Reconsidering the role of depression and common psychiatric disorders as partners in the type 2 diabetes epidemic.

Common psychiatric disorders (CPDs) and depression contribute significantly to the global epidemic of type 2 diabetes (T2D). We postulated a possible pathophysiological mechanism that through Bridge-Symptoms present in depression and CPDs, promotes the establishment of emotional eating, activation of the reward system, onset of overweight and obesity and, ultimately the increased risk of developing T2D. The plausibility of the proposed pathophysiological mechanism is supported by the mechanism of action of drugs such as naltrexone-bupropion currently approved for the treatment of both obesity/overweight with T2D and as separate active pharmaceutical ingredients in drug addiction, but also from initial evidence that is emerging regarding glucagon-like peptide 1 receptor agonists that appear to be effective in the treatment of drug addiction. We hope that our hypothesis may be useful in interpreting the higher prevalence of CPDs and depression in patients with T2D compared with the general population and may help refine the integrated psychiatric-diabetic therapy approach to improve the treatment and or remission of T2D.

Sleep, Health Outcomes and Body Weight (SHOW) study: a measurement burst design study on sleep and risk factors for obesity in black emerging adults in North Carolina, USA.

INTRODUCTION: Black emerging adults (18-28 years) have the highest risk of short sleep duration and obesity. This increased risk may be partly explained by greater stress levels, which may result from race-related stress (racial discrimination and heightened race-related vigilance) or living in more disadvantaged home and neighbourhood environments. Insufficient sleep may also impact obesity risk via several weight-related mechanisms including energy balance, appetite and food reward, cortisol profiles and hydration status. This paper describes the rationale, design and methods for the Sleep, Health Outcomes and Body Weight (SHOW) study. This study aims to prospectively assess the effects of sleep, race-related stress and home/neighbourhood environments on weight-related mechanisms and obesity markers (body weight, waist circumference and fat mass) in 150 black emerging adults. METHODS AND ANALYSIS: The SHOW study follows a measurement burst design that includes 3, 7-day data collection bursts (baseline, 6-month and 12-month follow-ups). Sleep is measured with three methods: sleep diary, actigraphy and polysomnography. Energy balance over 7 days is based on resting and postprandial energy expenditure measured via indirect calorimetry, physical activity via accelerometry and self-reported and ad libitum energy intake methods. Self-reported methods and blood biomarkers assess fasting and postprandial appetite profiles and a behavioural-choice task measures food reward. Cortisol awakening response and diurnal cortisol profiles over 3 days are assessed via saliva samples and chronic cortisol exposure via a hair sample. Hydration markers are assessed with 24-hour urine collection over 3 days and fasting blood biomarkers. Race-related stress is self-reported over 7 days. Home and neighbourhood environments (via the Windshield Survey) is observer assessed. ETHICS AND DISSEMINATION: Ethics approval was granted by the University of North Carolina at Greensboro's Institutional Review Board. Study findings will be disseminated through peer-reviewed publications, presentations at scientific meetings and reports, briefs/infographics for lay and community audiences.

Prevalence of depressive and anxiety symptoms and perceived stress in hospitalised patients with COVID-19.

BACKGROUND: COVID-19 infection is associated with significant depressive and anxiety symptoms and stress. We examined the prevalences of depressive and anxiety symptoms and perceived stress among patients with COVID-19. METHODS: Clinically stable patients with COVID-19 aged 18 to 60 years who were admitted between April 2021 and September 2021 to the MES Medical College in Kerala, India were prospectively recruited. They were assessed using the Montgomery-Asberg Depression Rating Scale, the Hamilton Anxiety Scale, and the Perceived Stress Scale. RESULTS: Of 112 patients screened, 103 were included in the analysis. Depression scores were higher in patients of lower socio-economic status (p = 0.04), of unemployed (p = 0.01), and with longer hospital stays (p < 0.001). Anxiety scores were higher in patients aged 31 to 40 years (p = 0.04), of lower socio-economic status (p = 0.01), with a history of psychiatric illness (p = 0.006), and with a history of self-harm (p = 0.019). Perceived stress scores were higher in patients of lower socio-economic status (p = 0.02), with a history of psychiatric illness (p = 0.001), and with a history of self-harm (p = 0.022). CONCLUSION: Socio-economic status, employment status, a history of psychiatric illness, and duration of hospital stay are associated with depression, anxiety, and stress among patients with COVID-19.

Promotive and protective effects of community-related positive childhood experiences on adult health outcomes in the context of adverse childhood experiences: a nationwide cross-sectional survey in Japan.

OBJECTIVE: Although adverse childhood experiences (ACEs) are associated with poor health in adulthood, positive childhood experiences (PCEs) can reduce the risk of negative health outcomes. This study aimed to investigate whether PCEs in the community (CPCEs, ie, trusted adults other than parents, supportive friends, belongingness to school, or community traditions) would have an independent effect on better health outcomes and moderate the association between ACEs and adult illnesses. DESIGN: Cross-sectional survey. SETTING: Data were gathered from a nationwide, cross-sectional internet survey conducted in Japan in 2022. PARTICIPANTS: This study included 28 617 Japanese adults aged 18-82 years (51.1% female; mean age=48.1 years). PRIMARY AND SECONDARY OUTCOME MEASURES: The associations among self-reported ACEs, CPCEs before the age of 18 years and current chronic diseases (eg, cancer and depression) were investigated using multivariable logistic regression models. RESULTS: CPCEs were associated with lower odds of adult diseases (such as stroke, chronic obstructive pulmonary disease (COPD), chronic pain, depression, suicidal ideation and severe psychological distress) after adjusting for ACEs. More CPCEs weakened the association between ACEs and adult diseases. Specifically, among those with ACEs, ≥3 CPCEs (vs 0-2 CPCEs) lowered the adjusted prevalence by ≥50% for stroke (2.4% to 1.2%), COPD (2.2% to 0.7%) and severe psychological distress (16.4% to 7.4%). CONCLUSION: CPCEs could reduce ACE-related risk of poor physical and mental health in later life. Early-life interventions that enhance PCEs in schools and/or neighbourhoods are recommended.

Social capital as a moderator of the relationship between violent community environment and psychological distress.

OBJECTIVE: To evaluate the modifying effect of social capital on the relationship between living in violent communities and the presence of psychological distress in adolescents and youth in Mexico. METHOD: The analysis of the Social Cohesion Survey for the Prevention of Violence and Crime (ECOPRED, by its acronym in Spanish) was conducted. The analytic sample consisted of 39,639 participants aged 12 to 29 years. Community violence and social capital were measured at the census tract level using the average answers of a household's head sample. These environmental variables were independent of the experiences of the participants. Social capital variables included structural (social ties, recreational participation, collaborative participation, and social cohesion), and cognitive (trust in neighbors) dimensions. Multilevel structural equation models were used. RESULTS: Recreational participation, collaborative participation, and social cohesion modified the relationship between community environments and psychological distress. In females who lived in places with less recreational participation or less social cohesion, the higher the social disorder, the higher the psychological distress. A similar relationship between vandalism and psychological distress was identified, but only in males who lived in places with less collaborative participation, and in females with less social cohesion. CONCLUSIONS: Our results suggest that dimensions of the structural social capital (organization and interest in the community and its members) were the ones that had the buffering effect of the exposure to disordered community environments on psychological distress.

Stress-Induced Autonomic Dysfunction is Associated With Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Artery Disease.

BACKGROUND: Mental stress-induced myocardial ischemia (MSIMI) is associated with adverse cardiovascular outcomes in individuals with coronary artery disease, but the mechanisms underlying this phenomenon are unknown. We examined the relationship between stress-induced autonomic dysfunction, measured by low heart rate variability (HRV) in response to stress, and MSIMI in patients with stable coronary artery disease. We hypothesized that stress-induced autonomic dysfunction is associated with higher odds of MSIMI. METHODS: In 735 participants with stable coronary artery disease, we measured high- and low-frequency HRV in 5-minute intervals before and during a standardized laboratory-based speech stressor using Holter monitoring. HRV at rest and stress were categorized into low HRV (first quartile) versus high HRV (second to fourth quartiles); the low category was used as an indicator of autonomic dysfunction. Multivariable logistic regression models were used to examine the association of autonomic dysfunction with MSIMI. RESULTS: The mean age was 58 (SD, ±10) years, 35% were women, 44% were Black participants, and 16% developed MSIMI. Compared with high HRV during stress, low HRV during stress (both high and low frequencies) was associated with higher odds of MSIMI after adjusting for demographic and clinical factors (odds ratio for high-frequency HRV, 2.1 [95% CI, 1.3-3.3]; odds ratio for low-frequency HRV, 2.1 [95% CI, 1.3-3.3]). Low-frequency HRV at rest was also associated with MSIMI but with slightly reduced effect estimates. CONCLUSIONS: In individuals with coronary artery disease, mental stress-induced autonomic dysfunction may be a mechanism implicated in the causal pathway of MSIMI.

Effects of a brief intervention based on Acceptance and Commitment Therapy versus usual care for cardiac rehabilitation patients with coronary heart disease (ACTonHEART): a randomised controlled trial.

OBJECTIVES: The main objective of the study is to investigate the short-term efficacy of Acceptance and Commitment Therapy (ACT) on the simultaneous modification of biological indicators of risk and psychological well-being in patients with coronary heart disease attending cardiac rehabilitation (CR). DESIGN: This was a two-arm randomised controlled trial comparing a brief, manualised, ACT-based intervention with usual care (UC). SETTING: The study was conducted in an outpatient CR unit in Italy. Data collection took place from January 2016 to July 2017. PARTICIPANTS: Ninety-two patients were enrolled and randomised, following an unbalanced randomisation ratio of 2:1 to the ACT group (n=59) and the control group (n=33). Eighty-five patients completed the ACT (n=54) and the UC (n=31) interventions and were analysed. INTERVENTIONS: The control group received UC, a 6 weeks multidisciplinary outpatient CR programme, encompassing exercise training, educational counselling and medical examinations. The experimental group, in addition to UC, participated in the Acceptance and Commitment Therapy on HEART disease (ACTonHEART) intervention encompassing three group sessions based on ACT. OUTCOMES: The primary outcomes were Low Density Lipoproteins (LDL)cholesterol, resting systolic blood pressure, body mass index (BMI) and psychological well-being measured by the Psychological General Well-Being Index (PGWBI). Outcome measures were assessed at baseline and at the end of CR. RESULTS: Based on linear mixed models, no significant group × time interaction was observed for either the primary outcomes (ß, 95% CI: PGWBI =-1.13, -6.40 to -4.14; LDL cholesterol =-2.13, -11.02 to -6.76; systolic blood pressure =-0.50, -10.76 to -9.76; diastolic blood pressure =-2.73, -10.12 to -4.65; BMI =-0.16, -1.83 to -1.51, all p values >0.05) or the secondary outcomes (all p values >0.05). A significant time effect was found for the PGWBI total (beta=4.72; p=0.03). CONCLUSIONS: Although analyses revealed null findings, the results can inform the design of future ACT-based CR interventions and can help researchers to strike a balance between the idealised implementation of an ACT intervention and the structural limitations of existing CR programmes. TRIAL REGISTRATION NUMBER: NCT01909102.

Factors influencing stigma among college students with COVID-19 in South Korea: a descriptive study.

PURPOSE: This study is descriptive research aiming to identify factors influencing the stigma experienced by college students with coronavirus disease 2019 (COVID-19), focusing on COVID-19 pandemic stress, depression, and fear of negative evaluation as the main variables. METHODS: An online survey was administered to 175 college students who had been diagnosed with COVID-19 from January to May 2022 and were enrolled in universities in Seoul, Cheongju, and Daegu, South Korea. The survey collected data on pandemic stress, depression, fear of negative evaluation, and stigma. The data were analyzed using the t-test, ANOVA, the Scheffé test, Pearson's correlation coefficients, and stepwise multiple regression in SPSS/WIN 26.0. RESULTS: We analyzed differences in stigma scores based on general characteristics of the college students and found significant differences in stigma scores by age, major satisfaction, interpersonal satisfaction, date of COVID-19 confirmation, treatment modality, and recent subjective health condition. Factors influencing stigmatization were identified as COVID-19 pandemic stress, depression, date of COVID-19 confirmation, treatment modality, recent subjective health condition, and major satisfaction, with an overall explanatory power of 37.6%. CONCLUSION: This study is significant as it identifies emotional changes across various aspects of pandemic stress, depression, fear of negative evaluation, and stigma among college students who have been diagnosed with COVID-19. The findings of this study suggest the development of programs to reduce psychological distress and enhance mental health management skills among these students.

Relationship between self-psychological adjustment and post-traumatic growth in patients with lung cancer undergoing chemotherapy: a cross-sectional study.

OBJECTIVES: This study aimed to determine the potential profiles of self-psychological adjustment in patients with lung cancer undergoing chemotherapy, including sense of coherence (SOC) and positive cognitive emotion regulation (PCER). The relationship between these profiles with post-traumatic growth (PTG) and the relevant factors of self-psychological adjustment in different profiles was analysed. DESIGN: Cross-sectional study. SETTING: Patients with lung cancer undergoing chemotherapy in China. PARTICIPANTS: A total of 330 patients with lung cancer undergoing chemotherapy were recruited out of which 321 completed the questionnaires effectively. METHODS: Latent profile analysis was used to identify self-psychological adjustment classes based on the two subscales of the Sense of Coherence Scale and Cognitive Emotion Regulation Questionnaire. One-way analysis of variance and multinomial logistic regression were performed to examine the subgroup association with characteristics and PTG. RESULTS: Three latent profiles of self-psychological adjustment were identified: low level (54.5%), high SOC-low PCER (15.6%) and high PCER (29.9%). The results of univariate analysis showed a significant difference in PTG scores among different self-psychological adjustment subgroups (F=11.55, p<0.001). Patients in the high-PCER group were more likely living in urban areas (OR=2.41, 95% CI 1.17 to 4.97, p=0.02), and time since cancer diagnosis was ≥6 months and <1 year (OR=3.54, 95% CI 1.3 to 9.64, p<0.001). CONCLUSION: This study revealed that most patients with lung cancer undergoing chemotherapy belonged to the low-level group. Three profiles are associated with PTG. There were differences in characteristics between patients treated with chemotherapy for lung cancer in the high-PCER and low-PCER groups. Thus, these profiles provide useful information for developing targeted individualised interventions based on demographic characteristics that would assist PTG in patients with lung cancer undergoing chemotherapy.

Care for the caregiver: an exploration of caregiver burden of children with chronic medical conditions at a tertiary care hospital in Karachi, Pakistan - a mixed-methods study.

OBJECTIVES: Caregiver burden often goes unrecognised and can substantially affect caregivers' physical, psychological and financial well-being, thereby impacting quality of care. This study investigates burden among caregivers of children with chronic medical conditions in a tertiary care hospital in Pakistan. The study aims to assess the extent of burden, explore influencing factors and recommendations for interventions. DESIGN: Mixed-methods study, comprising of an in-person paper-based survey, employing the Zarit Burden Interview scale to assess burden scores. Qualitative component included thematic analysis of semi-structured in-depth interviews with caregivers. PARTICIPANTS: 383 caregivers of children admitted to the inpatient paediatric services at our tertiary care centre were surveyed. In-depth interviews were conducted with 19 caregivers. RESULTS: The survey revealed a mean burden score of 35.35±15.14, with nearly half of the participants (46%, n=177) experiencing mild burden, while 37% (n=140) reporting moderate-to-severe burden. The most common diagnosis was cancer (24%, n=92), while the highest burden (42.97±15.47) was noted for congenital cardiac disease. Greater burden was significantly associated with lower caregiver education, young age of the child at diagnosis and increased number of hospital visits (p<0.05). Caregivers highlighted financial strain, psychosocial effects and impact on lifestyle and relationships as key challenges. They emphasised the need for improved medical coordination, financial support and enhanced hospital services. CONCLUSIONS: The study elucidates the multifaceted nature of caregiver burden in the context of paediatric chronic illnesses in Pakistan. Interventions should emphasise financial aid, educational support and development of system-level changes to improve access to resources and medical care coordination. These insights call for policy and practice integration to support caregivers effectively.

Effectiveness of stress management interventions for nursing students: A systematic review and meta-analysis.

Elevated stress levels are related to diminished mental health, potentially leading to decreased well-being and performance of nursing students. While researchers have focused on developing stress management interventions, there is a need to synthesize the evidence. A systematic review with meta-analysis was conducted to assess the evidence for the effectiveness of stress management interventions in nursing students. A systematic literature search identified controlled stress management interventions employing a validated psychological or physiological stress measure. Forty-one studies were included, with 36 forming a pool of 2715 participants in the meta-analysis. The overall effect on psychological stress was positive. Intervention type, delivery modality, intervention duration in weeks, and number of sessions were moderators of intervention effectiveness, with more significant effects for mind-body programs, on-site delivery methods, durations of 9-12 weeks, and 15-30 sessions. For physiological stress, the biomarkers of blood pressure, heart rate, and cortisol levels decreased significantly. Future research is necessary for promising outcomes related to currently underrepresented indicators and to investigate the long-term effects of interventions.

Educational intervention on perceived stress among adults with type 2 diabetes and metabolic syndrome: a non-randomized clinical trial / Intervención educativa sobre el estrés percibido en adultos con diabetes tipo 2 y síndrome metabólico: ensayo clínico no aleatorizado / Intervenção educativa sobre o estresse percebido de adultos com diabetes tipo 2 e síndrome metabólica: ensaio clínico não-randomizado

Objective.To assess the effectiveness of an educational intervention on perceived stress and metabolic syndrome parameters among adults with type 2 diabetes mellitus. Method. Fifty-one adults (aged 48.73±7.84; 86.3% of women) were included in a non-randomized clinical trial performed in a healthcare unit for six months (Brazilian Clinical Trial Registry: RBR-43K52N). All participants were diagnosed with type 2 diabetes mellitus and metabolic syndrome (intervention group, n=26; control group, n=25). The intervention consisted of a nurse-led educational health-promoting program with a multidisciplinary approach organized in seven workshops. The primary outcome was decreased perceived stress, and the secondary outcome was improvement in metabolic syndrome parameters according to perceived stress levels. These outcomes were assessed at two points in time, at the baseline and follow-up. Results. Participation in the intervention program resulted in a significant decrease in perceived stress (p=0.028). The stressed participants in the intervention group experienced a significant decrease in blood glucose levels (p=0.001) and a significant increase in high-density lipoprotein-cholesterol (p=0.003) concentrations after the six-month intervention. Conclusion.The nurse-led educational health-promoting program decreased perceived stress among adults with type 2 diabetes mellitus and metabolic syndrome, improving fasting blood glucose and high-density lipoprotein cholesterol among the stressed participants in the intervention group.

Objetivo. Evaluar la efectividad de una intervención educativa sobre el estrés percibido y los componentes del síndrome metabólico en adultos con diabetes mellitus tipo 2. Métodos. Se incluyeron 51 adultos (48.73±7.84 años; 86.3% mujeres) de un estudio no-ensayo aleatorizado realizado en una unidad de salud durante seis meses, con Registro Brasileño de Ensayos Clínicos: RBR-43K52N, todos los participantes fueron diagnosticados con diabetes mellitus tipo 2 y síndrome metabólico (grupo intervención, n=26; grupo control, n=25). La intervención consistió en un programa educativo de promoción de la salud con enfoque multidisciplinario, liderado por una enfermera, estructurado en siete talleres grupales. El resultado primario fue la reducción del estrés percibido y el secundario, la mejora de los componentes del síndrome metabólico influenciados por el nivel de estrés percibido, evaluado en dos momentos, al inicio y después del seguimiento. Resultados. La participación en el programa de intervención resultó en una reducción significativa del estrés percibido en comparación con el grupo control (p=0.028). Los participantes estresados en el grupo de intervención tuvieron, respectivamente, una disminución y un aumento significativos en las concentraciones séricas de glucosa (p=0.001) y lipoproteínas de alta densidad-colesterol (p=0.003) después de seis meses de intervención. Conclusión. Un programa educativo de promoción de la salud liderado por enfermeras fue eficiente para reducir el estrés percibido entre adultos con diabetes mellitus tipo 2 y síndrome metabólico, además de mejorar la glucemia en ayunas y el colesterol unido a lipoproteínas de alta densidad en los participantes del grupo estresado de intervención.

Objetivo. Avaliar a efetividade de uma intervenção educativa sobre o estresse percebido e os componentes da síndrome metabólica em adultos com diabetes mellitus tipo 2. Métodos. Foram incluídos 51 adultos (48.73±7.84 anos de idade; 86.3% mulheres) em um ensaio clínico não-randomizado realizado em uma unidade de saúde durante seis meses, com Registro de Ensaio Clínico Brasileiro: RBR-43K52N.Todos os participantes apresentavam diagnóstico de diabetes mellitus tipo 2 e síndrome metabólica (grupo intervenção, n=26; grupo controle, n=25). A intervenção consistiu em um programa educativo de promoção da saúde com abordagem multidisciplinar, liderado por enfermeiro, estruturado em sete oficinas em grupo. O desfecho primário foi a redução do estresse percebido, e o secundário, a melhora dos componentes da síndrome metabólica conforme influência do nível de estresse percebido, avaliados em dois momentos, na condição basal e após o acompanhamento. Resultados. A participação no programa de intervenção resultou na redução significativa do estresse percebido em comparação com o grupo controle (p=0.028). Os participantes estressados do grupo intervenção tiveram, respectivamente, diminuição e aumento significativos das concentrações séricas de glicose (p=0.001) e da lipoproteína-colesterol de alta densidade (p=0.003) após seis meses de intervenção. Conclusão. Um programa educativo de promoção da saúde liderado por enfermeiros foi eficiente para reduzir estresse percebido entre adultos com diabetes mellitus tipo 2 e síndrome metabólica, além de causar melhora da glicemia de jejum e e da lipoproteína-colesterol de alta densidade dos participantes estressados do grupo intervenção.

PERCEPTION OF STRESS OF MEDICAL STUDENTS DURING THE COVID-19 PANDEMIC IN 2020 / PERCEPÇÃO DO ESTRESSE DE ESTUDANTES DE MEDICINA DURANTE A PANDEMIA DA COVID-19 EM 2020

Introduction: In December 2019, the first cases of COVID-19 emerged in China and in March 2020, the WHO declared COVID-19 as the second pandemic of the 21st century. As a measure to contain the spread of the disease, social isolation was recommended. Numerous studies have pointed to an increase in stress symptoms related to the pandemic. It is known that medical students are more susceptible to responding to stressful situations in a non-adaptive way. Objectives: To evaluate the perceived stress level of medical students in 2019 and 2020, periods before and during the COVID-19 pandemic. Assess the level of stress in the middle and end (exam season) of the second semester of 2020, during the COVID-19 pandemic. Methods: The PSS-14 - Perceived Stress Scale was applied to medical students from the second to the eighth period of the Medicine course at Faculdade Evangélica Mackenzie do Paraná, in 2019 and 2020, through an online questionnaire. Results: In 2019, a total of 158 students participated in the two phases (beginning and end of the first semester) of the study. The average age was 22.2 years old and 57.6% were female. In 2020, a total of 42 students participated in the two phases (half and end of the second semester) of the study. The average age was 23.3 years old and 69% were female. When comparing the PSS 14 scale scores in the two assessments, the levels were lower in 2020. Conclusions: The perceived stress level of medical students was lower during the pandemic period compared to the pre-pandemic period. There was no difference in the assessment of perceived stress when comparing the middle and end of the 2020 semester.

Introdução: Em dezembro de 2019 surgiram na China os primeiros casos de COVID-19 e em março de 2020 a OMS declarou a COVID-19 como a segunda pandemia do século 21.  Como medida para conter a disseminação da doença, recomendou-se o isolamento social. Inúmeros estudos apontaram para aumento de sintomas de estresse relacionados à pandemia. Sabe-se que estudantes de Medicina estão mais suscetíveis a responder às situações estressantes de modo não adaptativo. Objetivos: Avaliar o nível de estresse percebido dos estudantes de medicina em 2019 e 2020, períodos pré e durante a pandemia de COVID-19. Avaliar o nível de estresse na metade e final (época de provas) do segundo semestre de 2020, durante a pandemia de COVID-19.  Métodos: Foi aplicada a Escala de Estresse Percebido PSS-14 aos alunos de Medicina do segundo ao oitavo período do curso de Medicina da Faculdade Evangélica Mackenzie do Paraná, em 2019 e 2020, através de questionário online. Resultados: Em 2019, participaram das duas fases (início e final do primeiro semestre) do estudo um total de 158 alunos. A média de idade foi de 22,2 anos e 57,6% eram do sexo feminino. Em 2020, participaram das duas fases (metade e final do segundo semestre) do estudo um total de 42 alunos. A média de idade foi de 23,3 anos e 69% eram do sexo feminino. Na comparação entre os escores da escala PSS 14 nas duas avaliações, os níveis foram menores em 2020. Conclusões: O nível de estresse percebido dos estudantes de medicina foi menor no período de pandemia em comparação ao período pré-pandemia. Não houve diferença na avaliação do estresse percebido na comparação entre o período da metade e do final do semestre de 2020.

[Benefits of participatory involvement of patients in the development of a dermatological treatment app-A report from the practice]. / Nutzen der partizipatorischen Mitwirkung von PatientInnen an der Entwicklung einer dermatologischen Therapie-App ­ ein Bericht aus der Praxis.

Approximately 2% of the German population suffer from psoriasis. HybridVITA has developed a mobile application (app) that enables psoriasis patients to independently document the progression of the disease and the current psychological stress at home. The HybridVITA app was created in close collaboration with user groups to ensure optimal adaptation to their needs. Two interactive workshops were held with the user groups and the technical developers of the app as a core element of the developmental process. The workshops identified the needs and suggestions for improvement of the various user groups and formulated user stories for the further development of the app using the Scrum method. The participatory approach of the workshop enabled the project team to gather valuable practical knowledge at an early stage of development. The team's awareness of potential obstacles during the early stages of the project enabled them to proactively identify and address these issues prior to implementing the app in dermatological care. We are confident that a patient-centered and participatory approach to health app development can provide valuable insights for developers.

Effects of cannabidiol on psychosocial stress, situational anxiety and nausea in a virtual reality environment: a protocol for a single-centre randomised clinical trial.

INTRODUCTION: The non-intoxicating plant-derived cannabinoid, cannabidiol (CBD), has demonstrated therapeutic potential in a number of clinical conditions. Most successful clinical trials have used relatively high (≥300 mg) oral doses of CBD. Relatively few studies have investigated the efficacy of lower (<300 mg) oral doses, typical of those available in over-the-counter CBD products. METHODS: We present a protocol for a randomised, double-blind, placebo-controlled, parallel-group clinical trial investigating the effects of a low oral dose (150 mg) of CBD on acute psychosocial stress, situational anxiety, motion sickness and cybersickness in healthy individuals. Participants (n=74) will receive 150 mg of CBD or a matched placebo 90 min before completing three virtual reality (VR) challenges (tasks) designed to induce transient stress and motion sickness: (a) a 15 min 'Public Speaking' task; (b) a 5 min 'Walk the Plank' task (above a sheer drop); and (c) a 5 min 'Rollercoaster Ride' task. The primary outcomes will be self-reported stress and nausea measured on 100 mm Visual Analogue Scales. Secondary outcomes will include salivary cortisol concentrations, skin conductance, heart rate and vomiting episodes (if any). Statistical analyses will test the hypothesis that CBD reduces nausea and attenuates subjective, endocrine and physiological responses to stress compared with placebo. This study will indicate whether low-dose oral CBD has positive effects in reducing acute psychosocial stress, situational anxiety, motion sickness and cybersickness. ETHICS AND DISSEMINATION: The University of Sydney Human Research Ethics Committee has granted approval (2023/307, version 1.6, 16 February 2024). Study findings will be disseminated in a peer-reviewed journal and at academic conferences. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12623000872639).

Examining the association of breakfast skipping with sleep disturbance, mental health, and health-related quality of life: data from the 2018 Korean community health survey.

Objectives: This study aimed to explore the relationship between breakfast skipping and its effects on sleep disorders, mental health, and health-related quality of life among Korean adults.Methods: Utilizing data from the 2018 Korea Community Health Survey, this cross-sectional analysis included 173,272 adults aged 19 years and older. Instruments used for assessment included the Patient Health Questionnaire-9 for depression, the EuroQol 5-dimension (EQ-5D) for health-related quality of life, and the Pittsburgh Sleep Quality Index for sleep disorders. The complex sample logistic regression analysis was employed to adjust for potential confounders.Results: Breakfast skipping was found to be significantly associated with delayed mid-sleep time, an increased propensity for daytime sleepiness, and a notable decline in sleep quality. Additionally, it was linked to a significant increase in depression risk, compromised health-related quality of life, and elevated stress levels across both genders. All five dimensions of the EQ-5D were negatively impacted by breakfast skipping.Discussion: The findings highlight the detrimental effects of skipping breakfast on sleep patterns, mental health, and overall quality of life, stressing the importance of regular breakfast consumption for enhancing these health outcomes. The study suggests the need for further research to uncover the mechanisms behind these associations and to devise targeted interventions to mitigate the negative impacts of breakfast skipping.

Comparison of the Perceived Stress Reactivity Scale with physiological and self-reported stress responses during ecological momentary assessment and during participation in a virtual reality version of the Trier Social Stress Test.

Valid approaches to conveniently measure stress reactivity are needed due to the growing evidence of its health-impairing effects. This study examined whether the Perceived Stress Reactivity Scale (PSRS) predicts cardiovascular and psychological responses to psychosocial stressors during daily life and during a virtual reality (VR) Trier Social Stress Test (TSST). Medical students answered a standardized baseline questionnaire to assess perceived stress reactivity by the PSRS. The PSRS asks participants to rate the intensity of their typical affective responses to common stressors during daily life. They were further asked to participate in a VR-TSST and in an ecological momentary assessment (EMA) over a period of three consecutive workdays during daily life. Blood pressure and self-reported stress were repeatedly, heart rate variability (HRV) continuously measured during the VR-TSST and EMA. Furthermore, participants repeatedly assessed task demands, task control and social conflict during the EMA. Data was analysed using multilevel analysis and multiple linear regression. Results indicate that the PSRS moderates associations between blood pressure (but not HRV) and demands and control during daily life. Furthermore, the PSRS directly predicted self-reported stress, but did not moderate associations between self-reported stress and demands, control and social conflict. The PSRS did not predict physiological and self-reported stress responses to the VR-TSST. This study partly confirmed convergent validity of the PSRS to stress reactivity in daily life. Furthermore, the lack of association between the PSRS and stress responses to the VR-TSST calls for future studies to search for reliable and valid ways to assess stress reactivity.

Battling Burnout: Raising Resilience in Education. Chiropractic Educators Research Forum (CERF), December 2, 2023.

This conference was convened by the Chiropractic Educators Research Forum (CERF) on December 2, 2023. This conference took a closer look at what chiropractic programs are doing to identify burnout and build student, faculty, and staff resilience in the psychosocial domain. During the meeting, presenters and panelists took an in-depth look at research related to how chiropractic programs are addressing issues in mental health of students, faculty, and staff as this relates to burnout and resilience in the chiropractic program and practice.

Factors affecting the health-related quality of life of children with cerebral palsy in Indonesia: a cross-sectional study.

PURPOSE: Children with cerebral palsy (CP) and their parents experience various problems that can affect their quality of life. This study examined factors affecting the quality of life of children with CP. METHODS: A cross-sectional study was conducted in Yogyakarta, Indonesia, from January to August 2019. The participants were consecutively recruited children with CP aged 2 to 18 years and their parents. Ninety-eight children with CP and their parents, specifically their mothers, were recruited. Children's health-related quality of life (HRQoL) was measured using the Pediatrics Quality of Life Cerebral Palsy. Parental HRQoL and stress were measured using the WHOQOL-BREF and Parenting Stress Index (PSI). RESULTS: Functional level V was the most common category for both Gross Motor Function Classification System (GMFCS) and Bimanual Fine Motor Function (BFMF) (35% and 28%, respectively). Children's mean HRQoL was medium (49.81±20.35). The mean total PSI score was high (94.93±17.02), and 64% of parents experienced severe stress. Bivariate analysis showed that GMFCS, BFMF, number of comorbidities, presence of pain, and parental stress were significantly correlated with the total score for children's HRQoL (p<.05). Multiple linear regression analysis (p<.05) demonstrated that more severe GMFCS and parental stress were associated with lower mean HRQoL scores in children. CONCLUSION: Factors including the level of GMFCS and parental stress affected the HRQoL of children with CP. Parental stress management should be included in the comprehensive management of these children.

Development, piloting and evaluation of an app-supported psychosocial prevention intervention to strengthen participation in working life: a study protocol of a mixed-methods approach.

INTRODUCTION: Rates of incapacity to work due to mental disorders have increased in many European countries. The consequences of persistent stress can impact individuals' physical and psychological well-being and gradually develop into chronic stress. Mental disorders or symptoms of burn-out syndrome can have severe consequences. Mental disorders leading to work incapacity significantly burden the health system. Prevention interventions can protect against burn-out, depression, anxiety and other mental health disorders. Digital health is a promising approach to increase the utilisation of effective prevention interventions. This mixed-methods study evaluates a newly developed app-supported psychosocial prevention intervention called 'RV Fit Mental Health' to strengthen participation in working life. METHODS AND ANALYSIS: The study uses a three-stage parallel mixed-methods design. This study accompanies the development (stage 1), piloting (stage 2) and evaluation (stage 3) of the new intervention. Within the stages, there is a quantitative as well as a qualitative research strand. Employed persons with an incipient mental disorder will be included. Additionally, experts within the project or connected areas will be included. Quantitative data will be analysed using multifactorial variance analyses in a pre-post design. Qualitative data will be analysed using qualitative content analysis. The study is a comprehensive research approach to investigate the development, piloting and evaluation of an app-supported psychosocial app-based prevention intervention. The rigour of the study will be achieved through data triangulation. ETHICS AND DISSEMINATION: All participants will receive detailed study information and give written informed consent before data collection. Ethical approval was obtained from the Technical University of Munich Ethics Committee. All data collection will follow all legislative rules regarding data protection, also following the Declaration of Helsinki. The study results will be disseminated in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBERS: DRKS00030818 and DRKS00033080.