Effect of patient COVID-19 vaccine hesitancy on hospital care team perceptions

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic posed new challenges in patient care worldwide.Vaccinations,which have proven efficacious in lowering the COVID-19 hospital burden,are still avoided by large populations.We,therefore,hypothesized that hospital care teams would have worse perceptions regarding the characteristics and care of patients with vaccine hesitancy.AIM To evaluate whether patient vaccine hesitancy affected the hospital care team(HCT)perceptions.METHODS We performed a prospective clinical study using structured questionnaires.We approached physicians and nurses with previous experience caring for COVID-19patients from 11 medical centers across Israel during the fourth COVID-19 surge(September and October 2021).The participants completed a questionnaire with the following parts:(1)Sociodemographic characteristics;(2)Assessment of anger(STAXI instrument)and chronic workplace stress(Shirom-Melamed burnout measure);and(3)Three tools to assess the effect of patient vaccine hesitancy on the HCT perceptions(the difficult doctor-patient relation questionnaire,the medical staff perception of patient’s responsibility questionnaire and the characterological derogation questionnaire).Results were evaluated according to each part of the questionnaire and the questionnaire as a whole.Associations between HCT perceptions and their baseline characteristics,anger or chronic workplace stress were assessed.RESULTS The HCT experienced their relationship with unvaccinated patients as more difficult(P<0.001,Cohen’s d=0.85),perceived unvaccinated patients as responsible for their medical condition(P<0.001,d=1.39)and perceived vaccinated patients as having a higher character value(P<0.001,d=1.03).Unvaccinated patients were considered selfish(P<0.001),less mature(P<0.001)and less satisfying to care for(P<0.001).The relationship with unvaccinated patients was more difficult among HCT with higher burnout(r=0.37,n=66,P=0.002).No correlations with baseline characteristics were found.All three study tools showed high internal consistency(αbetween 0.72 and 0.845).CONCLUSION Our results should raise awareness of the possible effects of vaccine hesitancy on HCT perceptions regarding unvaccinated patients.In order to minimize the potential negative impact on patient care,designated departments should promote specific patient-centered preparations.Further investigations should assess whether vaccine hesitancy directly affects patient quality of care.

International study of the Complex Stress Reaction Syndrome:Implications for transdiagnostic clinical practice

BACKGROUND The debate regarding diagnostic classification systems in psychiatry(categorial vs dimensional systems)has essential implications for the diagnosis,prevention and treatment of stress reactions.We previously found a unique pattern of stress reaction in a study executed during the coronavirus disease 2019 pandemic using large representative samples in two countries,and termed it the Complex Stress Reaction Syndrome(CSRS).AIM To investigate CSRS,Type A(psychiatric symptoms,spanning anxiety,depression,stress symptoms,and posttraumatic stress disorder(PTSD)),with or without long-coronavirus disease(COVID)residuals(CSRS,Type B,neuropsychiatric symptoms spanning cognitive deficits and fatigue,excluding systemic symptoms).Our two-tailed hypothesis was that CSRS is a condition related to an unrecognized type of stress reaction in daily life in the general population(Type A)or that it is related to the severe acute respiratory syndrome coronavirus 2 infection and its long-COVID residuals(Type B).METHODS 977 individuals in four continents(North America,Europe,Australia and the Middle East)completed the online study questionnaire in six languages using the Qualtrics platform.The study was managed by six teams in six countries that promoted the study on social media.The questionnaire assessed anxiety,depression,stress symptoms and PTSD(CSRS,Type A),cognitive deficits and fatigue(CSRS,Type B).The data were analyzed using Proportion Analyses,Multivariate Analysis of Co-Variance(MANCOVA),linear regression analyses and validated clinical cutoff points.RESULTS The results of the Proportion Analyses showed that the prevalence of 4 symptoms spanning anxiety,depression,stress symptoms,and PTSD was significantly higher than the most prevalent combinations of fewer symptoms across 4 continents,age groups,and gender.This supports the transdiagnostic argument embedded in the CSRS(Type A).The same pattern of results was found in infected/recovered individuals.The prevalence of the 4 psychiatric symptoms combination was significantly greater than that of 5 and 6 symptoms,when adding cognitive deficits and fatigue,respectively.MANCOVA showed a significant three-way interaction(age×gender×continent).Further analyses showed that the sources of this three-way interaction were threefold relating to two sub-populations at-risk:(1)Individuals that self-identified as non-binary gender scored significantly higher on all 4 psychiatric symptoms of the CSRS,Type A at young age groups(<50 years old)in North America compared to(self-identified)women and men located in the 4 continents studied,and to other ages across the adult life span;and(2)This pattern of results(CSRS,Type A)was found also in women at young ages(<40 years old)in North America who scored higher compared to men and women in other continents and other ages.Linear regression analyses confirmed the MANCOVA results.CONCLUSION These results show a combined mental health risk factor related to stress reactivity,suggesting that the CSRS is sensitive to populations at risk and may be applied to future identification of other vulnerable sub-populations.It also supports the transdiagnostic approach for more accurate prevention and treatment.Time will tell if such transdiagnostic syndromes will be part of the discussions on the next revisions of the traditional classification systems or whether the crisis in psychiatry further evolves.

儿童抑郁症的干预(英文)

Professor Du has provided a succinct summary of child and adolescent depression and its treatment with antidepressants. [1] There remains some controversy over the prevalence of depression in children and adolescents: Professor Du reports that 20% of individuals experience depression prior to the age of 18 while other epidemiological reports indicate that the rate is closer

Chronotype and self-reported sleep,alertness,and mental health in U.S. sailors

Service members are at risk for sleep and psychological conditions affecting their readiness. Chronotype(“morningness”or “eveningness”) is strongly associated with sleep, health and performance. The objective of this study was to examine associations between validated measures of chronotype and sleep quality, daytime functioning, alertness,and symptoms of depression, anxiety, and post-traumatic stress disorder(PTSD) in US service members(n=298).Although predominantly young males(who skew toward eveningness in civilian populations), these Sailors skewed toward morningness(35.6% morning, 51.3% intermediate). Eveningness was associated with symptoms of depression and PTSD(P<0.01), less time in bed(P<0.05), more sleep disruption(P<0.01), and poorer daytime functioning and alertness(P<0.05). Evening types were less likely to consider sleep important for performance(P<0.05). To maximize service member readiness, schedules should be aligned with endogenous rhythms, whenever possible, and evening chronotypes may benefit from targeted interventions. Chronotype should be examined alongside health and readiness in service members.

S1B-2 Therapeutics and Biomarker Development in Huntington’Disease

Most neurodegenerative diseases,including Alzheimer’s,Parkinson’s,and Huntington’s disease(HD),have converging pathogenesis,such as formation of abnormal protein aggregates and mitochondrial dysfunction.Unfortunately,despite tremendous efforts by many scientists and increasing knowledge about disease mechanisms,we still lack disease-modifying treatments for any of these diseases.Drug discovery has been revolutionized in the past decade.Despite technological advances as a result of substantial investment,the number of new drug approvals remains stagnant and the cost of bringing a drug to market is higher than ever.This highlights the persistence of a model of drug development that has not adapted to changes in science and public perception of drug companies.While these diseases affect different areas of the brain and are distinct at the cellular and molecular levels,they share many underlying similarities.Thus,development of treatment for any of these diseases may provide clues to accelerate the path to the treatment for other neurodegenerative diseases.Research into potential therapies for HD is particularly attractive because it is a genetically homogeneous disease for which well-established models exist.The HD gene encodes the protein huntingtin(Htt),whose polyglutamine expansion is believed to mediate the cytotoxic effects of HD.Therefore,HD also serves a model for polyglutamine diseases.HD is a monogenic neurodegenerative disorder caused by mutation of the gene Huntingtin.Htt lowering(gene silencing)strategies,including antisense oligonucleotides,shRNA,miRNA et al,have shown great preclinical promise,and the first HTT lowering clinical trial is underway.The key to success of these trials will be to know where and when to intervene,since these reagents do not penetrate the blood-brain-barrier,and must be delivered directly to the CNS.HD is notable for preferential atrophy of the striatum but also involves degeneration in cortex,subcortical white matter,and specific subcortical grey matter regions.It has been shown regional spread of pathology in the HD brain using neuroimaging.In addition,neurodegeneration in HD is mainly caused by toxic effects of the abnormal Htt protein,and there is increasing evidence that mutant Htt can spread,like prions.A better understanding of HD pathology at a cellular level and in the network context would be important for determining the optimal timing and brain regional location of therapeutic interventions.HD mouse models provide unique values to answer these questions,as brain samples can be collected at a temporal manner from different disease stages(before disease onset,at the onset,after the onset)in a relatively short period.Knowledge of HD pathogenesis is bearing fruit in experimental treatments,using agents to decrease production of the huntingtin message RNA and protein.An understanding of how pathology of HD may spread throughout the brain can be guided by an understanding of the cortico-basal-ganglionic circuitry.Selective pathology within the basal ganglia circuit may contribute to features of HD phenotype.

儿童工作记忆的事件相关电位

采用事件相关电位（ERPs）技术探讨了类似于Delayed-Matching-to-Sample任务范式下12～13岁儿童的工作记忆神经机制. 实验结果显示, 无论熟悉客体还是新客体, 工作记忆的ERPs均显示了潜伏期350 ms左右的一个晚正成分, 新客体的潜伏期比熟悉客体有所提前; 相比熟悉客体, 新客体的工作记忆在ERPs波形上表现出更正走向, 这种大脑活动主要发生在额区-中央区. 在分别追踪新靶和熟悉靶的工作记忆任务条件下, 靶与分心物的ERPs波形在150 ms后出现分离, 且靶刺激均比分心物更正; 新分心物、熟悉分心物显示出150～350 ms的额区新/旧效应以及350～550 ms的顶区新/旧效应; 靶的新/旧效应不同于分心物新/旧效应, 新靶更正, 且主要发生在250 ms之后; 与熟悉靶相比, 新靶出现P3a成分. 本研究结果揭示了儿童工作记忆神经机制的时空特征, 且某些特征不同于成人.

An event-related potential study of working memory in children

To examine the neural mechanisms o working memory in children, event-related potentials (ERPs) were recorded from the 12―13 year-old while they performed a delayed match-to-sample task. The ERP results revealed that new and studied objects both evoked a late positive ERP componen peaking around 350 ms during the working memory process. New objects evoke a more positive ERP waveform than the studied objects. The scalp distri bution showed that the frontal-central electrode sites were associated with object working memory proc esses. When tracking new or studied targets among visual distracters, ERPs of targets and distracters revealed differential responses as early as 150 ms The visual targets evoked larger and more positive ERP responses than the distracters. The typica old-new effect was observed between ERPs of stud ied and new distracters. However, ERPs of new and studied targets differed at about 250 ms, in which new targets evoked more positive-going and slightly earlier ERP responses. In addition, a P3a componen was found for new targets only, and was absent in ERPs of studied targets at frontal and central sites The present study results reveal the spatial and temporal characteristics of neural mechanisms un derlying working memory in children, some of which are distinct from those in adults.

Adult mammalian neurogenesis and motivated behaviors

Adult neurogenesis continues to captivate the curiosity of the scientific community;and researchers seem to have a particular interest in identifying the functional implications of such plasticity.While the majority of research focuses on the association between adult neurogenesis and learning and memory(including spatial learning associated with hippocampal neurogenesis and olfactory discrimination associated with neurogenesis in the olfactory system),the following review will explore the link to motivated behaviors.In particular,goal-directed behaviors such as sociosexual,parental,aggressive,as well as depression-and anxiety-like behaviors and their reciprocal association to adult neurogenesis will be evaluated.The review will detail research in humans and other mammalian species.Furthermore,the potential mechanisms underlying these neurogenic alterations will be highlighted.Lastly,the review will conclude with a discussion on the functional significance of these newly generated cells in mediating goal-directed behaviors.