Residual Fear Research Articles

The “glass shoulder”: Patients’ lived experiences of a traumatic shoulder dislocation – A qualitative study

BackgroundAnterior shoulder dislocations have a high recurrence rate, often necessitating stabilizing surgery, with residual long-term fear of reinjury. ObjectivesTo explore patients’ experiences of anterior shoulder dislocations in relation to their lives, well-being, fear of reinjury, and future perspectives. DesignQualitative study. MethodsWe interviewed fourteen individuals (median age 27.5 yrs, range 21–40; two women) with traumatic anterior glenohumeral dislocation within 5 years, with or without past stabilizing surgery. We analysed data using Interpretive Description. ResultsWe constructed three main themes. (1) Downward wellness spiral: The injury shattered their lives, influencing their self-identity and -confidence. Sleep disturbances added to stress levels, loss, depression and grief. The re-injury risk could lead to social isolation. (2) Out of arm's reach: Recurrences led to frustration as the prior surgery and rehabilitation appeared to have been unsuccessful, having to start again. Support from healthcare providers and whānau/family was crucial to regain trust in the body. (3) Obligatory compromise: Over time, some individuals accepted the re-injury risk, learnt to heed warning signals, or compromised by avoiding specific social and recreational activities, changing their sports or to other roles in their preferred sport, and adapting work-related and daily tasks. ConclusionParticipants described in-depth socio-emotional responses following shoulder dislocations. Most participants described an ongoing interplay between fear and confidence in their shoulder. Healthcare provider support and professional relationship, on-going shoulder-related strengthening, and risk mitigation strategies were important to facilitate and maintain confidence and self-efficacy, and to re-consider and adjust the participant's goals when needed.

Fear of Religious Hate Crime Victimization and the Residual Effects of Anti-Semitism and Islamophobia

Abstract An individual’s fear of hate crime victimization might be partially explained by direct experiences that influence their assessment of victimization risk. In some cases, though, fear of hate crime victimization is driven not by direct, personal experiences, but by historical and contemporary trauma suffered by those holding the targeted status. Using data from the 2019 nationally representative Experiences with Religious Discrimination Study (ERDS) survey, we show that part of Jewish and Muslim adults’ greater fears of victimization is explained by their past personal victimization experiences, their knowledge of close friends and family who have been victimized, and their greater religious visibility. Still, even after accounting for these factors, Jewish and Muslim adults report greater fears of religious hate crime victimization compared to Christian adults. We attribute this residual fear to the culture of anti-Semitism and Islamophobia within the United States and violence attributable to that culture, as well as the collective memory of historical religion-based victimization of Muslim and Jewish communities. These findings suggest the collective memory and knowledge of contemporary religious victimization may continue to affect Jewish and Muslim adults via a mechanism of fear, which has implications for scholarly and policy efforts to decrease religious victimization and its impact.

Humor and Rumor in the Post-Soviet Authoritarian State

Humor and Rumor in the Post-Soviet Authoritarian State

Androgen Therapy in Women with Testosterone Insufficiency: Looking Back and Looking Ahead

In women, androgens not only serve as precursors for biosynthesis of estrogens but also exert a critical physiological role in sexual function, bone health, mood, behavior, and cognition. Despite research in the 1940s establishing the physiological role of testosterone (T) in women's health and the substantial benefits of T therapy (TTh) in women, the use of TTh in women today is rare, with little awareness of its value and safety within the medical community. We have identified several factors that have contributed to this situation, including: The rationale and use of androgens in women is not taught in medical schools; residual fear from the Women's Health Initiative study that sex hormones are associated with increased breast cancer risk; and absence of regulatory-approved T products for women in most parts of the world, except Australia. Although concerns regarding the efficacy and safety of TTh in women with sexual dysfunction have been appropriately addressed in randomized, placebo-controlled, studies TTh in women is prescribed by only a small percentage of physicians, and women who choose this treatment must use products intended for men as off-label treatment or find products via compounding pharmacies. Looking forward, we envision the possibility within the near future of symptomatic women with T insufficiency finding sympathetic health care providers who will recognize and appropriately treat their condition without negative judgment, allowing these women to experience the health and well-being associated with robust T levels. For this vision to occur, it will require education in medical school and postgraduate training, and broader acceptance of the science of TTh in women, noting its benefits and excellent safety profile.

Evidence of a post-COVID change in travel behaviour – Self-reported expectations of commuting in Melbourne

This paper addresses the question, “Will post-pandemic travel behaviour, when the virus has gone, be different to pre-pandemic travel?”. It adopts an online survey where respondents were asked to report changes in travel during the various stages of the pandemic and expectations of future travel after the virus has gone. The paper focusses on commuting including total commuting, work from home (WFH), employment, travel mode volume and share and timing of morning commute trips using reported behaviour during pandemic shutdowns; and expectations of commuting when the virus has gone. The paper provides evidence that travel behaviour post-pandemic might be different to pre-pandemic travel. It suggests that after the pandemic, public transport ridership, which declined steeply during the pandemic, will return but not to pre-pandemic levels. A post-pandemic reduction effect of around 20% in transit commuting is expected. This effect is supported using secondary evidence from a number of international cities. Results imply a mode shift from public transport use to car driving; this will be particularly large for CBD/downtown areas and is likely to result in peak period traffic congestion after the virus has gone. Work from home increased substantially during the pandemic; this will reduce after the pandemic as enforced WFH is replaced by voluntary WFH. Nevertheless, a sustained future ongoing increase in WFH above pre-pandemic levels is suggested, acting to reduce peak commuting by 6% and commuting to Melbourne CBD by 20%. However, reductions in commuting due to WFH do not offset mode shift from public transport to car driving resulting in a net increase in car use after the pandemic. Infection fear is a new top concern of public transport users since the pandemic. This fear has transitioned from ‘fresh infection fear’; the initial concerns when the pandemic started to ‘residual infection fear’; a long-term effect when the virus has gone. Implications of the findings for research and practice are discussed.

Superior-Labrum Anterior-Posterior Return to Sport Index (SLAP-RSI) Score to Quantify Psychological Readiness to Return to Play (223)

Objectives:Superior-labrum anterior-posterior (SLAP) tears are common among athletic populations and may require surgical treatment. Return to play post-operatively may be complicated by a number of factors, including psychological readiness to return. The purpose of this study was to evaluate the use of the SLAP Return to Sport Index (SLAP-RSI) score to quantify psychological readiness to return to play following operative management of SLAP tears.Methods:A retrospective review of athletes who underwent operative management of SLAP tears with a minimum of 12-month follow-up was performed. Patients were evaluated for their psychological readiness to return to sport using the SLAP-RSI score. The SLAP-RSI score was created by adapting the terms in the Anterior (ACL-RSI score) with terms related to SLAP tears. A SLAP-RSI score > 56 is considered a passing score for being psychologically ready to return to play.Results:The study included 174 athletes who underwent operative management of SLAP tears. Overall, 73.5% percent of patients were able to return to play, and the mean SLAP-RSI score in this cohort was 74.1±20.9, as compared to 46.7±27.7 in those who were unable to return (p<0.0001). Of those who returned, 82.1% passed the SLAP-RSI benchmark of 56, while of those who did not return, 33.3% passed the SLAP-RSI benchmark of 56. Additionally, a significant difference was found in each component of the SLAP-RSI score between the two cohorts (p<0.05). No individual component of the SLAP-RSI score was below 56 in patients who were able to return to play, while none was above 56 in those who were unable to return. Among patients who were unable to return, ones who cited lifestyle reasons had a higher SLAP-RSI score (77.4 ± 21.8) than those who cited residual pain (28.2 ± 15.1) or fear of re-injury (42.6 ± 23.6) (p<0.0001).Conclusions:Following the operative management of SLAP repair, patients that are unable to return to play exhibit poor psychological readiness to return which may be due to residual pain or fear of re-injury.

Application of the health belief model to explain public perceptions, travel intentions and actions during COVID-19: a sequential transformative design

PurposeThis paper uses a supplemented health belief model (HBM) to explain the risk perception of COVID-19 coronavirus infection by potential and actual domestic and international travelers (from primarily European countries) in the early pre-vaccine phase of the pandemic and its influence on their travel intentions, decisions, and actions. With a health crisis of this magnitude, it is vital to understand the effect of COVID-19-associated containment measures and safety industry strategies in abating public fear and apprehension associated with non-essential travel.Design/methodology/approachThe authors used a sequential transformative design consisting of a (QUAN + Qual) survey to explore the HBM dimensions. The questions in the quantitative part of the survey were disseminated online examine perceptions of the severity and susceptibility of the disease, travel risks and willingness to travel. The questions in the qualitative face-to-face survey examined, how international/cross-border travelers (from Spain and Germany) perceive the benefits and barriers of personal protective behavior and the potential influence of cues to action.FindingsResults suggest that despite potential fear arousal and confusion associated with this infectious disease, people were willing to travel during periodic on-and-off travel restrictions and perceive the benefits of such travel as outweighing barriers like wearing masks, social distancing and other containment measures.Research limitations/implicationsThe conceptual model enabled the capture of real-time traveler's feelings about the benefits of traveling in the presence of the coronavirus and their perceptions of COVID-19 safety strategies used at destinations. This study adds to the lack of existing knowledge about potential psychological factors influencing travel decisions and behavior, including self-protective behavior. As borders reopen and we progress towards tourism and hospitality recovery, the results of this study can assist organizations, including health officials and governments, by reminding them of the likelihood of residual public fear when planning their COVID-19 safety strategies.Originality/valueGiven the scarcity of COVID-19 research on people's travel intentions and behavior following periods of social isolation due to lockdowns and border closures, this study captures sample public perceptions at two stages early in the pandemic. It is the first to apply all of the HBM dimensions with the addition of travel risk as a construct to investigate people's travel intentions and behaviors without vaccinations or treatments and to include cues to action in the investigation.

Transfer of exposure therapy effects to a threat context not considered during treatment in patients with panic disorder and agoraphobia: Implications for potential mechanisms of change

Further developments of exposure-based therapy (EBT) require more knowledge about transfer of treatment to non-trained everyday contexts. However, little is known about transfer effects of EBT.Using a standardized EBT protocol in 275 patients with panic disorder and agoraphobia we investigated the transfer of EBT to a highly standardized context during a Behavioral Avoidance Test (BAT; being entrapped in a small and dark test chamber) and not part of the exposure sessions. Patients of a treatment group underwent the BATs before treatment (t1), after a preparatory treatment phase (t2), and after an agoraphobic exposure phase (t3) and were compared with wait-list control patients, who repeated BAT assessments across the same time period.We found stronger reductions in avoidance behavior, reported fear, and autonomic arousal during the BAT from t1 to t3 in the treatment group patients who were anxious during t1 relative to the anxious but untreated patients. Fear reduction was related to treatment outcome indicating the contribution of transfer effects to successful EBT. Interestingly, reduction varied for different fear response systems suggesting different processes to may be involved in transfer effects. Importantly, final BAT assessment still evoked residual fear in the treatment group as compared to BAT non-anxious control patients, suggesting limited transfer effects – one possible reason for the return of symptoms in new situations.

Common and specific aspects of anxiety and depression and the metabolic syndrome

IntroductionThe associations of anxiety and depression with metabolic syndrome (MetS) are not consistent across studies. Anxiety and depression are highly correlated and traditional methods don't take the structure of this correlation into account. Our aim is to disentangle the relationship of these emotional conditions with MetS, using bifactor models, modelling both general and specific aspects between anxiety and depression. MethodsBifactor models were tested using the baseline data from the Brazilian Longitudinal Study of Adult Health (n = 13,584). Anxiety and depression were accessed with the Clinical Interview Schedule - Revised. MetS was measured through assessment of its continuous components. ResultsA bifactor S-1 model better represent the 14 CIS-R indicators, composed by an internalizing factor corresponding to depressive symptoms, anxiety, worry and the shared variance of all remaining CIS-R indicators, and also by residual variance explained by a somatic (e.g., fatigue and pain) and fear (e.g., panic and phobias) specific factors. Internalizing spectrum (β = 0.116; p < 0.001) and the fear specific factor (β = 0.060; p = 0.008) were associated with MetS after adjusting for confounders, whereas somatic specific factor was unlikely to be associated with MetS (β = 0.002; p = 0.934). ConclusionsAnxiety and depression indicators were associated with MetS via a shared internalizing factor and also by a residual fear factor, but not by somatic residual factor. This finding has potential implications about shared biological and behavioral mechanisms that may link emotional conditions with MetS in adults.

Exploring Cancer Treatment Experiences for Patients With Preexisting Mobility Disability.

We explored the process of cancer care for patients with preexisting mobility disability, focusing on treatment decisions and experiences. We recruited 20 participants with preexisting mobility disability, requiring use of an assistive device or assistance with activities of daily living, subsequently diagnosed with cancer (excluding skin cancers). We conducted open-ended individual interviews, which reached data saturation and were transcribed verbatim for conventional content analysis. Concerns coalesced around 4 themes: disability-related healthcare experiences affect cancer treatment decisions; concerns about cancer treatment worsening functional impairments; access barriers; and limited provider awareness and biases about treating people with disability. Residual fear from previous medical interventions and concerns about exacerbating functional impairments influenced cancer treatment preferences. Participants also raised concerns that their underlying disability may be used to justify less aggressive treatment. Nevertheless, cancer treatment did exacerbate mobility difficulties for some participants. Inaccessible hospital rooms, lack of accessible medical equipment, and attitudinal barriers complicated treatments. People with preexisting mobility disability experience barriers to cancer treatment, compromising quality of care and potentially outcomes. Further training and proactive planning for accommodating disability during cancer treatment and rehabilitation are warranted. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of the article, the reader should be able to: (1) Recognize inadequate accommodations that compromise the diagnosis and treatment of a new cancer in patients with preexisting disability; (2) Recommend involving rehabilitation specialists in the process of care and clinical decision making from the time of cancer diagnosis for patients with preexisting disability newly diagnosed with malignancy; and (3) In the setting of accessibility barriers, facilitate efforts to accommodate patients with preexisting disability to improve quality of care in diagnosing and treating cancer. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Attack on a hospital in the Gaza Strip: a descriptive study

BackgroundArticle 8(2) of the Rome Statute describes “war crimes” as grave breaches of the Geneva Conventions. Article 18 of the Fourth Geneva Convention provides protection for civilian hospitals and staff. On July 21–22, 2014, Al Aqsa hospital, a 190-bed government hospital in the Gaza Strip, was hit by several Israeli military strikes while fully operational, with hundreds of refuge-seeking civilians in its buildings and grounds. The attacks killed three people, injured 70 people (including 11 medical staff), and destroyed or damaged buildings, equipment, and ambulances. The aim of this study was to investigate the response to the attack in persons who were at or near the hospital during the attacks . MethodsFor this descriptive survey, we used convenience sampling of persons at or near the hospital during the attacks. 26 of the 29 people who were approached on Sept 1–2, 2014, consented to interview. 13 participants were hospital staff, two were patients, three were relatives of patients, five were refuge-seekers, one was a relative of a refuge-seeker, and two were hospital neighbours. Written consent was obtained from all participants, and reasons for refusal were recorded. FindingsAll refusals cited fear of Israeli reprisals. All participants reported no resistance presence or activity in or near the hospital before or during the attacks. Ten (38%) participants were injured, including seven staff members, two relatives visiting patients, and one patient. 21 (81%) participants believed the attacks were deliberately directed at the hospital. 12 (92%) of the 13 staff members reported high levels of concern about the future safety of hospital staff. 20 (77%) participants reported no longer feeling safe anywhere. Eight (31%) participants commented that the attacks showed that neither the international community nor international humanitarian law protect Palestinian hospitals and medical workers. InterpretationThe absence of resistance activity indicates that the attacks on Al Aqsa hospital were not justified by military necessity and were thus in breach of the Geneva Conventions, constituting war crimes. Residual fear and loss of faith in international instruments can only be addressed by holding Israel accountable. This will have important implications for both the credibility of international law and the safety of civilians, medical staff, and facilities in future conflicts, everywhere. FundingNone.

Prior fear conditioning does not impede enhanced active avoidance in serotonin transporter knockout rats

Stressors can be actively or passively coped with, and adequate adaption of the coping response to environmental conditions can reduce their potential deleterious effects. One major factor influencing stress coping behaviour is serotonin transporter (5-HTT) availability. Abolishment of 5-HTT is known to impair fear extinction but facilitates acquisition of signalled active avoidance (AA), a behavioural task in which an animal learns to avoid an aversive stimulus that is predicted by a cue. Flexibility in adapting coping behaviour to the nature of the stressor shapes resilience to stress-related disorders. Therefore, we investigated the relation between 5-HTT expression and ability to adapt a learned coping response to changing environmental conditions. To this end, we first established and consolidated a cue-conditioned passive fear response in 5-HTT−/− and wildtype rats. Next, we used the conditioned stimulus (CS) to signal oncoming shocks during signalled AA training in 5-HTT−/− and wildtype rats to study their capability to acquire an active coping response to the CS following fear conditioning. Finally, we investigated the behavioural response to the CS in a novel environment and measured freezing, exploration and self-grooming, behaviours reflective of stress coping strategy. We found that fear conditioned and sham conditioned 5-HTT−/− animals acquired the signalled AA response faster than wildtypes, while prior conditioning briefly delayed AA learning similarly in both genotypes. Subsequent exposure to the CS in the novel context reduced freezing and increased locomotion in 5-HTT−/− compared to wildtype rats. This indicates that improved AA performance in 5-HTT−/− rats resulted in a weaker residual passive fear response to the CS in a novel context. Fear conditioning prior to AA training did not affect freezing upon re-encountering the CS, although it did reduce locomotion in 5-HTT−/− rats. We conclude that independent of 5-HTT signalling, prior fear conditioning does not greatly impair the acquisition of subsequent active coping behaviour when the situation allows for it. Abolishment of 5-HTT results in a more active coping style in case of novelty-induced fear and upon CS encounter in a novel context after AA learning.

Patient Perspectives on Participation in Cognitive Functional Therapy for Chronic Low Back Pain.

Cognitive functional therapy (CFT) has been shown to reduce pain and disability in people with chronic low back pain. The purpose of this study was to investigate participants' experience of CFT by comparing participants who reported differing levels of improvement after participation in CFT, potentially yielding insight into the implementation of this approach. This was a noninterventional, cross-sectional, qualitative study with an interpretive description framework. Individuals who had participated in CFT in 2 physical therapy settings (in Ireland and Australia) were recruited through purposive sampling based on disability outcomes postintervention (n=9), and theoretical sampling (n=5). This sampling strategy was used to capture a range of participant experiences but was not used to define the final qualitative groupings. Semistructured interviews were conducted 3 to 6 months postintervention. Three groups emerged from the qualitative analysis: large improvers, small improvers, and unchanged. Two themes encapsulating the key requirements in achieving a successful outcome through CFT were identified: (1) changing pain beliefs and (2) achieving independence. Changing pain beliefs to a more biopsychosocial perspective required a strong therapeutic alliance, development of body awareness, and the experience of control over pain. Independence was achieved by large improvers through newly cultivated problem-solving skills, self-efficacy, decreased fear of pain, and improved stress coping. Residual fear and poor stress coping meant that small improvers were easily distressed and lacked independence. Those who were unchanged continued to feel defined by their pain and retained a biomedical perspective. A successful outcome after CFT is dependent on instilling biopsychosocial pain beliefs and developing independence among participants. Small improvers may require ongoing support to maintain results. Further study is needed to elucidate the optimal approach for those who were unchanged.

Fecal microbiota transplantation for recurrent Clostridium difficile infection: The patient experience

Although effectiveness of fecal microbiota transplantation (FMT) has been adequately documented, the patient experience of undergoing FMT has not. We carried out a qualitative interview study using semistructured questions relating to aspects of health pre-FMT, during FMT, and post-FMT periods with 17 participants. Inductive coding was used to identify core themes during the periods. Pre-FMT themes included physical (continuous diarrhea and weight loss), mental (depression, wanting to die, and fear), quality of life (unable to perform normal activities), social support, and financial (medication costs) factors. Provider resistance/limited awareness were barriers to FMT. Participants reached a tipping point, experiencing feelings of hopelessness, which led them to pursue FMT. During FMT, participants commented on lack of a so-called ick factor. During the posttreatment period, participants experienced symptom relief, but had residual fears. Patient activation was present during all phases, including information seeking and empowerment. During the pre-FMT period, participants experienced extreme discomfort and encountered FMT barriers. Undergoing FMT was reported as easy but residual fear remained. There were displays of patient activation at all FMT time periods, including the seeking of FMT. Participants could have benefited from having undergone FMT sooner, demonstrating a need for improvement in provider education and health system barriers regarding FMT.

Assessing Fear Following Retrieval + Extinction Through Suppression of Baseline Reward Seeking vs. Freezing.

Freezing has become the predominant measure used in rodent studies of conditioned fear, but conditioned suppression of reward-seeking behavior may provide a measure that is more relevant to human anxiety disorders; that is, a measure of how fear interferes with the enjoyment of pleasurable activities. Previous work has found that an isolated presentation of a fear conditioned stimulus (CS) prior to extinction training (retrieval + extinction) results in a more robust and longer-lasting reduction in fear. The objective of this study was to assess whether the retrieval + extinction effect is evident using conditioned suppression of reward seeking, operationalized as a reduction in baseline licking (without prior water deprivation) for a 10% sucrose solution. We found that, compared to freezing, conditioned suppression of reward seeking was much more sensitive to fear conditioning and far less responsive to extinction training. As in previous work, we found that retrieval + extinction reduced post-extinction fear reinstatement when measured as freezing, but it did not reduce fear reinstatement when measured as conditioned suppression. This suggests that there is still residual fear following retrieval + extinction, or that this procedure only modifies memory traces in neural circuits relevant to the expression of freezing, but not to the suppression of reward seeking.

Foraging decisions in wild versus domestic Mus musculus: What does life in the lab select for?

What does domestication select for in terms of foraging and anti-predator behaviors? We applied principles of patch use and foraging theory to test foraging strategies and fear responses of three strains of Mus musculus: wild-caught, control laboratory, and genetically modified strains. Foraging choices were quantified using giving-up densities (GUDs) under three foraging scenarios: (1) patches varying in microhabitat (covered versus open), and initial resource density (low versus high); (2) daily variation in auditory cues (aerial predators and control calls); (3) patches with varying seed aggregations. Overall, both domestic strains harvested significantly more food than wild mice. Each strain revealed a significant preference for foraging under cover compared to the open, and predator calls had no detectable effects on foraging. Both domestic strains biased their harvest toward high quality patches; wild mice did not. In terms of exploiting favorable and avoiding unfavorable distributions of seeds within patches, the lab strain performed best, the wild strain worst, and the mutant strain in between. Our study provides support for hypothesis that domestic animals have more energy-efficient foraging strategies than their wild counterparts, but retain residual fear responses. Furthermore, patch-use studies can reveal the aptitudes and priorities of both domestic and wild animals.

How Change of Public Transportation Usage Reveals Fear of the SARS Virus in a City

The outbreaks of the severe acute respiratory syndrome (SARS) epidemic in 2003 resulted in unprecedented impacts on people's daily life. One of the most significant impacts to people is the fear of contacting the SARS virus while engaging daily routine activity. Here we use data from daily underground ridership in Taipei City and daily reported new SARS cases in Taiwan to model the dynamics of the public fear of the SARS virus during the wax and wane of the SARS period. We found that for each reported new SARS case there is an immediate loss of about 1200 underground ridership (the fresh fear). These daily loss rates dissipate to the following days with an e-folding time of about 28 days, reflecting the public perception on the risk of contacting SARS virus when traveling with the underground system (the residual fear). About 50% of daily ridership was lost during the peak of the 2003 SARS period, compared with the loss of 80% daily ridership during the closure of the underground system after Typhoon Nari, the loss of 50–70% ridership due to the closure of the governmental offices and schools during typhoon periods, and the loss of 60% daily ridership during Chinese New Year holidays.

Adolescent traumatic stress experience results in less robust conditioned fear and post-extinction fear cue responses in adult rats

Early exposure to a traumatic event may produce lasting effects throughout the lifespan. Traumatic stress during adolescence may deliver a distinct developmental insult compared with more-often studied neonatal or juvenile traumatic stress paradigms. The present study describes the lasting effects of adolescent traumatic stress upon adulthood fear conditioning. Adolescent rats were exposed to a traumatic stressor (underwater trauma, UWT), then underwent fear conditioning during adulthood. Fear extinction was tested over five conditioned suppression extinction sessions three weeks later. The efficacies of two potential extinction-enhancing compounds, endocannabinoid reuptake inhibitor AM404 (10mg/kg) and M1 muscarinic positive allosteric modulator BQCA (10mg/kg), were also assessed. Finally, post-extinction fear responses were examined using a fear cue (light) as a prepulse stimulus. Rats traumatically stressed during adolescence showed blunted conditioned suppression on day 1 of extinction training, and AM404 reversed this effect. Post-extinction startle testing showed that fear conditioning eliminates prepulse inhibition to the light cue. Startle potentiation was observed only in rats without adolescent UWT exposure. AM404 and BQCA both ameliorated this startle potentiation, while BQCA increased startle in the UWT group. These results suggest that exposure to a traumatic stressor during adolescence alters developmental outcomes related to stress response and fear extinction compared to rats without adolescent traumatic stress exposure, blunting the adulthood fear response and reducing residual post-extinction fear expression. Efficacy of pharmacological interventions may also vary as a factor of developmental traumatic stress exposure.

Consensus on context-specific strategies for reducing the stigma of human immunodeficiency virus/acquired immunodeficiency syndrome in Zambézia Province, Mozambique

Stigma has been implicated in poor outcomes of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) care. Reducing stigma is important for HIV prevention and long-term treatment success. Although stigma reduction interventions are conducted in Mozambique, little is known about the current nature of stigma and the efficacy and effectiveness of stigma reduction initiatives. We describe action research to generate consensus on critical characteristics of HIV stigma and anti-stigma interventions in Zambézia Province, Mozambique. Qualitative data gathering methods, including in-depth key-informant interviews, community interviews and consensus group sessions, were utilized. Delphi methods and the strategic options development analysis technique were used to synthesize qualitative data. Key findings are that stigma enacted by the general public might be declining in tandem with the HIV/AIDS epidemic in Mozambique, but there is likely excessive residual fear of HIV disease and community attitudes that sustain high levels of perceived stigma. HIV-positive women accessing maternal and child health services appear to shoulder a disproportionate burden of stigma. Unintentional biases among healthcare providers are currently the critical frontier of stigmatization, but there are few interventions designed to address them. Culturally sensitive psychotherapies are needed to address psychological distress associated with internalized stigma and these interventions should complement current supports for voluntary counseling and testing. While advantageous for defining stakeholder priorities for stigma reduction efforts, confirmatory quantitative studies of these consensus positions are needed before the launch of specific interventions.

Adolescent traumatic stress experience shapes adulthood fear conditioning and extinction responses

A traumatic stress paradigm (underwater trauma, UWT) was used to model an intense developmental stress event during adolescence, and evaluate effects on fear and stress response lasting into adulthood. Adolescent rats (P37) were exposed to UWT or swim without submersion. Rats were then allowed to reach adulthood (P114) and fear conditioned using light and sound (conditioned stimulus), with or without footshock (unconditioned stimulus). After a three‐week fear incubation period, rats were given one extinction trial per day for five consecutive days using an operant behavior conditioned suppression task. Preliminary results suggest that adolescent traumatic stress experience shapes some aspects of adulthood stress response severity, and residual fear responses after five extinction trials.This work is supported by the Military Operational Medicine Research Program, US Army Medical Research and Materiel Command.