Severe Stressors Research Articles

When can model‐based estimates replace surveys of wildlife populations that span many discrete management units?

Abstract Monitoring widely distributed species on a budget presents challenges for the spatio‐temporal allocation of survey effort. When there are multiple discrete units to monitor, survey alternatives such as model‐based estimates can be useful to fill information gaps but may not reliably reflect biological complexity and change. The spatio‐temporal allocation of survey effort that minimizes uncertainty for the greatest number of units within a budget can help to ensure monitoring is optimized. We used aerial survey‐based population estimates of moose (Alces alces) across 30 Wildlife Management Units (WMUs) in Ontario, Canada to parameterize simulated populations and test the performance of different monitoring scenarios in capturing WMU‐specific annual variation and trends. Firstly, we tested scenarios that prioritized conducting a survey for a unit based on one of three management criteria: population state, population uncertainty or number of years between surveys. Also incorporated in the decision framework were WMU‐specific costs and annual budget constraints. Secondly, we tested how using model‐based estimates to fill information gaps improved population and trend estimates. Lastly, we assessed how the utility (based on minimizing population uncertainty) of using a model‐based estimate rather than conducting a survey was impacted by population density, severity of environmental stressors and years since the last survey. Interval‐based monitoring that minimized the number of years between surveys captured accurate trends for the highest number of WMUs, but annual variation was poorly captured regardless of management criteria prioritized. Using model‐based estimates to fill information gaps improved trend estimation. Further, the utility of conducting a survey increased with time since the last survey and was greater for populations with low densities when the severity of environmental stressors was high, while being greater for populations with high densities when environmental severity was low. Overall, the utility of aerial survey monitoring was strongly associated with WMU‐specific monitoring precision and the predictive power of model‐based estimates. If long‐term trends are evident, then there is greater value in using alternatives such as model‐based predictions to replace surveys, but model‐based estimates may be a poor substitute when there is strong annual variation and when using a simple model.

Music on Main: Supporting a Tangle of Main Streets during the Covid-19 Pandemic

Main streets are an amalgam of civic, commercial, and public spaces that serve as urban places of connection and exchange. Many factors have undermined the commercial functions of main street, but the Covid-19 pandemic has been a particularly severe stressor. This paper describes the manner in which the University of Orange Music City team planned festivals to support their local main streets during the pandemic. Drawing on the authors' previously developed box-circle-line-tangle model of main street social function, this paper uses the example of the Music City Festival to underscore how careful a ention to the tangle of main streets can stimulate new thinking and action in support of these crucial centres.

Duration of Reduction in Enduring Stress-Induced Hyperalgesia Via FKBP51 Inhibition Depends on Timing of Administration Relative to Traumatic Stress Exposure

Chronic pain development is a frequent outcome of severe stressor exposure, with or without tissue injury. Enduring stress-induced hyperalgesia (ESIH) is believed to play a central role, but the precise mechanisms mediating the development of chronic post-traumatic pain, and the time-dependency of these mechanisms, remain poorly understood. Clinical and preclinical data suggest that the inhibition of FK506-binding protein 51 (FKBP51), a key stress system regulator, might prevent ESIH. We evaluated whether peritraumatic inhibition of FKBP51 in an animal model of traumatic stress exposure, the single prolonged stress (SPS) model, reversed ESIH evaluated via daily mechanical von Frey testing. FKBP51 inhibition was achieved using SAFit2, a potent and specific small molecule inhibitor of FKBP51, administered to male and female Sprague-Dawley rats via intraperitoneal injection. To assess timing effects, FKBP51 was administered at different times relative to stress (SPS) exposure. SAFit2 administration immediately after SPS produced a complete reversal in ESIH lasting >7 days. In contrast, SAFit2 administration 72 hours following SPS produced only temporary hyperalgesia reversal, and administration 120h following SPS had no effect. Similarly, animals undergoing SPS together with tissue injury (plantar incision) receiving SAFit2 immediately post-surgery developed acute hyperalgesia but recovered by 4 days and did not develop ESIH. These data suggest that: 1) FKBP51 plays an important, time-dependent role in ESIH pathogenesis, 2) time windows of opportunity may exist to prevent ESIH via FKBP51 inhibition after traumatic stress, with or without tissue injury, and 3) the use of inhibitors of specific pathways may provide new insights into chronic post-traumatic pain development. PerspectiveThe current work adds to a growing body of literature indicating that FKBP51 inhibition is a highly promising potential treatment strategy for reducing hyperalgesia. In the case of post-traumatic chronic pain, we show that such a treatment strategy would be particularly impactful if administered early after traumatic stress exposure.

Feasibility of using ecological momentary assessment and continuous heart rate monitoring to measure stress reactivity in natural settings.

The way people respond to stressful situations (i.e., stress reactivity) varies widely. Researchers typically measure stress reactivity in controlled studies, but this is limited because laboratory stressors cannot capture the variety, severity, or duration of stressors that individuals face in their daily lives. The present study examined the feasibility of using ecological momentary assessment (EMA) and a wireless electrocardiography (ECG) patch to develop an understanding of stress reactivity in natural settings. Thirty-five adult women completed EMA surveys about stressors they were exposed to while wearing a wireless ECG monitor for 7 consecutive days. Daily stressors were measured using seven questions adapted from the Daily Inventory of Stressful Events and a stressor interval was defined as the presence of at least one stressor during the EMA survey prompt. Participants wore the Cardea SOLO wireless ECG monitor (Cardiac Insight Inc., Bellevue, WA) to continuously track their heart rate. Participant-specific differences in 5-minute heart rate variability (HRV) between intervals when participants did and did not report stressors were calculated and displayed in a heat map. Survey response rate was satisfactory (72.0%, n = 588) and nearly all participants (33 out of 35) reported both stressor and non-stressor intervals. Each participant reported at least one stressor on approximately 35% of completed surveys while wearing the ECG patch. Mean wear time (6.6 days) and the duration of analyzable data with an ECG monitor were close to the 7-day study period. While many participants had lower HRV during stressor versus non-stressor intervals, the magnitude and direction of these differences varied widely. In summary, we found that a 7-day sampling scheme combining ecological momentary assessment (EMA) with HRV measured using continuous ECG monitoring was feasible and effective in capturing a variety of daily stressors and measuring autonomic stress reactivity.

Graphene Oxide, a Novel Nanomaterial as Soil Water Retention Agent, Dramatically Enhances Drought Stress Tolerance in Soybean Plants.

Drought is one of the most severe environmental stressors that place major constraints on the growth of soybeans (Glycine max L.). Graphene oxide (GO) is a nanomaterial that can promote plant growth without toxic effects. In this study, the physiological and molecular responses to drought stress with GO treatment were examined. We discovered that the relative water content (RWC) of stems and leaves treated with GO was 127 and 128% higher than that of the WT plants, respectively. The root parameters in GO-treated soybeans were increased by 33, 38, 34, and 35% than WT plants in total root length, root surface area, root diameter, and root volume, respectively. The activities of superoxide dismutase (SOD), catalase (CAT), peroxidase (POD), and ascorbate peroxidase (APX) were also increased by 29, 57, 28, and 66%, respectively. However, the relative conductivity (REC), malondialdehyde (MDA), and hydrogen peroxide (H2O2) accumulation were remarkably decreased. Furthermore, the content of drought-related hormones JA, SA, and ABA in GO-treated soybeans increased by 32, 34, and 67% than WT plants, respectively. At the molecular level, the effects of GO treatment were manifested by relatively higher expression of four drought-related genes: GmP5CS, GmGOLS, GmDREB1, and GmNCED1. Taken together, our findings revealed that GO could directly increase plant defense enzymes, hormone content, and the expression of drought-related genes, thereby improving the soybean’s ability to resist drought. These findings could provide new opportunities for improving drought tolerance in soybeans through effective soil water retention agents.

Well-being in the Intensive Care Unit: Looking Beyond COVID-19.

Burnout among critical care personnel has increased due to the additional psychological and physical demands of caring for critically ill patients with limited resources. Factors that increase the risk of burnout include compassion fatigue, lack of control over the work environment, difficult interpersonal relationships, and constant exposure to end-of-life issues. Organizational commitment to physician wellbeing depends on improving workplace efficiency, recognizing stressors in the critical care environment, and providing resources to help manage staffing shortages. Community building, training in communication, and team-building strategies are important steps in building collaboration and camaraderie in the workplace.

Occupational Stressors and Access to COVID-19 Resources among Commuting and Residential Hispanic/Latino Farmworkers in a US-Mexico Border Region

Hispanic/Latino and migrant workers experience high degrees of occupational stress, constitute most of California’s agricultural workforce, and were among the most impacted populations by the COVID-19 pandemic. However, relatively little is known about the occupational stress experienced by farmworkers who commute daily between the US and Mexico. Occupational stress is considered an imbalance between the demands at work and the capabilities to respond in the context of the workforce. The goal of this study is to determine the type and severity of stressors in daytime and resident farmworkers and how COVID-19 vaccination status contributes to these stressors. Interviews containing the Migrant Farmworker Stress Inventory (MSWSI) were administered to a sample of 199 Hispanic/Latino farmworkers in Imperial County, a multi-billion-dollar agriculture sector in the US. Principal factor analysis differentiated latent factors in the MFSWI. Simple linear regression models and correlations identified associations between MFWSI scores and sample characteristics. The MFWSI reduced to five stressor domains: Health and Well-Being Vulnerabilities, Inadequate Standards of Living/Unknown Conditions of Living, Working Conditions, Working Environment, and Language Barriers. Approximately 40 percent of the respondents reported significant stress levels, with foreign-born (p = 0.014) and older respondents (p = 0.0415) being more likely to experience elevated stress regardless of their nighttime residence. We found that Spanish-language COVID-19 outreach might have been particularly effective for workers who reported high stress from English-language communication (p = 0.001). Moreover, our findings point to the importance of worker and human rights to mitigate the high-stress foreign-born workers who live in Mexico and the US experience.

Lifetime stressor exposure, systemic inflammation during pregnancy, and preterm birth among Black American women

Although Black American mothers and infants are at higher risk for morbidity and mortality than their White counterparts, the biological mechanisms underlying these phenomena remain largely unknown. To investigate the role that lifetime stressor exposure, perceived stressor severity, and systemic inflammatory markers might play, we studied how these factors were interrelated in 92 pregnant Black American women. We also compared inflammatory marker levels for women who did versus did not go on to give birth preterm. During the early third trimester, women completed the Stress and Adversity Inventory for Adults to assess the stressors they experienced over their lifetime. Women also provided blood samples for plasma interleukin (IL)-6, IL-8, IL-1β, and tumor necrosis factor (TNF)-α quantification. Preterm births were identified by medical record review. Controlling for relevant covariates, there were significant positive associations between average levels of both overall and acute perceived stressor severity and plasma IL-1β levels. Controlling for perceived stress at assessment and exposure to racial discrimination did not affect these results. Mediation models revealed that exposure to more chronic stressors was related to higher plasma IL-1β levels, as mediated by higher average levels of overall perceived stressor severity. Exposure to fewer acute stressors was related to higher plasma IL-1β levels, as mediated by higher average levels of acute perceived stressor severity. Finally, women who went on to give birth preterm had higher levels of plasma IL-6. These data thus highlight the potential importance of assessing and addressing lifetime stressor exposure among mothers before and during maternal-infant care.

Adapting Research to a Global Pandemic: A Fully Remote Actigraphy and Ecological Momentary Assessment Study.

Mandated social distancing practices and quarantines in response to COVID-19 have resulted in challenges for research on healthcare workers, such as hospital nurses. It remains unknown whether nursing studies utilizing complex methodology like sleep actigraphy and ecological momentary assessment (EMA) can be conducted remotely without compromising data quality. We aimed to (a) disseminate our remote study protocol for sleep actigraphy and EMA data from hospital nurses during COVID-19, (b) assess feasibility and acceptability of this approach for studies on hospital nurses, and (c) examine the reliability and ecological validity of sleep characteristics measured across 14 days. Using an online platform, we provided 86 outpatient nurses from a cancer hospital with detailed video/text instructions regarding the study and facilitated virtual study onboarding meetings. Feasibility was assessed by comparing adherence rates to a similar in-person study of nurses from the same hospital; acceptability was evaluated through content analysis of qualitative study feedback. Multilevel modeling was conducted to assess changes in sleep characteristics as a function of study day and daily stressful experiences. Adherence to EMA (91.8%) and actigraphy (97.9%) was high. EMA adherence was higher than the in-person study of inpatient day-shift nurses from the same hospital. Content analyses revealed primarily positive feedback, with 51.2% reporting "easy, clear, simple onboarding" and 16.3% reporting the website was "helpful." Six participants provided only negative feedback. Sleep characteristics did not change as a function of study day except for self-reported quality, which increased slightly during Week 1 and regressed toward baseline after that. A higher incidence of stressor days or higher stressor severity followed nights with shorter-than-usual time in bed or poorer-than-usual sleep quality, supporting the ecological validity for these methods of assessing sleep in nurses. Findings suggest that a fully remote study protocol for EMA and actigraphy studies in nursing yields robust feasibility, acceptability, reliability, and validity. Given the busy schedules of nurses, the convenience of this approach may be preferable to traditional in-person data collection. Lessons learned from COVID-19 may apply to improving nursing research postpandemic.

Abstract PO-073: Using spatial analysis to identify environmental stressors that affected women with gynecological cancer in Puerto Rico during and after Hurricane María

Abstract Socially vulnerable communities, such as women, cancer patients, and minorities, are at a high risk of poor health outcomes after a disaster. This ongoing study analyzes specific environmental stressors that affected women with gynecological (gyn) cancer during and after Hurricane María (HM) in Puerto Rico (PR) in September 2017. To do this, we recruited and interviewed 271 women aged ≥ 21 years diagnosed with gyn cancer between Sept 2016 and Sept 2018, from which only 195 met all the selection criteria. Some sections in the interview were divided into two different time periods: 3 months before and 3 months after HM. To carry-out a geospatial analysis, physical addresses 3 months before and after HM were geocoded using ArcGIS World Geocoding Service, in ArcMap 10.8.1. The software provided “automatically matched addresses” and “matched addresses with tied candidates”. The addresses identified as “matched addresses with tied candidates” were verified during the rematch process while also confirmed with Google Earth. Environmental hazards information and risk exposure were based on existing Earth Observation Data and Geodatabases from multiple agencies: flood from the Federal Emergency Management Agency (FEMA), HM's eye track from the National Oceanic and Atmospheric Administration (NOAA), social vulnerability index from the Centers for Disease Control and Prevention (CDC), and landslides from United States Geological Survey (USGS). 100 (51.3%) women were diagnosed with gyn cancer before HM, and 95 (48.7%) were diagnosed with gyn cancer after HM. Hazards such as floods and landslides were some of the primary environmental stressors experienced by the participants during and after HM. Geocoding process provided 247 (91%) automatically matched addresses and 24 (9%) tied addresses. Spatial analysis suggests that 12.3% of the participants were living in areas with the highest indices of social vulnerability. Some differences were identified for flood exposure. Geospatial analysis using FEMA-Flood Maps, suggests 18.5% of women were living in flood prone areas. Interview results suggested 54.4% gyn cancer patients suffered floods. Consistent with the characteristic of the storm, most of the participants (62.6%) were inside HM's eye track. 12.8% of the participants were living in areas that suffered landslides. Gyn cancer patients in this study suffered severe environmental stressors as a result of HM. Diminishing environmental health issues to cancer patients is key to support their access to care and quality of life. Oncology care approaches should be included on emergency plans for disasters, to guarantee access to care and health equity of cancer patients. Our preliminary findings and results are suggesting that FEMA-Flood Maps were underestimating flood risk in PR. Providing the most accurate geospatial information is essential for Risk Management. This information is crucial since it will allow citizens and communities to be better prepared and to take adaptation measures before the event. NCI Grants (R25CA240120 & R21CA239457-02) Citation Format: Camila V. Elías, Pablo A Méndez, Liz M. Martínez, Ana P. Ortiz. Using spatial analysis to identify environmental stressors that affected women with gynecological cancer in Puerto Rico during and after Hurricane María [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-073.

Assessment of perceived stress levels and its sources among indian students in Dental Colleges of Odisha - A cross-sectional study

Background: Dental school is a stressful experience for students as they face wide-ranging challenges related to patient care and pursuing academic excellence. Aim: The aim of the study is to estimate the psychological stress levels and its sources among undergraduate students at dental colleges in India. Materials and Methods: A cross-sectional survey was conducted among a sample of 308 undergraduate students in their 3rd year, 4th year, and internship from three private dental schools in Odisha. A self-administered questionnaire was designed and distributed where participants marked the stress levels caused by various academic and nonacademic stressors on a five-point Likert scale (strongly disagree to strongly agree). Demographic data of gender and year of study were also collected on the same questionnaire. Statistical Analysis Used: SPSS v27 was used to compute descriptive statistics, to perform tests for reliability and validity of the survey instrument and to perform two sample t-test for comparison of stressors with gender and one-way ANOVA for comparison of stressors year of study as factors. Results: Of the 300 completed questionnaires submitted, 49.7% of the participants were males (n = 151) and 50.3% were females (n = 149). Third-year students reported moderate stresses (mean stress >=3) due to factors related to curriculum structure, long classroom hours, reduced recreation time, homesickness, and hostel food. Fourth-year students reported severe stress (mean stress >=4) originating from stressors like completion of clinical quota and comparison with other professions. Interns reported severe stress (mean stress >=4) originating from stressors like family's expectations and fear of failure. There was a statistically significant difference in female participants who reported elevated stress compared to their male counterparts in dealing with stress related to workload and training (P = 0.008, two-tailed two-sample t-test). Conclusions: Students reported most stress originating from issues related to clinical workload burden, comparison with peers, family expectations, and personal relationship issues. We recommend that dentistry schools act with urgency to alleviate severe stressors with the formation of student advisory committees and appointment of counselors who can advocate for dental students' psychological well-being.

Effects of physical activity on prolactin and thyroid hormones

Thyroid hormones thyroxine and triiodothyronine, as well as the hormone of anterior pituitary gland prolactin, play an important role in various physiological processes in the human body. In high-stress situations, these hormones act to maintain homeostasis. One of the severe stressors is physical activity. Prolactin and thyroid hormones control the energy metabolism during physical activity, and are also an important link in adaptive reactions in response to physical activity.

Associations of Daily Sleep and Stress With Rumination: An Ecological Momentary Assessment and Actigraphy Study

Unconstructive repetitive thoughts are indicative of rumination about daily experiences. Given that poor sleep is associated with greater reactivity to daily stressors, we examined joint associations of daily sleep and stress with daily rumination. 143 nurses completed 14 days of ecological momentary assessments (EMA; assessments of daily sleep, stress, and rumination) and actigraphy. After controlling for age, sex, education, income, inpatient vs. outpatient nurse, workday, and day vs. night shift, there were significant joint associations of sleep and stress with daily rumination. Daily rumination was lowest when lower (-1SD) stressor severity or stressor frequency were paired with longer (+1SD) EMA or actigraphy sleep duration. Daily rumination was highest when higher stressor frequency was paired with higher actigraphy wake after sleep onset (i.e., poorer sleep quality). Future studies should assess whether rumination about daily experiences is associated with quality of patient care provided by nurses in a hospital setting.

Prediction of COVID-19 Stress among Community Dwelling Older Adults: The Role of Anxiety and Resiliency

Worldwide, the COVID-19 pandemic has been an unparalleled source of stress. Older adults with anxiety are vulnerable to higher levels of stress during the pandemic. However not all older adults with anxiety will experience severe stress; resiliency may decrease such negative outcomes. There have been few, if any, longitudinal studies that followed older adults before and during the pandemic. Our data of community dwelling older adults (aged 60-92) is unique in that it allowed for an investigation of psychological variables that increase and decrease negative outcomes during the pandemic. Our longitudinal study examined the influence of pre-pandemic anxiety and resiliency on the severity of COVID related stress. Methods: The pre-pandemic data was obtained in September 2018, and the pandemic data was collected in June 2020. In the baseline survey we obtained measures of anxiety and resiliency. During the pandemic we measured the severity of COVID related stressors. We hypothesized that anxiety would predict higher level of COVID-stress, whereas resiliency would be associated with decreased severity of COVID-stress. Further we predicted that resiliency would attenuate the association between anxiety and COVID-stress. Results: Using OLS regression, we found that anxiety predicted higher COVID-stress, whereas resiliency predicted lower COVID-stress. However, resiliency did not moderate the association between anxiety and COVID-stress. Conclusion: Older adults are subject to many unavoidable negative life events, such as death of family members and chronic health problems. Resiliency may help buffer against such adversities. Development of intervention programs to enhance resiliency may increase psychological resources and foster healthy aging.

Many Faces of Sleep: Diverse Sleep Characteristics and Their Joint Associations With Stress on Health in Adulthood

Two separate bodies of literature point to the significant roles of sleep and stress and their associations with health outcomes in adulthood. To further extend the field’s knowledge on sleep, stress, and health, it is essential to consider the multi-dimensional aspects of sleep and diverse stress contexts and identify ways in which the three factors are interrelated to each other. Different sleep characteristics may have varying implications for stress processes that, in turn, shape health outcomes. Therefore, this symposium integrates diverse characteristics of sleep (duration, quality, and pileup) in conjunction with various stress processes and experiences (bereavement, stressor exposure and appraisals, rumination), and examines their associations with cognitive, emotional, and physiological health outcomes. The first paper by Vigoureux and colleagues investigates the interaction between daily sleep and stressor frequency and severity on daily rumination. The second paper by Slavish and colleagues examines the bidirectional associations between daily stress and sleep duration and efficiency. The third paper by Mu and colleagues explores the mediated associations of sleep quality and sufficiency with work impairment through perceived cognitive abilities and rumination. The fourth paper by Lee uses the stress concept of pileup and tests how pileup of insufficient sleep is associated with day-to-day trajectories of affective and physical well-being. The final paper by Chai and colleagues examines whether sleep quality moderates the association between family bereavement and heart rate variability. The discussant, Dr. Nancy Sin, will integrate key points and discuss considerations for mechanisms and long-term implications of sleep, stress, and health.

Measurement of Cumulative Preterm Neonatal and Maternal Stressors During Neonatal Intensive Care Unit Admission.

By nature, the neonatal intensive care unit (NICU) environment is stressful for both infants and mothers. This study aimed to explore and quantify the severity of early life stressors in premature infants admitted to the NICU and evaluate the effect of cumulative neonatal stressors on maternal mental health. This cross-sectional study included 100 preterm infants admitted to the NICU for at least 10 days. Daily experiences with painful/stressful procedures for 10 days were determined using the Neonatal Infant Stressor Scale. The included mothers were assessed for their psychological well-being 1 week after NICU admission using the Parental Stressor Scale: NICU and Edinburgh Postnatal Depression Scale. During the first 10 days of NICU admission, preterm infants experienced an average of 350.76 ± 84.43 acute procedures and an average of 44.84 ± 11.12 cumulative hours of chronic events, with the highest scores recorded on first 3 days of admission. Although intravenous flushing for patency was the most frequent acute procedure, blood gas sampling was the most painful. Forty-five percent of the mothers showed significant depressive symptoms, with the maternal role alteration reported as the most stressful experience, especially for young and new mothers (p < .001). The cumulative stressors experienced by infants were significantly associated with elevated maternal perception of psychological maladjustment (p < .001). This study confirmed that the NICU environment is stressful for both infants and mothers, with the total cumulative stressors experienced by preemies in the NICU having an negative impact on maternal mental health.

Regional gray matter oligodendrocyte- and myelin-related measures are associated with differential susceptibility to stress-induced behavior in rats and humans

Individual reactions to traumatic stress vary dramatically, yet the biological basis of this variation remains poorly understood. Recent studies demonstrate the surprising plasticity of oligodendrocytes and myelin with stress and experience, providing a potential mechanism by which trauma induces aberrant structural and functional changes in the adult brain. In this study, we utilized a translational approach to test the hypothesis that gray matter oligodendrocytes contribute to traumatic-stress-induced behavioral variation in both rats and humans. We exposed adult, male rats to a single, severe stressor and used a multimodal approach to characterize avoidance, startle, and fear-learning behavior, as well as oligodendrocyte and myelin basic protein (MBP) content in multiple brain areas. We found that oligodendrocyte cell density and MBP were correlated with behavioral outcomes in a region-specific manner. Specifically, stress-induced avoidance positively correlated with hippocampal dentate gyrus oligodendrocytes and MBP. Viral overexpression of the oligodendrogenic factor Olig1 in the dentate gyrus was sufficient to induce an anxiety-like behavioral phenotype. In contrast, contextual fear learning positively correlated with MBP in the amygdala and spatial-processing regions of the hippocampus. In a group of trauma-exposed US veterans, T1-/T2-weighted magnetic resonance imaging estimates of hippocampal and amygdala myelin associated with symptom profiles in a region-specific manner that mirrored the findings in rats. These results demonstrate a species-independent relationship between region-specific, gray matter oligodendrocytes and differential behavioral phenotypes following traumatic stress exposure. This study suggests a novel mechanism for brain plasticity that underlies individual variance in sensitivity to traumatic stress.

Cognitive impairment and World Trade Centre-related exposures.

On 11 September 2001 the World Trade Center (WTC) in New York was attacked by terrorists, causing the collapse of multiple buildings including the iconic 110-story 'Twin Towers'. Thousands of people died that day from the collapse of the buildings, fires, falling from the buildings, falling debris, or other related accidents. Survivors of the attacks, those who worked in search and rescue during and after the buildings collapsed, and those working in recovery and clean-up operations were exposed to severe psychological stressors. Concurrently, these 'WTC-affected' individuals breathed and ingested a mixture of organic and particulate neurotoxins and pro-inflammogens generated as a result of the attack and building collapse. Twenty years later, researchers have documented neurocognitive and motor dysfunctions that resemble the typical features of neurodegenerative disease in some WTC responders at midlife. Cortical atrophy, which usually manifests later in life, has also been observed in this population. Evidence indicates that neurocognitive symptoms and corresponding brain atrophy are associated with both physical exposures at the WTC and chronic post-traumatic stress disorder, including regularly re-experiencing traumatic memories of the events while awake or during sleep. Despite these findings, little is understood about the long-term effects of these physical and mental exposures on the brain health of WTC-affected individuals, and the potential for neurocognitive disorders. Here, we review the existing evidence concerning neurological outcomes in WTC-affected individuals, with the aim of contextualizing this research for policymakers, researchers and clinicians and educating WTC-affected individuals and their friends and families. We conclude by providing a rationale and recommendations for monitoring the neurological health of WTC-affected individuals.

Death of a child and the risk of heart failure: a population-based cohort study from Denmark and Sweden.

We aimed to investigate whether the death of a child, one of the most severe stressors, is associated with the risk of heart failure (HF). We conducted a population-based cohort study involving parents of live-born children recorded in the Danish and Swedish Medical Birth Registers during 1973-2016 and 1973-2014, respectively (n=6 717 349). We retrieved information on child death, HF diagnosis and sociodemographic characteristics of the parents from several nationwide registries. We performed Poisson regression models to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for HF in relation to bereavement. A total of 129 829 (1.9%) parents lost at least one child during the follow-up. Bereaved parents had a 35% higher risk of HF than the non-bereaved (IRR 1.35, 95% CI 1.29-1.41; p < 0.001). The increased HF risk was observed not only when the child died due to cardiovascular or other natural causes, but also when the loss was due to unnatural causes. The association tended to be U-shaped when we categorized the exposed parents by the number of remaining live children at loss or by the age of the deceased child. We found that the death of a child was associated with an increased risk of HF. The finding that not only cardiovascular and other natural deaths, but also unnatural deaths were associated with HF suggests that stress-related mechanisms may contribute to the development of HF.

Methanol Poisoning Leading To Brain Death: a Case Report.

IntroductionThe COVID-19 pandemic has put increased stress on medical systems, infrastructure, and the public in expected and unexpected ways. This case report summarises an unexpected case of methanol poisoning from hand sanitiser ingestion due to changes in industry regulations, increased demand for cleaning products and severe psychosocial stressors brought on by the pandemic. Severe methanol toxicity results in profound metabolic disturbances, damage to the retina and optic nerves, and potentially death.Case PresentationThe patient was a 26-year-old male with alcohol use disorder who presented with one day of nausea, vomiting, and abdominal pain after consuming hand sanitiser. Within a few hours, the patient had suffered multiple seizures, cardiac arrests and required admission to the ICU for emergent management of methanol poisoning. EEG and brain perfusion imaging were performed to confirm brain death, given concerns about the cranial nerve exam after methanol poisoning.ConclusionsWhile rare, methanol toxicity remains a potentially fatal poisoning in the United States and worldwide. When healthcare and public resources are strained, healthcare professionals must consider particularly abnormal presentations. In patients suspected of brain death from methanol toxicity, cranial nerve examination may be unreliable. Therefore, additional testing is necessary to confirm brain death.