Moderate Distress Research Articles

Mental well-being in Sri Lankan medical students: a cross-sectional study

ABSTRACT Preventing burnout and promoting positive mental health among medical students is important. Relevant research is lacking on positive mental health in medical students, particularly in low- and middle-income countries. We conducted a cross-sectional survey of Sri Lankan students enrolled in a five-year medical program. Measures included the Mental Health Continuum-Short Form, Kessler 10 Psychological Distress Scale, and Oldenburg Burnout Inventory. We investigated relationships between year in program, mental health indicators, and academic performance. Three hundred twenty-seven students participated (35% response rate). Most students had moderate positive mental health (64.8%) and severe psychological distress (40.4%). Final year students reported more psychological distress and burnout than first year students. Female students had higher burnout scores than males. In multivariable models, fourth and fifth year students evidenced lower positive mental health than first year students. Mental health indicators were unassociated with academic performance. Overall, distress rates were higher than those reported among students in other countries. Higher burnout and distress may be driven by increased responsibilities in the final clinical years of training. Bolstering positive mental health through positive emotions, meaning, and social connection may minimize burnout and distress, although extracurricular activities require time. Interventions to reduce medical student distress in Sri Lanka are needed.

Classification of Mental Health among Korean Vietnam War Veterans: A Latent Profile Analysis

We investigated the dimensional structure of mental health among aging Korean Veterans using latent profile analysis (LPA) on posttraumatic stress disorder symptoms (PTSD), late onset stress symptomology (LOSS), and psychosocial well-being (PWB). The Korean Vietnam War Veterans Study consists of 367 men (Mage=72, SD=2.66). LPA identified five classes of mental health as best fitting the data. Most men were in the normal (38%) and moderate distress (31%) groups, while smaller proportions were in the low affect (13%) and severe distress (7%) groups. The resilient group (12%) had low PTSD, medium LOSS, and high PWB, and were highest on optimism, positive appraisals of military service, and social support. Negative and positive aspects of mental health outcomes were on separate dimensions rather than on a single bipolar dimension. Service providers should attempt to both reduce Veterans’ negative psychological symptoms and increase psychosocial well-being. Part of a symposium sponsored by the Aging Veterans: Effects of Military Service across the Life Course Interest Group.

Caregivers' mental distress and child health during the COVID-19 outbreak in Japan.

To clarify the physical and mental conditions of children during the coronavirus disease 2019 pandemic and consequent social distancing in relation to the mental condition of their caregivers. This internet-based nationwide cross-sectional study was conducted between April 30 and May 13, 2020. The participants were 1,200 caregivers of children aged 3-14 years. Child health issues were categorized into "at least one" or "none" according to caregivers' perception. Caregivers' mental status was assessed using the Japanese version of the Kessler Psychological Distress Scale-6. The association between caregivers' mental status and child health issues was analyzed using logistic regression models. Among the participants, 289 (24.1%) had moderate and 352 (29.3%) had severe mental distress and 69.8% of children in their care had health issues. The number of caregivers with mental distress was more than double that reported during the 2016 national survey. After adjusting for covariates, child health issues increased among caregivers with moderate mental distress (odds ratio 2.24, 95% confidence interval 1.59-3.16) and severe mental distress (odds ratio 3.05, 95% confidence interval 2.17-4.29) compared with caregivers with no mental distress. The results highlight parents' psychological stress during the pandemic, suggesting the need for adequate parenting support. However, our study did not consider risk factors of caregivers' mental distress such as socioeconomic background. There is an urgent need for further research to identify vulnerable populations and children's needs to develop sustainable social support programs for those affected by the outbreak.

Insomnia, fatigue and psychosocial well-being during COVID-19 pandemic: A cross-sectional survey of hospital nursing staff in the United States.

Aims and objectivesTo describe the levels of insomnia, fatigue and intershift recovery, and psychological well‐being (burnout, post‐traumatic stress and psychological distress), and to examine differences in these measures based on work‐related characteristics among nursing staff during COVID‐19 pandemic in the United States.BackgroundThe COVID‐19 pandemic has created a major physical and psychological burden on nursing staff in the United States and worldwide. A better understanding of these conditions will lead to tailored support and resources for nursing staff during and after the pandemic.DesignCross‐sectional study.MethodsHospital nurses and nursing assistants (N = 587) were recruited online between May–June 2020. The survey included measures on insomnia (Insomnia Severity Index) fatigue and intershift recovery (Occupational Fatigue and Exhaustion Recovery‐15), burnout (Maslach Burnout Inventory‐Human Services Survey), post‐traumatic stress (Short Post‐Traumatic Stress Disorder Rating Interview) and psychological distress (Patient Health Questionnaire‐4), and questions on work and demographics. The STROBE checklist was followed for reporting.ResultsThe sample had subthreshold insomnia, moderate‐to‐high chronic fatigue, high acute fatigue and low‐to‐moderate intershift recovery. The sample experienced increased emotional exhaustion and depersonalisation, increased personal accomplishment, moderate psychological distress and high post‐traumatic stress. Nurses who cared for COVID‐19 patients had significantly scored worse on almost all measures than their co‐workers. Certain factors such as working hours per week and the frequency of 30‐min breaks were significant.ConclusionNursing staff experienced poor sleep, fatigue and multiple psychological problems during the COVID‐19 pandemic. Moreover, staff who were involved in the care of COVID‐19 patients, worked more than 40 h per week and skipped 30‐min breaks showed generally worse self‐reported outcomes.Relevance to clinical practiceNursing administration is recommended to monitor for fatigue and distress on nursing units, re‐visit current scheduling practices, reinforce rest breaks and provide access to mental health and sleep wellness resources with additional support for their front‐line nursing groups.

Early, awake proning in emergency department patients with COVID-19.

ObjectiveProning has been shown to improve oxygenation and mortality in certain populations of intubated patients with acute respiratory distress syndrome. Small observational analyses of COVID-19 patients suggest awake proning may lead to clinical improvement. Data on safety and efficacy is lacking. We sought to describe the effect of proning on oxygenation in nonintubated COVID-19 patients. We also evaluated feasibility, safety, and other physiological and clinical outcomes associated with this intervention.MethodsWe conducted a prospective, observational cohort study of nonintubated patients with COVID-19 who underwent proning per an Emergency Department (ED) clinical protocol. Patients with mild to moderate respiratory distress were included. We calculated change in oxygenation by comparing the oxygen saturation to fraction of inspired oxygen ratio (SpO2:FiO2) during the five minutes prior to proning and first 30 min of proning. We also captured data on respiratory rate, duration of proning, need for intubation, intensive care unit admission, survival to discharge.ResultsFifty-two patients were enrolled. Thirty were excluded for not meeting protocol inclusion criteria or missing baseline oxygenation data, leaving 22 for analysis. The SpO2:FiO2 ratio increased by a median of 5 (IQR: 0–15) in the post-proning period compared to the pre-proning period (median: 298 (IQR: 263–352) vs 295 (IQR: 276–350), p = 0.01). Respiratory rate did not change significantly between time periods. No immediate adverse events occurred during proning. Five patients (23%) were intubated within 48 h of admission.ConclusionEarly, awake proning may be feasible in select COVID-19 patients and was associated with improved oxygenation.

Factors Associated with Psychological Distress and Brief Resilient Coping Level During the COVID-19 Pandemic Among Health-Care Professionals in Dessie, Ethiopia.

BackgroundThe outbreak of Coronavirus Disease 2019 (COVID-19) has caused serious threats to people’s health and lives in the world. The health-care professionals are bravely fighting on the front lines of the pandemic everywhere in the world. Our study is the first to study psychological distress and coping status among health-care professionals of Dessie town, Ethiopia during the unbridled time of the COVID-19 outbreak.MethodsA cross-sectional internet-based study was conducted between June 20 and July 13, 2020. The questionnaires included the demographic information, COVID-19 related questions, Kasseler-10 to assess psychological distress level and Brief Resilient Coping Scale, and Oslo-3 social support scale questionnaire were employed.ResultsA total of 423 participants were involved in the study with a response rate of 100%. The mean age of respondents was 34.5 years (SD = ±8.45 years). The prevalence of psychological distress among participants was 42%. Of these 18%, 11%, and 13% had mild, moderate, and severe psychological distress levels. Being married, being nurses and pharmacies, current substance users, working in emergency and outpatient departments, history of chronic medical illness, brief resilient coping level, and social support level were particularly associated with high psychological distress.ConclusionHealth-care professionals are experiencing a substantial level of psychological distress. In addition to other modifying factors coping level and social support was a significant predictor of psychological distress among health-care professionals. These findings should inform the implementation of interventions that increase coping resilience and social support to mitigate the impact of psychological distress among health-care professionals.

A comparison of self-care activities and diabetes distress among type II diabetic patients in urban and rural field practice area: a cross-sectional study

Background: Diabetes is a challenging disease that is considered to be hard to live with as it encompasses a lot of restrictive instructions. Self-care diabetes has been defined as an evolutionary process of development of knowledge or awareness by learning to survive with the complex nature of diabetes. Diabetic distress refer to an emotional state where people experience feelings such as stress, guilt or denial that arise from the living with diabetes and the burden of self-management. The emotional distress facing people with diabetes due to such life style restriction. The objectives were to evaluate self-care activities related to diabetes among type II diabetic patients using diabetes self-management questionnaire and to assess and compare the diabetes distress score using diabetes distress scale among urban and rural type II diabetic patient.Methods: A cross-sectional study was conducted in 140 urban and 70 rural study participants in field practice area of SNMC, Bagalkot. Diabetic self-care activities and diabetic distress were analyzed.Results: Our study showed most of the study participants had poor self-care activities. Our study showed 60% of rural participants screen positive for moderate diabetic distress where as 52.1% of urban participants showed positive for high diabetic distress.Conclusions: To combat the stress associated with diabetes, it is important to educate the patient to adapt with change in their life style following the diagnosis of diabetes.

Effect of Nebulized Magnesium vs Placebo Added to Albuterol on Hospitalization Among Children With Refractory Acute Asthma Treated in the Emergency Department

While intravenous magnesium decreases hospitalizations in refractory pediatric acute asthma, it is variably used because of invasiveness and safety concerns. The benefit of nebulized magnesium to prevent hospitalization is unknown. To evaluate the effectiveness of nebulized magnesium in children with acute asthma remaining in moderate or severe respiratory distress after initial therapy. A randomized double-blind parallel-group clinical trial from September 26, 2011, to November 19, 2019, in 7 tertiary-care pediatric emergency departments in Canada. The participants were otherwise healthy children aged 2 to 17 years with moderate to severe asthma defined by a Pediatric Respiratory Assessment Measure (PRAM) score of 5 or greater (on a 12-point scale) after a 1-hour treatment with an oral corticosteroid and 3 inhaled albuterol and ipratropium treatments. Of 5846 screened patients, 4332 were excluded for criteria, 273 declined participation, 423 otherwise excluded, 818 randomized, and 816 analyzed. Participants were randomized to 3 nebulized albuterol treatments with either magnesium sulfate (n = 410) or 5.5% saline placebo (n = 408). The primary outcome was hospitalization for asthma within 24 hours. Secondary outcomes included PRAM score; respiratory rate; oxygen saturation at 60, 120, 180, and 240 minutes; blood pressure at 20, 40, 60, 120, 180, and 240 minutes; and albuterol treatments within 240 minutes. Among 818 randomized patients (median age, 5 years; 63% males), 816 completed the trial (409 received magnesium; 407, placebo). A total of 178 of the 409 children who received magnesium (43.5%) were hospitalized vs 194 of the 407 who received placebo (47.7%) (difference, -4.2%; absolute risk difference 95% [exact] CI, -11% to 2.8%]; P = .26). There were no significant between-group differences in changes from baseline to 240 minutes in PRAM score (difference of changes, 0.14 points [95% CI, -0.23 to 0.50]; P = .46); respiratory rate (0.17 breaths/min [95% CI, -1.32 to 1.67]; P = .82); oxygen saturation (-0.04% [95% CI, -0.53% to 0.46%]; P = .88); systolic blood pressure (0.78 mm Hg [95% CI, -1.48 to 3.03]; P = .50); or mean number of additional albuterol treatments (magnesium: 1.49, placebo: 1.59; risk ratio, 0.94 [95% CI, 0.79 to 1.11]; P = .47). Nausea/vomiting or sore throat/nose occurred in 17 of the 409 children who received magnesium (4%) and 5 of the 407 who received placebo (1%). Among children with refractory acute asthma in the emergency department, nebulized magnesium with albuterol, compared with placebo with albuterol, did not significantly decrease the hospitalization rate for asthma within 24 hours. The findings do not support use of nebulized magnesium with albuterol among children with refractory acute asthma. ClinicalTrials.gov Identifier: NCT01429415.

Hospital Resources May Be an Important Aspect of Mortality Rate among Critically Ill Patients with COVID-19: The Paradigm of Greece.

For critically ill patients with coronavirus disease 2019 (COVID-19) who require intensive care unit (ICU) admission, extremely high mortality rates (even 97%) have been reported. We hypothesized that overburdened hospital resources by the extent of the pandemic rather than the disease per se might play an important role on unfavorable prognosis. We sought to determine the outcome of such patients admitted to the general ICUs of a hospital with sufficient resources. We performed a prospective observational study of adult patients with COVID-19 consecutively admitted to COVID—designated ICUs at Evangelismos Hospital, Athens, Greece. Among 50 patients, ICU and hospital mortality was 32% (16/50). Median PaO2/FiO2 was 121 mmHg (interquartile range (IQR), 86–171 mmHg) and most patients had moderate or severe acute respiratory distress syndrome (ARDS). Hospital resources may be an important aspect of mortality rates, since severely ill COVID-19 patients with moderate and severe ARDS may have understandable mortality, provided that they are admitted to general ICUs without limitations on hospital resources.

Specific symptoms of the General Health Questionnaire (GHQ) in predicting persistence of psychological distress: Data from two prospective cohort studies

Persistent psychological distress is more harmful than transient psychological distress, but little is known about the development of persistent distress. We examined whether some specific symptoms of the 12-item General Health Questionnaire (GHQ-12) were more important than others in predicting the persistence of psychological distress over a 3-year follow-up period among individuals who had at least moderate psychological distress at baseline (GHQ≥3). Participants were from the UK Household Longitudinal Study (UKHLS; n = 6430) and British Household Panel Survey (BHPS; n = 5954). Sense of worthlessness, loss of self-confidence, loss of sleep over worry, and feelings of strain were associated with increasingly persistent distress. General happiness, feelings of unhappiness or depressed mood, and enjoyment of activities showed no such increasing associations. Symptoms of social functioning (capability of making decisions, concentration problems, feelings of usefulness, ability to face problems) showed some but not consistent associations. These results suggest that feelings of worthlessness, loss of self-confidence, loss of sleep over worry, and strain may be particularly important markers for persistent psychological distress.

The Level of Distress From Fatigue Reported in the Final Two Months of Life by a Palliative Care Population: An Australian National Prospective, Consecutive Case Series

ContextFatigue is the most commonly reported symptom in life-limiting illnesses, although not much is known about the distress it causes patients as they approach death. ObjectivesTo map the trajectory of distress from fatigue reported by an Australian palliative care population in the last 60 days leading up to death. MethodsA prospective, longitudinal, consecutive cohort study using national data from the Australian Palliative Care Outcomes Collaboration between July 1, 2013, and December 31, 2018. Patients were included if they had at least one measurement of fatigue on a 0–10 numerical rating scale in the 60 days before death. Descriptive statistics were used to analyse patients by diagnostic cohort and functional status. ResultsA total of 116,604 patients from 203 specialist palliative care services were analyzed, providing 501,104 data points. Distress from fatigue affected up to 80% of patients referred to palliative care, with the majority experiencing moderate or severe distress. Malignant and nonmalignant diagnoses were equally affected, with the neurological cohort showing the greatest variability. The degree of distress correlated with a patient's functional level; it worsened as a patient's function declined until a patient became bedbound when the reporting of distress reduced. ConclusionsDistress from fatigue is high in this cohort of patients. Interventions to reduce this distress need to be a research priority.

Psychopathological profile in COVID-19 patients including healthcare workers: the implications.

The effects of COVID-19 seem to extend beyond the physical pain and is showing psychiatric implications as well. Moreover, psychopathological implications seem to last also after patients' discharge. Our goal is to investigate the psychological impact and psychopathological outcome of patients affected by COVID-19. We have engaged 34 patients with COVID-19 conditions [eight of them were healthcare workers patients (HCW)] hospitalized at "Policlinico Gemelli Foundation" of Rome, Italy. All patients were evaluated through the Impact of Event Scale-Revised (IES-R) and the Symptom Checklist 90-R (SCL-90-R) first, during their hospitalization (baseline), and then, after 4 months from hospital discharge (follow-up), through phone interviews. At baseline, 82% of patients revealed from mild to severe psychological impact of COVID-19, according to the IES-R. At follow-up, the mean IES-R total score was significantly decreased (p<0.001) even if almost half (46.6%) of our cohort still showed it. HCW patients showed a significantly higher score than other patients at IES-R scale, both at baseline (p=0.005) and at follow-up (p<0.001). Moreover, at 4 months from discharge, they showed a significantly higher percentage of moderate and severe distress (p=0.015). In addition to this, at follow-up, our cohort of patients showed an increase of anxiety symptoms, even if not significant compared to baseline (46.7% vs. 35.3% respectively; p=1.000), and HCW patients suffered more sleep disorders (p=0.019) and anxiety symptoms (p=0.019) compared to other patients. We indicate the importance of assessing psychopathology of COVID-19 survivors, monitoring their changes over time, and providing psychological support to improve their psychological well-being.

Aerosolized Calfactant for Newborns With Respiratory Distress: A Randomized Trial.

Exogenous surfactants to treat respiratory distress syndrome (RDS) are approved for tracheal instillation only; this requires intubation, often followed by positive pressure ventilation to promote distribution. Aerosol delivery offers a safer alternative, but clinical studies have had mixed results. We hypothesized that efficient aerosolization of a surfactant with low viscosity, early in the course of RDS, could reduce the need for intubation and instillation of liquid surfactant. A prospective, multicenter, randomized, unblinded comparison trial of aerosolized calfactant (Infasurf) in newborns with signs of RDS that required noninvasive respiratory support. Calfactant was aerosolized by using a Solarys nebulizer modified with a pacifier adapter; 6 mL/kg (210 mg phospholipid/kg body weight) were delivered directly into the mouth. Infants in the aerosol group received up to 3 treatments, at least 4 hours apart. Infants in the control group received usual care, determined by providers. Infants were intubated and given instilled surfactant for persistent or worsening respiratory distress, at their providers' discretion. Among 22 NICUs, 457 infants were enrolled; gestation 23 to 41 (median 33) weeks and birth weight 595 to 4802 (median 1960) grams. In total, 230 infants were randomly assigned to aerosol; 225 received 334 treatments, starting at a median of 5 hours. The rates of intubation for surfactant instillation were 26% in the aerosol group and 50% in the usual care group (P < .0001). Respiratory outcomes up to 28 days of age were no different. In newborns with early, mild to moderate respiratory distress, aerosolized calfactant at a dose of 210 mg phospholipid/kg body weight reduced intubation and surfactant instillation by nearly one-half.

Evaluation of Bonded Concrete Overlay of Asphalt under Accelerated Loading

Bonded concrete overlay of asphalt (BCOA), previously known as ultra-thin whitetopping (UTW), has been widely used to repair aged asphalt concrete (AC) pavements with moderate distresses. Because of the increasing costs of roadway maintenance, Louisiana has a great interest in determining whether thin BCOA (usually 2–6 in.) is a suitable and cost-effective alternative to the current practice of roadway maintenance. The objective of the study was to evaluate the performance of BCOA pavement and to identify the influence of in-situ interface bond strength on the performance of BCOA pavements. Three full-scale BCOA test sections with thicknesses of 6 in., 4 in., and 2 in. of Portland cement concrete (PCC) over an aged asphalt pavement were tested under accelerated pavement test (APT) loading under typical pavement conditions in southern Louisiana. Each section was trafficking-loaded to a failure (i.e., all the slabs in the loading path were cracked) under alternating load magnitudes of 9 kips and 16 kips of the ATLaS dual-tire wheel load. A falling weight deflectometer (FWD) backcalculated the effective thickness, a trench-cutting investigation was undertaken, and in-situ pull-off test revealed that a good bond was established initially between the PCC and AC layer. Several non-destructive test (NDT) methods indicated that the distresses of a BCOA slab could be coupled with a possible debonding at the PCC-asphalt interface. This paper mainly focuses on the APT results and the performance of BCOA test sections with different overlay thickness.

Dexamethasone in hospitalised patients with COVID-19: addressing uncertainties

Dexamethasone in hospitalised patients with COVID-19: addressing uncertainties

The Impact of the COVID-19 Pandemic and Emergency Distance Teaching on the Psychological Status of University Teachers: A Cross-Sectional Study in Jordan.

.The COVID-19 pandemic has struck many countries globally. Jordan has implemented strict nationwide control measures to halt the viral spread, one of which was the closure of universities and shifting to remote teaching. The impact of this pandemic could extend beyond the risk of physical harm to substantial psychological consequences. Our study aimed at assessing 1) psychological status, 2) challenges of distance teaching, and 3) coping activities and pandemic-related concerns among university teachers in Jordan in the midst of COVID-19–related quarantine and control measures. We conducted a cross-sectional study using an anonymous online survey. The measure of psychological distress was obtained using a validated Arabic version of the Kessler Distress Scale (K10). Other information collected included sociodemographic profile, methods used to handle distress, motivation to participate in distance teaching, and challenges of distance teaching as well as the most worrisome issues during this pandemic. Three hundred eighty-two university teachers returned completed surveys. Results of K10 showed that 31.4% of respondents had severe distress and 38.2% had mild to moderate distress. Whereas gender was not associated with distress severity, age had a weak negative correlation (Rho = −0.19, P < 0.0001). Interestingly, most teachers had moderate to high motivation for distance teaching. Engagement with family was the most reported self-coping activity. More than half of the participants were most concerned and fearful about SARS-CoV-2 infection. In conclusion, university teachers have shown to exhibit various levels of psychological distress and challenges during the implementation of precautionary national measures in the battle against COVID-19 in Jordan.

Mental Distress and Cognition among Long-term Survivors of Adolescent and Young Adult Cancer in the United States

Patients diagnosed with cancer as adolescent and young adult (AYA) are at risk for a range of long-term psychosocial sequelae both due to diagnosis and associated treatments, including radiation therapy. However, late effects of therapy in this population, particularly on mental distress and cognitive dysfunction are understudied. We therefore sought to characterize the prevalence of cognitive dysfunction and mental distress among long-term AYA cancer survivors. Using data from the National Health Interview Survey between 2010-2017, multivariable logistic regression analyses defined the association between AYA cancer diagnosis (defined as those reporting a diagnosis of cancer between the ages of 15-39 at least 10 years prior to survey administration) and cognitive dysfunction and mental distress, as defined by the 6-item Kessler Psychological Distress Scale. Among AYA cancer survivors, the association between mental distress and cognitive dysfunction was assessed via multivariable logistic regression. The weighted prevalence of cognitive dysfunction and mental distress was estimated. Among 89,141 participants, 1,039 (1.2%) were AYA cancer survivors diagnosed ≥ 10 years prior to survey administration. Prior cancer diagnosis was associated with greater odds of cognitive dysfunction (AOR 1.54, 95% CI 1.29-1.84) and mental distress (AOR 1.87, 95% CI 1.57-2.23). Notably, the prevalence of having cognitive dysfunction and mental distress was 24.1% and 29.2% in cancer survivors as compared to 14.3% and 16.0% in the general population. Among survey participants reporting a cancer diagnosis, increasing mental distress was associated with greater odds of cognitive dysfunction (AOR 3.57, 95% CI 2.25-5.65 for moderate cognitive distress, AOR 14.30, 95% CI 7.42-27.58 for severe mental distress) and cognitive dysfunction was associated with having mental distress (AOR 5.00, 95% CI 3.28-7.61). Among AYA cancer survivors with cognitive dysfunction, 27.6% (95% CI21.7%-34.5%) had difficulty remembering, 13.2% (95% CI 8.6%-19.7%) had difficulty concentrating, and 59.1% (95% CI 51.6%-66.3%) reported difficulty in both areas. Furthermore, among cancer survivors with cognitive dysfunction, the prevalence of low/none, moderate and severe mental distress was 41.3% (95% CI 34.2%-48.8%), 35.3% (95% CI 28.4%-42.8%) and 23.4% (95% CI 17.7%-30.4%), respectively. Long-term survivors of AYA cancer have higher rates of cognitive dysfunction and mental distress as compared to the general population, which appear to be highly intercorrelated among AYA cancer survivors. Providers and patients should be given adequate access to screening tools and counseling services for psychosocial and neurocognitive issues, which should be integrated into standard AYA cancer survivorship care.

Dexamethasone and remdesivir: finding method in the COVID-19 madness

Dexamethasone and remdesivir: finding method in the COVID-19 madness

Types of coastlines and the evacuees’ mental health: A repeated cross-sectional study in Northeast Japan

Although the health risks and benefits of coastal areas have long been researched, these effects of the different types of coastlines have rarely been explored on the evacuees living near the coast, in a post-disaster context. Thus, this study aimed to explore, with the passing of years after a disaster, what kind of coastline is a useful public health resource as a post-disaster reconstruction approach in coastal environments that have suffered significantly from the tsunami disaster in northeast Japan in 2011. This study compared the evacuees' mental health based on proximity to the coast and the types of coastlines (artificial, semi-natural, and natural). Data were drawn from the Miyagi Prefectural Government surveys, which targeted almost all evacuees of the 2011 Great East Japan Earthquakes and Tsunami (n = 96,203). We applied a pooled Poisson regression model to a repeated cross-sectional dataset of evacuees' mental health between 2012 and 2016. Moderate psychological distress, measured via the Kessler Psychological Distress Scale (K6) score, was the dependent variable, while proximity to the coast and type of coastline were the independent variables. The estimated main effects of type of coastline indicated that overall associations between K6 ≥5 and all types of coastlines within a 1.6 km buffer of participants' residential space were not statistically significant (p > 0.05). However, among types of coastlines, the interaction terms of semi-natural coastline × year (2015 and 2016) were significantly associated with lower incidence rate ratios (IRR), which decreased in 2015 and 2016 (IRR: 0.88, 95%CI: 0.79–0.98; IRR: 0.78, 95%CI: 0.68–0.90, respectively). Further, we computed the marginal effects of coastline types for each year to observe differences in the impact on moderate psychological distress depending on different accessible coastline types within a distance of 1.6 km from the participants’ living space. We found that, after the revision of the coastal act in 2014, the moderate mental stress of participants who lived around semi-natural coastlines significantly tended to be low (dy/dx: −0.04, 95%CI: −0.08–0.01 in 2015; dy/dx: −0.07, 95%CI: −0.11–0.04 in 2016). This finding can encourage policymakers to manage coastal areas with green infrastructure in the post-disaster reconstruction sustainably.

Effectiveness of Aromatherapy on Menstrual Distress among Adolescent Girls

Aim: To determine the effectiveness of Aromatherapy on menstrual distress among young adolescent girls with primary dysmenorrhea.&#x0D; Study Design: Quantitative approach with Pre-experimental research design.&#x0D; Place and Duration of Study: Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai, from December 2019 to February 2020.&#x0D; Methodology: Sixty adolescent girls were selected for the study by using a convenience sampling technique. The participants who participated in the study were adolescent girls with 17 - 19 years of age, have regular menstrual cycle, having primary dysmenorrhea, and willing to participate in the study. Demographic variables and clinical variables were collected by using structured questionnaire. Followed by pre-test assessment on primary dysmenorrhea symptom was assessed on 5th day of menstruation by primary dysmenorrhea symptoms questionnaire. Aromatherapy was administered by inhalation method in alternate days from 7th day of menstrual cycle for two consecutive menstrual cycles. Post test was conducted at the end of intervention on the first day of menstrual cycle using the same tool. The data were tabulated and analyzed by descriptive and inferential statistics using SPSS statistical package.&#x0D; Results: The result of the study shows that in the pre-test, 54(90%) had moderate menstrual distress and 6(10%) had severe menstrual distress. Whereas in the post test, almost all 60(100%) had mild menstrual distress. pre-test and post-test mean score of menstrual distress was 62.83±2.93 and 33.03± 2.48. Which was compared by paired ‘t’ test revealed that the post-test mean value is lower than the pre-test mean value and found statistically significant at the level of p&lt;0.001&#x0D; Conclusion: The finding of the present study concludes that aromatherapy using lavender oil is significantly effective in reducing the menstrual distress without side effects among adolescent girls with primary dysmenorrhea and also reduces the risk pharmacological intervention.