Corrigendum to “Protocol for an Exploratory RCT of the Traumatic Stress Relief Intervention With Persons With Lived Experience of Leprosy in Addis Ababa, Ethiopia”

Traffic police officers represent a critical occupational group with high vulnerability to vehicular air pollution, a severe environmental health threat in rapidly urbanizing metropolises such as Addis Ababa. This cross-sectional study explored occupational exposure, protective practices, health risks, perceptions, and awareness of air-quality-associated health risks among 120 traffic police officers in Addis Ababa. The officers were mostly male (80%) and married (93.3%), with the majority (62.6%) having served for more than ten years. While vehicle emissions were consistently recognized as the main source of air pollution, critical knowledge gaps were identified, i.e., only 24.2% had received pollution-related training, fewer than half (45.8%) were aware of government policies, and just 9.2% reported collaboration with environmental authorities. Awareness of the Air Quality Index (AQI) was generally low, and regular monitoring of AQI was limited. Self-reported health symptoms were highly prevalent among participants, with cough (75.0%), eye irritation (61.7%), sneezing (58.3%), and runny nose (55.8%) being the most frequently reported. Notably, sneezing, runny nose, eye irritation, and psychological stress showed significant association with perceived pollution levels at the workplace (p < 0.05), while blood pressure, cough, difficulty concentrating, and sleep loss were not significantly associated (p > 0.05). A higher prevalence of symptoms was generally observed in groups experiencing moderate-to-very high levels of pollution. Protective measures were applied inconsistently; while 63.3% of participants reported using masks, their beliefs about the effectiveness of using masks varied. Relocation (60%) and use of face covers/glasses (13.3%) were less commonly practiced. Overall, traffic police officers are exposed to occupational air pollution, which is associated with various health symptoms. These findings highlight the need for enhanced training, clearer communication of policies, stronger institutional engagement, the provision of standardized protective masks, and the promotion of AQI utilization to reduce occupational health risks and safeguard the wellbeing of traffic police officers in Addis Ababa.

Background: Despite the growing health needs of adolescents due to intrinsic and extrinsic factors, health services in developing countries are not prepared to provide appropriate care due to inadequate awareness of adolescent health needs, and inadequate training and capacity of the service providers. Methods: A cross-sectional survey, to assess adolescents’ health service utilization pattern, their attitudes towards the existing health services and their preferences was conducted in selected schools in Addis Ababa using an anonymous self-administered questionnaire. Results: A total of 2,647 students from 13 high schools participated in the study. Of these, 1,177(44.5%) were males and 1,470(55.5%) were females. Considerable proportion of the adolescents reported that existing health services are inaccessible (30.5%), unaffordable (20.2%) and unacceptable (24.2%). The major barriers to utilizing reproductive health services are feeling of embarrassment (72.0%) and fear of being seen by parents or people who know them (67.8%). Adolescent’s preference regarding the service place and person serving varies widely; but the majority prefers special service hours designated for adolescents (70.1%), and a discounted price or free service (80.0%). Disclosing reproductive health problems and mental stress to parents, and seeking appropriate medical care for these problems is much less likely compared to other non-reproductive physical health problems. Conclusion: Adolescents are less likely to utilize existing health services when facing reproductive health problems and suffering from mental stress. Innovative and youth friendly approaches with due consideration of the heterogeneity of their needs should be adapted in order to increase accessibility and utilization of appropriate health services. [Ethiop.J.Health Dev. 2005;19(1):29-36]

1. Public Mental Health, Traumatic Stress and Human Rights Violations in Low-Income Countries: A Culturally Appropriate Model in Times of Conflict, Disaster and Peace J.T.V.M. De Jong. 2. The Cambodian Experience W.A.C.M. Van de Put, M. Eisenbruch. 3. Community Based Psychosocial and Mental Health Services for Southern Sudanese Refugees in Long-Term Exile in Uganda N. Baron. 4. Psychosocial Consequences of War - Northern Sri Lankan Experience D. Somasundaram, C.S. Jamunanantha. 5. Addressing Human Rights Violations: A Public Mental Health Perspective on Helping Torture Survivors in Nepal M.H. Van Ommeren, et al. 6. Addressing the Psychosocial and Mental Health Needs of Tibetan Refugees in India E. Ketzer, A. Crescenzi. 7. Community Mental Health as Practiced by the Gaza Community Mental Health Programme S. Qouta, E. el Sarraj. 8. Walks in Kaliti, Life in a Destitute Shelter for the Displaced in Addis Ababa L. Aptekar, R. Giel. 9. Terrorism, Traumatic Events and Mental Health in Algeria M.A.A. Sidhoum, et al. 10. How can participation on the community and traditional healers improve primary health care in Kinshasa, Congo? J. Le Roy.

Objectives: Neglected tropical diseases (NTDs), such as leprosy, significantly impact mental health and overall well-being. This study aims to evaluate the effectiveness and acceptability of a mental health intervention targeting individuals affected by leprosy in Ethiopia. The intervention utilizes the Traumatic Stress Relief (TSR) program to target symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression, and to improve overall mental health.Methods: This exploratory randomized controlled trial (RCT) will recruit participants with lived experiences of leprosy. Participants will receive four group sessions of a low-intensity TSR intervention. The intervention will be administered by a pair of trained facilitators, including one mental health practitioner and one community member with lived experience of leprosy. Data will be collected through self-report questionnaires to assess changes in PTSD symptoms, anxiety, and depression. In addition, interviews will provide further insights into participants' experiences and the acceptability of the intervention.Discussion: This exploratory trial will provide insights into the feasibility of mental health interventions for individuals affected by leprosy. The findings will inform the design of future trials to evaluate the effectiveness of such programs on a larger scale and in more diverse contexts.Trial Registration: The UK's Clinical Study Registry: ISRCTN868254411

Introduction: Sexual and physical abuse against children and adolescents are major public health and social problems around the world. Child physical and sexual abuses occur in all cultural, socio economic, educational, racial and ethnic groups. The high prevalence and the devastating negative consequences of sexual and physical abuse initiate research inquiry in the intervention and treatment aspects of the problem. Objective: This study examined whether Trauma Focused Cognitive Behavioral Group Therapy (TF-CBGT) is effective in treating both sexually and physically abused children among Kechene and OPRIFS (Organization for Prevention, Rehabilitation and Integration of Female Street Children) Children’s home. Methods: It is a control group’s pretest-posttest quasi-experimental design. Sixty female participants aged 8 to 18 were selected purposefully. So as to make equivalent in terms of their score of child post traumatic stress symptoms scale and types of abuse they experienced, participants were divided in to treatment and control group. The treatment group received TF-CBGT for 3 sessions a week for a total of 12 contacts. Child posttraumatic stress disorder symptoms scale (CPSS) used to measure post traumatic stress symptoms of participants. Test was conducted before the treatment, just after the treatment and 15 days after the treatment. Results: TF-CBGT is potentially effective in reducing symptoms of posttraumatic stress disorder from pretest to posttest measures. However, it is recommended to conduct a large scale study with more sample size and diversity to expand the findings of this study.

Background: The outbreak of coronavirus infectious disease-19 (COVID-19) is a public health emergency of international concern. The epidemic has brought not only the risk of being infected and death but also unbearable psychological impact like anxiety and depression. The aim of this study was investigating the psychological status and behavior changes of the public during COVID-19 epidemic. Methods: None randomly selected 300 respondents were recruited voluntarily and completed questionnaire. We used the StateTrait Anxiety Inventory, Self-rating Depression Scale, and Symptom Checklist-90 to evaluate psychological status. We also investigated respondents’ behavior changes. Quantitative data were analyzed by t-tests or analysis of variance, and classified data were analyzed with chi-square tests. We describe the qualitative data by interviewing medical doctors who are working at referral hospitals and designated COVID-19 treatment center in Addis Ababa. Result: More respondents had state anxiety than trait anxiety (46.7% vs. 30.0%). Mild, moderate and severe depression was found among 28.1%, 7.2% and 1.4% of respondents respectively and 27.4% had psychological abnormalities. Our analysis of the relationship between subgroup characteristics and psychological status showed that age, occupation, income level, knowledge about COVID-19, Place where the participants’ lives and confidence about overcoming the outbreak significantly influenced psychological status. Around 84.1% of respondents were avoided and significantly reduce going to public places than in previous years. 91.8 % of respondents reduced visiting families, relatives, friends and holyday-related activities during Eastern and Arafa. Conclusion: COVID-19 not only causes physical health concerns but also results in a number of psychological problems. We need to pay more attention to public psychological stress, especially among young people as they are likely to experience anxiety, depression, and psychological abnormalities.

INTRODUCTION: Surgical resection, though the most optimal treatment for lung cancer induces immunosuppression that can lead to unfavorable outcomes such as tumor recurrence. High psychological stress and sociodemographic factors can further exacerbate outcomes. Chronic stress and sociodemographic factors are significant contributors to dysregulated psycho-immune outcomes. A paucity of literature evaluating the relationship between psychological stress and inflammation exists prospectively among lung cancer patients undergoing surgical resection and personal-level factors that are associated with these outcomes. OBJECTIVE: To examine the relationship between levels of inflammation and psychological stress and the association between sociodemographic factors and psychological stress and inflammation before and after surgical resection for lung cancer. METHODS: We used a prospective pre- and post-test design to study clinically recruited early stage I and II non-small cell lung cancer patients. Inflammation and psychological stress were evaluated preoperatively and 2-weeks postoperatively. Inflammatory markers interlukin-6 and C-reactive protein were assessed via venipuncture and laboratory assay testing. Psychological stress was evaluated through self-report using the 15-item Impact Events Scale to evaluate traumatic stress. A score of 30 or greater is indicative of high traumatic stress. Correlation and bivariate analyses were used to examine the association between levels of psychological stress, inflammation and sociodemographic factors. RESULTS: Of the 21 patients who participated, the majority were smokers (87%), white (93%), married (60%), had a college education or greater (60%), and an annual household income of less than $50,000 (53%). Mean levels of psychological stress decreased and levels of inflammation increased following resection; however, overall levels of psychological stress and inflammation were low preoperatively (M=27.40) and postoperatively (M=24.13). The mean changes in stress and inflammation from pre- to postoperatively were not significant. Effect size analyses revealed a small effect between mean differences in pre- and postoperative stress and inflammation. No relationship between psychological stress and inflammation was found pre- or postoperatively. When we examined associations between levels of traumatic stress and depressive symptoms, we found that those with high stress also had high depressive symptoms. When we examined sociodemographic factors, a lower income level was significantly associated with higher baseline inflammation levels preoperatively (P=0.02). CONCLUSIONS: This exploratory study was a necessary initial step for establishing preliminary estimates and feasibility data for a novel area of research. A more longitudinal examination among a larger diverse sample of patients is needed in order to further assess the nature and course of psychological stress and inflammation and its long-term impact on quality of life and survival. Due to the perceived self-inflicted and internal causal nature of the diagnosis of lung cancer, patients may perceive less stress and have better coping because of their smoking behavior. Future studies will include both a biological marker of stress (such as cortisol) along with self-report data to evaluate psychological stress more expansively in order to better screen for psychological and inflammatory deficits. Citation Format: Melanie Jefferson, Marvella Ford, Heather Bonilha, Elizabeth Garrett-Mayer, Chanita Hughes-Halbert. An exploratory study examining the acute phase impact of resection on biological and psychological markers of stress among early stage non-small cell lung cancer patients. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A50.

Traumatic brain injury (TBI) is a major source of morbidity and mortality within current war zones. On the other hand, psychological disorders such as post‐traumatic stress disorder (PTSD) are emerging as the major career limiting factors for combat soldiers. A knowledge‐driven unbiased panel of signatures to discriminate between psychological stress and TBI is essential for designing precise care management. Towards this objective, the present study was conducted in the fecal microbiome in rats maintained on diets with varied polyunsaturated fat compositions, intended to nutritionally influence their vulnerabilities to these insults. Emerging knowledge has suggested a role of TBI and psychological stress in alterations of the gut microbiota architecture leading to bacterial translocation. However, the biological importance of these alterations in traumatic injury or stress is not well understood. To determine how the shift in the microbiome population is coordinated with the traumatic injury and stress responses, two animal models were chosen. A closed‐head TBI model consisting of blast overpressure (BOP) wave exposure coupled with a weight drop concussion (Marmarou method) was used on a group of rats selected to receive TBI. The anesthetized animals were subjected once to BOP (18 psi) inside an Advanced Blast Simulator (ABS), which was then immediately followed by dropping a 500‐gram metal weight from 125 cm above onto a stainless steel disc affixed to the rat's skull midway between lambda and bregma. Shams received anesthesia. In parallel, an independent group of rats was subjected to an underwater trauma (UWT) stressor model that consisted of 30s of swimming and habituation, followed by 30s of forced whole body immersion. Shams received 1min of free swimming. Existing literature and our data shows that UWT elicits PTSD‐like features in rats (e.g. prolonged “anxiety” behaviors). Before TBI or UWT, animals were maintained for 6 weeks and continued thereafter on three different diets: (i) Standard house chow; (ii) Custom chow enriched with 1% of calories as Linoleic acid (LA) and (iii) Custom chow enriched with 8% LA. Unlike the house chow, the two custom diets contained no long chain ω‐3 polyunsaturated fatty acids (PUFAs) to offset their high LA (ω‐6 PUFA) content.The fecal bacterial populations were characterized by identification of 16S ribosomal RNA sequencing. Principal Coordinate Analysis (PCoA) showed clear separation between phylogenetic profiles linked to TBI and UWT, respectively; however, only TBI showed some distinctions from their corresponding shams. Within each group, TBI or UWT, the phylogenetic profile linked to rodents fed on house chow showed diversion from the other two diet groups. No significant separation was observed between rats fed on either the 1% or 8% LA enriched diets that were absent in long chain omega‐3 PUFAs.We will further investigate genomic alterations within tissues that can be attributed to the different traumatic injury and stress factors and diet compositions. Final deliverable will articulate the role of the gut‐brain axis in different traumatic injury and stress conditions while also defining how fecal microbial signatures can discriminate between the features linked to TBI and psychological stress.Support or Funding InformationMOMRPThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Objective To explore the effects of early psychological trauma and corticotropin-releasing factor receptor 1(CRHR1) gene polymorphism on working memory. Methods 1 534 healthy adult volunteers were recruited and divided into 3 groups according to whether ever being exposed to the Tangshan earthquake in their early life: infant exposure group (IEG, n=176), fetal exposure group (FEG, n=172), and control group (n=182). The fetal exposure group was further divided into three subgroups: exposure in the first trimester (1~3months, n=50), exposure in the second trimester (4~6months, n=59), and exposure in the third trimester (7~9months, n=63). Brief Visuospatial Memory Test-Revised (BVMT-R) and Hopkins Verbal Learning Test-Revised (HVLT-R) were used to measure their working memory. The DNA extracted from the peripheral blood were analyzed to determine the CRHR1 rs242924 and rs7209436 gene polymorphism real-time PCR.The CRHR1 genotype was further divided into two groups: A/T gene carrier and C gene carrier. Possible interactions between psychological impact of the earthquake in early life time and the CRHR1 genotype were explored. Results The total scores of BVMT-R in the FEG and IEG groups were significantly lower than that in the control group; The total BVMT-R scores of the CRHR1 C gene carriers in the IEG and FEG groups were significantly lower than that in the control group (22.5±8.1 vs. 28.9±5.7; t=-4.231, P 0.05). Conclusions The early psychological traumatic stress after earthquake exposure may contribute to the adulthood visual spatial memory decline, which may be explained partly by the interaction of the early psychological stress with the CRHR1 vulnerable genotype. Key words: Natural disasters; Stress; Polymorphism, single nucleotide; Visuospatial memory; Corticotropin-releasing factor receptor 1

Objective The purpose of this study was to examine the contribution of maternal financial, emotional, traumatic, and partner-associated stressors on breastfeeding initiation and duration. Methods Data (216,756 records) from the Pregnancy Risk Assessment Monitoring System surveys were used in the analysis. Logistic regressions were conducted to estimate the magnitude and direction of associations between maternal stressors occurring in the 12 months prior to infant birth and both breastfeeding initiation and duration up to 4 weeks infant age. Results A substantial proportion of mothers (42%) reported having experienced one or two major stressors during the 12 months prior to the birth of their infant. Mothers who reported at least one major life stressor in the year before their baby was born were less likely to initiate breastfeeding and more likely to cease by 4 weeks infant age. Emotional and traumatic stressors were found to have the greatest impact on breastfeeding outcomes. Conclusions Findings support the design and implementation of screening protocols for major maternal life stressors during regularly scheduled prenatal and newborn visits. Screening for at-risk mothers may lead to more targeted anticipatory guidance and referral with positive effects on breastfeeding outcomes and overall well-being of the mothers and their families.

Psychological Stress–Induced Immune Response and Risk of Alzheimer's Disease in Veterans from Operation Enduring Freedom and Operation Iraqi Freedom

Transcutaneous cervical vagal nerve stimulation reduces sympathetic responses to stress in posttraumatic stress disorder: A double-blind, randomized, sham controlled trial

Since observing customers outnumber focal customers in most service interactions, service managers aim to engage them despite triggers, such as service incivility. This research contributes to the understanding of the role of stress in observing customers' engagement (CE). It answers two RQs: (1) What is the relationship between their stress and engagement?; (2) What are the triggers of stress? Since ethnically different people pay different levels of attention to contextual and social factors, two sequential scenario‐based experiments are adopted to study two triggers of stress (i.e., availability of information about an incivility incident, and ethnic similarity between the observing customer and the mistreated employee), which impacts CE in an intercultural service encounter. Study 1 compares being exposed to full versus partial information and demonstrates that full information about the incivility incident increases observers' psychological stress, which reduces their behavioral and emotional engagement. Study 2 compares how white and black observers react to ethnic similarity between the observing customer and the mistreated employee. Results show that incivility triggers outward psychological stress in white and black observers. In turn, black observers' outward stress reduces their behavioral engagement, while white observers' behavioral engagement is reduced by both their inward and outward stress.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder. It is often reported to be worsened by psychological stress. To explore the role of psychological stress and related triggers in AD, and its connection to worsening of this disease, focusing on patients' perspectives. In total, 28 patients with AD were included in focus groups. Topics regarding psychological stress and psychological triggers were discussed. The hypothesis that psychological stress may have impact on eczema and its pruritus was supported by all of the patients. Distinguishing the worsening effect of psychological stress from effects of physiological triggers, such as infection, climate and allergic factors, was claimed to be difficult by many patients. Most of the patients thought that chronic stress affected the AD more when compared to acute stress. Family problems, financial problems, work overload, school exam periods, lack of structure at work, and unforeseen events were identified as important psychological triggers. Conventional treatment/therapy with topical corticosteroids and emollients, UV light treatment, were suggested as possible treatments, as well as psychological intervention and physical exercise. Psychological stress is an important factor to consider in the management of patients with AD. In particular, chronic stress tends to worsen AD. The type of stress can possibly also affect the quality of the pruritus experienced by the patients. Unforeseen events and decision making were frequently mentioned as important triggers. Furthermore, physical exercise was reported to provide beneficial effects.

Great advances have been made in our understanding of Takotsubo syndrome in the past decade, but the aetiology of the condition remains incompletely understood. The most established theory, that catecholamine-mediated myocardial stunning is provoked by emotional or physiological stress, is supported by the presence of supraphysiological levels of plasma catecholamines in patients with Takotsubo syndrome. For this reason, the hyperexcitability of the autonomic nervous system under conditions of physical and emotional stress is often assessed in these patients. Observational studies have indicated that a predisposing influence of chronic or traumatic stress, anxiodepressive disorders, and maladaptive personality traits are linked to the pathogenesis of Takotsubo syndrome. Chronic stress can influence autonomic function through dysregulation of the hypothalamic-pituitary-adrenal axis and contribute to the development of cardiovascular disorders. In this Perspectives article, we discuss the current knowledge of the psychoneuroendocrinological and psychosocial mechanisms underlying the pathophysiology of Takotsubo syndrome.