Psychological Stress Research Articles

Temporal inequality of RR intervals like a new psychophysiological indicator of mental stress

Introduction: Gini coefficient (Gini index or Gini ratio) is a parameter that is normally used in economy to measure the income distribution in a country or in the whole wide world, but it can be used to measure any kind of distribution. In the present study it is exposed an innovative proposal of application of the Gini coefficient to Heart Rate Variability (HRV) like a psychophysiological indicator of mental stress.Objective: to assess the application of the Gini coefficient as a psychophysiological indicator of mental stress.Methods: a non-observational crossover study, carried out in the biomedical laboratory of the Medical University of Santiago de Cuba. The involved participants are 13 healthy individuals (age 19 ± 1,5 years). Heart rate was continuously recorded at rest (5 minutes) and during a mental stress (5 minutes). Linear and nonlinear methods of heart rate variability were assessed, and 2 new indicators (Sequential and Non-Sequential Gini) were calculated and proposed to measure HRV differences between states.Results: when comparing rest and mental stress conditions, a sensible decrease of the traditional indicators of the HRV was founded (p<0,05), an increase of the heart rate (p=0,004) and of the Sequential Gini (p=0,004) and Non-Sequential Gini (p=0,04).Conclusions: the results suggest that temporary inequality of the RR intervals analyzed from the Gini coefficient could be an adequate indicator of sympathetic activity present during the mental stress

A New Test for Evaluating the Psychological Impact of COVID-19 in Nurses

Introduction During the COVID-19 pandemic, many health care workers were involved and suffered significant physical and psychological strain, and nursing was one of the main players. Clearly and objectively establishing the psychological impact on nurses during the pandemic is necessary for long-term recovery and to be prepared for new outbreaks in the future. Aim The aims of this study were to evaluate the perceived impact on nurses at risk of psychological stress at work during a major health care crisis and determine the psychological impact and its influencing factors. Methods An online questionnaire was designed and distributed between April 9 and April 19, 2020, in Spain. The comprehensive self-conducted questionnaire included demographic information and the Psychological Stress and Adaptation at work Score. For the analysis, descriptive statistics, logistic regressions, and receiver operating characteristic curves were determined. Results A total of 825 nurses (33% working in intensive care units and emergency departments) answered the questionnaire. A logistic regression analysis revealed that nurses with higher psychological stress scores experienced more physical overload (P = .02), higher psychological overload (P < .01), poor teamwork (P = .02), more distress due to new circumstances (P < .01), more personal impact of how society responded to COVID-19 (P < .01), anticipation of negative future consequences (P < .01), and worse balance between family and work (P < .01). The area under the curve for the cutoff point of Psychological Stress and Adaptation at work Score 40 was 0.82 (95% confidence interval, 0.79-0.91), with 70% sensitivity and 81% specificity. The positive predictive value was 72%, and the negative predictive value was 80%. Conclusion Psychological Stress and Adaptation at work Score is a rapid and accurate test for evaluating the psychological well-being of health care staff that can be used when crisis prevents the use of conventional stress diagnosis methods. Higher psychological impact was observed in nurses who worked in the intensive care unit and in the hospital ward.

Influence of build orientation and heat treatment on high cycle fatigue of additively manufactured AlSi10Mg

This study examines how build orientation and heat treatment affect microstructure and, consequently, the mechanical properties in tensile and high cycle fatigue of additively manufactured AlSi10Mg. Specimens were manufactured in two orientations (0° and 45°) using a laser-based powder bed fusion and subsequently subjected to two heat treatments: (i) direct aging at 170 °C for 2 h (A170) and (ii) stress relief at 300 °C for 2 h (SR300). Two routes for direct aging were previously explored to determine the ideal time and temperature for heat treatment: direct aging at 155 °C and direct aging at 170 °C, both for up to 10 h. It was found that aging at 170 °C for 2 h resulted in higher hardness, yield strength, and ultimate tensile strength than aging at 155 °C for 6 h (A155). The specimens subjected to heat treatment A170 exhibited similar stress amplitude at 106 fatigue life than SR300, with 43.8 MPa and 45.6 MPa, respectively. At similar stress amplitudes, below 106 cycles, the build orientation (0° and 45°) slightly affect the high cycle fatigue properties.

Have You Done Any Interactive Work Today?: An Empirical Study on the Relationship Between Customer Interaction and Psychological Stress in German Software Developers

Have You Done Any Interactive Work Today?: An Empirical Study on the Relationship Between Customer Interaction and Psychological Stress in German Software Developers

Christensenella minuta Mitigates Behavioral and Cardiometabolic Hallmarks of Social Defeat Stress

Psychological stress during early development and adolescence may increase the risk of psychiatric and cardiometabolic comorbidities in adulthood. The gut microbiota has been associated with mental health problems such as depression and anxiety and with cardiometabolic disease, but the potential role of the gut microbiota in their comorbidity is not well understood. We investigated the effects and mode of action of the intestinal bacterium Christensenella minuta DSM 32891 on stress-induced mental health and cardiometabolic disturbances in a mouse model of social defeat stress. We demonstrate that administered C. minuta alleviates chronic stress-induced depressive, anxiogenic and antisocial behavior. These effects are attributed to the bacterium’s ability to modulate the hypothalamic-pituitary-adrenal axis, which mediates the stress response. This included the oversecretion of corticosterone and the overexpression of its receptors, as well as the metabolism of dopamine (DA) and the expression of its receptors (D1, D2L and D2S). Additionally, C. minuta administration reduced chronically induced inflammation in plasma, spleen and some brain areas, which likely contribute to the recovery of physical and behavioral function. Furthermore, C. minuta administration prevented chronic stress-induced cardiovascular damage by regulating key enzymes mediating liver fibrosis and oxidative stress. Finally, C. minuta increased the abundance of bacteria associated with mental health. Overall, our study highlights the potential of microbiota-directed interventions to alleviate both the physical and mental effects of chronic stress.

Water-avoidance stress aggravates prostatic inflammation in a murine model of chronic prostatitis.

To date, few studies have considered the influence of psychological factors on chronic prostatitis (PRO) models. Here, we aimed to refine a murine PRO model combining chemically induced prostatitis with psychological stress. A total of 40 mice were randomly divided into four groups: normal control (NC) group, PRO group, water avoidance stress (WAS) group, and PRO + WAS group. Ten mice were assigned to each group: five for cystometrograms (CMGs) and five for von Frey testing and histological analysis. PRO was induced through a prostatic injection of 10% paraformaldehyde. The WAS mice were placed on the middle platform for 1 h per day for 10 consecutive days. The results of the von Frey test demonstrated that both WAS and PRO induced bladder hyperalgesia in mice, and the WAS + PRO group showed significant pelvic pain symptoms either. The CMG results suggested that the PRO group, the WAS group, and the PRO + WAS group all exhibited bladder overactivity, presented as a shortened micturition interval and decreased threshold pressure evoking bladder contraction. The symptoms of the PRO group and the PRO + WAS group were more severe than those of the WAS group. The tissue staining results indicated that WAS itself caused only mild prostatic inflammation but could significantly aggravate chemical-induced prostatic inflammation, as well as the total number of mast cells and proportion of activated mast cells. Our refined murine PRO model could manifest persistent bladder overactivity, pelvic hyperalgesia and prostatic inflammation. WAS could induce mild prostatic inflammation and aggravate primary prostatic inflammation.

Maternal obesity induces sex-specific changes in the endocannabinoid system of the hypothalamus and dorsal hippocampus of offspring associated with anxiety-like behavior in adolescent female rats

Maternal obesity during perinatal period increases the risk of metabolic and behavioral deleterious outcomes in the offspring, since it is critical for brain development, maturation, and reorganization. These processes are highly modulated by the endocannabinoid system (ECS), which comprises the main lipid ligands anandamide and 2-arachidonoylglycerol, cannabinoid receptors 1 and 2 (CB1R and CB2R), and several metabolizing enzymes. The ECS is overactivated in obesity and it contributes to the physiological activity of the hypothalamus-pituitary-adrenal (HPA) axis, promoting stress relief. We have previously demonstrated that maternal high-fat diet during gestation and lactation programmed the food preference for fat in adolescent male offspring and adult male and female offspring. In the present study, we hypothesized that maternal diet-induced obesity would induce sex-specific changes of the ECS in the hypothalamus and dorsal hippocampus of rat offspring associated with dysregulation of the HPA axis and stress-related behavior in adolescence. Rat dams were fed a control (C) or an obesogenic high-fat high-sugar diet (OD) for nine weeks prior to mating and throughout gestation and lactation. Maternal obesity differentially altered the CB1R in the hypothalamus of neonate offspring, with significant increase in male but not in female pups, associated with decreased CB2R prior to obesity development. In adolescence, maternal obesity induced anxiety-like behavior only in adolescent females which was associated with increased content of CB1R in the dorsal hippocampus. Our findings suggest that the early origins of anxiety disorders induced by maternal exposome is associated with dysregulation of the brain ECS, with females being more susceptible.

Cardiovascular responses to experimental weight gain in humans: a feasibility study.

Obesity and hypertension share a well known association. However, the mechanisms underlying their relationship are not well understood. Our goal was to assess the feasibility of a longitudinal, interventional weight gain study with detailed cardiovascular measurements in humans. Sixteen healthy, normotensive, young, male volunteers (28 ± 7 years) were enrolled. Body composition, biochemical and cardiovascular data were obtained at baseline, and after an 8-week period of overfeeding (800-1000 kcal/day). Blood pressure (BP), cardiac output (CO) and peripheral vascular resistance (PVR) were determined, as were the minimum forearm vascular resistance (MFVR), forearm blood flow (FBF) response to mental stress and heart rate variability (HRV) parameters. Overfeeding resulted in a median weight gain of 5.6 kg [interquartile range (IQR) 4.6-6.4 kg; P < 0.001]. Seated systolic and diastolic BP were significantly increased by 10 ± 9 and 4 ± 6 mmHg, respectively, after weight gain ( P < 0.001 and P = 0.011, respectively). CO also increased and PVR decreased significantly as a result of weight gain ( P = 0.032 and P = 0.044, respectively). MFVR was also significantly decreased after weight gain ( P = 0.023). The FBF response to mental stress was blunted significantly ( P = 0.002), and sympathovagal balance and responsiveness to orthostatic challenge altered moderately after weight gain. Our overfeeding regimen resulted in moderate weight gain and significant increases in BP. An increase in CO is likely to be the dominant mechanism underlying the observed BP changes, with decreases in PVR partially compensating for these effects. Experimental weight gain, coupled with detailed cardiovascular phenotyping, is a feasible model to examine potential mechanisms underlying obesity-associated hypertension in young adults.

Challenges of remote working, perceived peer support, mental health and well-being of WIL students

PurposeThis study explored the relationship between perceived peer support, mental health and the well-being of students enrolled in work-integrated learning (WIL) at a Canadian institute of higher education, who were completing remote work experiences.Design/methodology/approachAn online survey and virtual semi-structured interviews were used to collect data. The online survey captured demographic information as well as measures of perceived peer support, loneliness, positive mental health (PMH) and stressors associated with the on-going pandemic. The interviews captured narratives regarding peer support, attitudes surrounding remote work, mental health and well-being.FindingsWIL students completing remote work terms experienced only moderate levels of peer support, moderate loneliness, below-average PMH and all the stressors associated with the on-going pandemic. Data also revealed that completing a remote work term negatively impacted work communications, opportunities to build connections with colleagues and overall motivation. On the other hand, WIL students appreciated the flexibility and comfort of working from home, as well as reduced work-related expenses.Originality/valueWith remote work experiences increasing globally and now a reality for many WIL students, the potential negative effects emphasize the importance of providing social and mental health support and resources, especially during stressful times.

Improving Outdoor Thermal Comfort for Agricultural Workers: A Study of Heat Stress Relief Measures Using Sun Protection Lotions

The entire study was carried out on a group of 100 female farm workers at the CTAE university campus in Udaipur during the wheat crop harvesting season, with the aim of examining the effectiveness of various heat stress relief measures (sun protection lotion with different sun protection factors, SPF) in improving outdoor thermal comfort. The experiments were designed to assess the average skin temperature of Indian female farm workers under five fixed Wet Bulb Globe Temperature (WBGT) conditions (28, 29, 30, 31, 32°C), all falling within the heat stress category as per American Conference of Governmental Industrial Hygienists (ACGIH) standards. The mean skin temperature was determined using the Hardy du-bois 7-point model formula, which involved measuring the mean temperature of specific body parts of the 100 female farm workers. A variation of ± 0.5°C was considered due to the challenge of achieving precise thermal conditions in open field settings. The experiment aimed to evaluate the thermal and physiological responses of the participants. The findings revealed that the use of sun protection lotion alone resulted in increased cooling effect, thereby expanding the thermal comfort range. Additionally, the application of sun protection lotion alone reduced the mean skin temperature by 0.39, 0.38, 0.36, 0.30, 0.27°C by the end of the work period.

Beat-to-beat analysis of hemodynamic response to mental and psychological stress in sickle cell anemia

Abstract Vaso-occlusive crises are a hallmark symptom of sickle cell disease. Physical stressors can trigger decreased microvascular blood flow and increase the risk for vaso-occlusive crises. However, the effect of mental and psychological stressors on vascular physiology in sickle cell disease is not well-established. We hereby examined fluctuations in continuous blood pressure to evaluate hemodynamic changes in sickle cell disease patients during mental and psychological stress. Thirteen sickle cell disease subjects from the Children’s Hospital Los Angeles and 11 healthy volunteers were recruited. Continuous blood pressure was recorded during two mental tasks and one psychological stress task. Systolic beat-to-beat blood pressure variability measurements were calculated for each subject. Three very short-term blood pressure variability metrics served as outcome measures: standard deviation, coefficient of variation, and average real variability. Peripheral augmentation index was calculated from arterial waveforms. Linear mixed effects models evaluated associations between patient factors and outcome measures. Sickle cell disease patients exhibit increased systolic blood pressure variability in response to psychological stress. All subjects exhibited a decrease in systolic blood pressure variability in response to mental stress tasks. During mental stress, both groups displayed increased augmentation index, reflective of stress-induced vasoconstriction, while psychological stress in sickle cell disease patients led to both decreased mean arterial pressure and increased augementation index, suggestive of uncompensated vasoconstriction. These findings emphasize the impact of mental and psychological stressors on vascular function in sickle cell disease and the potential for monitoring physiological signals to predict vaso-occlusive crisis events.

Stress-induced coronary spasms: evaluating the role of serum cortisol in variant angina

Abstract Background and purpose Variant angina is a type of angina pectoralis caused by vasospasm, and the patients were recommended to take lifelong medication to suppress spasms. In addition to risk factors, mental stress can be a precipitating factor in vasospasm. We can analyze whether mental stress can affect vasospasm by analyzing the relationship between serum cortisol levels, the major stress hormone, and coronary artery vasospasm. Methods We prospectively enrolled patients who were admitted for coronary angiography from October 2022 to August 2023. We divided them into 2 groups: variant angina and those who had other angiographic findings such as insignificant, stable angina, unstable angina, or non ST segment elevation myocardial infarction. The primary endpoint was the norepinephrine, cortisol, and adrenocorticotropic hormone (ACTH) level at admission, cortisol and ACTH level at Day 1 after admission, and after discharge when visiting the outpatient clinic. We used students' t-tests to examine the differences between groups. Results A total of 196 patients were enrolled, and 23 patients were diagnosed with variant angina. The variant angina group showed significantly higher serum cortisol levels on Day1 than the other diagnosis group (10.1±3.4 µg/dL vs. 8.4±4.1 µg/dL, p-value 0.044). There were no significant differences between baseline norepinephrine, ACTH, cortisol levels, Day 1 ACTH, and serum ACTH, cortisol levels after discharge. However, the serum cortisol levels showed an increased trend than other diagnosis group (baseline cortisol 9.7±3.5 vs. 8.3±4.1, p-value 0.082; after discharge cortisol 9.3±2.7 vs. 8.6±3.6, p-value0.294). Conclusions The variant angina group had a higher level of serum cortisol level than other diagnosis groups. Also, this trend was sustained at baseline and after discharge. Further research with a large cohort is warranted.

Evaluation of specific offers for mothers with mental stress

Abstract Background As part of the Austrian early intervention programme ‘Frühe Hilfen’, specific interventions (a psychotherapeutic short-term intervention and a therapeutic group) were implemented in some regions. An evaluation was carried out to gain general insights into the need for and benefits of psychosocial services as well as in-depth information on the benefits of the two selected services. The results of the project should also enable further conclusions/recommendations for appropriate services. Methods Mixed-methods approach: qualitative (focus groups, individual interviews, online surveys, participant observation) and quantitative (screening questionnaires) instruments involving a large number of relevant stakeholders and actors. Data analysis: content-structuring qualitative content analysis according to Kuckartz; descriptive analysis of the screening questionnaires. Results The analysis revealed a great need for specific psychosocial services for this target group as well as a high level of satisfaction with the psychosocial services utilised. However, all respondents pointed out barriers to the utilisation of psychosocial services. The evaluation results show that the two specific services make an important contribution to improving the well-being of mothers with mental health problems. Both services largely reach their target group well and, thanks to their focus, contribute to the well-being of mothers with mental health problems. The effectiveness of the service is underpinned by the fact that all participants perceive a reduction in mental stress and notice a reduction in stress during the screenings. Conclusions Based on the evaluation results, it is generally recommended that low-threshold, free and needs-based services be established or expanded. In addition, there is a need for more educational and public relations work on psychosocial stress/diseases and more information on support services. Key messages • There is a great need for psychosocial support among mothers. • The high level of satisfaction with the services evaluated indicates that more such services are needed to support families.

Gender-specific impact of COVID-19 in the UAE: Analyzing gender disparities in health and well-being

Abstract Background Understanding gender disparities in health impacts during pandemics is crucial. While early observations of the COVID-19 pandemic suggested higher severity and mortality rates among males, subsequent studies hinted at a disproportionate impact on females’ health and well-being. This study aimed to explore gender-specific differences related to COVID-19 in the United Arab Emirates (UAE). Methods Data from four independent surveys were analyzed to assess gender differences in knowledge about available vaccines, vaccine hesitancy, COVID-19 severity, admission to the Intensive Care Unit (ICU), anxiety among healthcare workers (HCWs), and psychological health of healthcare workers and the general population. Gender gaps were calculated as the absolute difference between males and females. Chi-square tests and logistic regression were performed to test the association between gender, age, and selected outcome variables. Results Males had a significantly higher risk of moderate to severe COVID-19 symptoms (71%) compared to females (63%). The gender gap in symptom severity was smallest among those aged 55+ and highest among adults aged 35-54. Post-discharge, 22% more females reported multiple conditions than males. Among HCWs, females showed lower knowledge (19% gap) and higher vaccine hesitancy (20% gap), with larger gaps among older age groups. Females also experienced more anxiety and psychological stress, especially in the 35-54 age group. Logistic regression confirmed higher odds for females in reporting vaccine hesitancy, long COVID-19 symptoms, and anxiety, even after adjusting for demographic factors. Conclusions This study highlights unequal health outcomes and burdens experienced by women and men during the COVID-19 pandemic in the UAE. The distinct challenges faced by women, including higher mental health burdens and persistent post-recovery symptoms, suggest systemic gender disparities that require targeted attention in healthcare policies and practices. Key messages • Gender disparities in COVID-19 were evident in the UAE with males experiencing severe COVID-19 symptoms, while females experienced post-recovery symptons, vaccine hesitancy, and stress. • Urgent action is required to address gender disparities in COVID-19 impacts, emphasizing mental health support and post-recovery care in policy formulation.

Improving Workplace Safety and Health Through a Rapid Ergonomic Risk Assessment Methodology Enhanced by an Artificial Intelligence System

The comfort of a worker while performing any activity is extremely important. If that activity extends beyond a person’s capacity to withstand physical and psychological stress, the worker may suffer from both physical and mental ailments. Over time, if the stress persists, these conditions can become chronic diseases and can even be the cause of workplace accidents. In this research, a methodology was developed for the rapid assessment of ergonomic risks and for calculating the level of ergonomic comfort in the workplace. This methodology uses artificial intelligence through a specific algorithm and takes into account a number of factors that, when combined, can have a significant impact on workers. To achieve a more accurate simulation of a work situation or to evaluate an ongoing work situation, and to significantly correlate these parameters, we used logarithmic calculation formulas. To streamline the process, we developed software that performs these calculations, conducts a rapid assessment of ergonomic risks, estimates a comfort level, and proposes possible measures to mitigate the risks and effects on workers. To assist in diagnosing the work situation, we used a neural network with five neurons in the input layer, one hidden layer, and two neurons in the output layer. As a result, most work situations, in any industrial field, can be quickly analyzed and evaluated using this methodology. The use of this new analysis and diagnosis tool, implemented through this new research technology, is beneficial for employers and workers. Moreover, through further developments of this methodology, achieved by increasing the number of relevant input parameters for ergonomics and integrating advanced artificial intelligence systems, we aim to provide high precision in assessing ergonomic risk and calculating the level of ergonomic comfort.

Synthetic assessment of cardiac autonomic modulation and Baevsky stress index in patients with synucleinopathies

Abstract Background The Baevsky Stress Index (BSTRi), calculated from Heart Rate Variability (HRV) data, has been proposed for quantitative assessment of physiological stress, with higher scores indicating higher levels of physical and/or psychological stress [1]. Cardiac autonomic modulation can be synthetically quantified by calculating the parasympathetic (PNSi) and the sympathetic (SNSi) indexes. The values of the BSTRi, SNSi, and PNSi in patients with synucleinopathies of different prognoses have not been reported yet. Purpose To quantify, in patients with Parkinson's disease (PD) and Multisystem Atrophy (MSA), the BSTRi, its correlation with the PNSi and the SNSi indexes, and their potential value for a synthetic assessment of cardiac autonomic modulation and early differential diagnosis between PD and MSA. Methods Holter ECG data of 66 patients with Parkinsonian syndromes were retrospectively analyzed after 10 years of follow-up. Out of them, 34 patients with a certain diagnosis of PD (17) and MSA (17) were selected for this study. HRV was analyzed with the Kubios software (version 4.0), providing automatic calculation of the BSTRi, PNSi, and SNSi [2], as well as of time domain (TD), frequency domain (FD), nonlinear (NL), and time-varying (TV) HRV parameters. HRV was calculated from selected short-term intervals (of 5 minutes), during daily activity (ACT5’), and non-REM sleep (NREM5’), and from 24-hours Holter recordings. Patients’ HRV findings were compared with those of 51 age-matched healthy subjects (HS). Results An example of individual automatic graphic summary is shown in Figure 1. Both short-term and 24-hour BSTRi and SNSi values were significantly (p &amp;lt; 0.05) higher in PD and MSA compared to those of HS, in all investigated conditions. Short-term PNSi was significantly higher in HS than in PD in all conditions, but only during NREM5’ in MSA patients (Table 1). No significant difference was found between the indexes of PD and MSA patients. As in HS (R=92), BSTRi was positively correlated with the SNSi in MSA (average R= 0.83 and 0.89 during ACT5’ and NREM5’, respectively), but less evident in PD (R=0.67). The inverse correlation between PNSi and SNSi (R=0.75 in HS) was lost in both MSA and PD. Conclusions Higher values of BSTRi in PD and MSA compared to HS suggest that patients with synucleinopathies do experience higher levels of psychophysiological stress, which may affect their quality of life negatively. However, since no significant difference was found in this study between BSTRi values of PD and MSA patients, BSTRi seems at present unreliable for early differentiation between the two diseases. Telematic assessment of BSTRi, SNSi, and PNSi could be useful for remote monitoring of PD and MSA patients’ psychophysiological stress, to provide timely intervention and adaptive treatment.Fig.1 Example of graphic summary (ACT5')

“We want to get out” – A qualitative study on reasons for nurses’ early retirement intentions

Abstract Background Nurses, the largest workforce in healthcare, play a central role in health systems. There is a severe global shortage of nurses, which is expected to worsen as a significant portion approaches retirement age. Early retirements can harm care quality and healthcare access, thus significantly impacting public health. Identifying reasons is crucial to prevent this trend. This study examined factors behind nurses’ early retirement intentions. Methods A descriptive qualitative study was conducted in an Irish hospital (July to September 2023) including individual interviews with 10 nurses aged 55 and over. A thematic analysis was conducted collaboratively by three researchers to identify key factors influencing nurses’ intentions to retire early. Results Five main themes emerged: 1) Health concerns, encompassing physical strain and psychological stress, significantly influencing early retirement intentions; 2) Struggling to balance job demands with personal responsibilities such as caring for ageing parents due to inflexible work schedules; 3) Need for more support from senior leaders to address staffing shortages and investment in aging nurses’ career and retirement planning to make staying more desirable and easier; 4) Feelings about nurses’ experience being undervalued in the evolving healthcare; and 5) Facing constant heavy responsibility in guiding new nurses, while simultaneously fearing patient safety risks and encountering generational differences. Conclusions Developing support systems for ageing nurses, encompassing strategies to ease workload strain, enhancing career opportunities, and promoting intergenerational collaboration are critical for reducing early retirement trends and sustaining a resilient healthcare workforce. By implementing tailored approaches, such as flexible scheduling and mentorship programs for ageing nurses, healthcare organisations can promote workforce longevity and enhance public health outcomes through improved care delivery. Key messages • Health challenges and struggles in work-life balance influence early retirement intentions among nurses, urging flexible work arrangements and improved recognition and leadership in healthcare. • To extend work careers, organisations must invest in ageing nurses’ career and retirement planning, value experience, and acknowledge potential challenges and benefits in intergenerational nursing.

Optimising liver screening in patients with a Fontan circulation: a cost-effective approach to detection of Fontan associated liver disease which enhances patient care

Abstract Introduction Patients with Fontan circulation, require screening for liver cirrhosis and malignancy, to which they are susceptible with time. Surveillance biopsies reveal nearly all adult Fontan patients develop asymptomatic fibrosis, and a majority have abnormal liver function tests (LFTs). This presents significant financial healthcare burden and psychological stress with testing for patients. Objective We aim to present "real-world" liver screening data, from a leading Adult Congenital Heart Disease (ACHD) centre, to propose a cost-reducing testing regimen, which delivers effective screening, while taking account of the challenges of current guidance, patient compliance, and clinical practice. Methods We analysed liver screening data for Fontan patients at a leading ACHD centre, focusing on biochemical tests (bilirubin, ALT, GGT) and imaging. We evaluated the 10-year financial impact of current practices, versus a hypothetical model based on age and risk factors, alongside biannual and annual screening strategies. Tariffs for biochemical test were provided by the local pathology service and we used NHS HRG tariffs for imaging and phlebotomy. Results We included data from 114 patients with a Fontan circulation (median age 32 range 19-56, 42% females). Eighteen patients developed liver cirrhosis diagnosed on imaging (median age 32, range 22-48). None developed hepatocellular carcinoma. A lack of clear and agreed local screening guidelines (over years) resulted in vastly different investigations for FALD, with inconsistent time intervals for testing. Bilirubin was elevated in 59% (55% in age 18-29), ALT was elevated in 41% (31% in age 18-29), GGT was elevated in 83% (80% in age 18-29). We found 3 cases of cirrhosis in the age group 18-29, all with hypoplastic left heart; 4 cases of cirrhosis in age group 30-34 - all had significant comorbidities; 33% had normal bilirubin, LFT and GGT, potentially not requiring further screening until the age of 35. Eleven patients (22%) age 35+ had confirmed cirrhosis (Figure 1). Performing full FALD screening with biochemistry and liver ultrasound every 12-24 months would increase the cost of screening three- to six-fold. We propose rationalising liver screening by age and underlying risk (Figure 2) to minimise the economic burden and equally the psychological impact of frequent testing on patients. Conclusions Our analysis underscores the necessity for an optimised liver screening protocol in Fontan patients, balancing diagnostic accuracy with cost-efficiency. By integrating this data, we have identified a pathway to streamline screening, tailoring it to individual risk profiles and age groups, thereby reducing unnecessary tests, lowering costs and reducing the impact of testing on patients. This approach not only fosters better patient care, but also provides a framework for developing clearer, cost-effective screening guidelines, to monitor liver health, in these complex CHD patients.

Takotsubo Cardiomyopathy After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for a Recurrent Colon Cancer: A Life-Threatening Complication

(1) Background: Takotsubo cardiomyopathy, or stress cardiomyopathy, is an acute heart failure condition with transient left ventricular (LV) motion abnormalities but no significant coronary artery obstruction. It mimics acute coronary syndrome (ACS), with symptoms like chest pain, dyspnea, and ECG changes. (2) Case Report: We present the case of a 44-year-old female with relapsed colon cancer and peritoneal carcinomatosis. After undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), she experienced cardiac arrest from ventricular fibrillation 18 h postoperatively. Echocardiography revealed a reduced LV ejection fraction (20%) and apical akinesia, suggesting a Takotsubo Cardiomyopathy. Intensive resuscitation and inotropic support led to gradual recovery. Coronary angiography confirmed no coronary artery obstruction. (3) Discussion: This case highlights TTS as a rare but severe complication following major oncological surgeries, possibly triggered by both physical and emotional stressors. TTS should be considered in the differential diagnosis of perioperative cardiac events in cancer patients. (4) Conclusions: Prompt recognition and management of TTS in the perioperative period are crucial to improving outcomes, especially in high-risk oncological patients undergoing extensive surgeries.

WeCare – Mental healthcare for health professionals

Abstract Issue/Problem Health professionals face physical and mental stressors (risk factors) due to challenging working conditions. Description of the Problem Despite high levels of health literacy among healthcare workers, maintaining healthy habits is challenging due to variable shifts, including nights, high workloads, and intense emotional and mental demands. Adopting a healthier lifestyle requires personal changes that can be difficult to implement, particularly in nursing and caregiving. This is critical, as retaining and attracting new staff in these fields is essential for the healthcare sector. Results/Effects/Changes To address these challenges, it’s crucial to boost intrinsic motivation and provide healthcare workers with practical tools to support their well-being and encourage them to remain in the sector. The WeCare project offers a mobile app designed as a ‘pocket coach,’ accessible at any time. Healthcare professionals can use the app to assess their current mental well-being through self-evaluation. With built-in assessments and predefined thresholds, the app tracks stress levels and quality of life. Depending on the outcomes, users are automatically guided to appropriate information, gamified activities, and exercises tailored to their specific needs. The project, running from 2022 to 2024, is co-funded by the European Union’s Erasmus+ programme. Lessons The app is beta-tested during 2024 in five countries: Germany, Austria, Serbia, Poland, and Italy, with local language support. The test group will consist of healthcare professionals and related professions. The results, including user engagement and motivational factors are analyzed. As the project concludes in autumn, comprehensive recommendations and lessons learned will be compiled and presented at the European Public Health (EPH) Conference. This will also include sharing the app and its solution with the broader healthcare community. Key messages • The WeCare app supports healthcare workers’ mental health with a mobile “pocket coach” that provides personalized exercises. Through gamification, it promotes healthy habits and boosts job motivation. • It is critical to support healthcare workers, as retaining and attracting new persons is essential for the healthcare sector.