Anger Dimensions and Mental Health Following a Disaster: Distribution and Implications After a Major Bushfire

Anger is an important dimension of affect and a prominent feature of posttraumatic mental health, but it is commonly overlooked in postdisaster settings. We aimed to examine the distribution and implications of significant anger problems in the aftermath of a natural disaster, via analyses of Beyond Bushfires survey data from 736 residents of rural communities 5 years after the 2009 Black Saturday bushfires in Victoria, Australia. Assessments included the five‐item Dimensions of Anger Reaction (DAR‐5) scale along with measures of PTSD, depression, and significant mental illness, and indicators of life satisfaction, suicidality, hostile aggressive behavior, and violence exposure. The results indicated that approximately 10% of respondents from areas highly affected by the bushfires scored above the provisional cutoff criteria for significant anger problems on the DAR‐5, which was a more than 3‐fold increase, OR = 3.26, relative to respondents from areas of low‐to‐moderate bushfire impact. The rates were higher among women, younger participants, and those who were unemployed, and co‐occurred commonly, although not exclusively, with other postdisaster mental health problems. Anger problems were also associated with lower life satisfaction, β = ?.31, an 8‐fold increase in suicidal ideation, OR = 8.68, and a nearly 13‐fold increase in hostile aggressive behavior, OR = 12.98. There were associations with anger problems and violence exposure, which were reduced when controlling for covariates, including probable PTSD. The findings provide evidence indicating that anger is a significant issue for postdisaster mental health and should be considered routinely alongside other posttraumatic mental health issues.     

Guidelines for gastrostomy tube placement and enteral nutrition in patients with severe,refractory hypoglycemia after gastric bypass

BackgroundPostbariatric hypoglycemia (PBH) affects up to 38% of Roux-en-Y gastric bypass (RYGB) patients. Severe cases are refractory to diet and medications. Surgical treatments including bypass reversal and pancreatectomy are highly morbid and hypoglycemia often recurs. We have developed a highly effective method of treatment by which enteral nutrition administered through a gastrostomy (G) tube placed in the remnant stomach replaces oral diet: if done correctly this reverses hyperinsulinemia and hypoglycemia, yielding substantial health and quality of life benefits for severely affected patients.ObjectivesTo provide clinical guidelines for placement of a G-tube to treat postRYGB hypoglycemia, including candidate selection, preoperative evaluation, surgical considerations, and post-RYGB management.SettingStanford University Hospital and Clinics.MethodsBased on our relatively large experience with placing and managing G-tubes for PBH treatment, an interdisciplinary task force developed guidelines for practitioners.ResultsA team approach (endocrinologist, dietitian, surgeon, psychologist) is recommended. Appropriate candidates have a history of RYGB, severe hypoglycemia refractory to medical-nutrition therapy, and significantly affected quality of life. Preoperative requirements include education and expectation setting, determination of initial enteral feeding program, and establishing service with a home enteral provider. Close postoperative follow-up is needed to ensure success and may require adjustments in formula and mode/rate of delivery to optimize tolerance and meet nutritional goals. G-tube nutrition must fully replace oral nutrition to prevent hypoglycemia.ConclusionsG-tube placement in the remnant stomach represents a relatively well-tolerated and effective treatment for severe, refractory hypoglycemia after RYGB.     

Partners’ Consensus About Joint Effort and COVID-19 Prevention Among Sexual Minority Men

The current study examined the relevance of relationship functioning to partners’ agreement or consensus about joint effort surrounding COVID-19 prevention. Interdependence theory has been widely used to understand how relationship partners influence health behavior, including how sexual minority male (SMM) couples regulate HIV risk. Couples with better relationship functioning tend to be more successful at negotiating joint (shared) goals and subsequently accomplishing them. The study recruited 134 cis-male, SARS-CoV-2 negative adults in relationships with cis-male partners from phone-based social networking applications. Participants completed an online survey assessing relationship functioning (Perceived Relationship Components Questionnaire), COVID-19 prevention behaviors, and risk perceptions. Partners’ consensus around joint COVID-19 prevention effort was assessed using an adapted version of the Preferences for Sexual Health Outcomes scale. Path analyses indicated that consensus for joint prevention effort predicted social distancing (B?=?0.23; p?=?.001) and the number of other COVID-19 prevention behaviors engaged in (B?=?0.17; p?=?.003) above and beyond perceived risk and relationship functioning. Relationship satisfaction predicted higher levels of consensus for joint COVID-19 prevention effort (B?=?0.40; p?=?.029). Findings suggest that the theoretical foundations of successful HIV prevention interventions that utilize joint goal formation may generalize to the prediction of COVID-19 prevention behavior and may be leveraged to mitigate the risk of SARS-CoV-2 infection among SMM in relationships. Interventions that overlook the potential for dyadic regulation of health behavior may miss opportunities to capitalize on shared coping resources and fail to address relational barriers to prevention.

     

Unpredictable and uncontrollable stress impairs neuronal plasticity in the rat hippocampus

Almost by definition, learning and the effect of stress on learning represent modifications of existing neuronal circuitry. Under some circumstances, this modification can be measured electrophysiologically. One such measure of plasticity is long-term potentiation (LTP), a long-lasting increase in synaptic efficacy following brief exposure to tetanic stimulation. In 1987, Foy et al. reported that hippocampal LTP was impaired by exposure to inescapable shock. We have recent evidence that the impairment in LTP can be prevented by allowing the animal to learn to escape the shock (Shors et al., 1989), indicating that the stress effect is to some extent mediated by "psychological" variables. Regardless of LTP's putative role in learning and memory processes, such a stress-induced decrease in neuronal plasticity is likely to have profound effects on the behaving organism.     

Patient-focused care: key principles to restructuring

Patient-focused care (PFC) is a unique patient care delivery model that is becoming more popular in today's hospitals. Bishop Clarkson Memorial Hospital in Omaha, Nebraska, was one of the first hospitals to implement PFC. Clarkson used four principles to guide its pilot unit implementation--grouping similar patient populations, moving services closer to the patient, broadening staff skills, and simplifying processes. The four principles and their implementation are described; preliminary results are reported.     

Dyadic reciprocal associations between self-efficacy and planning predict sedentary behaviour

Objectives

There are two alternative hypotheses regarding bidirectional associations between self-efficacy and planning in predicting health behaviour change: self-efficacy may establish planning (cultivation hypothesis) or planning may enable the formation of self-efficacy (enabling hypothesis). This study investigates the order in which these two social cognitions are linked in adult–adult dyads in the context of sedentary behaviours (SB).

Design

A longitudinal study with 4 measurement points, spanning 8 months.

Methods

A total of 320 dyads (age: 18–90 years) were enrolled. Dyads included a focus person (who received the recommendation to reduce SB and intended to change their SB), and their partners, who were willing to support the focus persons and intended to reduce their own SB as well. Data were collected at Time 1 (T1), Time 2 (1 week later, T2), Time 3 (T3, 2 months after T1) and Time 4 (T4, 8 months after T1). SB was measured with accelerometers at (T1 and T4). Mediation models with individual and dyadic reciprocal effects were tested with path analyses.

Results

Only one indirect effect was found: A higher level of partners' SB reduction-specific self-efficacy at T2 was related to the focus person's more frequent planning to reduce SB at T3, which, in turn, predicted lower SB time among partners at T4.

Conclusions

The findings provide partial support for the cultivation model (self-efficacy prompting planning) and for dyadic reciprocal associations in the context of SB time reduction among adult dyads.     

Women in general practice in New Zealand

AIM: To investigate the role of women general practitioners (GPs) in New Zealand. METHOD: A five-page questionnaire was posted to 200 randomly selected women GPs from throughout New Zealand. One follow-up mailing was sent. RESULTS: A response rate of 79% was achieved. Twenty-four percent of women GPs work less than 5/10 but 46% earn less than $40000. Forty-eight percent of women GPs' partners also earn less than $40000. The most common reason for working part-time was parenting responsibilities. Eighty-seven percent are married or live with a partner, 77% have children, 48% have preschool-aged children. Only 15% have Membership of the RNZCGP and 57% are owner or partner in their practice. CONCLUSION: Women GPs suffer both professional and financial difficulties because of their dual motherhood/professional roles.     

Use of Biota-Sediment Accumulation Factors to assess similarity of nonionic organic chemical exposure to benthically-coupled organisms of differing trophic mode

The U.S. Environmental Protection Agency is in the process of developing Sediment Quality Criteria (SQC) to specify the acceptable degree of risk from sediment-mediated chemical exposure for the protection of benthically-coupled organisms. In this study, potential differences in chemical exposure for benthic organisms of differing habitats or feeding types were evaluated through the use of Biota-Sediment Accumulation Factors (BSAFs). It was hypothesized that If species of different habitats have similar exposures, then the BSAF values should not be different. The BSAFs are calculated using the concentrations of chemicals in an organism (g/g lipid) divided by the concentrations of the same chemicals in sediment (g/g_oc). Data from both freshwater and saltwater studies that met specified criteria for data quality were obtained from published papers or reports. These included three laboratory and five field studies containing 27 species and 4054 BSAF values. The BSAFs were intercompared for similarity of central tendency as grouped by chemical class (PCBs, PAHs, pesticides), individual species, and species grouped by habitat (infaunal deposit feeder, scavenger, filter feeder, and benthically-coupled fish). Plots of BSAFs grouped by class and K_ow revealed that the BSAFs for the PAHs were uniformly lower (mean 0.34) than the PCB (1.03) or pesticide (1.36) classes. For the PCBs, the BSAFs for all species exhibited a K_ow dependency with decreased bioaccumulation evident above and below the range of 5.99–7.27 log₁₀ K_ow. In order to optimize the detection of species/habitat differences in the BSAFs, further analyses were segregated by chemical class and excluded PCB data outside the above K_ow range. These analyses revealed similar BSAF values for various species both within and among habitat groups, and indicated that the sum total of exposures from all routes is similar across species. This similarity of chemical exposure across benthic species, and the similarity of sensitivities between benthic species and species used to derive WQC FCVs supports the applicability of SQC for all benthic organisms as a group.Contribution No. 1641 of the U.S. Environmental Protection Agency, Environmental Research Laboratory, Narragansett, RI