ABSTRACT
BACKGROUND: Law enforcement officers are routinely exposed to hazardous, disturbing events that can impose severe stress and long-term psychological trauma. As a result, police and other public safety personnel (PSP) are at increased risk of developing posttraumatic stress injuries (PTSIs) and disruptions to the autonomic nervous system (ANS). ANS functioning can be objectively and noninvasively measured by heart rate (HR), heart rate variability (HRV), and respiratory sinus arrhythmia (RSA). Traditional interventions aimed at building resilience among PSP have not adequately addressed the physiological ANS dysregulations that lead to mental and physical health conditions, as well as burnout and fatigue following potential psychological trauma. OBJECTIVE: In this study, we will investigate the efficacy of a web-based Autonomic Modulation Training (AMT) intervention on the following outcomes: (1) reducing self-reported symptoms of PTSI, (2) strengthening ANS physiological resilience and wellness capacity, and (3) exploring how sex and gender are related to baseline differences in psychological and biological PTSI symptoms and response to the AMT intervention. METHODS: The study is comprised of 2 phases. Phase 1 involves the development of the web-based AMT intervention, which includes 1 session of baseline survey measures, 6 weekly sessions that integrate HRV biofeedback (HRVBF) training with meta-cognitive skill practice, and 1 session of follow-up survey measures. Phase 2 will use a cluster randomized control design to test the effectiveness of AMT on the following prepost outcomes: (1) self-report symptoms of PTSI and other wellness measures; (2) physiological indicators of health and resilience including resting HR, HRV, and RSA; and (3) the influence of sex and gender on other outcomes. Participants will be recruited for an 8-week study across Canada in rolling cohorts. RESULTS: The study received grant funding in March 2020 and ethics approval in February 2021. Due to delays related to COVID-19, phase 1 was completed in December 2022, and phase 2 pilot testing began in February 2023. Cohorts of 10 participants in the experimental (AMT) and control (prepost assessment only) groups will continue until a total of 250 participants are tested. Data collection from all phases is expected to conclude in December 2025 but may be extended until the intended sample size is reached. Quantitative analyses of psychological and physiological data will be conducted in conjunction with expert coinvestigators. CONCLUSIONS: There is an urgent need to provide police and PSP with effective training that improves physical and psychological functioning. Given that help-seeking for PTSI is reduced among these occupational groups, AMT is a promising intervention that can be completed in the privacy of one's home. Importantly, AMT is a novel program that uniquely addresses the underlying physiological mechanisms that support resilience and wellness promotion and is tailored to the occupational demands of PSP. TRIAL REGISTRATION: ClinicalTrials.gov NCT05521360; https://clinicaltrials.gov/ct2/show/NCT05521360. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/33492.
ABSTRACT
Loneliness is a pervasive concern among young adults that has been exacerbated by the COVID-19 pandemic. Identifying factors that mitigate the negative impact of loneliness is important for protecting young adults' mental health and well-being. Among 188 undergraduates (71.8% women;77.1% White), the present study examined physiological regulation and sleep quality as moderators of the association between loneliness and adjustment. Physiological regulation was assessed via resting respiratory sinus arrhythmia (RSA), a measure of parasympathetic activity. Participants self-reported loneliness, sleep quality, mental health symptoms, and positive affect/well-being. Three-way interactions were significant, such that at higher levels of loneliness, the combination of high resting RSA and high sleep quality was protective against elevated anxiety and depressive symptoms and low positive affect/well-being. Multi-pronged, tailored interventions that target improvement in loneliness, physiological regulation, and sleep quality based on an individual's unique risk factors may best promote young adults' adjustment. © 2023 Society for the Study of Emerging Adulthood and SAGE Publishing.
ABSTRACT
Post-coronavirus disease 19 (COVID-19) syndrome has substantial health and economic implications. It is multi-systemic, with prevalent autonomic symptoms. Understanding presentations and potential autonomic causes may help guide treatment strategies and recovery. All patients with a suspected or confirmed history of COVID-19 infection who underwent autonomic testing between May 2020 and October 2021 were reviewed retrospectively. We evaluated 62 patients (20 male, 42 female, mean age of 41.38 +/-11.52). COVID-19 was PCR confirmed in 15 patients (26%), and five (8%) required acute hospital intervention. Most common symptoms included palpitations (81%), lightheadedness/ dizziness (62%), dyspnoea (48%), fatigue (46%), or cognitive symptoms (33%) Autonomic testing showed normal blood pressure responses to pressor stimuli, a mean respiratory sinus arrhythmia of 18.89b/m, and Valsalva ratio of 2.09. Postural tachycardia syndrome (PoTS) was diagnosed in 12 patients, autonomically mediated syncope (AMS) in 11, neurogenic orthostatic hypotension (NOH) in two, and initial orthostatic hypotension (IOH) in seven. Normal supine and upright plasma noradrenaline levels were measured in 34 patients (mean 283.38 pg/ml supine;472.43pg/ml tilted). Autonomic testing was reassuring (PoTS and syncope) in the majority with abnormal testing (n=32, or 52%). Further phenotyping of PoTS to exclude neuropathic pathology may be needed. IOH and OH are important considerations.
ABSTRACT
Children's risk of poorer mental health due to the COVID-19 pandemic may depend on risk and protective factors heading into the pandemic. This study examined same-day associations between COVID-19 stressors and children's mental health using a daily diary design across 14 days, and considered the moderating roles of pre-pandemic peer victimization experiences and resting respiratory sinus arrhythmia (RSA; an indicator of cardiac regulatory capacity). Forty-nine Canadian children aged 8-13 years (Mage = 10.69, 29 girls) participated in the final wave of a longitudinal study just prior to the pandemic and a daily diary extension during the pandemic (N = 686 pandemic measurement occasions). Multilevel modeling indicated that children had poorer mental health on days when they experienced a COVID-19 stressor (e.g., virtual academic difficulties, social isolation). A three-way interaction indicated that this association was stronger for those with higher pre-pandemic peer victimization experiences and lower pre-pandemic resting RSA; however, highly victimized children with higher resting RSA did not experience poorer mental health on days with COVID-19 stressors. Findings offer preliminary insights into the preceding risk and protective factors for children's mental health amidst major subsequent stress.
ABSTRACT
Background: Vertatrum viride (false hellebore) is a perennial commonly found in eastern North America. The most common cause of exposure is misidentification when foraging for wild onion, or skunk cabbage. One regional poison center saw an increase in foraging-related poisonings during initial COVID-19 restrictions. The case report highlights severe delayed cardiac effects after ingestion of Veratrum viride in an otherwise healthy, young, female athlete. Case report: A 24-year-old female presented to an emergency room alongside family with complaints of nausea and vomiting that started 30 min after a meal consisting of foraged wild onion (Allium triccocum). Five others ate the same meal and noted similar symptoms. Vitals upon arrival (3 h post ingestion) are as described: HR 51, BP 88/52, Temp 36.7, RR 18 and O2 sat 100% on room air. The patient had no previous cardiac history and was athletic. Management included D5LR with K replacement, and dopamine infusion at 10mcg/kg/min. Dopamine was tapered slowly, down to 6 mcg/kg/min at 16.5 h. Vitals continued to be stable at 17.5 h post ingestion and dopamine was discontinued. The patient developed severe bradydysrhythmia 15 min later, consisting of complete heart block leading to prolonged sinus pause. She responded to 10 s of CPR with return of spontaneous circulation with a junctional escape rhythm which reverted back to sinus bradycardia. A repeat EKG was unremarkable. The dopamine infusion was reinstituted at 4 mcg/kg/min and continued until 26.5 h post ingestion. She was monitored an additional 9.5 h, and remained in sinus rhythm with mild complaints of dizziness that resolved before discharge. Discussion(s): Veratrum spp. toxicity is due to alkaloids found throughout the plant which cause sodium channel opening when bound to type 2 sodium channels. By increasing sodium ion influx during the resting potential and delaying inactivation to create a late sodium current, these alkaloids increase automaticity in conductive cells. This mechanism, paired with the Bezold-Jarisch reflex, is likely responsible for increased vagal tone leading to bradycardia, hypotension, sinus arrhythmia, and junctional escape rhythm. It is noteworthy that even 18 h post ingestion in a relatively stable patient with no significant cardiac history, cardiac arrest occurred just after treatment tapering. Clinicians should consider prolonged observation time in the setting of discontinuation of vasopressors. Conclusion(s): Both clinicians and amateur foragers should be aware of the risks associated with ingestion of Veratrum viride, especially during early spring when it more closely resembles wild onion. While uncommon, significant delayed cardiac effects are possible. Mistaking the plant for edible wild onions can be the difference between a delectable dinner, and a night in the ICU.
ABSTRACT
During COVID-19 pandemic, one of the most common arrythmia reported with this illness is sinus bradycardia. Treatment for COVID-19 and associated cardiac dysfunction is still evolving. Temporary pacemaker insertion is difficult due to pandemic and risk of spread of infection to the additional staff involved. Orciprenaline stimulates the sino-atrial and atrioventricular nodes and accelerates atrioventricular conduction. Theophylline improves sinus node function in subjects with sinus bradycardia and enhances atrioventricular nodal conduction We report a case series of 10 patients admitted in dedicated COVID-19 ICUs and developed sinus node dysfunction. All of these patients were started on etophylline and theophylline prolonged release tablet (150 mg) once a day. On subsequent follow up after 72 hours, all patients reported heart rate well within normal range. COVID-19 virus directly involves the myocardium by entering the cardiac myocytes resulting in inflammation and injury. As the sinus bradycardia due to COVID-19 is usually transient and respond well this drug, short course of this drug could be added to treat this arrythmia in future.
ABSTRACT
The coronavirus (COVID-19) pandemic has impacted young adults across a number of different domains. It is critical to establish the degree to which the COVID-19 pandemic has affected mental health and identify predictors of poor outcomes. Neuroticism and (low) respiratory sinus arrhythmia (RSA) are risk factors of internalizing disorders that might predict increased psychopathology symptoms. The present study included 222 undergraduate students from [name removed] in Long Island, NY. Before the COVID-19 pandemic, participants completed self-report measures of neuroticism and internalizing symptoms and an electrocardiogram. Between April 15th to May 30th, 2020, participants again completed the measure of internalizing symptoms and a questionnaire about COVID-19 experiences. The COVID-19 pandemic was associated with increased distress, fear/obsessions, and (low) positive mood symptoms. There was a Neuroticism x RSA interaction in relation to distress symptoms, such that greater pre-COVID-19 neuroticism was associated with increased distress symptoms, but only in the context of low RSA. These findings suggest the COVID-19 pandemic has contributed to increased internalizing symptoms in young adults, and individuals with specific personality and autonomic risk factors may be at heightened risk for developing psychopathology.