support at time 2 and time 3 coping self-efficacy, in sequential order to reduce time 4 traumatic stress severity. CONCLUSIONS: Findings show the importance of received social support and coping self-efficacy in mitigating psychopathology risk. Interventions can support mental health by focusing on social resource engagement that facilitates coping empowerment, which may decrease risk for mental health job-related problems among frontline healthcare workers exposed to highly stressful events.
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COVID-19 , Pandemias , Adaptação Psicológica , COVID-19/epidemiologia , Cognição , Pessoal de Saúde/psicologia , HumanosRESUMO
OBJECTIVES: Open primary balloon gastrostomy (PBG) presents a potential alternative to percutaneous endoscopic gastrostomy (PEG) in children as it obviates the need for change under general anaesthetic; however, the complication profile of PBG compared to PEG is not well defined. Previous series comparing the two have been hampered by the groups not being equivalent. Our paediatric surgical centre has offered PBG as an alternative PEG since 2014. We used a matched case-control study to compare outcomes for PBG and PEG. METHODS: Patients undergoing PBG were used as "cases" and matched 1:3 by age and diagnosis to patients undergoing PEG, demographics, and clinical data as "controls." Primary outcome was rate of complications classified according to Clavien-Dindo (I-V). Secondary outcomes included time to feed and length of stay. Non-parametric, categorical and multivariate logistic regression analyses were performed. Data here presented as median with interquartile range (IQR). RESULTS: We included 140 patients (35 PBG:105 PEG). The 2 groups were comparable for sex, weight at surgery, and follow-up duration. Median operative time was longer for PBG (43âmin [IQR 36.5-61.5] vs 27.5âmin [18.25-47.75], Pâ<â0.001). Multivariate analysis demonstrated a statistically significant, higher incidence of symptomatic granulation tissue in PBG (10 [29%] vs 6 [6%], Pâ=â0.0008), this remained significant on multivariate analysis (OR 7.56 [2.33-23.5], Pâ=â0.001), no other complication remained significant. The overall complication rate was not statistically different. CONCLUSIONS: PBG and PEG have similar overall complication rates; however, PBG appears to have a higher incidence of granulation tissue. This observation must be weighed against the need for further general anaesthetic which is not insignificant in medically complex children.
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Gastrostomia , Laparoscopia , Estudos de Casos e Controles , Criança , Gastrostomia/efeitos adversos , Humanos , Incidência , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos RetrospectivosRESUMO
BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) feeding can provide long-term nutritional support for patients with a functional gastrointestinal system but insufficient oral intake. Some patients, however, may require jejunal feeding, which can be achieved using a PEG tube with jejunal extension (PEG-J). A previous review at a tertiary paediatric hospital revealed poor documentation and a high incidence of buried bumper syndrome (BBS) in children with gastrostomies. Subsequently, a nurse-led service for gastrostomy care was introduced. AIM: To determine the impact of the nurse-led service. METHODS: Prospective review, at 1 year and 2 years, following either a PEG or PEG-J insertion. Patient records were reviewed and a telephone survey was conducted. Statistical analysis was performed using Fisher's exact test. FINDINGS: 32 PEG and 6 PEG-J patients were included in this study. There was 100% documentation of provision of care instructions. Average satisfaction with the service was over 8/10. Incidence of BBS was 0% in the PEG group and 17% in the PEG-J group. Of those parents/carers surveyed, 74% wanted additional tube care support via SMS text message. CONCLUSION: Introduction of a nurse-led service resulted in complete documentation of provision of care and sustained high levels of parental satisfaction. Future care should focus on utilising technological platforms.
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Nutrição Enteral , Gastrostomia , Criança , Humanos , Intubação Gastrointestinal , Estudos Prospectivos , Estudos RetrospectivosRESUMO
Most prison food research focuses on aspects of consumption rather than production yet farming, horticulture and gardening have been integral to the prison system in England and Wales for more than 170 years. This paper explores the interplay between penological, therapeutic and food priorities over the last fifty years through an examination of historical prison policies and contemporary case studies associated with the Greener on the Outside for Prisons (GOOP) programme. Findings are discussed in relation to how joined-up policy and practice can impact positively on whole population health and wellbeing within and beyond the prison setting.
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Abastecimento de Alimentos/métodos , Promoção da Saúde/métodos , Horticultura Terapêutica/psicologia , Prisioneiros/psicologia , Prisões/organização & administração , Inglaterra , Feminino , Abastecimento de Alimentos/história , Promoção da Saúde/história , História do Século XIX , História do Século XX , História do Século XXI , Horticultura Terapêutica/história , Humanos , Masculino , Prisões/história , Avaliação de Programas e Projetos de Saúde , País de GalesRESUMO
Soil drying and re-wetting (DRW) occurs at varying frequencies and intensities during crop production, and is deliberately used in water-saving irrigation techniques that aim to enhance crop water use efficiency. Soil drying not only limits root water uptake which can (but not always) perturb shoot water status, but also alters root synthesis of phytohormones and their transport to shoots to regulate leaf growth and gas exchange. Re-wetting the soil rapidly restores leaf water potential and leaf growth (minutes to hours), but gas exchange recovers more slowly (hours to days), probably mediated by sustained changes in root to shoot phytohormonal signalling. Partial rootzone drying (PRD) deliberately irrigates only part of the rootzone, while the remainder is allowed to dry. Alternating these wet and dry zones (thus re-wetting dry soil) substantially improves crop yields compared with maintaining fixed wet and dry zones or conventional deficit irrigation, and modifies phytohormonal (especially abscisic acid) signalling. Alternate wetting and drying (AWD) of rice can also improve yield compared with paddy culture, and is correlated with altered phytohormonal (including cytokinin) signalling. Both PRD and AWD can improve crop nutrition, and re-wetting dry soil provokes both physical and biological changes which affect soil nutrient availability. Whether this alters crop nutrient uptake depends on competition between plant and microbes for nutrients, with the rate of re-wetting determining microbial dynamics. Nevertheless, studies that examine the effects of soil DRW on both crop nutritional and phytohormonal responses are relatively rare; thus, determining the cause(s) of enhanced crop yields under AWD and PRD remains challenging.
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Irrigação Agrícola , Dessecação , Fenômenos Fisiológicos da Nutrição/efeitos dos fármacos , Reguladores de Crescimento de Plantas/farmacologia , Solo , Transdução de Sinais/efeitos dos fármacosRESUMO
INTRODUCTION: Immunizing the population is a vital public health priority. This article describes a resident-led continuous quality improvement project to improve the immunization rates of children under 3 years of age at two urban family medicine residency clinics in Salt Lake City, Utah, as well as a break-even cost analysis to the clinics for the intervention. METHODS: Immunization records were distributed to provider-medical assistant teamlets daily for each pediatric patient scheduled in clinic to decrease missed opportunities. An outreach intervention by letter, followed by telephone call reminders, was conducted to reach children under 3 years of age who were behind on recommended immunizations for age (total n=457; those behind on immunizations n=101). Immunization rates were monitored at 3 months following start of intervention. A break-even analysis to the clinics for the outreach intervention was performed. RESULTS: Immunizations were improved from a baseline of 75.1% (n=133) and 79.6% (n=223) at the two clinics to 92.1% (n=163) and 89.6% (n=251), respectively, at 3 months following the start of intervention (P<0.01). The average revenue per immunization given was $81.57. The financial break-even point required 36 immunizations to be administered. CONCLUSION: Significant improvement in the immunization rate of patients under 3 years of age at two family medicine residency training clinics was achieved through decreasing missed opportunities for immunization in clinic, and with outreach through letters and follow-up phone calls. The intervention showed positive revenue to both clinics.
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Análise Custo-Benefício , Medicina de Família e Comunidade/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Promoção da Saúde/métodos , Vacinação/estatística & dados numéricos , Pré-Escolar , Feminino , Seguimentos , Promoção da Saúde/economia , Humanos , Lactente , Masculino , Melhoria de Qualidade , Utah , Vacinação/economiaRESUMO
Involvement in positive leisure activities is a key way for young people to develop resilience and social and emotional skills. This paper outlines the evaluation of a six-week surfing intervention, the Wave Project, which aimed to boost wellbeing and confidence among 84 young people aged eight to 18, all of whom faced mental health issues or social exclusion. The intervention resulted in a significant and sustained increase in wellbeing. One year later, 70% of clients regularly attend a surf club and many have become trained as session volunteers. Parents and referrers noticed an increase in positive attitude and better communication, as well as improved self-management and behaviour at both home and school It is concluded that the Wave Project provides a demonstrable and cost-effective way to deliver mental health care, mentoring and social integration of young people. Further service evaluation of accessibility and long-term outcomes is also recommended.
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Promoção da Saúde/métodos , Atividades de Lazer , Transtornos Mentais/reabilitação , Esportes , Populações Vulneráveis , Adolescente , Criança , Feminino , Humanos , Masculino , Inquéritos e QuestionáriosRESUMO
Individual differences in impulsivity occur at a cognitive and/or behavioural level and are associated with differing life outcomes. However, there is a lack of empirical evidence to support the long-term stability of these characteristics in non-human animals. This study reports on the stability of convergent measures of impulsivity in domestic dogs assessed more than 6 years apart. Measures were (1) owner assessment by means of a questionnaire, the validated 'Dog Impulsivity Assessment Scale' (DIAS) and (2) dogs' performance in a delayed reward choice test. Dogs had 15-min free access to two food dispensers, one dispensing a piece of food immediately, the other dispensing three pieces after a delay, which increased by 1 s every other time the dogs sampled it. Maximum delay reached in this task reflects decision-making, or cognitive impulsivity, whereas the rate of extra presses on the delayed reward device during the delay can be considered as a measure of motor or behavioural impulsivity. DIAS scores were strongly and significantly correlated across years. The maximum delay reached in the behaviour test was also highly stable, whereas paw-pressing rate was uncorrelated between the years. These results demonstrate that cognitive but not motor impulsivity is highly consistent over time in dogs.
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Cães/psicologia , Comportamento Impulsivo , Envelhecimento/psicologia , Animais , Comportamento de Escolha , RecompensaRESUMO
BACKGROUND: Current treatments for people with obesity emphasise the need for person-centred approaches that consider complex biopsychosocial factors and value the lived experience of people when attempting to lose weight. METHODS: Narrative interviews (n = 20) were conducted with people living with obesity to explore the causes of their weight gain and their expectations and engagement with treatment at a Weight Management Clinic. A mixed inductive and deductive qualitative analysis identified utterances that represented psychological constructs used to understand self-appraisal and health behaviour. A narrative analysis was used to situate these findings in the context of a participant's life story. RESULTS: Locus of control was a dominant construct evidenced through a person's attributional style and self-efficacy. Transcripts represented a heightened sense of self-understanding and shifts in control, and styles of attribution and efficacy resulted in either stasis or self-actualisation. The Stages of Change model could be applied to narratives to ascertain a patient's motivation to access treatment. Importantly, narrative interviews also allowed for the consideration of how a person's systemic context influenced their weight. CONCLUSION: Narrative interaction supports both self- and shared understandings of the causes and consequences of obesity for individuals, in a non-blaming or shaming manner. It provides an opportunity to enhance engagement through tailored, person-centred treatments.
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The ability of fungi to establish mycorrhizal associations with plants and enhance the acquisition of mineral nutrients stands out as a key feature of terrestrial life. Evidence indicates that arbuscular mycorrhizal (AM) association is a trait present in the common ancestor of land plants,1,2,3,4 suggesting that AM symbiosis was an important adaptation for plants in terrestrial environments.5 The activation of nuclear calcium signaling in roots is essential for AM within flowering plants.6 Given that the earliest land plants lacked roots, whether nuclear calcium signals are required for AM in non-flowering plants is unknown. To address this question, we explored the functional conservation of symbiont-induced nuclear calcium signals between the liverwort Marchantia paleacea and the legume Medicago truncatula. In M. paleacea, AM fungi penetrate the rhizoids and form arbuscules in the thalli.7 Here, we demonstrate that AM germinating spore exudate (GSE) activates nuclear calcium signals in the rhizoids of M. paleacea and that this activation is dependent on the nuclear-localized ion channel DOES NOT MAKE INFECTIONS 1 (MpaDMI1). However, unlike flowering plants, MpaDMI1-mediated calcium signaling is only required for the thalli colonization but not for the AM penetration within rhizoids. We further demonstrate that the mechanism of regulation of DMI1 has diverged between M. paleacea and M. truncatula, including a key amino acid residue essential to sustain DMI1 in an inactive state. Our study reveals functional evolution of nuclear calcium signaling between liverworts and flowering plants and opens new avenues of research into the mechanism of endosymbiosis signaling.
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Evolução Biológica , Sinalização do Cálcio , Marchantia , Medicago truncatula , Micorrizas , Simbiose , Medicago truncatula/microbiologia , Medicago truncatula/metabolismo , Medicago truncatula/genética , Micorrizas/fisiologia , Marchantia/metabolismo , Marchantia/genética , Marchantia/fisiologia , Raízes de Plantas/microbiologia , Raízes de Plantas/metabolismo , Embriófitas/metabolismo , Embriófitas/fisiologia , Núcleo Celular/metabolismoRESUMO
This meta-analysis of 160 semiconductor crystals that were grown in microgravity on orbital vehicles between 1973 and 2016 is based on publicly available information documented in the literature. This analysis provides comparisons of crystal metrics including size, structure quality, uniformity, and improved performance between crystals grown in microgravity or terrestrially. Improvement in at least one of these metrics was observed for 86% of those materials that included data in their studies.
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Introduction: Attention Deficit Hyperactivity Disorder (ADHD) affects up to 5% of the population and is characterised by symptoms of impulsivity, hyperactivity and inattention. These symptoms are significantly impairing and carry additional risks for children and adults with ADHD, including negative mental health (e.g. depression), physical health (e.g. obesity) and societal outcomes (e.g. imprisonment, divorce). Very few studies have attempted to synthesise these risks in one publication due to the breadth of evidence published on the adverse outcomes of ADHD. Methods: An umbrella review was performed to identify reviews (systematic, meta-analysis and narrative) that investigate the risks arising from having ADHD. We conducted a narrative synthesis of the findings and conducted a quality review of the included publications. Results: Upon searching five databases, 16,675 records were identified. Of these, 125 reviews met the criteria for inclusion. A narrative synthesis of these findings highlighted three key domains of risks associated with ADHD: mental health, physical health, social and lifestyle. Most reviews were of good and moderate quality. Discussion: This review highlights the many risks associated with having ADHD, beyond its three key symptom domains and the impact of the condition on daily functioning. Registration: International Prospective Register of Systematic Reviews (PROSPERO CRD42023404073).
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OBJECTIVE: We examined the impact of health care workers' (HCWs) adjustment to the COVID-19 pandemic on their work-related attitudes and behaviors. METHODS: HCWs ( n = 1468) participated in an observational longitudinal study in which they completed surveys of anxiety and occupational health between 2020 and 2021. RESULTS: Most HCWs reported anxiety that was consistently below the diagnostic threshold (68%) or fell below the threshold within a year (16%). Others reported consistently high (14%) or increasing (2%) anxiety, especially women, younger HCWs, those with a weakened immune system, and allied health professionals. Consistently high or increasing anxiety was associated with poorer job satisfaction, work engagement, perceived supervisor support, burnout, and turnover intentions. CONCLUSIONS: Resources to support HCWs may be focused on those who report consistently high or increasing anxiety to minimize the effects of crises and disasters on the workforce.
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Ansiedade , Atitude do Pessoal de Saúde , Esgotamento Profissional , COVID-19 , Pessoal de Saúde , Satisfação no Emprego , SARS-CoV-2 , Local de Trabalho , Humanos , COVID-19/psicologia , COVID-19/epidemiologia , Feminino , Masculino , Adulto , Pessoal de Saúde/psicologia , Pessoa de Meia-Idade , Estudos Longitudinais , Ansiedade/epidemiologia , Ansiedade/psicologia , Local de Trabalho/psicologia , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Inquéritos e Questionários , Reorganização de Recursos Humanos/estatística & dados numéricos , Adaptação Psicológica , Pandemias , Engajamento no TrabalhoRESUMO
INTRODUCTION: Sex workers, who provide sexual or erotic acts in exchange for payment, often experience multiple disadvantages, including mental ill health and substance misuse. Mainstream healthcare services are generally not configured to facilitate engagement with sex workers and therefore, services are needed that are accessible to this population. The aim of this scoping review is to understand the evidence base for approaches, services and interventions that are aimed at addressing sex workers' health needs. METHODS AND ANALYSIS: Nine databases, CINAHL, Embase, EThOS, Google Scholar, Health Management Information Consortium, MEDLINE, ProQuest Dissertations and Theses, PsycINFO and Web of Science (Core Collection), will be searched, with results limited to English language publications and those published from 2003 onwards. De-duplication, study selection and data extraction will be conducted using Covidence software. Included studies will describe or evaluate approaches, services or interventions that address the health needs of sex workers who offer services that involve physical contact with a client. ETHICS AND DISSEMINATION: No ethical review is needed. The final report will be shared with Birmingham City Council as part of ongoing work and will be disseminated by peer-reviewed publication. STUDY REGISTRATION: Open Science Framework (doi: 10.17605/OSF.IO/N7WSX).
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Profissionais do Sexo , Humanos , Atenção à Saúde/métodos , Serviços de Saúde , Saúde Mental , Instalações de Saúde , Literatura de Revisão como AssuntoRESUMO
OBJECTIVE: Online patient-reported outcome measures (PROMs) enable remote collection of perceptions of health status, function, and well-being. We aimed to explore patterns of PROM completion in patients with early inflammatory arthritis (EIA) recruited to the National Early Inflammatory Arthritis Audit (NEIAA). METHODS: NEIAA is an observational cohort study design; we included adults from this cohort with a new diagnosis of EIA from May 2018 to March 2020. The primary outcome was PROM completion at baseline, 3 months, and 12 months. Mixed effects logistic regression and spatial regression models were used to identify associations between demographics (age, gender, ethnicity, deprivation, smoking, and comorbidity), clinical commissioning groups, and PROM completion. RESULTS: Eleven thousand nine hundred eighty-six patients with EIA were included, of whom 5331 (44.5%) completed at least 1 PROM. Patients from ethnic minority backgrounds were less likely to return a PROM (adjusted odds ratio [aOR] 0.57, 95% CI 0.48-0.66). Greater deprivation (aOR 0.73, 95% CI 0.64-0.83), male gender (aOR 0.86, 95% CI 0.78-0.94), higher comorbidity burden (aOR 0.95, 95% CI 0.91-0.99), and current smoker status (aOR 0.73, 95% CI 0.64-0.82) also reduced odds of PROM completion. Spatial analysis identified 2 regions with high (North of England) and low (Southeast of England) PROM completion. CONCLUSION: We define key patient characteristics (including ethnicity) that influence PROM engagement using a national clinical audit. We observed an association between locality and PROM completion, with varying response rates across regions of England. Completion rates could benefit from targeted education for these groups.
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Artrite , Etnicidade , Adulto , Humanos , Masculino , Grupos Minoritários , Comorbidade , Medidas de Resultados Relatados pelo PacienteRESUMO
OBJECTIVE: The current studies explored associations between exposure to potentially morally injurious events (PMIEs) and mental health outcomes among frontline workers affected by the coronavirus pandemic. METHOD: We administered online self-report surveys to emergency responders (N = 473) and hospital personnel (N = 854) in the Rocky Mountain region of the United States between April and June of 2020. Surveys assessed frequency and intensity of exposure to PMIEs alongside psychological and functional outcomes. RESULTS: Between 20% and 30% of frontline workers reported exposure to PMIEs of at least moderate frequency and intensity. Exposure to more intense PMIEs was associated with greater psychological symptoms (i.e., stress, depression, and anxiety) and functional impairment (i.e., professional burnout), especially among emergency responders who reported frequent exposure but also hospital workers who reported few exposures. CONCLUSION: Efforts to facilitate and maintain the well-being of the public health workforce should specifically address critical incidents encountered by frontline workers that have embedded moral and ethical challenges. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Infecções por Coronavirus , Coronavirus , Humanos , Estados Unidos , Pandemias , Infecções por Coronavirus/psicologia , Ansiedade , Avaliação de Resultados em Cuidados de Saúde , Pessoal de Saúde/psicologiaRESUMO
BACKGROUND: Perinatal mental health difficulties affect up to 27% of birthing parents during pregnancy and the first postnatal year, and if untreated are associated with difficulties in bonding and long-term adverse outcomes to children. There are large evidence gaps related to psychological treatment, particularly in group therapy approaches and parent-infant interventions. One intervention showing preliminary efficacious findings and user acceptability is Circle of Security-Parenting (COS-P), which is a brief, weekly, group programme. However, these studies were underpowered and predominantly non-randomised, and there has never been a research trial in England or with birthing parents experiencing severe and complex perinatal mental health difficulties. The aim of the research is to conduct a randomised control trial to test whether COS-P will reduce perinatal mental health symptoms in birthing parents accessing NHS perinatal mental health services, compared to treatment as usual (TAU). Secondary objectives include exploring whether the intervention improves parenting sensitivity, emotion regulation skills, attachment security and infant development. Additionally, the project aims to examine whether the intervention is acceptable to parents and NHS staff, and whether it is cost-effective. METHODS: COSI is an individually randomised, single-blind parallel arm controlled trial with an embedded internal pilot aiming to recruit 369 participants in a 2:1 ratio (intervention: TAU). Participants will be recruited from ten NHS community perinatal mental health services in England and screened based on clinical levels of both mental health symptoms (average CORE-OM score ≥ 1.1) and postnatal bonding difficulties (total PBQ score ≥ 12). This trial has 90% power to detect a MCID of 5 points on the CORE-OM. Primary and secondary outcomes will be measured at baseline, 3, 7 and 12 months after baseline. Service use and quality of life measures will also be collected alongside a process evaluation of parents' and interveners' views and experiences. DISCUSSION: This will be the first large pragmatic trial to test whether COS-P is effective for birthing parents with severe and complex perinatal mental health difficulties in improving their mental health symptoms. If shown to be effective, the intervention could be delivered widely across the NHS and other similar services globally. TRIAL REGISTRATION: ISRCTN, ISRCTN18308962. Registered 18 February 2022.