Not one thing at a time:When concomitant multiple stressors produce a transdiagnostic clinical picture

A condition of exposure to multiple stressors resulting in a mixed clinical picture spanning conventional categories without meeting any of them in full,encompasses a risk for a list of comorbidities preventing appropriate prevention and treatment.New transformative transdiagnostic approaches suggest changes spanning conventional categories.They base their systems of classification on biomarkers as well as on brain structural and functional dysregulation as associated with behavioral and emotional symptoms.These new approaches received critiques for not being specific enough and for suggesting a few biomarkers for psychopathology as a whole.Therefore,they put the value of differential diagnosis at risk of avoiding appropriate derived prevention and treatment.Multiplicity of stressors has been considered mostly during and following catastrophes,without considering the resulting mixed clinical picture and life event concomitant stressors.We herewith suggest a new category within the conventional classification systems:The Complex Stress Reaction Syndrome,for a condition of multiplicity of stressors,which showed a mixed clinical picture for daily life in the post coronavirus disease 2019 era,in the general population.We argue that this condition may be relevant to daily,regular life,across the lifespan,and beyond conditions of catastrophes.We further argue that this condition may worsen without professional care and it may develop into a severe mental health disorder,more costly to health systems and the suffering individuals.Means for derived prevention and treatment are discussed.

Stressors in Nurse Students’ Formation in the New Normality Post COVID-19

Background: Mental health has been impaired and at risk due to the worldwide COVID-19 pandemic. The consequences due to confinement impacted every scenario, which directly influenced the daily routine of nurse students;in each setting students faced stressors that trigger fear, anxiety and others, since being in confinement learning of topics moved to the home, laboratory practices in hospitals were cancelled leaving the room that is uncertain up to their return to in-person activities. It is important to highlight the need for innovation and strengthening of theoretical-pedagogic aspects centered at the student’s context as a human being with their own needs and problems, who will interact with others in the continuous process of health-illness. Objective: the aim was to identify the stressors in the nurse students’ formation in the new normality post-COVID-19. Methods: Qualitative and phenomenological research with 27 participants aged 20 - 25 years, nurse students of a public university. The information collection was through four focal groups of 6-7 members each, data analysis was done according to Miles & Huberman after signed informed consent of each participant, and authorized by the chairperson of the Nurse’ career. Results: Category 1, Cumulative stressors with sub-categories 1.1 Uncertainty, 1.2 Isolation, 1.3 Invisibility, 1.4 Mockery, 1.5 Exclusion. Category 2, Expectancy states with sub-categories 2.1 Low self-esteem, 2.2 Insecurity, 2.3 Anxiety, 2.4 Depression, 2.5 Temporary leave, 2.6 Search for authenticity. Category 3, Internalization processes with sub-categories 3.1 Social rejection, 3.2 Self-censorship, 3.3 Discrediting, 3.4 Disempowerment. Category 4, Academic aspects affected with sub-categories 4.1 Deficient studying habits, 4.2 Deficient assimilations of knowledge, 4.3 Archived knowledge in the computer, 4.4 Absence of practice in previous semesters. Conclusion: Once identified the stressors in nurse students in the new normality post-COVID-19, it will allow the creation of settings that help in getting confidence for students, i.e., a safe surrounding promotes the development of abilities and competencies during formation, as well as recommendations of teachers in the classroom and laboratories that contribute to filling space that students perceive as empty, and to intensifying the companionship in clinical settings where students perceive most aggressiveness.

Validation of Stressors in Nursing Students Scale-Chinese Version (SINS-CN) in a Population of Macao Nursing Students

Objective： To validate the Stressors in Nursing Students Scale-Chinese Version（SINS-CN） in a population of Macao nursing students. Methods： A methodological study was designed with 2 phases. In phase 1, a three-expert panel was invited to evaluate the content validity of SINS-CN, and then its test-retest reliability was examined over a 2-week interval. In phase 2,211 undergraduate nursing students were recruited, and 203 valid responses to the questionnaire were obtained. A principal component analysis with varimax rotation was applied to validate the structure of the instrument. Results： The content validity index（CVI） was 0.89. The correlation coefficient of the test-retest reliability was 0.82 for the overall instrument and 0.70-0.88 for the instrument＇s sub-dimensions. Based on the 43 items of the instrument, five components were identified and accounted for 60. 28% of the variance with eigenvalues ranging from 1.32 to 10. 18. The factor loadings were 0.42-0.79. The internal consistency reliability of Cronbach＇s ot was 0.96 for the overall scale and 0.67-0.94 for its sub-dimensions. Conclusion： The study findings indicated that SINS-CN had acceptable psychometric properties in terms of content validity, stability and internal consistency reliability. The principal component analysis generated a 5-component structure with 43 items; this was slightly different from the origi- nai structure but was more applicable to the studied population, which suggests that this instrument has cross-cultural sensitivity.

Biological responses of small yellow croaker(Larimichthys polyactis) to multiple stressors: a case study in the Yellow Sea, China

Temporal changes in biological characteristics of small yellow croaker Larimichthys polyactis in the Yellow Sea were examined for the period of 1960–2008. The body size and age of small yellow croaker decreased substantially, in particular, average length of fish in 2008 was reduced by ~85% than those occurring in 1985, and at that time ~93% of the total catch was dominated by one-year-old individuals. Correspondingly, growth parameters also varied significantly over the years, i.e., k（growth coefficient） and t_0（zero-length age） gradually increased from 0.26 and –0.58 year in 1960 to 0.56 and –0.25 year in 2008, respectively. Although, L∞（body length）sharply decreased from 34.21 cm in 1960 to 24.06 cm in 2008, and t_r（inflexion age） decreased from 3.78 year in1960 to 1.61 year in 2008. There was a great increase both in natural mortality coefficient and fishing mortality coefficient. However, according to the gray correlation analysis, changes in the biological characteristics of small yellow croaker were induced by different stressors ranked as： fishing vessel power〉feeding grade〉sea surface temperature. This study suggests that the active fishery management measures for biological characters of fish populations should be considered.

Strain Engineering for Germanium-on-Insulator Mobility Enhancement with Phase Change Liner Stressors

We investigate the strain in various Ge-on-insulator （GeOI） micro-structures induced by three phase-change maferials （PCMs） （Ge2Sb2Te5, Sb2Te3, GeTe） deposited. The PCMs could change the phase from amorphous state to polycrystalline state with a low temperature thermal annealing, resulting in an intrinsic contraction in the PCM films. Raman spectroscopy analysis is performed to compare the strain induced in the GeOI micro- structures by various PCMs. By comparison, Sb2 Tea could induce the largest amount of tensile strain in the GeOI micro-structures after the low temperature annealing. Based on the strain calculated from the Raman peak shifts, finite element numerical simulation is performed to calculate the strain-induced electron mobility enhancement for Ge n-MOSFETs with PCM liner stressors. With the adoption of Sb2 Te3 liner stressor, 22% electron mobility enhancement at Xinv=1×10^13cm^-2 could be achieved, suggesting that PCM especially Sb2 Te3 liner stressor is a promising technique for the performance enhancement of Ge MOSFETs.

THE ROLE OF PSYCHOSOCIAL STRESSORS,PERSONALITY AND COPING IN THE MULTIFACTORIAL ORIGIN,INITIATION AND CLINICAL COURSE OF NEOPLASTIC DISEASE AND IN HOST-DEFENSE

Summary: Retrospective and prospective bio-behavioral cancer studies have revealed that psycho social stressors may play a pivotal role in the initiation and progression of malignant neoplasia. In recent research, a pattern has emerged, which in analogy to the coronary prone pattern (type A) has been labelled type C, encompassing suppression of emotional responses, such as anger and hostility, rationality and antiemotionality, as well as high social conformity and a lack of self-assertiveness. There is growing evidence in both infrahuman and human research that specific coping styles (repressive coping) with stress may be associated with specific biologic responses, including neuroendocrine, immunologic and other bodily functions. The application of this model appears to be of importance for further research, as well as for the detection of high risk individuals, but also in regard to therapy, rehabilitation, early detection and possibly also prevention of malignant disease. This concept suggests also new directions and modifications of stress research, as stressors are to be viewed not necessarily as pathological, but in some instances as quite possibly salutary, depending on the nature of the stres-sor, the psychophysiologic state of the individual and his or her ability to cope with adverse life situations. Quite naturally, the development of this concept is still in its initial stages, there remain anumber of open questions, and it needs hardly to be pointed out in this connection that further and painstaking clinical and laboratory work is warranted in order to clarify the role of stressors, life and coping styles and its biological concomitants in neo-plastic disease.

A Japanese version of the stressors in nursing students(SINS)scale

Objectives:To translate and study the factor structure of a Japanese version of the Stressors in Nursing Students scale.Methods:The Stressors in Nursing Students scale was translated into Japanese and administered to a large cohort(N=1298)of female Japanese nursing students across five universities and across all four years of the nursing programme.The data were analysed using exploratory factor analysis.Results:Exploratory factor analysis revealed four factors:‘Clinical’;‘Conflict and confidence’;‘Education’;and‘Free time’.The relationship between the total score on the Stressors in Nursing Students scale and the demographic aspects of the sample was weak but there was a significant increase in the perception of stressors between first and second year students.Conclusions:There were similarities and differences between the perception of stressors by nursing students in Japan compared with,for example,the United Kingdom and China mainland.While a fourfactor structure was found here,the distribution of items in the Stressors in Nursing Students scale differed from previous studies in the United Kingdom and China with the‘Free time’factor being unique to this study.Stress is an issue for nursing students and is related to the specific stressors they encounter in the process of their work and study.Findings can inform the development of strategies to reduce such stressors among nursing students in multiple,global contexts.

Which stressors are responsible for the worsening in the clinical symptomatology of lupus?

Objective: The purpose of this study was to test which stressors worsen the symptoms perceived by patients with lupus, thus broadening and corroborating results obtained in a previous study published in Psychosomatic Medicine. Methods: In order to examine this question, we selected 43 patients with lupus whose symp-toms worsened due to the effects of daily stress. These patients were divided into two groups: patients whose increase in clinical lupus symp-tomatology was predicted by an increase in daily stressors on the same day (G1) and pa-tients whose increase in clinical lupus symp-tomatology was predicted by an increase in daily stressors the day before and the same day (G2). Later, three factorial analyses were con-ducted with the items related to stressors and the items related to lupic symptoms. Results: The results showed that in G1 there were three factors that made up a total of 35.08% of the explained variance. The stressors associated with certain symptoms of the illness in this group are feeling ill or being worried about their physical appearance, with the main stressor being the illness itself. However, in G2, two factors were found that made up a total of 40.37% of the explained variance for lag=0 and 38.67% for lag=1. The stressors associated with the majority of the lupus symptoms are of an interpersonal and work-related nature. This as-sociation was maintained when we carried out the factorial analyses with the items of the symptoms from the following day. Conclusions: The interpersonal and work-related stressors are related to a worsening in the majority of the lupic symptoms in the patients whose sympto-matology worsens as a result of daily stress experienced the day before.

The Relationship between Workplace Stressors and Job Strain with Psychological Distress among Employed Malaysian Breast Cancer Survivors

Evidence showed occupational factors may contribute distress to breast cancer survivors, however, very few studies focused on the occupational factors and job strain among breast cancer survivors. This study examined the relationship between job strain and workplace stressors with psychological distress among employed breast cancer survivors after the completion of their medical treatment. Study subject were outpatients of 2 hospitals and members of 4 breast cancer support groups. They were requested to fill up the Job Content Questionnaires (JCQ), the Hospital Anxiety and Depression Scale (HADS) and the Distress Thermometer (DT) were filled up by the selected respondents. On simple logistic regression, psychological job demand and job strain were significantly associated with anxiety, distress on HADS-T and DT at (p < 0.001). While, psychological job demand (p < 0.001), social support (p = 0.047) and job strain (p < 0.001) were significantly associated with depression. Results showed survivors with high job strain has 4.74 time the odds of having anxiety (p < 0.001). Survivors with high psychological job demand have 8.08 time the odds of getting depression (p < 0.001). On the other hand, social support served as a protective factor of depression, (p = 0.041). Survivors with high psychological job demand were 4.4 time the odds of having distress (HADS-T) (p = 0.012). As a conclusion, survivors who experienced high psychological job demand, low social support and high job strain were reported with anxiety, depression or psychological distress.

Separate But not Equal:Stressors in the Work of Arab Teachers in Israel

Teaching is a stressful profession characterizing the work of teachers.The Neoliberal reforms have added a further burden on teachers’work,increasing stress at work and resulting in negative health,occupational and economic consequences.The aims of the study were to examine the perceptions of stress factors among Arab teachers in Israel,and the relationship between Arab teachers’stress factors by types of school(elementary,middle school,and high school)and gender.Stress factors were measured by using an instrument developed by Ablin et al.(2010).Three hundred forty-two public school Arab teachers participated in the study,of whom 230 were female and 112 were male.One hundred twenty-five worked in elementary schools,78 in middle schools,and 130 in high schools.The most stressful factors among Arab teachers were“busy schedule and lack of flexibility”,“the student composition of the class”,and“conflicting requirements between school assignments and home responsibilities”.Significant statistical differences were found between teachers’stress factors by gender and school type.Female teachers rated stress factors“the student composition of the class”and“conflicting requirements between school assignments and home responsibilities”higher than male teachers.Elementary teachers rated stress factors“student parents”,“lack of proper physical conditions”,and“requirement to teach a subject other than one’s specialty”higher than high school teachers.Middle school teachers rated stress factors“school management”,“general supervisor”,and“requirement to teach a subject other than one’s specialty”higher than primary school teachers.The leading stressor in this study is a result of educational disparities between Jews and Arabs.Israel formally purports to embrace the liberal responsibility of providing educational and development opportunities to all of its citizens,enabling them to actualize their full potential as human beings.

Technological Stressors in Developing Countries

Stress as a state of anxiety is produced when responsibilities do not match expected knowledge, and hence challenges one’s coping abilities. Job stress can be as a result of the nature of the job (work) or can result from the workers commonly referred to as dispositional stress. Stressors are conditions or situations which trigger stress response. Stressors can be inherent in the job due to factors affecting the occupation. This paper therefore highlights impact of technological stress (technostress) in auditing firm in developing countries.

Investigate Stressors Levels and Identify Coping Strategies of Frontline Nurses during the COVID-19 in Sharjah Primary Health Center—A Quantitative Research Study

During the COVID-19 Epidemic, nurses are usually informed of emotional exhaustion, increased workloads, and uncertainty, leading to burnout. Consequently, psychological health initiatives are essential to support nurses during a pandemic. This project aims to investigate the stress levels and identify the Coping Strategies of Nurses during the COVID-19 Epidemic in Sharjah Primary Health Center, as they are always at the front line of this epidemic. The nature of their work, they are mainly infected and spread the virus amongst colleagues and family. The target population is nurses working in Sharjah primary health centers, and the number sample is 230. The researcher sent the survey through the link. And in this research, we used two instruments which include the Expanded Nursing Stress Scale and The Coping Strategies Scale (CSS). This study shows that the most stressful factor is related to workload, especially related to unpredictable staffing and scheduling. On the other hand, the most coping strategies were those that were associated with Meaning-focused Coping Strategies, especially believing that valuable lessons can learn from undesirable experiences.

College Students’Academic Stressors on Mental Health during the COVID-19 Pandemic: A Comparison between Graduating Students and Non-Graduating Students

The study aimed to investigate the influence of academic stressors on mental health and the mediating effect of social support and self-identity among college students and further studied the difference between the graduating students and non-graduating students during the COVID-19 Pandemic.Recruiting 900 college students as sub-jects,used the college students’academic stressors questionnaire,social support questionnaire,self-identity scale and depression anxiety stress scales(DASS-21).The results showed that:(1)The college students’academic stressor posi-tively predicted mental health;(2)Social support and self-identity mediated the relationship;(3)The model also held when academic stressors was replaced by work stressor,but there were differences between the graduating and non-graduating students;(4)The direct effect work stressor on mental health in the graduating group was not significant;(5)The non-graduating students’work stressor could not predict mental health through social support.

Stressors and coping mechanisms of people with mental disorders in the community

Background:People with mental disorders often experience human rights violations,discrimination,exclusion,and stigma.Objective:To determine the stressors and coping mechanisms of people with mental disorders in society.Methods:This research is a qualitative phenomenological research.We wanted to explore and describe the experiences of mentally ill patients in the community at the rehabilitation stage in stress management,including the stressors in people with a mental health condition and the coping mechanisms used.Data collection was carried out using in-depth interviews with 15 participants.Results:The results of this study show that the stressors of mental illness patients are a less-accepting environment,feeling of shame,fear of being excluded,having no income,and side effects of drugs.Conclusions:The coping mechanisms used include carrying out activities,telling stories to others,and diverting emotions.

A Study on the Correlation between Stressors and Psychological Behaviors of Nurses in Support of COVID-19 Ward

COVID-19 has been a hot topic of research in medical journals. There are many articles which have been published on the genetic sequencing, pathology and other medical conditions associated with COVID-19, however, there are very few articles which acknowledge the psychological and behavioral aspects of front-line medical workers especially nurses. The purpose of the study is to understand the stressors, psychological behavior status and the correlation between psychological behavior and stressors for nurses who served in COVID-19 ward. The general information questionnaire, the nurse job stressor scale in Chinese, and the emergency public health incident questionnaire were used to survey 282 nurses in Jingzhou Central Hospital who supported COVID-19 ward. The result shows that the average work stress of nurses in this study was 1.40 ± 0.54 points. The top 3 dimensions were conceptual stress (1.67 ± 0.68), working environment stress (1.57 ± 0.60), and occupational hazard stress (1.57 ± 0.66). With different marital status, the average scores of stress are different, and the difference is statistically significant (t = 2.139, P = 0.034). For nurses in COVID-19 ward who faced sudden public health crisis, the self-evaluated psychological score of nurses in COVID-19 ward averages 1.40 with a deviation of 0.54. In our study, fear had the highest influence on psychological behavior, while the lowest was the compulsive-anxiety factor. There was a positive correlation between the stressor scores and the psychological behavior scores (P < 0.01). The conclusion is that the pressure of nurses supporting COVID-19 ward is under moderate pressure, and the psychological behavior is moderately responded with a few nurses having psychological behavior deviation.

A review of ARGs in WWTPs:Sources,stressors and elimination

Antibiotic re sistance genes(ARGs)in aquatic enviro nments,which seriously endanger human health and ecological safety,have become a worldwide concern due to their easy diffusion and proliferation.Wastewater treatment plants(WWTPs),which receive resistant bacteria and ARGs from a wide variety of sources(i.e.,livestock farms,hospitals,antibiotic manufactures,and households),are regarded as important emission sources of aquatic ARGs.This review presents a quantitative profile of the majority sources of ARGs in the influent of WWTPs and discusses the potential factors that affect the concentration distribution of ARGs.Specifically,a noteworthy existence of ARGs,which ranged from 1 E+05 to 1 E+11 copies/mL,was detected in livestock breeding wastewater,and household wastewater(caused by the unlimited utilization of antibiotics)was determined to be the predominant contributor of ARGs in WWTPs.We summarized the selective pressure on ARGs and determined the positive correlation of the concentration of ARGs and the existence of many containments,including antibiotics,heavy metals(Zn and Cu were frequently reported),quaternary ammonium compounds,etc.In the last section,physical,chemical,and biological treatments for the removal of ARGs and their effluent in WWTPs are discussed and prospective future studies are summarized.

Influence of various stressors on the expression of core genes of the small interfering RNA pathway in the oriental fruit fly, Bactrocera dorsalis

RNA interference （RNAi）-based technology has emerged as a potential tool for controlling insect pests, however, previous studies found that the efficiency of RNAi in Bactrocera dorsalis was variable. In nature, insects often meet various challenges, such as pathogen infections, extreme temperatures, lack of nutrition and heavy metals. To better understand the association of the stressors with efficiency of RNAi, in the current study we tested the expression of three core genes, dicer2 （Bddcr2）, r2d2 （Bdr2d2） and argonaute2 （Bdago2）, of the small interfering RNA （siRNA） pathway of B. dorsalis upon various stressors. Our results showed that all three genes were upregulated by the infection of invertebrate iridescent virus 6, which suggested a function of the siRNA pathway against viral infection. The loading of FeC13 could also increase the expression of Bddcr2. The treatments ofEscherichia coli, extremely high （40~C） and low （0~C） temperatures, as well as starvation, could negatively influence the expression of Bddcr2 and/or Bdago2. In total, our results showed that various stressors could influence the expression of core components ofB. dorsalis siRNA pathway. This highlights further speculation on the RNAi efficiency upon these stressors. Considering the complexity and variation of RNAi efficiency in different conditions, these results provide initial aspects in possible environmental stressors to influence the activity of the siRNA pathway, but the real impact of RNAi efficiency posed by these stressors requires further studies.

Recent Advances in Nano‑Enabled Seed Treatment Strategies for Sustainable Agriculture:Challenges,Risk Assessment,and Future Perspectives

Agro seeds are vulnerable to environmental stressors,adversely affecting seed vigor,crop growth,and crop productivity.Different agrochemical-based seed treatments enhance seed germination,but they can also cause damage to the environment;therefore,sustainable technologies such as nano-based agrochemicals are urgently needed.Nanoagrochemicals can reduce the dose-dependent toxicity of seed treatment,thereby improving seed viability and ensuring the controlled release of nanoagrochemical active ingredients However,the applications of nanoagrochemicals to plants in the field raise concerns about nanomaterial safety,exposure levels,and toxicological implications to the environment and human health.In the present comprehensive review,the development,scope,challenges,and risk assessments of nanoagrochemicals on seed treatment are discussed.Moreover,the implementation obstacles for nanoagrochemicals use in seed treatments,their commercialization potential,and the need for policy regulations to assess possible risks are also discussed.Based on our knowledge,this is the first time that we have presented legendary literature to readers in order to help them gain a deeper understanding of upcoming nanotechnologies that may enable the development of future generation seed treatment agrochemical formulations,their scope,and potential risks associated with seed treatment.

Single and combined eff ects of fertilization,ectomycorrhizal inoculation,and drought on container-grown Japanese larch seedlings

Climate change can intensify drought in many regions of the world and lead to more frequent drought events or altered cycles of soil water status.Therefore,it is important to enhance the tolerance to drought and thus health,vigor,and success of transplantation seedlings used in the forestry by modifying fertilization and promoting mycorrhization.Here,we sowed seeds of Japanese larch(Larix kaempferi)in 0.2-L containers with 0.5 g(low fertilization;LF)or 2 g(high fertilization;HF)of slow-release fertilizer early in the growing season.One month later,we irrigated seedlings with non-sterilized ectomycorrhizal inoculum(ECM)or sterilized solution(non-ECM),and after about 2 months,plants were either kept well watered(WW;500 mL water/plant/week)or subjected to drought(DR;50 mL water per plant/week)until the end of the growing season.HF largely stimulated plant growth and above-and belowground biomass production,eff ects that are of practical signifi cance,but caused a small decrease in stomatal conductance(Gs 390)and transpiration rate(E 390),which in practice is insignifi cant.ECM treatment resulted in moderate inhibition of seedling growth and biomass and largely canceled out the enhancement of biomass and foliar K content by HF.DR caused a large decrease in CO 2 assimilation,and enhanced stomatal closure and induced senescence.DR also largely depleted foliar Mg and enriched foliar K.Although DR caused a large decrease in foliar P content in LF,it moderately increased P in HF.Likewise,DR increased foliar K in HF but not in LF,and decreased foliar P in ECM plants but not in non-ECM plants.Conversely,ECM plants exhibited a large enrichment in foliar P under WW and had a lower water potential under DR when grown in LF.These results indicate that the drought tolerance and health and vigor of Japanese larch seedlings can be modifi ed by soil fertility and soil microorganisms.This study provides a basis for new multifactorial research programs aimed at producing seedlings of superior quality for forestation under climate change.

Animal models for posttraumatic stress disorder: An overview of what is used in research

Posttraumatic stress disorder(PTSD) is a common anxiety disorder characterised by its persistence of symptoms after a traumatic experience. Although some patients can be cured, many do not benefit enough from the psychological therapies or medication strategies used. Many researchers use animal models to learn more about the disorder and several models are available. The most-used physical stressor models are single-prolonged stress, restraint stress, foot shock, stress-enhanced fear learning, and underwater trauma. Common social stressors are housing instability, social instability, earlylife stress, and social defeat. Psychological models are not as diverse and rely on controlled exposure to the test animal's natural predator. While validation of these models has been resolved with replicated symptoms using analogous stressors, translating new findings to human patients remains essential for their impact on the field. Choosing a model to experiment with can be challenging; this overview of what is possible with individual models may aid in making a decision.