Severe Distress Research Articles

The power of music.

How music can so powerfully impact our bodies and minds defies rational explanation. Through our senses, music can mysteriously reach our deepest emotions without using language or images. Even if we do not understand it intellectually, music speaks to us, and can transform our experience. Music is often a communal experience. Anthony Storr, psychoanalyst and musician, writes that when a group of people sing together, ‘a culturally agreed upon pattern of rhythm and melody, i.e. a song, that is sung together, provides a shared form of emotion that, at least during the course of the song, carries along the participants so that they experience their bodies responding emotionally in very similar ways, sharing the emotions of the music’ (Music and the Mind, HarperCollins Publishers, 1992). But why are we talking about music here? Music is integral to healing practices in many indigenous cultures. In Western medicine, the impact of music on wellbeing is increasingly explored. The beneficial impact of music on reducing anxiety and stress responses, with possible resulting immune system modulation, has been observed in individuals with a range of nervous system conditions, from autism, depression, Parkinson's and schizophrenia. In patients with dementia, music and singing can reduce hallucinations and depression, increase social interactions and may even be associated with slower cognitive impairment. During the early phases of the COVID-19 outbreak, when most of the world was in lockdown and clinical staff were under severe psychological distress, an Italian hospital piloted a music therapy programme for healthcare staff assisting COVID-19 patients (https://doi.org/10.1016/j.aip.2020.101688). After listening to playlists prepared by trained music therapists and customized to individual preferences, clinical staff reported significantly reduced tiredness, sadness, fear and worry. Similarly, in a randomized controlled trial investigating mindfulness and music therapy in nurses caring for COVID-19 patients in Turkey, work-related strain was reduced in the intervention compared to control group. (https://doi.org/10.1097/hnp.0000000000000511). British Lung Foundation (BLF) commissioned Phoene to deliver a training programme for singing leaders entitled ‘Singing for Lung Health (SLH)’, with more than 100 groups established across the UK. Service evaluation has shown that SLH is associated with improved respiratory related quality of life and reduced health care utilization (https://journals.sagepub.com/doi/10.1177/1757913918774079). In the words of a SLH participant: ‘I feel as though my airways have really opened up and my natural breathing is more fluid. Singing has so many benefits: physical, emotional and pure enjoyment’. Group singing as a treatment for patients with chronic lung diseases is increasingly explored in Europe, North America, Australia and Africa, with research ongoing to study the physiological and psychosocial benefits for participants and how this intervention could best be implemented more widely (https://www.mdpi.com/2227-9059/10/9/2086#B14-biomedicines-10-02086). None declared.

Improvement of Engineering Properties of Asphalt Binder and Mixture by Using SBS Additive Material

Rutting, thermal cracking, and stripping are among the most severe distress types in asphalt pavement. In this study, a specified type of styrene-butadiene-styrene (SBS) was used as a modifier for a low viscosity asphalt binder G80/100 (PG 58-22) to overcome the issues of the distresses in the asphalt mixture. The mixing process had been evaluated by using fluorescent microscopy. The control- and SBS-modified binders were subjected to all conventional and Superpave binder tests. The Hamburg wheel tracker (HWT) and indirect tensile strength ratio (ITSR) tests were conducted to evaluate the engineering properties of the control and modified asphalt mixtures. The used SBS percentages were 1, 2, 3, 4, and 5% of the total weight of the binder. The results showed lower penetration, higher softening point, viscosity, and elastic recovery. The dynamic shear rheometer (DSR) and bending beam rheometer (BBR) tests showed an increasing SBS% leading to an increase in both values of high and low temperatures of the asphalt performance grade (PG). The tensile strength ratio and Hamburg wheel tracker tests’ results showed that the highest TSR and rutting parameter values were obtained at 3% SBS, which was the optimum SBS content for the asphalt mixture and the resulted modified asphalt is PG76-16.

Patients' experiences undergoing cancer surgery during the COVID-19 pandemic: a qualitative study.

This study aimed to understand patients' experiences undergoing cancer surgery during the COVID-19 pandemic. In response to COVID-19, many elective cancer surgeries were delayed creating a massive backlog of cases. Patients' experiences with surgical delays may inform healthcare systems' responses to the backlog of cases and guide preparations for future healthcare emergencies. This was a qualitative description study. Patients undergoing general surgery for cancer at two university-affiliated hospitals between March 2020 and January 2021 were invited to one-to-one interviews. Patients were purposefully selected using quota sampling until interviews produced no new information (i.e., thematic saturation). Interviews were conducted using a semi-structured guide and analyzed according to inductive thematic analysis. Twenty patients were included [mean age 64 ± 12.9; male (n = 10); surgical delay (n = 14); cancer sites: breast (n = 8), skin (n = 4), hepato-pancreato-biliary (n = 4), colorectal (n = 2), and gastro-esophageal (n = 2)]. When determining their willingness to undergo surgery, patients weighed the risk of COVID-19 infection against the urgency of their disease. Changes to the hospital environment (e.g., COVID-19 preventative measures) and deviations from expected treatment (e.g., alternative treatments, remote consultations, rescheduled care) caused diverse psychological responses, ranging from increased satisfaction to severe distress. Patients employed several coping strategies to mitigate distress, including eliciting reassurance from care providers, seeking information from unconventional sources, and reframing care interruptions. Changes in care during the pandemic elicited diverse psychological responses from patients undergoing cancer surgery. Coping was facilitated by consistent communication with providers, emphasizing the importance of patient-centered expectation setting as we prepare for the future within and beyond the pandemic.

Watermelon and dietary advice compared to dietary advice alone following hospitalization for hyperemesis gravidarum: a randomized controlled trial

BackgroundHyperemesis gravidarum (HG) affects about 2% of pregnancies and is at the severe end of the spectrum of nausea and vomiting of pregnancy. HG causes severe maternal distress and results in adverse pregnancy outcomes long after the condition may have dissipated. Although dietary advice is a common tool in management, trial evidence to base the advice on is lacking.MethodsA randomized trial was conducted in a university hospital from May 2019 to December 2020. 128 women at their discharge following hospitalization for HG were randomized: 64 to watermelon and 64 to control arm. Women were randomized to consume watermelon and to heed the advice leaflet or to heed the dietary advice leaflet alone. A personal weighing scale and a weighing protocol were provided to all participants to take home. Primary outcomes were bodyweight change at the end of week 1 and week 2 compared to hospital discharge.ResultsWeight change (kg) at end of week 1, median[interquartile range] -0.05[-0.775 to + 0.50] vs. -0.5[-1.4 to + 0.1] P = 0.014 and to the end of week 2, + 0.25[-0.65 to + 0.975] vs. -0.5[-1.3 to + 0.2] P = 0.001 for watermelon and control arms respectively. After two weeks, HG symptoms assessed by PUQE-24 (Pregnancy-Unique Quantification of Emesis and Nausea over 24 h), appetite assessed by SNAQ (Simplified Nutritional Appetite Questionnaire), wellbeing and satisfaction with allocated intervention NRS (0–10 numerical rating scale) scores, and recommendation of allocated intervention to a friend rate were all significantly better in the watermelon arm. However, rehospitalization for HG and antiemetic usage were not significantly different.ConclusionAdding watermelon to the diet after hospital discharge for HG improves bodyweight, HG symptoms, appetite, wellbeing and satisfaction.Trial registrationThis study was registered with the center’s Medical Ethics Committee (on 21/05/2019; reference number 2019327–7262) and the ISRCTN on 24/05/2019 with trial identification number: ISRCTN96125404. First participant was recruited on 31/05/ 2019.

Epidemioclinical and Therapeutic Study of Caesarean Sections at the Markala Reference Health Centre

This was a retrospective study conducted at the Markala referral health centre from 2019 to 2022. The general objective was to study caesarean section at CS Réf in Markala. During our study period from 2019 to 2022, we recorded 1244 caesarean sections, i.e. a frequency of 28.29% of all deliveries. Parturients were evacuated in 51.6% of cases. Only 14.23% of our parturients were well monitored. The most frequent indication for caesarean section was SFA in 30.1%, i.e. 375 cases. The surgical procedure most frequently associated with caesarean section was LRT. Maternal mortality was 0.3%, mainly due to haemorrhage and pregnancy-related maternal pathologies. Maternal morbidity was dominated by infections, severe anaemia and haemorrhage. Fetal mortality was 11.9%, mainly due to severe fetal distress. Resuscitation was required for 23.5% of our caesarean section babies. Improving these results requires the support of all sectors of society.

Heavy social media use and psychological distress among adolescents: the moderating role of sex, age, and parental support.

Despite increasing evidence that social media use is associated with adolescents' mental well-being, little is known about the role of various factors in modifying the effect of this association during adolescence. This study examined the association between social media use and psychological distress among adolescents and explored whether sex, age, and parental support moderate this association. Data came from a representative sample of middle and high school students in Ontario, Canada. Cross-sectional analyses included 6,822 students derived from the 2019 Ontario Student Drug Use and Health Survey. Our results showed that 48% of adolescents used social media for 3 h or more per day, and 43.7% had moderate to severe psychological distress, with a higher prevalence among females (54%) than males (31%). After adjustment for relevant covariates, heavy social media use (≥3 h/day) was associated with increased odds of severe psychological distress [odds ratio (OR): 2.01; 95% confidence interval (CI):1.59-2.55]. The association of social media use with psychological distress was modified by age (p < 0.05) but not sex or parental support. The association was stronger among younger adolescents. Heavy social media use is associated with higher levels of psychological distress, with younger adolescents being the most vulnerable. Longitudinal studies are recommended for future research to examine in more depth the role of sex, age, and parental support in the association between social media use and psychological distress to better determine the strength and of the association.

Urinary Incontinence Affects the Quality of Life and Increases Psychological Distress and Low Self-Esteem.

Urinary incontinence is a common problem among women of reproductive age. The objectives of this study were to measure the prevalence of urinary incontinence and the association with quality of life, psychological distress and self-esteem in Saudi women in the city of Riyadh. A questionnaire-based cross-sectional study was conducted in primary healthcare centers with Saudi women aged between 30 and 75 years. The questionnaire consisted of Urinary Distress Inventory, Incontinence Impact Questionnaire, Kessler Psychological Distress Scale, Rosenberg Self-esteem Scale, and the Female Sexual Function Index. Around 47.5% of women were suffering from urinary incontinence. The most common type of incontinence was stress (79%), followed by urge (72%) and mixed type (51%). Multivariate logistic regression analysis found that stress (5.83 (3.1, 11.1)), urge (3.41 (2.0, 5.8)), mixed (8.71 (3.4, 22.4)) incontinence and severe urinary distress (8.11 (5.2, 12.7)) were associated with impaired quality of life. Women suffering from stress and urge incontinence were twice (2.0 (1.3, 2.2)) as likely of reporting moderate/severe mental distress. Women suffering from urge incontinence (1.92 (1.4, 2.7)) and severe urinary distress (1.74 (1.1, 2.8)) were at a higher prevalence of reporting low self-esteem. Urinary incontinence affects the physical, psychological, social, and sexual health of women. Healthcare providers should be knowledgeable about the adverse consequences of UI on women's personal and social life, and provide counseling and treatment accordingly.

July 2023

July 2023

Medium- and Long-Term Effects of Insomnia Severity and Circadian Preference on Pain and Emotional Distress Among Individuals With Chronic Pain

Studies have identified insomnia as having significant influence on chronic pain. A rising body of research has also underscored the association between eveningness and chronic pain. However, co-assessment of insomnia and eveningness in the context of chronic pain adjustment has been limited. The present study sought to investigate the effects of insomnia and eveningness on pain severity, pain interference, and emotional distress (ie, depressive and anxiety symptoms) over nearly 2 years among adults with chronic pain in the U.S. Adults with chronic pain (N = 884) were surveyed 3 times via Amazon’s MTurk online crowdsourcing platform: baseline, 9-month follow-up, and 21-month follow-up. Path analysis was conducted to examine the effects of baseline insomnia severity (Insomnia Severity Index) and eveningness (Morningness and Eveningness Questionnaire), as well as their moderating effects on outcomes. Controlling for select sociodemographic variables and baseline outcome levels, greater insomnia severity at baseline was associated with worsening of all of the pain-related outcomes at 9-month follow-up, and pain interreference and emotional distress at 21-month follow-up. We did not find evidence that evening types are at a higher risk of experiencing worsening pain-related outcomes over time compared to morning and intermediate types. There were also no significant insomnia severity and eveningness moderation effects on any outcome. Our findings suggest that insomnia is a more robust predictor of changes in pain-related outcomes as compared to eveningness. Treatment of insomnia can be important in chronic pain management. Future studies should evaluate the role of circadian misalignment on pain using more accurate biobehavioral makers. PerspectiveThis study examined the effects of insomnia and eveningness on pain and emotional distress in a large sample of individuals with chronic pain. Insomnia severity is a stronger predictor of changes in pain and emotional distress than eveningness, highlighting insomnia as an important clinical target for chronic pain management.

The accuracy of the Psychological Distress Inventory – Revised (PDI-R) in identifying distress in oncological outpatients: A pilot study using a machine learning approach.

e24222 Background: Ever greater importance is given to psychological distress in oncological settings. Distress could have a severe adverse effect on adherence and compliance to therapies, medical treatments, and quality of life (NCCN, 2015). Moreover, psychological research is progressively increasing in oncological settings and psychological distress has rapidly gained popularity – leading to the development of scales aimed at its evaluation. In this regard, the revised version of the Psychological Distress Inventory – the PDI-R (Rossi et al., 2022) – has demonstrated excellent psychometric properties but its screening properties were limited to self-report questionnaires. Consequently, to fill this gap, this study aimed to evaluate the accuracy of the PDI-R in identifying the levels of distress of oncological outpatients compared to a diagnostic interview – using a machine learning approach. Methods: Oncological outpatients ( n = 603; mean age = 68.38, SD = 9.31; 316 males) were enrolled at the Presidio Ospedaliero of Saronno, ASST Valle Olona, Italy. Patients were tested with the PDI-R which is composed of 8 items that evaluate internal, external, and general distress. In this study, the PDI-R shows good internal consistency: McDonald’s omega = .922. Then, patients were interviewed by a psycho-oncologist who assessed distress levels of each patient. In accordance with the methodological procedures for the application of machine learning algorithms, patients were randomly divided into two different databases. The first database ( n = 400) was used to train the machine learning algorithm and the second one ( n = 203) was used to test the accuracy of its predictions. The k-nearest neighbors ( k-NN) algorithm was applied. Results: According to the clinical interview, the training database (mean age = 67.78, SD = 9.10; 212 males) shows that 76% of patients were without distress (or mild distress) and 24% had moderate or severe distress. Moreover, according to the clinical interview, the testing database (mean age = 69.58, SD = 9.62; 104 males) shows that 71% of patients were without distress (or mild distress) and 29% had moderate or severe distress. Using the 8 items of the PDI-R, the k-NN algorithm, correctly identified 193 subjects (144 true negatives and 49 true positives). At the same time, only 10 subjects (10 false negatives) were incorrectly classified – thereby showing a machine learning-based accuracy of 95%. Conclusions: These findings suggest that the PDI-R is a reliable self-report questionnaire with strong psychometric properties and high accuracy in identifying psychological distress. Its use in research and clinical practice is therefore recommended to increase the quality of both assessment and treatment of psychological distress in patients with oncological difficulties.

Impact of the COVID‐19 pandemic on moral distress of care home staff caring for people with dementia

AbstractBackgroundHealthcare providers caring for people living with dementia may experience moral distress when faced with an ethically challenging situation, such as an inability to provide care that is consistent with their values. The COVID‐19 pandemic both created new and exacerbated pre‐existing factors which contributed to the experience of moral distress amongst healthcare providers in LTCHs.MethodWe conducted an online survey to examine changes in mortal distress during the first wave of the pandemic, its contributing factors and correlates, and its impact on the well‐being of LTCH staff. A total of 227 health care providers from LTCHs across Ontario, Canada completed the online survey. Using a Bayesian approach, we examined the associations between moral distress and staff demographics and roles, and characteristics of the LTCH in which they worked.ResultMore than 80% of LTCH healthcare providers working with people with dementia reported an increase in moral distress since the start of the pandemic. They frequently experienced physical and emotional symptoms related to moral distress more than once a week, with the most common symptoms being physical exhaustion (55%) powerlessness (39%), sadness/anxiety (38%) frustration/anger (31%), and difficulty sleeping (33%). There was no difference in the severity of distress by age, sex, role, or years of experience. The most common situations associated with moral distress were lack of activities and family visits, insufficient staffing and high turnover, and having to follow policies and procedures that were perceived to harm residents with dementia. Respondents working in not‐for‐profit or municipal homes reported less sadness/anxiety and feelings of not wanting to go to work than those in for‐profit homes. Front‐line staff were more likely to report not wanting to work than those in management or administrative positions. In the survey’s free‐text responses, respondents elaborated on the emotional impact of the change in care delivery for LTCH residents.ConclusionMoral distress increased during the pandemic, negatively affecting the well‐being of healthcare providers in LTCHs, with preliminary evidence suggesting that individual and systemic factors may intensify this negative effect.

Neuropsychiatric symptoms in Amnestic Mild Cognitive Impairment: Mexican clinical and community based‐study

AbstractBackgroundThe neuropsychiatric symptoms (NPS) are common clinical manifestation in older adults with amnestic mild cognitive impairment (aMCI). Global prevalence of 35%‐85% is estimated, though there are inconsistencies across the studies. There are reports of its prevalence in clinical and community‐based studies but few comparisons between them.MethodsRestrospective and cross‐sectional study design. A total of 86 patients with amnestic MCI, aged 65 years or older were included. Of these, 27 were a tertiary hospital clinical sample and 59 from a population‐based study, from the 10/66 Dementia Research Group protocols. We described and compared sociodemographic, comorbidity and neuropsychiatric symptoms data, last ones measured by the Neuropsychiatric Inventory Questionnaire (NPI‐Q). Aim was to compare the frequency of NPS, its severity and caregiver distress between samples.ResultsThe most frecuent NPS in both populations were depression, anxiety and irritability with no differences between samples. Apathy was more prevalent in clinical sample versus community‐based (33.3% vs 8.47%, p: 0.009). The most severe NPS were anxiety, nightime behaviors and delusions with no differences among samples. Appetite/eating disorders had a moderate to severe caregiver distress but no differences were found.ConclusionThe results of this study are consistent with the international literature as depression been the most frecuente NPS in aMCI. Only apathy was found more prevalent in clinical community but no relation with higher severity and caregiver distress.

Association of sexual dysfunction according to DSM-5 diagnostic criteria with avoidance of and discomfort during sex in a population-based sample.

Sexual dysfunction frequencies and diagnostic indicators among older populations are relevant for public health measures, but evidence from large population-based studies is still scarce. To determine sexual dysfunction frequencies for women and men according to the Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM-5) among 45- to 74-year-old participants of the population-based Hamburg City Health Study and the factors associated with sexual dysfunction diagnoses. We determined sexual dysfunction frequencies according to the DSM-5 and the factors associated with sexual dysfunction diagnoses (quality/avoidance of and discomfort during sex) among 45- to 74-year-olds from 7786 participants of the population-based Hamburg City Health Study. We analyzed cross-sectional self-report questionnaire data collected between 2016 and 2019 using descriptive statistics, comparative tests (Fisher test, Mann-Whitney U test), and logistic regression. Outcomes included sexual dysfunction frequencies - specifically, sexual difficulties experienced frequently or more often, over at least six months in the last year, causing severe or very severe distress, and not associated with physical health or relationship problems - and items on quality/avoidance of and discomfort during sex. Participants' median age was 62.0 years (IQR,14) and 51.1% were women. The frequency of sexual dysfunction according to the DSM-5 was 9.3% (95% CI, 8.3%-10.4%) in women and 6.2% (95% CI, 5.4%-7.1%) in men, with women's sexual interest/arousal and men's erectile disorder being most common. Sexual dysfunction rates increased with age: whereas complaints were more frequent among women than men in the younger groups, participants aged ≥65 years with a sexual dysfunction were more often men. Quality/avoidance of and discomfort during sex were significantly associated with a diagnosis of sexual dysfunction. Results suggest that sexual dysfunction caused by other than physical health or relationship factors is important to consider in this population. In addition, the avoidance of, perceived quality of, and discomfort during sex serve as valuable diagnostic indicators for the presence of sexual dysfunction. This study draws on robust data from a large sample to give valuable insight on the frequency of sexual difficulties and dysfunctions as defined by DSM-5 criteria. Limitations represent the restriction to self-report questionnaire data, the focus on participants living in a metropolitan area, and the lack of experience of sexual difficulties due to a lack of sexual activity not being taken into account. The study provides estimates for DSM-5 sexual dysfunction frequencies among Germans from a metropolitan area and points to the diagnostic value of age-related changes as well as the quality/avoidance of and discomfort during sex.

Psychological health of Indian youth during COVID-19: a study through three chronological surveys

The COVID-19 pandemic and its aftereffects have affected human lives psychologically, economically, and socially. The study examines the dynamics of mental health problems faced by young adults and the consequent effects on their daily lives during the pandemic period. Three surveys were conducted among colleges/universities going students in India during the time periods May-June 2020, October 2020-February 2021, and January-February 2022; using Strengths and Difficulties Questionnaire (SDQ) 17+ self-reported extended version. Through 1,021, 743, and 932 responses in the three surveys respectively, the effect of the pandemic on the mental health (characterized by behavioral problems and social dysfunction) of respondents, categorized on basis of demographic variables and ‘COVID-19’ status was studied. Females were found to be more ‘distressed’ than during this period. There was no effect of age and family income. The 45% of the respondents in the Non-COVID group and 48% in the COVID-19 group had severe distress. With the passing of time, both the number of problem areas and the severity of problems faced by young adults increased thus affecting their day-to-day activities. The proportions of the respondents in borderline and abnormal categories were much higher both for difficulty and the impact scores of SDQ than the standard proportions.

A novel low-cost multi-sensor solution for pavement distress segmentation and characterization at night

The pavement distress measurement is a crucial aspect in guaranteeing the safety of transportation infrastructure. In this regard, we introduce a novel and cost-effective multi-sensor approach for pavement segmentation during low-light night conditions. By utilizing the low-cost Azure Kinect multi-sensor system, we generated a multi-sensor dataset that encompasses aligned IR, RGB, and depth images. Then we carried out the data annotation process on the RGB images. A total of 11,343 manual annotations were meticulously made on 791 images, which were randomly selected from a collection of 96,891 frames. Subsequently, four different deep learning-based image segmentation models were analyzed both quantitatively and qualitatively. The results indicated that the segmentation performance on the IR dataset outperformed that of the RGB dataset. The model with the highest mIoU (mean Intersection over Union) of 0.7169 was ConvNext when trained on the IR dataset. Furthermore, we proposed the use of relative height for evaluating the severity of pavement distress. On the aligned depth map, the relative height was calculated using the depth data from the corresponding pavement distress area. Additionally, a quantitative comparison between manual annotations and the results obtained through deep learning revealed that the latter was more effective in identifying more severe forms of pavement distress. Through this study, we established the feasibility of collecting pavement distress data during nighttime using a low-cost multi-sensor system.

The impact of perceived social support and coping on distress in a sample of Atlantic Canadian health professional students during COVID-19 compared to pre-COVID peers

PurposeStudents pursuing higher education and health professional (HP) programs (e.g., nursing, pharmacy, social work, medicine) experience stressors including academic pressures, workload, developing professional competencies, professional socialization, the hidden curriculum, entering clinical practice and navigating relationships with colleagues. Such stress can have detrimental effects on HP students physical and psychological functioning and can adversely affect patient care. This study examined the role of perceived social support and resilience in predicting distress of Atlantic Canadian HP students during the COVID-19 pandemic and compared the findings to a pre-COVID population of age and sex matched Canadians.MethodSecond year HP students (N = 93) completed a survey assessing distress, perceived social support, and resilience and open-ended questions on student awareness of supports and counselling available to them, their use/barriers to the services, and the impact of COVID-19 on their personal functioning. HP student responses were also compared with age and sex matched Canadian peers from data collected prior to COVID-19.ResultsIt was found that HP students reported moderate to severe psychological distress, and while they reported high levels of social support on a measure of perceived social support they also reported that the COVID-19 pandemic made them feel isolated and that they lacked social support. It was found that the sample of HP students reported significantly higher psychological distress than the mean scores of the age and sex matched sample of Canadian peers.ConclusionsThese findings call for creation of more tailored interventions and supports for HP students.

Return to work in breast cancer patients with and without pre-diagnosis psychological distress.

e18883 Background: Women comprise more than 40% of the American workforce, with many women working at the time of a breast cancer diagnosis. Pre-diagnosis psychological distress is a rarely studied factor that may affect cancer survivors’ workforce participation and mental health status post treatment. In this 2-site prospective cohort study, we evaluated return to work (RTW) in breast cancer patients (pts) with and without reported pre-diagnosis stress. Methods: We enrolled 198 female pts at Mayo Clinic in Minnesota and Florida with newly diagnosed stage 0-III breast cancer who worked 35-plus hours/week at time of diagnosis. Pts were screened for eligibility at the intake visit. Eligible pts were emailed a baseline survey at the time of diagnosis, then a follow-up survey at 3 months. Surveys assessed demographics, work factors, treatment, and psychological distress per the validated Kessler Psychological Distress Scale (K6). Primary aims were to assess 1) the impact of pre-diagnosis psychological distress on RTW in pts with a breast cancer diagnosis and 2) the incidence of severe psychological distress (K6 ≥13) in those with and without delay in RTW. Wilcoxon rank sum tests were used to compare pts with and without pre-diagnosis stress at baseline and 3 months. Results: 189 and 142 pts took part in the baseline and 3-month surveys, respectively. Here, 40.7% of enrolled pts reported experiencing one or more major life stressors in the 18 months before diagnosis. At 3 months, 6 of the 75 pts who responded (8.0%) endorsed a delay in RTW after breast cancer diagnosis. Half of these pts (3/75) had reported a pre-diagnosis stressor, revealing no significant difference in time to RTW between the stressed and not-stressed groups. Median K6 at diagnosis in those with delay in RTW was 14 (range, 10-17), significantly higher than the median K6 of 9 in those without delay in RTW (range, 6-23; p = 0.026). 5/6 pts who reported delay in RTW had baseline or 3-month K6 ≥13. There was no significant difference in the number of pts with K6 ≥13 at baseline vs. 3 months (31.2% vs. 21.8%, p = 0.85). Overall, the pt population was well educated and well salaried. Conclusions: Pre-diagnosis psychological distress is prevalent, but it does not seem to be associated with delayed RTW in breast cancer pts; indeed, few pts reported a delay in RTW. Pts with delayed RTW after a breast cancer diagnosis had significantly higher median K6, generally ≥13. Thus, delay in RTW in breast cancer pts may be a surrogate marker of more serious psychological illness. Additional study in a socioeconomically diverse pt population is needed.

Symptoms: Abdominal Pain, Diaphoresis, Fever, Nausea, and Constipation

Symptoms: Abdominal Pain, Diaphoresis, Fever, Nausea, and Constipation

Sovereign Debt in the Twenty-first Century

How will sovereign debt markets evolve in the twenty-first century? We survey how the literature has responded to the eurozone debt crisis, placing “lessons learned” in historical perspective. The crisis featured: (i) the return of debt problems to advanced economies, (ii) a bank–sovereign “doom loop” and the propagation of sovereign risk to households and firms, (iii) rollover problems and self-fulfilling crisis dynamics, (iv) severe debt distress without outright sovereign defaults, (v) large-scale sovereign bailouts from abroad, and (vi) creditor threats to litigate and hold out in a debt restructuring. Many of these characteristics were already present in historical debt crises and are likely to remain relevant in the future. Looking forward, our survey points to a growing role of sovereign bank linkages, legal risks, domestic debt and default, and of official creditors, due to new lenders such as China as well as the increasing dominance of central banks in global debt markets. Questions of debt sustainability and default will remain acute in both developing and advanced economies. (JEL E58, F33, F34, G01, G21, H63, N20)

Psychological impact of COVID-19 vaccination in patients with cancer: The VACCINATE study.

e24207 Background: Measures adopted to contain COVID-19 may impact cancer pts' psychological well-being and clinical status. We assessed the psychological status and attitude towards COVID-19 vaccination in adult cancer pts who accepted vaccination at the University and Hospital Trust of Verona and Camposampiero Hospital in the Veneto region. Methods: A self-reported questionnaire was administered to pts undergoing the first and second dose of COVID-19 vaccination in the context of the vaccination campaign promoted by the Veneto Oncology Network (Rete Oncologica Veneta - ROV) between March and May 2021. Overall, 27 items were investigated: i) demographics/clinical characteristics; ii) psychological status (Hospital Anxiety and Depression Scale - HADS - and Distress Thermometer - DT); iii) awareness about infection risks, interference with anticancer treatments, and vaccine side effects. Results: Overall, only 2.5% of the invited active oncological population refused COVID-19 vaccination. Data collected in both Verona and Camposampiero (1089 and 286 respondents, respectively) demonstrated borderline and clinical levels of anxiety in 14% and 10% of pts, borderline and clinical levels of depression in 14% and 8% of pts; and moderate and severe distress levels in 33% and 9% of pts, respectively. No significant differences between the two sites and between the first and second dose were observed, with the exception of significantly lower levels of distress at the time of the second dose administration at the Camposampiero site. In the Verona cohort, clinical anxiety was significantly more frequent in breast cancer and rare tumor pts (17.5% and 21.4%, respectively; p= 0.005); no significant associations were found for depression and distress. Overall, there was high confidence that vaccination would reduce the risk of contracting COVID-19 (70%), which would make pts feel less worried about contracting the infection (60%); among pts with borderline and clinical depression levels, there was less confidence that vaccination would "make [them] feel less worried to contract COVID-19" ["Not at all" or "Only a little" in 16.2% and 20% of pts with borderline and clinical depression levels, respectively, as opposed to 6.6% among pts with normal depression levels (p = 0.005)]. Fear that vaccine-related side effects would interfere with anticancer treatment and/or global health status was low (10% and 9% for items 3 and 4, respectively) and significantly associated with baseline psychological status at multivariate analysis. Similar results were obtained in the Camposampiero cohort. Conclusions: During the COVID-19 vaccination campaign, adult cancer pts demonstrated high levels of confidence towards vaccination; baseline psychological status was the only significant predictor of reduced confidence.