Ongoing Stress Research Articles

Atmospheric plasmas research linked to electromagnetic signals and earthquakes

This paper presents the outcome of monitoring aimed at studying seismic precursor candidates with a multi-parameter system, carried out at a Science Camp in July 2022 in the northwestern Italian Apennines, in the province of Parma. Pre seismic signals, closely related to the preparatory stages of an earthquake, were detected with a crustal diagnosis, based on physical signals, generated by tectonic stress. The instrumental results show a potential temporal concatenation, which describe, at the level of hypothesis, the phases of the ongoing tectonic stress. The model followed Zou’s theories who which associate the formation of plasmas in the atmosphere with the piezoelectricity of rocks under stress. According to his model, rocks placed under tectonic stress and in the presence of moisture can produce both charged particles and radio electromagnetic waves, at high and low frequencies. A spherical plasmoid would originate from this combination as a wave-particle interaction effect. According to Teodorani’s description High-Frequency radio waves-particularly microwaves-would heat and ionize the surrounding air, while low-frequency waves, particularly Very Low Frequencies and Extremely Low Frequency, would help condense the plasma, which in turn would immediately go into swirling motions within it, until it formed the «self-contained» structure seen in the sky as a light phenomenon. Monitoring, therefore, involved the detection of low-frequency waves preceding plasmas in the atmosphere, directional electromagnetic signals from the Radio Direction Finding (RDF) network, and the occurrence of an earthquake within the 5/6 days’ time window along the same fracture line. A study model that, if confirmed, could be applied to other seismic zones for crustal monitoring.

The Prevalence of PTSD of Mothers and Fathers of High-Risk Infants Admitted to NICU: A Systematic Review.

Admission of a preterm or sick full-term infant to the neonatal intensive care unit (NICU) is a stressful experience for parents. Indeed, the 'NICU experience' may constitute a traumatic event for parents, distinct from other birth-related trauma, leading to significant and ongoing posttraumatic stress disorder (PTSD) symptoms. However, the rates at which this outcome occurs are not well understood. This review aimed to identify the prevalence of PTSD in mothers and fathers of high-risk infants admitted to the NICU, specifically focusing on the NICU experience as the index trauma. The PRISMA-P: Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols were used to conduct this review. We searched PsycINFO, PubMed, Scopus, EMBASE, Web of Science, ProQuest Dissertations and Theses databases, and reference lists of included articles (1980-2021). Two independent reviewers screened titles and abstracts and conducted the full-text screening assessment. Of the 707 records identified, seven studies met the inclusion criteria. In this systematic review, PTSD symptomatology was assessed by self-report measures rather than a clinical interview. We identified significant variations in the methodologies and quality between studies, with a wide variation of reported prevalence rates of PTSD of 4.5-30% in mothers and 0-33% in fathers. Overall, the findings indicate that up to one-third of parents experience PTSD symptomatology related to the NICU experience. These results emphasize the importance of universal routine antenatal and postnatal screening for symptoms of PTSD to identify parents at risk of distress during the NICU experience and after discharge.Trial registration: The study protocol was registered with Prospero registration number CRD42020154548 on 28 April 2020.

THE IMPACT OF SOCIAL DETERMINANTS ON SLEEP HEALTH AMONG MIDDLE-AGED AND OLDER ADULTS

Abstract Poor sleep health, including short or long duration and/or irregular timing may lead to a variety of chronic health conditions including diabetes and heart disease. An estimated 50-70 million adults in the United States have poor sleep health and this burden is disproportionately felt among systematically disadvantaged groups. While social and behavioral determinants of sleep duration and quality have been examined, sleep health, a multidimensional concept, has been less explored. The study aims to examine the impact of social determinants on sleep health among middle-aged and older adults. Data from the 2014 wave of the Health and Retirement Study were weighted and restricted to respondents of “Leave-Behind” questionnaire (n=5334). Sleep Health score was derived from sleep variables (range 0-100). Structural equation modeling was conducted using the R package lavaan. Sample mean age was 68.2 years (SD=10.1). Majority were female (60%) and white (76%) with mean Sleep Health score of 50 (SD=5.2). Black (p< 0.0001) and Latinx respondents (p< 0.0001) had worse sleep health than white respondents. Depression, financial strain, and neighborhood characteristics of socioeconomic status, social cohesion, and physical disorder mediated the relationship between race and sleep health. Ongoing chronic stress and everyday discrimination also mediated the relationship between race and Sleep Health among Black vs. white respondents. These findings suggest multiple individual and neighborhood-level determinants may negatively influence sleep health among a nationally representative sample of middle-aged and older Black and Latinx adults. Neighborhood-level characteristics may be modifiable factors that can be targeted to improve sleep and related health outcomes.

Perceived stress and stress responses during COVID-19: The multiple mediating roles of coping style and resilience.

Although many studies have examined the effects of perceived stress on some specific stress responses during the COVID-19, a comprehensive study is still lacking. And the co-mediating role of coping style and resilience as important mediators of stress processes is also unclear. This study aimed to explore the effects of perceived stress on emotional, physical, and behavioral stress responses and the mediating roles of coping style and resilience in Chinese population during the recurrent outbreak of COVID-19 from a comprehensive perspective. 1087 participants were recruited to complete the anonymous online survey including the Perceived Stress Scale, the Stress Response Questionnaire, the Simplified Coping Style Questionnaire and the Emotional Resilience Questionnaire. Pearson's correlation and Hayes PROCESS macro 3.5 model 6 were used in the mediating effect analysis. Results showed that positive coping style and resilience both buffered the negative effects of perceived stress on emotional, physical, and behavioral responses through direct or indirect pathways, and resilience had the strongest mediating effects. The findings urged relevant authorities and individuals to take measures to promote positive coping style and resilience to combat the ongoing pandemic stress and protect public physical and mental health.

The Strong Black Woman Archetype and Therapeutic Outcomes: Examining Relationships Among Women with Childhood Sexual Abuse Histories.

The Strong Black Woman archetype (SBWA) describes a cultural pattern where Black women are expected to and present as physically and mentally strong, regardless of past and ongoing stressors. The SBWA has served the historical purpose of aiding survival for Black women throughout years of racial and gender oppression. However, the practice has also been associated with adverse mental health and with behaviors, such as self-silencing, that could impede therapeutic process. The purpose of this empirical study was to investigate the relationships between adherence to the SBWA and therapeutic outcomes (i.e., satisfaction with therapy, satisfaction with therapist, perceptions of one's global improvement in therapy) among Black women with childhood sexual abuse histories-a subpopulation at increased need for mental health treatment and who may be susceptible to high levels of adherence to the SBWA. Black adult female participants (N = 103) completed an online survey including a demographic questionnaire, an assessment of SBWA endorsement, and treatment outcomes from their current or most recent therapy experience. Three hierarchical linear regressions were conducted with SBWA as the independent variable and (i) satisfaction with therapist, (ii) satisfaction with therapy, and (iii) global improvement as the dependent variables. Consistent with our hypotheses, we found that SBWA inversely predicted satisfaction with therapy and the therapist. While the relationship between SBWA and global improvement was statistically significant, the finding was not practically significant. Still, our study findings suggest that higher levels of SBWA predict less favorable therapy outcomes. Future research directions and clinical implications are discussed.

Lack of robust associations between prepandemic coping strategies and frontolimbic circuitry with depression and anxiety symptoms during the COVID-19 pandemic: A preregistered longitudinal study.

The COVID-19 pandemic is an ongoing stressor that has resulted in the exacerbation of mental health problems worldwide. However, longitudinal studies that identify preexisting behavioral and neurobiological factors associated with mental health outcomes during the pandemic are lacking. Here, we examined associations between prepandemic coping strategy engagement and frontolimbic circuitry with internalizing symptoms during the pandemic. In 85 adults (71.8% female; age 18-30 years), we assessed prototypically adaptive coping strategies (Connor-Davidson Resilience Scale), resting-state functional magnetic resonance imaging functional connectivity (FC) of frontolimbic circuitry, and depression and anxiety symptoms (Beck Depression Inventory, Screen for Child Anxiety-Related Emotional Disorders-Adult, respectively). We conducted general linear models to test preregistered hypotheses that (1) lower coping engagement prepandemic and (2) weaker frontolimbic FC prepandemic would predict elevated symptoms during the pandemic; and (3) coping would interact with FC to predict symptoms during the pandemic. Depression and anxiety symptoms worsened during the pandemic (ps < .001). Prepandemic adaptive coping engagement and frontolimbic FC were not associated with depression or anxiety symptoms during the pandemic (uncorrected ps > .05). Coping interacted with insula-rostral anterior cingulate cortex (ACC) FC (p = .003, pFDR = .014) and with insula-ventral ACC FC (p < .001, pFDR < .001) to predict depression symptoms, but these findings did not survive FDR correction after removal of outliers. Findings from our preregistered study suggest that specific prepandemic factors, particularly adaptive coping and frontolimbic circuitry, are not robustly associated with emotional responses to the pandemic. Additional studies that identify preexisting neurobehavioral factors implicated in mental health outcomes during global health crises are needed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

African American Dementia Caregivers’ Perspectives on and Appraisal of Stress Associated with the Caregiving Role: A Qualitative Study

AbstractBackgroundAfrican Americans are disproportionately impacted by Alzheimer’s disease and related dementias (ADRD), with family members providing the majority of support and care. Dementia caregivers often face high levels of stress and burden which contribute to poor physical and psychological health outcomes. African American dementia caregivers often face greater risk for stress and burden with discrepant evidence on whether this leads to worse outcomes compared to counterparts. Yet African American dementia caregivers remain under‐included in research designed to understand and ameliorate the stress and burden of caregiving. Our study aimed to understand African American dementia caregivers’ perspectives and appraisal of stressors surrounding caregiving and stressful events, such as hospitalization of the person with ADRD.MethodsWe harnessed qualitative interview data from the Stakeholders Understanding of Prevention Protection and Opportunities to Reduce HospiTalizations (SUPPORT) Study, a multi‐site study designed to determine family caregiver perspectives surrounding hospitalizations for people with ADRD residing in highly disadvantaged neighborhoods. Data from 30 dementia caregivers who self‐identified as African American were analyzed using thematic analysis.ResultsAll participants described the presence of stressors and stressful events related to their life broadly and to dementia caregiving more specifically. However, there was great variation in the described degree of stressors in caregiver’s daily life. Caregivers experiencing a greater number, more recent, and more acute stressors described greater burden in their daily life. Long‐standing stressors, such as family conflict and financial hardship, sometimes ‘resurfaced’ with the proximity and role changes brought on by caregiving. Other individual and situational factors, such as one’s own health or status as a ‘sandwich caregiver,’ or the habits and preferences of the person with ADRD, could serve as contributors to overall stress. Few caregivers related stressors to long‐term outcomes, though some described strategies to seek formal mental health counseling.ConclusionsAfrican American dementia caregivers described a variety of acute and ongoing stressors that related not only to caregiving for the person with ADRD but also the caregiver’s personal health and their broader familial and neighborhood context, signaling the need for adaptive caregiver support interventions capable of addressing intervention targets across various stressors.

Novel Role of Mammalian Cell Senescence-Sustenance of Muscle Larvae of Trichinella spp.

Muscle larva of the parasitic nematode Trichinella spp. lives in a portion of muscle fibre transformed to a nurse cell (NC). Based on our previous transcriptomic studies, NC growth arrest was inferred to be accompanied by cellular senescence. In the current study, NC was proven to display the following markers of senescence: high senescence-associated β-galactosidase activity, lipid deposition, DNA damage, and cell cycle inhibition. Moreover, the nuclear localization of Activator Protein 1 (c-Fos, c-Jun, and FosB), as well as the upregulation of numerous AP-1 target genes in the NC, remained in accord with AP-1 recently identified as a master transcription factor in senescence. An increase in reactive oxygen species generation and the upregulation of antioxidant defence enzymes, including glutathione peroxidases 1 and 3, catalase, superoxide dismutases 1 and 3, and heme oxygenase 1, indicated an ongoing oxidative stress to proceed in the NC. Interestingly, antioxidant defence enzymes localized not only to the NC but also to the larva. These results allowed us to hypothesize that oxidative stress accompanying muscle regeneration and larval antigenic properties lead to the transformation of a regenerating myofibre into a senescent cell. Cellular senescence apparently represents a state of metabolism that sustains the long-term existence of muscle larva and ultimately provides it with the antioxidant capacity needed during the next host colonization. Senotherapy, a therapeutic approach aimed at selective elimination of senescent cells, can thus be viewed as potentially effective in the treatment of trichinosis.

Transportation Burden Associated With Hemodialysis in Canada: A Qualitative Study of Stakeholders

For patients requiring in-center hemodialysis, suboptimal transportation arrangements are commonly cited as a source of ongoing stress and anxiety and have been associated with a reduced quality of life and increased mortality risk. Transportation-related problems are especially pronounced in Canada given its size, low population density, and long, often snowy winters. We aimed to identify and better understand transportation options for hemodialysis patients in Canada and to describe stakeholder experiences. We used a qualitative descriptive research design to explore stakeholder experiences and perspectives of transportation to and from dialysis facilities. We recruited participants from a large urban hemodialysis program in Western Canada and included 11 participants from a project group, 45 participants from an open forum, and a survey of 8 social workers. Data collection occurred at a series of project group meetings and an open forum (n=45). In addition, we asked 8 renal social workers based in major cities across Canada to comment on the provision of transport for patients in their area via email or telephone consult. We used conventional content analysis to explore stakeholder experiences. Traveling to and from dialysis facilities remains a source of stress and anxiety for many patients and their families. Patients described several factors contributing to these feelings including: the challenges of physically getting to the treatment center, particularly in adverse weather conditions; being a burden on family and friends; difficulties accessing the treatment facility; issues with public transport; and financial worries related to high costs. Findings may not be relevant in low- and middle-income countries and those with a warmer climate. Without a concerted and collaborative approach to address the barriers identified here, it is likely that travel to and from in-center hemodialysis will continue to adversely affect patients' quality of life.

Essential Public Health Functions in Ireland: Perspectives to strengthen capacities and stewardship

Abstract Background COVID-19 has caused unprecedented disruptions to health, social and economic systems in countries worldwide including Ireland. Weaknesses in Public Health capacities have undermined health system resilience compounding the effects of the pandemic. The Essential Public Health Functions (EPHFs) provide a comprehensive, cost-effective approach to operationalising public health and a means to build health systems resilience. As Ireland looks to recovery, the Department of Health engaged the World Health Organization (WHO) to undertake a mapping of the current state of delivery of EPHFs to identify opportunities for improvement and support wider health system strengthening towards resilience. Methods A strategic review of the delivery of EPHFs in Ireland was conducted with respect to policy, infrastructure, service provision and coordination and integration. Findings were reported in the context of international lessons identified through experience with COVID-19 and major health system challenges within the Irish context. Results There are significant capacities present within the Irish context to support the delivery of the EPHFs though they are limited in strategic cohesion, coordination and implementation. These include a high level of Public Health expertise, an agile and resourceful workforce, a strongly engaged community and significant evidence generation and synthesis capacities. Gaps recognised included ICT infrastructure and capacity, workforce resourcing and support, pandemic planning and public health governance, visibility, legislation, strategy and resourcing. COVID-19 has led to the development and strengthening of mechanisms to leverage a whole-of-government and -society approach to health that should be sustained to tackle ongoing and future stressors. Conclusions The use of the EPHFs within the Irish setting provides a comprehensive approach to strengthening capacities for public health and enhanced population health and wellbeing.

7.A. Round table: Sustainable health system responses to meet the chronic health care needs of refugees from Ukraine

Abstract Background Since Russia's reinvasion of Ukraine on 24 February, more than 5 million people have fled the country. Most have gone to the neighbouring countries of Poland, Slovakia, Hungary, Romania, and Moldova. This vulnerable population has significant healthcare needs. Among the most challenging to address will be chronic non-communicable diseases (NCDs), including mental disorders, as these require long-term, continuous care and access to medicines. NCDs are already the biggest contributor to disease burden among Ukrainian adults. About a third have hypertension and 7% have diabetes. Refugees are also at increased risk of mental disorders due to exposure to trauma and ongoing daily stressors. Host country health systems are faced with the challenge of ensuring accessible and affordable care for NCDs and mental disorders to this population. There is no consensus on the most effective and sustainable approaches for achieving this. Objectives This workshop will provide a platform for sharing knowledge to support host country health systems. The objectives of the workshop are to i) identify sustainable health system approaches to providing quality health care for NCDs and mental disorders to refugees from Ukraine, and ii) establish research priorities to support host country health system decision-making. Format The workshop will consist of a panel with 4 speakers, followed by a roundtable discussion. Each panel member will make a short presentation (5 min) related to health system responses for NCDs and mental disorders in refugee populations. They will highlight challenges faced in the current crisis and evidence of approaches that have worked in other refugee contexts. The roundtable discussion will focus on the adaptation of evidence-based approaches to countries hosting refugees from Ukraine, and the research needed to support this. Interventions will be made by representatives from countries hosting refugees, including from WHO country offices, and from the WHO Europe Migration and Health Programme. All workshop participants will be invited to contribute. The discussion will be chaired by Natasha Azzopardi-Muscat, Director of the Division of Country Health Policies and Systems, WHO European Regional Office. A report on the conclusions of the workshop, including research priorities to support host country health systems, will be published. Key messages • Health systems receiving refugees from Ukraine will face challenges in providing them long-term and affordable care for NCDs and mental disorders. • Drawing on evidence, the workshop will help to identify sustainable health system responses to NCDs and mental disorders, and priorities for research to support host country health systems. Introduction Adrianna Murphy LSHTM, London, UK Impact of the crisis in Ukraine on neighbouring health systems Kayvan Bozorgmehr Bielefeld University, Bielefeld, Germany Financing to meet the chronic health care needs of refugees Triin Habicht Senior Health Economist, WHO Barcelona Office for Health Systems Strengthening, Barcelona, Spain Implementing responsive integrated mental health care for refugees Sergiy Bogdanov Centre for Mental Health and Psychosocial Support, National University of Kyiv Mohyla Academy, Kyiv, Ukraine Ensuring continuous access to NCD treatment among refugees Sigiriya Aebischer Perone Geneva University Hospitals, Geneva, Switzerland

Context, coping, and mental health in refugees living in protracted displacement.

There is currently an unprecedented number of forcibly displaced people worldwide. Little is known, however, about how external stressors and internal coping strategies intersect to influence mental health in displaced refugees, particularly whether specific types of coping strategies are more or less effective across different levels of external stress. This study aimed to understand whether positive and negative internal coping strategies were differentially associated with mental health across high and low levels of external stressors in displaced refugees. Participants were 1,216 refugees living in Indonesia who completed an online survey indexing demographic characteristics, exposure to ongoing stressors, positive psychological coping strategies (i.e., cognitive flexibility, self-efficacy, and hope), negative psychological coping strategies (i.e., rumination and intolerance of uncertainty), psychological symptoms (i.e., posttraumatic stress disorder, depression, and anxiety) and mental health-related quality of life. Participants (27.3% female, Mage = 30.52 years) were from Arabic-, Farsi-, Tamil-, Somali-, Dari-, and English-speaking backgrounds. Results of latent moderated structural equation modeling indicated that the association between negative psychological coping strategies and poorer mental health was stronger at higher levels of stress, whereas the association between positive psychological coping strategies and better quality of life was stronger at lower levels of stress. These findings provide evidence in support of tailored approaches that integrate interventions addressing external stressors and internal coping strategies to support positive mental health and enhanced quality of life in displaced refugees.

The cellular landscape of the normal kidney allograft: Main players balancing the alloimmune response.

Despite recent advances made in short-term outcomes; minimal improvements have been observed in long-term kidney transplantation outcomes. Due to an imbalance between organ transplant availability and patient waiting list, expanding kidney allograft longevity is a critical need in the field. Prior studies have either focused on early ischemic and immunological conditions affecting kidney allografts (e.g., delayed graft function, acute rejection) or late stage chronic injury when interventions are no longer feasible. However, studies characterizing kidney allografts with normal function by its cellular distribution, cell-cell interactions, and associated molecular pathways are lacking. Herein, we used single nuclei RNA-sequencing to uncover the cellular landscape and transcriptome of the normal kidney allograft. We profiled 40,950 nuclei from seven human kidney biopsies (normal native, N = 3; normal allograft, N = 4); normal allograft protocol biopsies were collected ≥15-months post-transplant. A total of 17 distinct cell clusters were identified with proximal tubules (25.70 and 21.01%), distal tubules (15.22 and 18.20%), and endothelial cells (EC) (4.26 and 9.94%) constituting the major cell populations of normal native and normal allograft kidneys, respectively. A large proportion of cycling cells from normal native kidneys were in G1-phase (43.96%) whereas cells from normal allograft were predominantly in S-phase (32.69%). This result suggests that transcriptional differences between normal native and normal allograft biopsies are dependent on the new host environment, immunosuppression, and injury-affliction. In the normal allograft, EC-specific genes upregulated metabolism, the immune response, and cellular growth, emphasizing their role in maintaining homeostasis during the ongoing alloreactive stress response. Immune cells, including B (2.81%), macrophages (24.96%), monocytes (15.29%), natural killer (NK) (12.83%), neutrophils (8.44%), and T cells (14.41%, were increased in normal allografts despite lack of histological or clinical evidence of acute rejection. Phenotypic characterization of immune cell markers supported lymphocyte activation and proinflammatory cytokines signaling pathways (i.e., IL-15, IL-32). The activation of B, NK, and T cells reveals potential immune cells underlying subclinical inflammation and repair. These single nuclei analyses provide novel insights into kidney and immune cell associated signaling pathways that portray kidney grafts with normal allograft function beyond 2-years post-transplant, revealing a novel perspective in understanding long-term allograft graft survival.

The effect of an integrated care intervention of multidisciplinary mental health treatment and employment services for trauma-affected refugees: study protocol for a randomised controlled trial

BackgroundThe complexity of past trauma and ongoing post-migration stressors challenges the existing mental health treatment for trauma-affected refugees. Therefore, interventions are needed to accommodate these complex challenges in mental health treatment. This study examines the effect of an add-on integrated care intervention compared to treatment as usual (TAU) for trauma-affected refugees in a randomised controlled trial (RCT).MethodsThe study is carried out at a Danish outpatient clinic and will include 197 treatment-seeking refugees with post-traumatic stress disorder (PTSD) who are unemployed and affiliated with municipal employment services. Mental health TAU comprises 10 sessions with a medical doctor (pharmacological treatment and psychoeducation) and 16–20 sessions with a psychologist (manual-based cognitive behavioural therapy) for a period of 8 to 12 months. The add-on intervention strengthens coordination between mental health treatment and employment interventions with three cross-sectoral collaborative meetings during the mental health treatment. The integrated care intervention draws attention to the bidirectional impact of mental health problems and post-migration stressors and focuses on cross-sectoral shared plans. The primary outcome is functioning, measured by WHODAS 2.0, the interviewer-administered 12-item version, with secondary outcomes measuring quality of life, mental health symptoms, and post-migration stressors.DiscussionThe RCT is novel in intervention design for trauma-affected refugees and will bring forward new perspectives and knowledge of integrated care interventions for trauma-affected refugees. The integrated care intervention is expected to reduce post-migration stressors that negatively affect the treatment of trauma-related mental health problems, thereby improving preconditions for enhanced treatment outcomes. The intervention builds on existing practices in the Danish healthcare and employment sectors, which ensures high scalability and sustainability for future practices.Trial registrationClinicalTrials.gov Identifier: NCT04244864, registered 28 January 2020. Protocol version: 17 September 2022, version 2.

'Like ships in the night': A qualitative investigation of the impact of childhood cancer on parents' emotional and sexual intimacy.

Childhood cancer is highly distressing for families and can place strain on parents' relationships. Parental functioning and cohesiveness are important predictors of family functioning and adaptation to stress. This qualitative study investigated the perceived impact of childhood cancer on parents' relationship with their partner, with a focus on emotional and sexual intimacy. We conducted semi-structured interviews with 48 parents (42 mothers, six fathers) of children under the age of 18 who had completed curative cancer treatment. We analysed the interviews using thematic analysis. At interview, parents were on average 40.7years old (SD=5.5, range: 29-55years), and had a child who had completed cancer treatment between 3months and 10.8years previously (M=22.1months). All participants were living with their partner in a married/de facto relationship. Most parents reported that their child's cancer treatment had a negative impact on emotional and sexual intimacy with their partner, with some impacts extending to the post-treatment period. Reasons for compromised intimacy included exhaustion and physical constraints, having a shifted focus, and discord arising from different coping styles. Some parents reported that their relationship strengthened. Parents also discussed the impact of additional stressors unrelated to the child's cancer experience. Parents reported that childhood cancer had a negative impact on aspects of emotional and sexual intimacy, although relationship strengthening was also evident. It is important to identify and offer support to couples who experience ongoing relationship stress, which may have adverse effects on family functioning and psychological wellbeing into survivorship.

Association between sleep quality and stress among medical students of a rural indian tertiary care setting

Background: Due to the rigorous academic standards and demanding professionals, the medical field is thought to be a stressful subject of study. This has a negative impact on the student’s mental and physical health. The long-term effects of this study will have an impact on identifying major issues that our students are facing, which will ultimately improve the level of medical treatment offered by future doctors. Materials and Methods: This cross-sectional study was conducted from October to December 2020 at a tertiary care institution in Tamil Nadu, India for three months. After getting the necessary ethical permissions from the institution with reference number GEMC/2020/002, the undergraduate students from the first year to the internship were included in the study. Results: The educational status of the students indicated that around 147 (31.1%) of respondents belonged in the first year. The mean + Pittsburgh Sleep Quality Index (PSQI) was observed to be 6.33 + 2.13, where undesirable sleep quality was predominant among 370 (78.3%) of the respondents with a p-value of less than 0.0001. The majority of the students (70.1%) have normal levels of stress which were significant with a p-value of 0.0027. Conclusion: Medical students experience poor sleep and ongoing stress, which can result in harmful behaviors like overindulging in junk food and a reduced likelihood of exercising. They are undeniably more prone to developing chronic illnesses. If these issues are not addressed, they will affect the medical care that is given to their incoming patients.

Understanding the effects of being separated from family on refugees in Australia: a qualitative study

ObjectiveTo understand the impact of family separation on refugees living in Australia. MethodThirteen participants with a refugee background and experiencing separation from family participated in a semi‐structured qualitative interview. Interviews were coded and a thematic analysis was conducted using NVivo software. ResultsIdentified themes were organised under four domains. Domain 1 focused on the personal impact of family separation. Themes were the effects on mental health and functioning, driven by incessant worrying about the safety of family and the absence of key attachment figures, the specific effects of having missing family, alterations to self‐identity and family dynamics. Domain 2 focused on themes relating to actions taken to find missing family, connect or reunite with separated family. Domain 3 highlighted the coping strategies, support mechanisms and protective factors used by participants. Domain 4 identified core beliefs about the importance of family unity, focusing on security, settlement and a happy future. ConclusionsFamily separation has an enduring effect on the wellbeing of refugees, with key pathways being ongoing fear and insecurity, disrupted social attachments and identity shifts in relation to the future self. Implications for public healthRefugees separated from or missing family struggle with ongoing stress and adjustment issues.

Romantic Relationship Quality and Mental Health in Pregnancy During the Covid-19 Pandemic

Introduction: Social capital is important for good mental health and the quality of close relationships is one key indicator of social capital. Examining the association between relationship quality and mental health may be particularly important during pregnancy as mental health concerns during this period pose significant risk to families. The COVID-19 pandemic has contributed to increased mental health problems among pregnant individuals. The resulting lockdown protocols of the pandemic have also disrupted larger social networks and couples spent more time together in the context of ongoing chronic stress, highlighting the particular importance of romantic relationship quality. This study explored longitudinal associations between relationship satisfaction, depression, and anxiety among pregnant individuals during the first wave of the COVID-19 pandemic. Methods: Pregnant individuals (n = 1842) from the Pregnancy During the Pandemic Study were surveyed monthly (April-July 2020). Depression, anxiety symptoms, and relationship satisfaction were self-reported. Cross-lagged panel models were conducted to examine bidirectional associations between relationship satisfaction and mental health symptoms over time. Results: Relationship satisfaction was significantly correlated with depression and anxiety at all time points. Longitudinally, relationship satisfaction predicted later depression and anxiety symptoms, but depression and anxiety symptoms did not predict later relationship satisfaction. Discussion: This study suggests that poor relationship satisfaction was linked to subsequent elevations in prenatal depressive and anxiety symptoms during the COVID-19 pandemic. Relationship enhancement interventions during pregnancy may be a means of improving the mental health of pregnant individuals, and interrupting transgenerational transmission, during times of prolonged psychological distress.

A qualitative analysis of stressors affecting 999 ambulance call handlers' mental health and well-being

PurposeThe 999 ambulance call handler is critical in responding to emergency patient treatment; however, the call handlers are often a hidden component of the healthcare workforce and an under-researched group. The objective of this study is to understand stress triggers experienced by 999 ambulance call handlers that could lead to burnout and examine personal and organisational mechanisms and strategies which reduced the risk of burnout.Design/methodology/approachA single interview case study approach applying qualitative methods was undertaken. Participants were identified through a purposive sample of 999 ambulance call handlers with the Yorkshire Ambulance Service National Health Service Trust (UK). Participants were interviewed via telephone between July 2019 and September 2019.FindingsIn total, 18 staff participated in this study. Societal factors including public incivility and media representation and organisational factors, such as a demanding environment, lack of appreciation and career progression, training issues and protocols were key stressors. Organisational well-being services were helpful for some, but for others lacked accessibility and appropriateness. Positive public feedback and speaking with peers bolstered well-being. 999 ambulance call handlers suggested that sufficient breaks, co-design or feeding back on training and protocols and creating more informal opportunities to discuss ongoing everyday stressors as methods to reduce stress and burnout.Originality/valueThis paper explores a previously under researched area on stressors and potential burnout in 999 call handlers. This paper highlights the need for improved organisational support services and appropriate public and sector peer recognition of the role of ambulance 999 ambulance call handlers.

Analysis of the Influence of Mental Workload on Employee Performance with the Subjective Workload Assessment Technique (SWAT) Method at PT. Bumi Jasa Utama (Kalla Group)

Purpose: This study aimed to measure the mental workload experienced by employees in the finance department and to analyze the effect of mental workload on employee performance.&#x0D; Design/methodology/approach: This study used the Subjective Workload Assessment Technique (SWAT) method to measure the mental workload faced by employees who must perform various activities in their work.&#x0D; Findings: The results of this study indicate that the time load factor (T) is the dominant factor affecting employee workload because employees are required in terms of time to perform each activity included in the work process quickly, precisely, and in large quantities every day. Mental workload has a direct and significant positive effect on employee performance.&#x0D; Research limitations/implications: Data collection was only conducted on employees of the Finance Department of PT Bumi Jasa Utama.&#x0D; Practical implications: Based on the results of this study, the company is expected to increase the number of employees in the finance department to streamline time and minimize the workload of each employee in the finance department. The company is also expected to improve service and service quality by considering employee comfort and performance.&#x0D; Originality/value: The condition of employees who are given a high workload and ongoing causes stress and anxiety, so it is necessary to measure mental workload and the effect of mental workload on employee performance.