Digital Alcohol Interventions Could Be Part of the Societal Response to Harmful Consumption, but We Know Little About Their Long-Term Costs and Health Outcomes.

Alcohol consumption causes both physical and psychological harm and is a leading risk factor for noncommunicable diseases. Digital alcohol interventions have been found to support those looking for help by giving them tools for change. However, whether digital interventions can help tackle the long-term societal consequences of harmful alcohol consumption in a cost-effective manner has not been adequately evaluated. In this Viewpoint, we propose that studies of digital alcohol interventions rarely evaluate the consequences of wider dissemination of the intervention under study, and that when they do, they do not take advantage of modeling techniques that allow for appropriately studying consequences over a longer time horizon than the study period when the intervention is tested. We argue that to help decision-makers to prioritize resources for research and dissemination, it is important to model long-term costs and health outcomes. Further, this type of modeling gives important insights into the context in which interventions are studied and highlights where more research is required and where sufficient evidence is available. The viewpoint therefore invites the researcher not only to reflect on which interventions to study but also how to evaluate their long-term consequences.

Prevalence of child sexual abuse in Spain: a survey study / Prevalencia del abuso sexual infantil en España: un estudio de encuesta

Background/aim: Child sexual abuse (CSA) is a pervasive issue that affects children and adolescents worldwide, and Spain is no exception. Despite its high impact, there is a lack of comprehensive data on the prevalence of CSA in Spain. This study aims to update the current state of the prevalence of CSA, providing a comprehensive picture of the prevalence of sexual abuse from data using varying defining criteria. Method: A cross-sectional design was conducted, including a total of 1,323 participants, aged between 18 and 70 years (M = 28.40, SD = 10.31) responded to a measure of exposure to child sexual abuse. Results: The results exhibited that the prevalence of CSA was 9.2% for male and 22.1% for female participants, significantly higher for them. In terms of prevalence rate, females reported more frequently than males having suffered a more severe form of sexual abuse when they were 13 to 18 years old, with a large magnitude of the effect. Another notable finding was that the occurrence of global CSA with and without intercourse was significant, not a trivial effect. Conclusions: Consequently, there is a need for increased awareness, education, and resources to prevent and address CSA. The results of this study highlight the need for continued research to better understand the extent of CSA and to develop evidence-based interventions to protect children and adolescents from CSA victimization. (AU)

Antecedentes/objetivo: El abuso sexual infantil (ASI) es un problema generalizado que afecta a niños y adolescentes en todo el mundo, y España no es una excepción. A pesar de su gran repercusión, faltan datos completos sobre la prevalencia del ASI en España. El estudio pretende actualizar el estado actual de la prevalencia del ASI, proporcionando una imagen completa de la prevalencia del abuso sexual a partir de datos que utilizan diferentes criterios de definición. Método: Se realizó un diseño transversal, incluyendo un total de 1,323 participantes, en edades comprendidas entre 18 y 70 años (M = 28.40, DT = 10.31) respondieron a una medida de exposición a abuso sexual infantil. Resultados: Los resultados mostraron que la prevalencia de ASI fue del 9.2% para los hombres y del 22.4% para las mujeres, significativamente mayor para ellas. En cuanto a la tasa de prevalencia, las mujeres declararon con mayor frecuencia que los hombres haber sufrido una forma más grave de abuso sexual cuando tenían entre 13 y 18 años, con tamaño del efecto grande. Otro hallazgo a destacar fue que la existencia de ASI global con y sin coito resultó significativa, esto es, la prevalencia no es trivial. Conclusiones: Se concluye que hace falta una mayor concienciación, la educación y recursos para prevenir y abordar el ASI. Los resultados de este estudio ponen de relieve la necesidad de seguir investigando para comprender mejor el alcance del ASI y desarrollar intervenciones con fundamento empírico para proteger a los niños y adolescentes de la victimización de ASI. (AU)

'My mind pretty much went to mush': A qualitative exploration of trenbolone in the performance and image enhancing drug community.

INTRODUCTION: There are a variety of harms associated with anabolic-androgenic steroids (AAS), with some AAS associated with an increased risk profile for users. Despite potentially different risk profiles, these harms are seldom discussed with respect to specific compounds although recent ethnographic research has identified a need to do so. Specifically, myth has developed among users with trenbolone reportedly having more dramatic effects on individuals, with reports of aggression, violent behaviour and extreme mood disturbances, and this is reflected in extant literature. This paper aims to report on the narrative surrounding the use of trenbolone among AAS users. METHOD: As part of a larger qualitative study, a number of AAS users were interviewed regarding their usage practices. A narrative emerged regarding the physical and psychological harms which accompanied their AAS use of which trenbolone played a central role (N = 16). RESULTS: Of all the AAS, trenbolone was viewed as having the most deleterious consequences for those who used it. Users reported an extreme shift in risk profile for psychosocial harms, particularly increased aggression and violent behaviour, as well as impulsivity regulation issues. AAS-using peers and family members of users reported the readily observable effect of trenbolone. DISCUSSION AND CONCLUSIONS: Users should be cognisant of the potential for significant harms and health-care providers working with this group may consider more focused screening strategies. Future policy decisions regarding AAS may wish to consider the pivotal role trenbolone plays in adverse outcomes for this unique group of substance users.

The Duty of Care to Protect Employees against the Risk of Psychiatric Harm from Vicarious Trauma: Kozarov v Victoria.

An employer owes every employee a duty to take all reasonable steps to provide a safe place and system of work. Whether an employer will be liable for psychological harm suffered by an employee will depend on the particular circumstances of the case. In Kozarov v Victoria (2022) 273 CLR 115; [2022] HCA 12 (Kozarov), the High Court considered whether the Victorian Office of Public Prosecutions had been placed on notice of a risk of "vicarious trauma" to a solicitor employed in the Special Sexual Offenders Unit and whether it was required to make a response by taking active steps including offering a rotation to another section where the solicitor did not to have to manage cases of child rape and other sexual offences of gross depravity. The High Court also considered whether by failing to advise her employer of her developing mental illness in a timely way and not accessing the Employee Assistance Program, the solicitor had failed to take reasonable care of her mental health. The article argues that the Kozarov decision is likely to prove a landmark in terms of employers' occupational health and safety responsibilities in respect of exposure to vicarious trauma.

A Systematic Review of Recreational Nitrous Oxide Use: Implications for Policy, Service Delivery and Individuals.

BACKGROUND: Nitrous oxide (N2O) is a dissociative anaesthetic that is sometimes used recreationally. The prevalence of N2O use is difficult to quantify but appears to be increasing. Research on N2O harms and application of harm reduction strategies are limited. The aim of this mixed method systematic review was to collate and synthesise the disparate body of research on recreational nitrous oxide use to inform harm reduction approaches tailored for young people. METHODS: To identify publications reporting the recreational use of N2O, a search of public health, psychology and social science databases was conducted. Databases included PubMed, CIHNAL, PsycINFO, Scopus and Web of Science. Grey literature and Google advanced search were also used. Due to limited published literature on the recreational use of N2O, no limit was placed on publication date or study type. A thematic synthesis extracted descriptive and analytical themes from the selected studies. Quality appraisal was conducted using the CASP Tool for Qualitative studies and the Joanna Briggs Institute case report assessment tool. RESULTS: The search retrieved 407 reports. Thirty-four were included in the final analysis, including sixteen case reports. The included studies were primarily concerned with raising awareness of the apparently increasing use and subsequently increasing harms of recreational N2O use. There was limited reference to policy or legislative responses in any published studies, no suggestions for harm reduction strategies or application of service level responses. In general, individuals lack awareness of N2O-related harms. CONCLUSION: The review found three key areas that deserve further consideration including: (1) policy, (2) service delivery, and (3) harm associated with N2O use. We recommend a top-down (policy) and bottom-up (services delivery/services users) approach to harm reduction for N2O use which also includes further consultation and research with both groups. Future research could explore young people's experience of N2O use including benefits and problems to inform contextually relevant harm reduction strategies.

Pre-Procedural Anxiety and Associated Factors Among Women Seeking for Cervical Cancer Screening Services in Shenzhen, China: Does Past Screening Experience Matter?

Background: Research gaps exist in addressing the psychological harm related to the cervical cancer screening. Anxiety is the most common distress driven by the screening procedures, which may be affected by past screening experience (PSE) but with uncertainty. This study aimed to evaluate the pre-procedural anxiety in cervical cancer screening and to identify the influence attributed to PSE. Methods: A cross-sectional survey targeted women seeking for cervical cancer screening services was conducted from June 5th to December 31st, 2020 in Shenzhen. The 20-item state anxiety scale of the State-Trait Anxiety Inventory (STAI-S) was applied to measure pre-procedural anxiety, in which a score of 40 or higher was regarded with anxiety symptom. Logistic regression models were established to explore potential associated factors of pre-procedural anxiety both for women with and without PSE. Results: Overall, 3,651 women were enrolled, in which 36.1% had never been screened and the remaining 63.9% had been screened at least once before. Women without PSE demonstrated more prevalent pre-procedural anxiety (74.5% vs. 67.8%, P <0.001) than their experienced counterparts. Among women without PSE, having heard of cervical cancer screening was associated with a lower likelihood of pre-procedural anxiety (OR: 0.37, 95%CI: 0.25~0.56). Among experienced women, participating three or more times screening was negatively associated with anxiety symptom (OR: 0.67, 95%CI: 0.53~0.84), however, both receiving screening within three years (OR: 1.58, 95%CI: 1.27~1.97) and unknowing previous screening results (OR: 1.42, 95%CI: 1.11~1.82) increased the susceptibility of pre-procedural anxiety. Conclusions: Women participating in cervical cancer screening commonly present pre-procedural anxiety. The association between PSE and pre-procedural anxiety may be influenced by past screening times, interval, and results. Psychological counseling according to women's PSE before cervical cancer screening is warranted of necessity.

The forgotten group of donor-conceived persons.

A forgotten group of donor-conceived persons is those who believe that gamete donation is morally wrong and should be prohibited. Although they share the two main arguments with the anti-anonymity group, i.e. the psychological harm as a consequence of lacking the necessary information for identity construction, and the violation of a fundamental human right, namely the right to be cared for by one's genetic parents, their voices are largely ignored in the debate. The anti-donation group also has a large part of the ideology of the family in common with the anti-anonymity group. The paper concludes that the anti-donation position should be accepted as an equivalent position. Moreover, given the similarities between the two positions, people who accept the claims of the anti-anonymity donor-conceived persons should explain why the claims of the anti-donation group should not be honoured.

Gaslighting in nursing academia: A new or established covert form of bullying?

Gaslighting is an insidious, pernicious form of bullying that is gaining notoriety in nursing academia anecdotally. Attempting to identify the behaviors associated with gaslighting are difficult because of the subtle nature with which gaslighting is performed by the perpetrator. Traditional tools/models used for identifying bullying and horizontal violence are not sensitive enough to pick up gaslighting behaviors. Perpetual lies and mistruths, vexatious or frivolous complaints, praise and positive reinforcement, the use of blame or mobbing, and coercion are some of the tactics a gaslighter will use to create confusion and chaos for the gaslightee. The psychological harm for the gaslightee can lead to self-doubt, hypervigilance, depression, anxiety, addiction, and suicidal ideation as well as the physical symptoms associated with stress. Left with very few choices the gaslightee either adheres to the behavior or leaves. It is important to raise awareness and perhaps education and training of this form of bullying behavior because of the deleterious effects it has personally and professionally.

Impacts of COVID-19 on caregivers of childhood cancer survivors.

PURPOSE: We sought to assess the impact of disruptions due to coronavirus disease 2019 (COVID-19) on caregivers of childhood cancer survivors. METHODS: A 13-question survey containing multiple-choice, Likert-type, and free-text questions on experiences, behaviors, and attitudes during the COVID-19 outbreak was sent to childhood cancer caregivers and completed between April 13 and May 17, 2020. Ordered logistic regression was used to investigate relationships between demographics, COVID-related experiences, and caregiver well-being. RESULTS: Caregivers from 321 unique families completed the survey, including 175 with children under active surveillance/follow-up care and 146 with children no longer receiving oncology care. Overall, caregivers expressed exceptional resiliency, highlighting commonalities between caring for a child with cancer and adopting COVID-19 prophylactic measures. However, respondents reported delayed/canceled appointments (50%) and delayed/canceled imaging (19%). Eleven percent of caregivers reported struggling to pay for basic needs, which was associated with greater disruption to daily life, greater feelings of anxiety, poorer sleep, and less access to social support (p < .05). Caregivers who were self-isolating reported greater feelings of anxiety and poorer sleep (p < .05). Respondents who expressed confidence in the government response to COVID-19 reported less disruption to their daily life, decreased feelings of depression and anxiety, better sleep, and greater hopefulness (p < .001) CONCLUSIONS: Caregivers are experiencing changes to medical care, financial disruptions, and emotional distress due to COVID-19. To better serve caregivers and medically at-risk children, clinicians must evaluate financial toxicity and feelings of isolation in families affected by childhood cancer, and work to provide reliable information on how COVID-19 may differentially impact their children.

A Qualitative Study of Child and Adolescent Mental Health during the COVID-19 Pandemic in Ireland.

Mitigating the adverse physical health risks associated with COVID-19 has been a priority of public health incentives. Less attention has been placed on understanding the psychological factors related to the global pandemic, especially among vulnerable populations. This qualitative study sought to understand the experiences of children and adolescents during COVID-19. This study interviewed 48 families during the COVID-19 pandemic restrictions, and a national lockdown, to understand its impacts. The study used an Interpretative Phenomenological Analysis (IPA) methodology. Parents and children discussed the negative impact of the restrictions on young people's wellbeing. Children and adolescents experienced adverse mental health effects, including feelings of social isolation, depression, anxiety, and increases in maladaptive behaviour. Families with children with Autism Spectrum Disorders reported increased mental health difficulties during this period mostly due to changes to routine. The findings highlight the impact of severe restrictions on vulnerable populations' wellbeing and mental health outcomes, including children, adolescents, and those with Autism spectrum disorder (ASD).

Children's moral judgments about psychological harm: Links among harm salience, victims' vulnerability, and child sympathy.

This study examined 106 5- and 6-year-olds' (M = 5.84 years, SD = 0.62) judgments and justifications about psychological harm (e.g., acts such as teasing or excluding others) assessed in three experimental harm salience conditions (highly salient harm, less salient harm, and no harm) crossed with two victims' vulnerability conditions (typical child and vulnerable child). We also examined interactions between these features and parent and child ratings of sympathy. Children evaluated highly salient harm as more unacceptable, more punishable, and more wrong independent of authority and as resulting in victims' more negative emotions than less salient harm and, in turn, no harm. Children reasoned about others' welfare most for highly salient harm stories, whereas children reasoned about less salient harm stories as involving moral and non-moral concerns. In considering victims' vulnerability, children evaluated harm done to typical victims as more wrong than harm done to vulnerable victims. Higher levels of child-reported sympathy were associated with ratings of transgressions as more unacceptable and wrong independent of authority, but only for less salient harm stories. The results demonstrate children's ability to incorporate different features of psychological harm into their moral judgments and highlight the importance of child sympathy in their understanding of more nuanced forms of harm.

Supporting people who experience intimate partner violence.

Intimate partner violence (IPV) is a significant issue in health and social care. Nurses may encounter individuals in healthcare settings who experience IPV, and they have an important role in supporting these people by providing person-centred care. It is important that nurses understand the complex issues involved in IPV, including those related to its presentation and effects on physical and psychological health. Nurses should also be aware of factors such as lack of knowledge among healthcare professionals and the challenge for some individuals of disclosing IPV, which can affect nurses' ability to identify and support those who experience IPV.

An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings.

In Western society, policy and legislation seeks to minimize restrictive interventions, including physical restraint; yet research suggests the use of such practices continues to raise concerns. Whilst international agreement has sought to define physical restraint, diversity in the way in which countries use restraint remains disparate. Research to date has reported on statistics regarding restraint, how and why it is used, and staff and service user perspectives about its use. However, there is limited evidence directly exploring the physical and psychological harm restraint may cause to people being cared for within mental health inpatient settings. This study reports on an integrative review of the literature exploring available evidence regarding the physical and psychological impact of restraint. The review included both experimental and nonexperimental research papers, using Cooper's (1998) five-stage approach to synthesize the findings. Eight themes emerged: Trauma/retraumatization; Distress; Fear; Feeling ignored; Control; Power; Calm; and Dehumanizing conditions. In conclusion, whilst further research is required regarding the physical and psychological implications of physical restraint in mental health settings, mental health nurses are in a prime position to use their skills and knowledge to address the issues identified to eradicate the use of restraint and better meet the needs of those experiencing mental illness.