Conducting exposure and response prevention treatment for contamination fears during COVID-19: The behavioral immune system impact on clinician approaches to treatment

The coronavirus disease 2019 (COVID-19) pandemic sparked significant anxiety regarding viral rates and means of transmission. Heightened concerns about contamination have prompted new hygienic strategies to vigilantly guard against infection, including hand washing immediately after touching foreign objects or suspected contaminants. This has presented a critical challenge for the delivery of exposure and response prevention (ERP) therapy to individuals with contamination fears due to Obsessive Compulsive Disorder (OCD), as providers must manage not only their clients’ attitudes and reactions but their own as well. In this investigation, self-identified anxiety and OCD treatment specialists (N = 139) provided demographic information, including their anxiety and OCD caseloads, and completed measures related to intolerance of uncertainty (IUS-SF; Carlton et al., 2007), beliefs about exposure therapy (TBES; Deacon et al., 2013), and emotional reactions to physical sensations (The Chills; Maruskin et al., 2012). We tested the hypothesis that intolerance of uncertainty and activation of the behavioral immune system (BIS; Schaller & Park, 2011), a mechanism theoretically activated by the prominent emergence of pathogens to protect against illness would predict attitudes toward exposure. The Chills Scale was used to assess BIS activation, a broad assessment of vasoconstriction responses associated with different emotional reactions, and includes a subscale (coldness) that evaluates vasoconstriction associated with defense against pathogens. Both coldness and OCD caseload, but not anxiety caseload or subscales of intolerance of uncertainty, emerged as significant predictors of clinicians’ beliefs about exposure; increases in OCD caseload were also related to decreases in negative beliefs about exposure. Findings are useful in determining methods for aiding clinicians in developing effective approaches to contamination fears during and post-pandemic that include addressing their own BIS-related concerns and mapping out means for social behavioral norms associated with engaging in exposure treatment.     

Prostate-specific Antigen–Based Prostate Cancer Screening: Reduction of Prostate Cancer Mortality After Correction for Nonattendance and Contamination in the Rotterdam Section of the European Randomized Study of Screening for Prostate Cancer

BackgroundLarge randomized screening trials provide an estimation of the effect of screening at a population-based level. The effect of screening for individuals, however, is diluted by nonattendance and contamination in the trial arms.ObjectiveTo determine the prostate cancer (PCa) mortality reduction from screening after adjustment for nonattendance and contamination.Design, setting, and participantsA total of 34 833 men in the core age group, 55–69 yr, were randomized to a screening or control arm in the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Prostate-specific antigen (PSA) testing was offered to all men in the screening arm at 4-yr intervals. A prostate biopsy was offered to men with an elevated PSA. The primary end point was PCa-specific mortality.Outcome measurements and statistical analysisNonattendance was defined as nonparticipation in the screening arm. Contamination in the control arm was defined as receiving asymptomatic PSA testing or a prostate biopsy in the absence of symptoms. Relative risks (RRs) were calculated with an intention to screen (ITS) analysis and after correction for nonattendance and contamination using a method that preserves the benefits obtained by randomization.Results and limitationsThe ITS analysis resulted in an RR of 0.68 (95% confidence interval [CI], 0.53–0.89) in favor of screening at a median follow-up of 13 yr. Correction for both nonattendance and contamination resulted in an RR of 0.49 (95% CI, 0.27–0.87) in favor of screening.ConclusionsPCa screening as conducted in the Rotterdam section of the ERSPC can reduce the risk of dying from PCa up to 51% for an individual man choosing to be screened repeatedly compared with a man who was not screened. This benefit of screening should be balanced against the harms of overdiagnosis and subsequent overtreatment.Trial registrationISRCTN49127736.     

Microleakage and sealant penetration in contaminated carious fissures

Objectives

The aim of the present in vitro study was to evaluate the effect of an adhesive system on microleakage and sealant penetration depth in carious fissures after different surface contamination circumstances.

Methods

Extracted third molars (n = 128) with small occlusal cavitated carious lesions were randomly divided into eight experimental groups and sealed under four different surface conditions. 1, Dry conditions; 2, water contamination; 3, saliva contamination; 4, saliva contamination and air-drying. Two sealant protocols were applied, one using a fissure sealant (Teethmate F) and one using an additional adhesive system (SA primer and Photo Bond). The control group consisted of sound third molars (n = 16), that were sealed under dry conditions. After thermocycling (n = 500 cycles), teeth were immersed in 1% methylene blue for 24 h, sectioned and digitally photographed. Microleakage was evaluated on a three-point rating scale and analysed using a Chi-square test. Additionally, the presence of caries and incomplete sealant penetration was scored from photographs and analysed using logistic regression.

Results

A statistical significant difference regarding microleakage scores was present between sealed carious and sealed sound fissures. The use of an adhesive system in case of water contamination significantly reduced microleakage (p < 0.05). With regard to sealant penetration depth, there were significant differences present for carious sealed fissures, use of an adhesive system prior to sealing, and water and saliva contamination.

Conclusions

Use of an adhesive system improved the effectiveness of sealants placed after water contamination in carious fissures. However, sound fissures showed less microleakage and better penetration abilities than carious fissures.     

Contamination: Nursing Diagnoses with Outcome and Intervention Linkages

PURPOSE: To relate the collaborative processes involved in the evolution of environmental nursing diagnoses and the linkages between two new nursing diagnoses and their associated interventions and outcomes; to describe the environmental health implications of contamination. DATA SOURCES: Published research articles, official reports, textbooks, and collaborative discussion with experts in community and global health. DATA SYNTHESIS: Reflection following review of the literature and collaboration with experts led to the development of a new schema for environmental diagnoses and development of two new diagnoses, allowing for greater clarity and distinction between the contamination diagnoses and risk for poisoning diagnosis. CONCLUSIONS: An environmental nursing diagnosis schema, with its emphasis on contamination, infection, and violence, provides nurses with a holistic framework for making judgments about environmental influences related to individual, family, community, and global health. The diagnoses of Contamination and Risk for Contamination provide necessary language to describe human responses and risk states that may arise following exposure to environmental contaminants. PRACTICE IMPLICATIONS: Development of environmental diagnostic labels and delineation of the linkages to nursing outcomes and interventions will allow nurses to take active roles in identifying environmental components that affect health and planning care that responds to environmental health needs. Greater clarity in the use of language will allow nurses to incorporate environmental concepts appropriately in nursing assessments and improve the accuracy of the diagnostic process and selection of distinct interventions and outcomes. This will result in better outcomes for patients and communities and permit greater accountability of nursing's contribution to environmental health.     

核事故放射性污染伤员空运后送防护服的研制

目的 研制用于核事故放射性污染伤员空运后送防护服。方法 根据放射性污染伤员的后送救护和污染防护要求，选用防污材料，设计结构布局，在演练行动中论证该防护服的合理性和实用并加以改进。结果 该型防护服材料具有较好的防渗透、耐腐蚀等理化特性，整体采用连体式结构，对伤员体表覆盖率达到97%，设计6个医学操作窗口和体侧游离拉链，达到了有效防止伤员体表放射性污染扩散和方便医疗救护的效果。结论 完成了放射性污染伤员空运后送防护服的研制，可满足核事故救援行动中伤员转运需要。     

Medical examiners and Crimean-Congo hemorrhagic fever contamination risk

Crimean-Congo Hemorrhagic Fever (CCHF) is an acute zoonotic infection caused by the CCHF virus. The viruses' activity peaks during April and May with a mortality rate of 3–30%. Transmission of the virus to human occurs through tick bites or exposure to infected animals' tissues or blood. The major at-risk group includes farmers living in endemic areas. Health-care workers are the second most affected group. Virus has shown up in a diverse geographic area which includes Middle East, Asia, Africa and Eastern Europe and is considered one of the most wide-spread tick borne infections. The most recent cases are from Iran and Turkey. This article represents autopsy results of four CCHF infected cases in 2011 and 2012, in Ankara, Turkey.     

Obsessive-compulsive disorder during COVID-19: Turning a problem into an opportunity?

The COVID-19 pandemic has prompted global measures to prevent infection. Experts assume that it is particularly affecting people with obsessive-compulsive disorder (OCD), especially those with washing compulsions. Data, however, are currently lacking.394 participants with OCD (n = 223 washers) participated in an online survey. Change in severity of OCD symptoms, reasons participants reported for the change (e.g., reduced mobility, reduced availability of cleaning products, economic factors, interpersonal conflicts), as well as participants’ beliefs and experience associated with COVID-19 were assessed.72 % of the participants reported an increase in OCD. This increase was significantly stronger in washers compared to non-washers. The worsening of symptoms was primarily associated with reduced mobility and interpersonal conflicts. Dysfunctional hygiene-related beliefs were significantly higher in washers than non-washers and were associated with greater symptom progression. Washers were more confident than non-washers about providing other people with helpful advice related to infection preventions. Washers, however, received more negative feedback from others in response to the advice they provided than non-washers.The majority of participants with OCD were negatively affected by the COVID-19 pandemic, and the negative effects were more pronounced in washers than in non-washers. Rapid interventions for OCD should be implemented to prevent long-term deterioration.