Changes on risky drinking after the COVID-19 outbreak in Brazil: results from three consecutive web surveys.

INTRODUCTION: Risky drinking (RD) is associated with an increased risk of chronic and infectious diseases, injuries, and violence. This study aimed to assess changes in risky drinking (RD) in Brazil after COVID-19 outbreak, both overall and among individuals with self-reported chronic diseases and mental health disorders. METHODS: We conducted three independent, anonymous web surveys in Brazil including adult participants: S1 (April/2020, n=19,257), S2 (August/2020, n=1,590), and S3 (January/2021, n=859). Participants were recruited through adapted snowball sampling and sponsored social network advertisements. RD was assessed using the Alcohol Use Disorder Identification Test-Concise, designed to identify individuals at risk of alcohol-related problems. Logistic regression analyses with bootstrapping (B=2,000) were performed, with stratification by sex, age, education, employment, household size, and the presence of chronic and mental health conditions, as well as lifestyle factors, to address sample imbalances. RESULTS: The estimated prevalence of RD was 45.8% [95%CI 45.5, 46.1] in S1, 35.3% [95%CI 34.9, 35.6] in S2, and 33.7% [95%CI 33.3, 34.0] in S3. Participants with chronic diseases consistently presented lower RD prevalence across all three surveys, compared to those without such conditions. Conversely, individuals with mental health disorders presented higher RD prevalence than those without such diagnoses in S1 and S2, but not in S3. DISCUSSION: Despite the decrease in RD prevalence, monitoring of alcohol consumption trends remains essential for shaping effective public health policies. Additionally, the observed variations among individuals reporting chronic and mental health disorders highlight the need for targeted interventions in future crises.

Tonic immobility is associated with posttraumatic stress symptoms in healthcare professionals exposed to COVID-19-related trauma.

The Coronavirus Disease 2019 (COVID-19) pandemic has exposed healthcare workers (HCW) to traumatic situations that might lead to the development of posttraumatic stress disorder (PTSD). An important vulnerability factor for PTSD is the peritraumatic tonic immobility (TI) reaction, an involuntary and reflexive defensive response evoked by an intense and inescapable threat. TI is largely understudied in humans and has not been investigated during trauma related to COVID-19. For HCW, the pandemic context might be experienced as an intense and potentially inescapable threat, i.e., an overwhelming situation. Here, we investigated if TI response occurred during traumatic events related to the pandemic and its association with posttraumatic stress symptoms (PTSS). An online survey of 1001 HCW investigated COVID-19-related traumatic experiences, TI and PTSS. TI was reported for all types of traumatic events, and multivariate regression models revealed that TI was significantly associated with PTSS severity. HCW who reported high TI scores exhibited an increase of 9.08 times the probability of having a probable diagnosis of PTSD. Thus, TI was evoked by pandemic-related traumatic situations and associated with PTSS severity and higher odds of a PTSD diagnosis. Tonic immobility occurrence should be screened, and psychoeducation about its reflexive biological nature should be introduced.

Vulnerability and Protective Factors for PTSD and Depression Symptoms Among Healthcare Workers During COVID-19: A Machine Learning Approach.

Background: Healthcare workers are at high risk for developing mental health problems during the COVID-19 pandemic. There is an urgent need to identify vulnerability and protective factors related to the severity of psychiatric symptoms among healthcare workers to implement targeted prevention and intervention programs to reduce the mental health burden worldwide during COVID-19. Objective: The present study aimed to apply a machine learning approach to predict depression and PTSD symptoms based on psychometric questions that assessed: (1) the level of stress due to being isolated from one's family; (2) professional recognition before and during the pandemic; and (3) altruistic acceptance of risk during the COVID-19 pandemic among healthcare workers. Methods: A total of 437 healthcare workers who experienced some level of isolation at the time of the pandemic participated in the study. Data were collected using a web survey conducted between June 12, 2020, and September 19, 2020. We trained two regression models to predict PTSD and depression symptoms. Pattern regression analyses consisted of a linear epsilon-insensitive support vector machine (ε-SVM). Predicted and actual clinical scores were compared using Pearson's correlation coefficient (r), the coefficient of determination (r2), and the normalized mean squared error (NMSE) to evaluate the model performance. A permutation test was applied to estimate significance levels. Results: Results were significant using two different cross-validation strategies to significantly decode both PTSD and depression symptoms. For all of the models, the stress due to social isolation and professional recognition were the variables with the greatest contributions to the predictive function. Interestingly, professional recognition had a negative predictive value, indicating an inverse relationship with PTSD and depression symptoms. Conclusions: Our findings emphasize the protective role of professional recognition and the vulnerability role of the level of stress due to social isolation in the severity of posttraumatic stress and depression symptoms. The insights gleaned from the current study will advance efforts in terms of intervention programs and public health messaging.

Unilateral Brachial Plexus Lesion Impairs Bilateral Touch Threshold.

Unilateral brachial plexus injury (BPI) impairs sensory and motor functions of the upper limb. This study aimed to map in detail brachial plexus sensory impairment both in the injured and the uninjured upper limb. Touch sensation was measured through Semmes-Weinstein monofilaments at the autonomous regions of the brachial plexus nerves, hereafter called points of exclusive innervation (PEIs). Seventeen BPI patients (31.35 years±6.9 SD) and 14 age-matched healthy controls (27.57 years±5.8 SD) were tested bilaterally at six selected PEIs (axillary, musculocutaneous, median, radial, ulnar, and medial antebrachial cutaneous [MABC]). As expected, the comparison between the control group and the brachial plexus patients' injured limb showed a robust difference for all PEIs (p ≤ 0.001). Moreover, the comparison between the control group and the brachial plexus uninjured limb revealed a difference for the median (p = 0.0074), radial (p = 0.0185), ulnar (p = 0.0404), and MABC (p = 0.0328) PEIs. After splitting the sample into two groups with respect to the dominance of the injured limb, higher threshold values were found for the uninjured side when it occurred in the right dominant limb compared to the control group at the median (p = 0.0456), radial (p = 0.0096), and MABC (p = 0.0078) PEIs. This effect was absent for the left, non-dominant arm. To assess the effect of the severity of sensory deficits observed in the injured limb upon the alterations of the uninjured limb, a K-means clustering algorithm (k = 2) was applied resulting in two groups with less or more severe sensory impairment. The less severely affected patients presented higher thresholds at the median (p = 0.0189), radial (p = 0.0081), ulnar (p = 0.0253), and MABC (p = 0.0187) PEIs in the uninjured limb in comparison with the control group, whereas higher thresholds at the uninjured limb were found only for the median PEI (p = 0.0457) in the more severely affected group. In conclusion, an expressive reduction in touch threshold was found for the injured limb allowing a precise mapping of the impairment caused by the BPI. Crucially, BPI also led to reduced tactile threshold in specific PEIs in the uninjured upper limb. These new findings suggest a superordinate model of representational plasticity occurring bilaterally in the brain after a unilateral peripheral injury.

Fact or fiction? An event-related potential study of implicit emotion regulation.

Emotion regulation can be achieved through a number of processes. Previous studies have investigated this issue by encouraging individuals to voluntarily change how they think about a situation in order to decrease its emotional impact. However, little is known about automatic regulation processes. The goal of the present study was to investigate whether an "implicit reappraisal strategy" would modulate the Late Positive Potential (LPP) associated to affective picture viewing. Unpleasant pictures, presented as distractors, were shown in two contexts in which a prior description presented them as taken from either movie scenes (fictitious) or real scenes. Results showed that the interference produced by unpleasant pictures under the real context, indexed by reaction time and LPP amplitude, was attenuated under the fictitious context. These results provide evidence for implicit down-regulation of the stimulus relevance during an inattention condition.

Emotion affects action: Midcingulate cortex as a pivotal node of interaction between negative emotion and motor signals.

Affective pictures drive the activity of brain networks and impact behavior. We showed previously that viewing unpleasant pictures interfered in the performance of a basic nonemotional visual detection task. In the present study, we employed functional magnetic resonance imaging to test the hypothesis that behavioral interference may result from the interaction between negatively valenced and motor-related signals in the brain. As in our previous study (Pereira et al., 2006), participants performed a simple target detection task that followed the presentation of unpleasant or neutral pictures. Our results revealed that an unpleasant emotional context modulated evoked responses in several regions engaged by the simple target detection task. In particular, the midcingulate cortex was recruited when participants performed target detection trials during the unpleasant context, and signal responses in this region closely mirrored the pattern of behavioral interference (as revealed via reaction time). Our findings suggest that the midcingulate cortex may be an important site for the interaction between negatively valenced signals and motor signals in the brain and that it may be involved in the implementation of defensive responses, such as freezing.

Regulation of negative emotions in high trait anxious individuals: an ERP study

Literature has shown that failures in the ability to down-regulate negative emotions are the core substrate of anxiety disorders. Previous studies have investigated this issue by encouraging individuals to voluntarily change how they think about a situation in order to decrease its emotional impact. The majority of studies has demonstrated that explicit instructions to reduce negative affect in anxious individuals are usually ineffective. Thus, the goal of the present study was to investigate whether an implicit regulation strategy would modulate electrophysiological activity (Late Positive Potential) associated to affective picture viewing. The Late Positive Potential (LPP) is a sustained positive deflection in the event-related potential that is larger following the presentation of emotional compared to neutral visual stimuli. Participants (low trait anxious - LTA and high trait anxious - HTA individuals) performed an attention task (bar orientation discrimination) while emotional distractive pictures were presented. The task was performed in two different contexts: in the Real context, participants were informed that the distractive pictures had been obtained from real life situations, whereas in the Fictitious context they were told that the pictures had been obtained from movie scenes. In this vein, we encouraged participants to change how they appraised the pictures. Results showed that HTA individuals exhibited larger Late Positive Potential (LPPs) when mutilation pictures were presented in the Real context. Importantly, during the Fictitious one (regulation strategy) the LPP was reduced even in HTA individuals, emphasizing its importance to psychotherapeutic interventions. The present results indicate that HTA individuals are susceptible to modifications in affective contexts.(AU)

Regulation of negative emotions in high trait anxious individuals: an ERP study

Literature has shown that failures in the ability to down-regulate negative emotions are the core substrate of anxiety disorders. Previous studies have investigated this issue by encouraging individuals to voluntarily change how they think about a situation in order to decrease its emotional impact. The majority of studies has demonstrated that explicit instructions to reduce negative affect in anxious individuals are usually ineffective. Thus, the goal of the present study was to investigate whether an implicit regulation strategy would modulate electrophysiological activity (Late Positive Potential) associated to affective picture viewing. The Late Positive Potential (LPP) is a sustained positive deflection in the event-related potential that is larger following the presentation of emotional compared to neutral visual stimuli. Participants (low trait anxious - LTA and high trait anxious - HTA individuals) performed an attention task (bar orientation discrimination) while emotional distractive pictures were presented. The task was performed in two different contexts: in the Real context, participants were informed that the distractive pictures had been obtained from real life situations, whereas in the Fictitious context they were told that the pictures had been obtained from movie scenes. In this vein, we encouraged participants to change how they appraised the pictures. Results showed that HTA individuals exhibited larger Late Positive Potential (LPPs) when mutilation pictures were presented in the Real context. Importantly, during the Fictitious one (regulation strategy) the LPP was reduced even in HTA individuals, emphasizing its importance to psychotherapeutic interventions. The present results indicate that HTA individuals are susceptible to modifications in affective contexts.

Load-dependent modulation of affective picture processing.

Because of the biological significance of emotional stimuli, their processing is considered largely automatic. In the study reported herein, we tested the alternative hypothesis-namely, that the processing of emotional stimuli requires some level of attention. Our experiments utilized highly negative and arousing visual stimuli comprising mutilated bodies. All experiments employed a single task, which consisted of determining whether two peripheral bars were like oriented or not, thereby eliminating potential task-difference confounds that may have contaminated prior studies. Our results revealed that task-irrelevant unpleasant images slowed reaction time during the performance of the main task. Such interference was modulated by task difficulty as well as by alcohol consumption, showing that the processing of emotional visual stimuli is not immune to attentional manipulations. These results suggest that it is essential to utilize attentional manipulations that more fully consume attentional resources in order to demonstrate that the processing of emotional stimuli is resource limited.