Older men worry less than others about COVID-19

May 29, 2020

Science Daily/Georgia State University

Older men may be at greater risk of contracting COVID-19 because they worry less about catching or dying from it than women their age or than younger people of both sexes, according to a new study by Sarah Barber, a gerontology and psychology researcher at Georgia State University.

This is a concern because older men are already more at risk of severe or fatal COVID-19 infections. Data from the CDC show the fatality rate of COVID-19 steadily rises with age, and that men are more at risk than women.

To test levels of worry and protective behaviors, Barber teamed with Hyunji Kim, a Georgia State doctoral student in psychology, and administered an online questionnaire assessing COVID-19 perceptions and behavior changes. The results were published by the Journals of Gerontology.

It is well established that worry is a key motivator of behavioral health changes, said Barber, including motivating people to engage in preventive health care activities such as healthy eating, exercise and timely screenings. In general, worry begins to ease with age, and is also lower among men than women.

"Not only do older adults exhibit less negative emotions in their daily lives," she said, "they also exhibit less worry and fewer PTSD symptoms following natural disasters and terrorist attacks."

She said that this may be because older adults have better coping strategies, perhaps gained through experience, and thus are able to regulate their emotional responses better.

Knowing that older adults tend to worry less, Barber conducted a study to see how this affected responses to the global pandemic.

"In normal circumstances," said Barber, "not worrying as much is a good thing. Everyday life is probably happier if we worry less. However, where COVID-19 is concerned, we expected that lower amounts of worry would translate into fewer protective COVID-19 behavior changes."

COVID-19 was declared a pandemic on March 11, and the questionnaire took place from March 23-31. Widespread behavioral changes were taking place, including the beginning of sheltering at home and social distancing.

All participants lived in the United States, and were primarily Caucasian with at least some college education. Participants were either aged 18-35 or aged 65-81, with 146 younger adults and 156 older adults studied.

The questionnaire assessed the perceived severity of COVID-19, such as whether respondents thought people were over-reacting to the threat of COVID-19 and whether it was similar in risk to flu. It also assessed worries about COVID-19, including how worried participants were about catching the virus themselves, dying as a result of it, a family member catching it, lifestyle disruptions, hospitals being overwhelmed, an economic recession, personal or family income declining and stores running out of food or medicine.

The questionnaire assessed behavioral changes that can reduce infection risk, from washing hands more often, to wearing a mask, avoiding socializing, avoiding public places, observing a complete quarantine or taking more care with a balanced diet and purchasing extra food or medications.

Not surprisingly, said Barber, most participants were at least moderately concerned about COVID-19, and only one individual, an older male, had "absolutely no worry at all." Also as expected, worry translated to protective behavior: more than 80 percent of participants reported washing their hands more frequently, taking more care about cleanliness, no longer shaking hands and avoiding public places. More than 60 percent of participants also reported no longer socializing with others. The participants who were most worried about COVID-19 were also the most likely to have implemented these behavior changes.

The catch was older men: compared to all other participants, older men were less worried about COVID-19, and had adopted the fewest number of behavior changes. They were relatively less likely to have worn a mask, to report having stopped touching their faces or to have purchased extra food.

Barber does not think the answer is to try to incite worry in older men. She thinks a better answer is to help them understand their risk accurately.

"Our study showed that for older men, accurate perception of risk worked as well as worry to predict preventive behaviors," she said.

If older men can be better educated about the virus, they may adopt protective behaviors even if they don't feel worried. She also notes that the survey took place "right after the pandemic was declared, and we all hope that a more accurate perception of risk has evolved over the last two months."

Either way, said Barber, older men may need a little extra coaching and attention to risk assessment and protective behaviors, both from concerned family members as well as their healthcare practitioners.

https://www.sciencedaily.com/releases/2020/05/200529150712.htm

Clues to COVID-19 in the brain uncovered

Researchers review neuroimaging for patients and show altered mental state and stroke dominate

May 27, 2020

Science Daily/University of Cincinnati

A study by University of Cincinnati researchers and four Italian institutions reviewing neuroimaging and neurological symptoms in patients with COVID-19 may shed light on the virus's impact on the central nervous system.

The findings, published in the journal Radiology, reveal that altered mental status and stroke are the most common neurological symptoms in COVID-19 patients, which authors say could help physicians notice "red flags" earlier.

"Studies have described the spectrum of chest imaging features of COVID-19, but only a few case reports have described COVID-19 associated neuroimaging findings," says lead author Abdelkader Mahammedi, MD, assistant professor of radiology at UC and a UC Health neuroradiologist. "To date, this is the largest and first study in literature that characterizes the neurological symptoms and neuroimaging features in COVID-19 patients. These newly discovered patterns could help doctors better and sooner recognize associations with COVID-19 and possibly provide earlier interventions."

Researchers in this study investigated neurological symptoms and imaging findings in patients from three major institutions in Italy: University of Brescia, Brescia; University of Eastern Piedmont, Novara; and University of Sassari, Sassari. Italy was the second epicenter of the spread of COVID-19, resulting in over 30,000 deaths.

The study included images from 725 hospitalized patients with confirmed COVID-19 infection between Feb. 29 and April 4. Of these, 108 (15%) had serious neurological symptoms and underwent brain or spine imaging. Most patients (99%) had brain CT scans, while 16% had head and neck CT imaging and 18% had brain MRI.

Investigators found that 59% of patients reported an altered mental state and 31% experienced stroke, which were the most common neurological symptoms. Patients also experienced headache (12%), seizure (9%) and dizziness (4%), among other symptoms.

"Of these 108 patients, 31, or 29%, had no known past medical history. Of these, aged 16 to 62 years, 10 experienced stroke and two had brain bleeds," Mahammedi says. "Seventy-one, or 66%, of these patients had no findings on a brain CT, out of which 7 of them (35%) brain MRI showed abnormalities."

He adds that altered mental status was more common in older adults.

While results show that the neuroimaging features of patients with COVID-19 vary, and an altered mental status and stroke are the most prevalent in patients, Mahammedi says this study reveals that there are other conditions to be on the lookout for.

"This topic definitely needs more research," he says. "Currently, we have a poor understanding of the neurological symptoms in COVID-19 patients, whether these are arising from critical illness or from direct central nervous system invasion of SARS-CoV-2. We hope further study on this subject will help in uncovering clues and providing better interventions for patients."

https://www.sciencedaily.com/releases/2020/05/200527105049.htm

Dementia gene raises risk of severe COVID-19

May 26, 2020

Science Daily/University of Exeter

Having a faulty gene linked to dementia doubles the risk of developing severe COVID-19, according to a large-scale study.

Researchers at the University of Exeter Medical School and the University of Connecticut School of Medicine analysed data from the UK Biobank, and found high risk of severe COVID-19 infection among European ancestry participants who carry two faulty copies of the APOE gene (termed e4e4). One in 36 people of European ancestry have two faulty copies of this gene, and this is known to increase risks of Alzheimer's disease up to 14-fold and also increases risks of heart disease.

Now, the research team has found that carrying these gene mutations doubles the risks of COVID-19 -- even in people who had not developed these diseases.

The team has previously found that people with dementia are three times more likely to get severe COVID-19, yet they are not one of the groups advertised to shield -- or shelter in place -- on health grounds. Part of the increased risk effect may have been exposure to the high prevalence of the virus in care homes. However, the new study, published in the Journal of Gerontology: Medical Sciences, indicates that a genetic component may also be at play. The team found that people with the APOE e4e4 genotype were at double the risk of developing severe COVID-19, compared to those with the common e3e3 form of the APOE gene. The team used data from the UK Biobank study, which collects health and genetic data on 500,000 people.

The majority of people in the population and in the sample size have not yet been exposed to the virus. In this analysis, 2.36% (n=9,022) of participants with European ancestries (n=382,188) had the ApoE e4e4 faulty gene, but 5.13% (n=37) of those who tested positive for COVID-19 (n=721) had this gene variant, suggesting the risk is doubled compared to e3e3 (410 per 100,000 versus 179 per 100,000).

Co-author Dr. Chia-Ling Kuo, of the UConn School of Medicine, said: "This is an exciting result because we might now be able to pinpoint how this faulty gene causes vulnerability to COVID-19. This could lead to new ideas for treatments. It's also important because it shows again that increasing disease risks that appear inevitable with ageing might actually be due to specific biological differences, which could help us understand why some people stay active to age 100 and beyond, while others become disabled and die in their sixties."

Professor David Melzer, who led the team, said: "Several studies have now shown that people with dementia are at high risk of developing severe COVID-19. This study suggests that this high risk may not simply be due to the effects of dementia, advancing age or frailty, or exposure to the virus in care homes."

Melzer stresses: "The effect could be partly due to this underlying genetic change, which puts them at risk for both COVID-19 and dementia."

https://www.sciencedaily.com/releases/2020/05/200526091412.htm

Child's play 'lost' in pandemic fear

Safe interactions are important to wellbeing: Experts

May 22, 2020

Science Daily/Flinders University

Social and community disruptions caused by the COVID-19 restrictions could have a lasting effect on child wellbeing, Flinders University researchers warn.

While health, safety and education responses are the focus of restrictions, the needs of childhood independence, self-determination and play are less acknowledged, Flinders University experts explain in a new publication.

"Play is a key aspect of children's wellbeing from their perspectives," says lead author Jennifer Fane. "The closure of playgrounds, schools and the fear and worry associated with being in public spaces has likely had significant impacts on children during this time.

"As children return to school, and life starts to resume as it did pre-COVID-19, focus and attention to children's opportunities for play -- and their ability to exercise reasonable 'agency' during this time of significant transition -- are two key aspects that can support their wellbeing during this difficult time."

While everyone's freedoms have been impacted by COVID-19 pandemic, children's agency, or ability to make choices and decisions within adult-imposed constraints, has never been more apparent.

"Young children interviewed in the study told us of the importance to their lives of trying new things and having a say about play," says Flinders Professor of Public Health Colin MacDougall, a co-author on the Child Indicators Research paper.

"As the world takes baby steps to ease these life-saving restrictions, and move into an uncertain future, we must take the time to think about very young children.

"This research can be used to help chart a course for the multiple transitions these children are undergoing."

Ms Fane, whose PhD at Flinders focused on communicating with preschoolers, says these perspectives can support child wellbeing in future, including as government restrictions on people's boundaries affects where children play and how much they can have a say.

https://www.sciencedaily.com/releases/2020/05/200512134437.htm

High stress related to coronavirus is the new normal for many parents, says new APA survey

Online learning, basic needs, missing milestones contribute to parental stress

May 21, 2020

Science Daily/American Psychological Association

Nearly half of parents of children under age 18 say their stress levels related to the coronavirus pandemic are high, with managing their kids' online learning a significant source of stress for many, according to a new survey by the American Psychological Association.

As the global pandemic continues and parents juggle child care, work and schooling demands, the mental health toll on parents is growing, warns APA. At the same time, the proportion of Americans saying that the economy or work is a significant source of stress in their life has risen significantly.

"For many parents, it can feel overwhelming to face competing demands at home and work along with possible financial challenges during this unprecedented crisis," said Arthur C. Evans Jr., PhD, APA's chief executive officer. "Children are keen observers and often notice and react to stress or anxiety in their parents, caregivers, peers and community. Parents should prioritize their self-care and try their best to model healthy ways of coping with stress and anxiety."

Stress in America 2020 Stress in the Time of Coronavirus, Volume 1, was conducted by The Harris Poll from April 24 to May 4, 2020, and surveyed online 3,013 adults age 18+ who reside in the United States. This is the first of at least three monthly surveys APA and The Harris Poll plan to gauge the impact of the pandemic on stress.

The survey found that 46% of parents say their average stress level related to the coronavirus pandemic is high (between 8 and 10 on a 10-point scale where 1 means "little or no stress" and 10 means "a great deal of stress"). Only 28% of adults who don't have children under the age of 18 report similar levels of stress.

With schools closed and many parents working from home while coordinating their children's schedules, 71% of parents say managing distance/online learning for their children is a significant source of stress.

Parents are more likely than those without children to say basic needs -- such as access to food and housing -- are a significant source of stress (70% compared with 44%). Other significant stressors for parents include access to health care services (66% vs. 44%) and missing major milestones, such as weddings and graduation ceremonies (63% vs. 43%).

As unemployment numbers have reached record highs, the economy and work have increased as stressors for Americans. The current survey found that the economy is a significant source of stress for 70% of adults, compared with 46% in APA's 2019 Stress in America poll. Current stress levels are similar to the levels seen in the 2008 Stress in America poll during the Great Recession. Similarly, 7 in 10 employed adults say work is a significant source of stress in their lives, compared with 64% in the 2019 survey.

Pandemic-related stress is having a disproportionate impact on communities of color. People of color are more likely than white adults to report significant stressors in their life as a result of the coronavirus pandemic, namely getting coronavirus (71% vs. 59%, respectively), basic needs (61% vs. 47%), and access to health care services (59% vs. 46%). Slightly more than 2 in 5 Hispanic adults (41%) say their average level of stress related to the coronavirus pandemic during the past month was between 8 and 10. Hispanic adults are also most likely to say they constantly or often feel stress as a result of the pandemic (37%), as compared with white (32%), black (32%), Native American (31%), and Asian (28%) adults.

"The mental health ramifications of the coronavirus pandemic are immense and growing," Evans warned. "We need to prepare for the long-term implications of the collective trauma facing the population. On an individual level, this means looking out for one another, staying connected, keeping active and seeking help when necessary."

To read Stress in America 2020 Stress in the Time of Coronavirus, Volume 1 in full or to download graphics, visit the Stress in America Press Room webpage (https://www.apa.org/news/press/releases/stress). APA also offers resources for the public on mental health during the time of COVID-19 (https://www.apa.org/topics/covid-19), including resources specially for parents and on racial equity and health disparities.

https://www.sciencedaily.com/releases/2020/05/200521151919.htm

Stroke rates among COVID-19 patients are low, but cases are more severe

Overall stroke hospital admissions are down globally

May 21, 2020

Science Daily/American Heart Association

The rate of strokes in COVID-19 patients appears relatively low, but a higher proportion of those strokes are presenting in younger people and are often more severe compared to strokes in people who do not have the novel coronavirus, while globally rates for stroke hospitalizations and treatments are significantly lower than for the first part of 2019, according to four separate research papers published this week in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.

In "SARS2-CoV-2 and Stroke in a New York Healthcare System," researchers reported key demographic and clinical characteristics of patients who developed ischemic stroke associated with the COVID-19 infection and received care within one hospital system serving all 5 boroughs of New York City.

During the study period of March 15 through April 19, 2020, out of 3,556 hospitalized patients with diagnosis of COVID-19 infection, 32 patients (0.9%) had imaging-proven ischemic stroke. They compared those 32 patients admitted with stroke and COVID-19 to those admitted only with stroke (46 patients) and found that the patients with COVID-19:

• tended to be younger, average age of 63 years vs. 70 years for non-COVID stroke patients;

• had more severe strokes, average score of 19 vs. 8 on the National Institutes of Health Stroke Scale;

• had higher D-dimer levels, 10,000 vs. 525, which can indicate significant blood clotting;

• were more likely to be treated with blood thinners, 75% vs. 23.9%;

• were more likely to have a cryptogenic stroke in which the cause is unknown, 65.6% vs. 30.4%; and

• were more likely to be dead at hospital discharge, 63.6% vs. 9.3%.

Conversely, COVID-19 stroke patients were less likely than those stroke patients without the novel coronavirus to have high blood pressure (56.3% vs. 76.1%) or to have a prior history of stroke (3.1% vs. 13%).

The researchers observed that the rate of imaging-confirmed acute ischemic stroke in hospitalized patients with COVID-19 in their New York City hospital system was lower compared to prior reports in COVID-19 studies from China. One reason for the difference might be related to variations in race/ethnicity between the two study populations. In addition, the low rate of ischemic stroke with COVID-19 infection may be an underestimate because "the diagnosis of ischemic stroke can be challenging in those critically ill with COVID-19 infection who are intubated and sedated," said lead study author Shadi Yaghi, M.D., FAHA, of the department of neurology at NYU Grossman School of Medicine in Manhattan.

Yaghi said, "It was difficult to determine the exact cause of the strokes of the COVID-19 patients, however, most patients appeared to experience abnormal blood clotting. Additional research is needed to determine if therapeutic anticoagulation for stroke is useful in patients with COVID-19." The researchers noted that at least one clinical trial is already underway to investigate the safety and efficacy of treatment for active clotting vs. preventive treatment in certain patients with COVID-19 infection presenting with possible clotting indicators.

Yaghi and his coauthors also noted the number of stroke cases with COVID-19 seems to have peaked and is now decreasing. This finding may be related to the overall reduction in COVID-19 hospital admissions, which may be due to social distancing and guidance for people to stay at home. In addition, the number of stroke patients hospitalized during the study period was significantly lower than the same time frame in 2019.

Similar trends are reported in several other studies also published this week in Stroke, reflecting a global disruption of emergency health care services including delayed care and a lower-than-usual volume of stroke emergencies during the COVID-19 pandemic crisis.

In a Hong Kong study, "Delays in Stroke Onset to Hospital Arrival Time during COVID-19," by lead author Kay Cheong Teo, M.B.B.S., researchers compared the stroke onset time to hospital arrival time for stroke and transient ischemic attack (TIA) patients from Jan. 23 to March 24, 2020 (the first 60 days from the first diagnosed COVID-19 case in Hong Kong) to the same time period in 2019. In 2020, 73 stroke patients presented to Queen Mary Hospital compared to 83 in 2019. However, the time from stroke onset-to-arrival time was about an hour longer in 2020 compared with last year (154 minutes vs. 95 minutes). In addition, the number of patients arriving within the critical 4.5-hour treatment window dropped from 72% in 2019 to 55% in 2020.

Also from China, "The impact of the COVID-19 epidemic on stroke care and potential solutions," by lead author Jing Zhao, M.D., Ph.D., detailed survey results from more than 200 stroke centers through the Big Data Observatory Platform for Stroke of China, which consists of 280 hospitals across China. They found that in February 2020, hospital admissions related to stroke dropped nearly 40%, while clot-busting treatment and mechanical clot-removal cases also decreased by 25%, compared to the same time period in 2019. The researchers cited several factors likely contributed to the reduced admissions and prehospital delays during the COVID-19 pandemic, such as lack of stroke knowledge and proper transportation. They also noted that another key factor was patients not coming to the hospital for fear of virus infection.

In a fourth study, "Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak," by lead author Basile Kerleroux, M.D., researchers in France compared patient data from stroke centers across the country from February 15 through March 30, 2020 to data of patients treated during the same time period in 2019. They found a 21% decrease (844 in 2019 vs. 668 in 2020) in overall volume of ischemic patients receiving mechanical thrombectomy during the pandemic compared to the previous year.

Additionally, there was a significant increase in the amount of time from imaging to treatment overall -- 145 minutes in 2020 compared to 126 minutes in 2019, and that delay increased by nearly 30 minutes in patients transferred to other facilities for treatment after imaging. The researchers said delays may have been due to unprecedented stress on emergency medical system services, as well as primary care stroke centers lacking transfer resources needed to send eligible patients to thrombectomy capable stroke centers within the therapeutic window. They noted stricter applications of guidelines during the pandemic period could also have meant some patients may have not been referred or accepted for mechanical thrombectomy treatment during that time.

https://www.sciencedaily.com/releases/2020/05/200521124648.htm

Coronavirus infections may lead to delirium and potentially PTSD

May 19, 2020

Science Daily/University College London

People taken ill by coronavirus infections may experience psychiatric problems while hospitalised and potentially after they recover, suggests an analysis of past research led by the UCL Institute of Mental Health with King's College London collaborators.

The systematic review paper, published in The Lancet Psychiatry, compiled results from short- and long-term studies of people hospitalised by recent coronaviruses, namely SARS (Severe acute respiratory syndrome) in 2002-2004, MERS (Middle East respiratory syndrome) in 2012, as well as COVID-19 this year.

COVID-19 is caused by the SARS-CoV-2 virus, a type of coronavirus. Some coronaviruses only cause mild symptoms of the common cold, but SARS-CoV-2 can cause severe respiratory illness, as did SARS-CoV-1 (the virus implicated in the 2002-2004 SARS epidemic) and MERS-CoV, which caused MERS in 2012.

The analysis found that one in four people hospitalised with COVID-19 may experience delirium during their illness, a known problem among hospital patients, which can increase risk of death or extend time in hospital.

The post-recovery effects of COVID-19 are not yet known, so long-term risks such as post-traumatic stress disorder (PTSD), chronic fatigue, depression, and anxiety are based on SARS and MERS studies, which may or may not apply to COVID-19 as well.

Co-lead author Dr Jonathan Rogers (UCL Psychiatry and South London and Maudsley NHS Foundation Trust) said: "Most people with COVID-19 will not develop any mental health problems, even among those with severe cases requiring hospitalisation, but given the huge numbers of people getting sick, the global impact on mental health could be considerable.

"Our analysis focuses on potential mental health risks of being hospitalised with a coronavirus infection, and how psychiatric conditions could worsen the prognosis or hold people back from returning to their normal lives after recovering."

The authors of the new paper analysed 65 peer-reviewed studies and seven recent pre-prints that are awaiting peer review, which included data from over 3,500 people who have had one of the three related illnesses. The review only included results from people who were hospitalised, and not people with more mild cases. The findings cover both acute symptoms during the illness, and long-term outcomes from two months to 12 years.

Almost one in three people hospitalised with SARS or MERS went on to develop PTSD, at an average follow-up time of almost three years, especially if they had ongoing physical health problems. Rates of depression and anxiety were also high, at roughly 15% one year or longer after the illness, with a further 15% also experiencing some symptoms of depression and anxiety without a clinical diagnosis. More than 15% also experienced chronic fatigue, mood swings, sleep disorder or impaired concentration and memory.

While in hospital, a significant minority of people with coronavirus infections experienced delirium symptoms such as confusion, agitation and altered consciousness. Almost 28% of people hospitalised for SARS and MERS experienced confusion, and early evidence from the ongoing pandemic suggests that delirium could be similarly common in COVID-19 patients. The authors found some preliminary evidence that delirium may have been associated with raised mortality during the MERS outbreak.

Co-lead author Dr Edward Chesney (Institute of Psychiatry, Psychology & Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust) said: "We need more research on how to prevent mental health problems in the long term. One possibility might be to reduce social isolation by allowing patients to communicate with their loved ones by using video links."

The body of research also identified some of the risk factors associated with worse mental health outcomes. Researchers found that worrying a lot about the illness was associated with worse mental health in the long run, and healthcare workers had worse long-term mental health outcomes than other groups, while making a good physical recovery predicted better long-term mental health.

Senior author Professor Anthony David (UCL Institute of Mental Health) said: "To avoid a large-scale mental health crisis, we hope that people who have been hospitalised with COVID-19 will be offered support, and monitored after they recover to ensure they do not develop mental illnesses, and are able to access treatment if needed.

"While most people with COVID-19 will recover without experiencing mental illness, we need to research which factors may contribute to enduring mental health problems, and develop interventions to prevent and treat them."

https://www.sciencedaily.com/releases/2020/05/200518184914.htm

Call for broad changes in stroke care during COVID-19

New guidelines needed to preserve health care resources, limit disease spread and ensure optimal care

May 14, 2020

Science Daily/Loyola University Health System

Broad modifications to current standards for treating acute stroke patients during the COVID-19 pandemic may be needed to preserve health care resources, limit disease spread and ensure optimal care, according to a Loyola Medicine neurologist.

"Doctors are seeing a rise in COVID-19 patients of all ages suffering from stroke and other vascular complications, as the COVID-19 virus overwhelms the health care system," said Jose Biller, MD, chairperson of neurology at Loyola University Medical Center, and professor, Loyola University Chicago Stritch School of Medicine, and co-author of a new editorial, "Acute Stroke Care in the Coronavirus 2019 Pandemic."

"COVID-19 may increase the risk of stroke as a result of several mechanisms, including enhanced inflammatory response, increased blood clotting tendencies, and damage of the inner layers of the blood vessels (endothelial damage)," said Dr. Biller. In general, the majority of stroke patients are older and have underlying medical conditions associated not only with risk for acute ischemic stroke (AIS), but also poor outcomes associated with COVID-19.

Dr. Biller says new guidelines are needed to safely manage stroke patients, both with and without COVID-19, within the limitations of strained health systems during this "ferocious novel pandemic."

"We believe that it is crucial for the stroke community to relax guidelines and stroke pathways while continuously providing high quality of care, including treatment algorithms, post intravenous thrombolysis monitoring, diagnostic work up, disposition planning, prevention measures, in order to optimally care for stroke patients while minimizing the chances of contributing to the rapid spread of COVID-19," according to the editorial, co-authored by Rima M. Dafer, MD, MPH, and Nicholas D. Osteraas, MD, MS, both of Rush University Medical Center, and appearing in the Journal of Stroke and Cerebrovascular Diseases.

The recommendations pertain to all aspects and stages of care, and include the following highlights:

• Prehospitalization. Patients or loved ones should continue to call 911 to report a stroke. In addition to standard triage, emergency medical system (EMS) personnel should screen patients over the phone for COVID-19 symptoms. Telemedicine should be considered for patients with low suspicion of stroke, or mild symptoms with no potential indication for intervention. All patients with acute stroke symptoms should be treated as suspected or possible COVID-19 patients.

• Emergency Room Evaluation. In the emergency room, patients should be screened for COVID-19 prior to evaluation by the stroke team. All patients should wear a mask.

• Hospitalization. Hospitals should designate isolated units for stroke care. Patients receiving intravenous chemical thrombolysis (a common stroke treatment involving an intravenous injection of drugs directly to the blood clot) may be monitored virtually with two-way video conferencing to minimize staff infection.

• Rehabilitation Planning. Rehabilitation for stroke patients can include physical, occupational, and speech therapy, along with other rehabilitation. All therapists and health care workers caring for COVID-19 patients should wear appropriate protective gear. Whenever appropriate, therapy services should emphasize patient exercises that can used at home.

• Family Members. As many hospitals have restricted visitors during COVID-19, extra effort will need to be made to reach families by phone to discuss a patient's condition, treatment options and discharge planning. Exceptions to the visitor policy, such as discussions regarding end-of-life care, should be made when appropriate.

• Transfers. Stroke care often involves networks of hospitals; commonly a comprehensive "hub" with multiple smaller hospitals or "spoke" sites which transfer stroke patients to the "hub" for emergency treatment or Intensive Care Unit (ICU) care. Tele-stroke should be encouraged to evaluate patients and to prevent unnecessary transfers. For AIS patients, neuroimaging and COVID-19 screening should be obtained at the smaller, spoke site hospital before a patient is transferred to a larger medical center.

• Discharge Planning. Discharges to acute rehabilitation institutions and long-term facilities have been delayed due to concerns about the spread of COVID-19 infections in long-term care facilities and nursing homes. Hospitals may need to designate rehabilitation beds for patients who do not qualify for transfer to acute inpatient facilities, as well as discussing possible discharge to home when medically stable and appropriate until the pandemic is under control.

Finally, the article recommends establishing stroke networks within cities, as well as collaboration between institutions "as the surge of COVID-19 worsens." This should include "collaborations among stroke networks to establish a rotating weekly coverage for acute stroke care in a specified geographic area; thus, both freeing hospital resources and releasing stroke call responsibilities, and allowing these physicians to help in caring for patients on the COVID-19 units."

https://www.sciencedaily.com/releases/2020/05/200507150514.htm

Infecting the mind: Burnout in health care workers during COVID-19

May 13, 2020

Science Daily/Texas A&M University

Doctors and nurses across the country are experiencing occupational burnout and fatigue from the increased stress caused by the COVID-19 pandemic. A team of researchers and medical professionals at Texas A&M University and Houston Methodist Hospital are working together to fight two afflictions: COVID-19 and the mental strain experienced by medical professionals.

In an article recently published in the journal Anesthesia & Analgesia, Dr. Farzan Sasangohar, assistant professor in the Department of Industrial and Systems Engineering and colleagues at Houston Methodist Hospital, outline the effects of fatigue and burnout on intensive care unit (ICU) workers, and the steps that can be taken to mitigate these symptoms.

"The COVID-19 pandemic exacerbated an already existing problem within our health care systems and is exposing the pernicious implications of provider burnout," Sasangohar said.

Health care workers are experiencing added stress from multiple areas. Many of them are working longer shifts and experiencing more loss of life. The lack of personal protective equipment (PPE) and training on how to use new equipment causes many professionals to question if they have been exposed. This leads to fear that they could infect their family and loved ones. In addition to those fears, there is anxiety surrounding job security. To reduce the spread of infection, many states have stopped elective procedures and consequently, many health care professionals have been laid off or had their hours reduced.

Sasangohar and the research team documented four major areas of stress with the goal of identifying mitigation strategies to reduce burnout among these life-saving workers. The four areas identified by the researchers include occupational hazards, national versus locally scaled responses, process inefficiencies and financial instability.

The symptoms

Health care workers need effective PPE readily accessible and available to ensure their safety and that of their patients. Getting the necessary equipment has been challenging due to the low numbers of PPE and ventilators in the U.S. Strategic National Stockpile and delays getting equipment into local areas. This slow response, which has caused some providers to reuse PPE past the point of safety and warranty protections, can contribute to anxiety in providers.

"Minimizing occupational hazard is the most important criteria to assure that our health care workforce is fully equipped and assured to be safe in order to face the battle against this virus," said Dr. Bita Kash, professor of health policy and management in the Texas A&M School of Public Health and director of the Joint Center for Outcomes Research at Houston Methodist Hospital.

The process to secure assistance from federal authorities has been cumbersome and slow for providers. Many requests for additional ventilators and PPE are not being met. These uncertainties about when assistance will arrive has resulted in widespread anxiety among providers.

Process inefficiencies have also contributed to fatigue and burnout due to misinformation or conflicting information given between different specialties. While one subspecialty's professional organization recommends a certain guideline, another specialty could recommend something else, which leads to confusion.

Anxiety and worry about future career prospects and the overall economy can also lead to provider burnout. Elective surgeries have been canceled or delayed, causing financial stress on some physicians. Others not directly affected by financial hardship may be worried about loved ones or their own family and how they will weather a coming economic recession.

Prescription for the future

While this is the first world-wide pandemic in many years, there will be more. Working together, local researchers, health care professionals and government officials can prepare for future pandemics and subsequent waves of the COVID-19 pandemic. Houston Methodist Hospital has already begun learning from this pandemic and making changes to be more resilient in response to the current crisis and prepared for similar crises in the future.

In response to the pandemic, Houston Methodist Hospital adapted their policies and focused on constant and responsive communication from leadership to their employees. Proactive and positive responses have allowed the hospital to adapt quickly during the pandemic and reduce employee stress overall. This success has led to recommendations for future preparations.

The researchers' recommendations to reduce provider burnout and fatigue:

• Pandemic plans should include guidance for relevant industries to quickly transition into producing needed medical supplies

• National and regional disaster mitigation plans to help shorten the time needed to provide necessary equipment and testing

• Provision of adequate numbers of test kits and PPE

• Training on disaster management and response for medical professionals

• Relaxing licensing restrictions for individuals licensed outside their state of residence

• Creating a medical reserve corps of these licensed individuals

• Using wearable sensors to monitor health care workers' mental health and provide simple ways to mitigate anxiety and stress

"There is much to learn from the response to COVID-19," said Sasangohar. "In our approach, we used a multi-disciplinary systems approach to learn not just from failures and shortcomings, but also from successful adaptations and improvised interventions at the individual, team and system levels to improve our resilience."

While ICU workers in Houston have weathered many storms, including Hurricanes Ike and Harvey, the COVID-19 pandemic has brought new challenges to already challenging work. The areas identified by the researchers can help make this work safer, more effective and reduce burnout in these critical roles.

https://www.sciencedaily.com/releases/2020/05/200513143749.htm

Stroke doctors establish best practices to protect against COVID-19

Patients should continue to seek early treatment for a suspected stroke, they advise

May 7, 2020

Science Daily/University of California - Los Angeles Health Sciences

To keep patients and health-care providers safe from COVID-19, while providing urgent treatment to stroke patients, extra precautions must be taken, according to new guidelines published in the journal Stroke.

The guidelines were established by the Society of Vascular & Interventional Neurology (SVIN).

UCLA professor of neurology Dr. David Liebeskind, who is president of SVIN and director of the UCLA Stroke Center, expressed concern that fear of COVID-19 may make patients hesitate to seek treatment in the event of a possible stroke.

"People are passing away or having severe strokes out of the hospital," he said. "There are a lot of people who are not coming in."

Delaying treatment by just 15 minutes can make a world of difference in terms of the patient's recovery. Yet stroke centers around the country report that they are treating fewer patients than usual. To minimize the possibility of transmitting infections among patients in the hospital, the SVIN team developed guidelines based on review of the published research, consensus among practicing neurologists and shared best practices.

"Some of these things are intuitive or straightforward in terms of minimizing exposure and maximizing the use of personal protective equipment," said Dr. Liebeskind. Because stroke patients may be unable to communicate and describe their history or symptoms, he said, every patient should be initially considered to be positive for COVID-19.

According to the guidelines, a definitive diagnosis of COVID-19 should be made as soon as possible, as patients who test negative can decrease the use of protective equipment. Patients who test positive should be placed in isolation in a negative pressure room, when available.

Any tests that do not change the treatment strategy should be delayed or deferred until COVID-19 status is established, the guidelines recommend.

The doctors say that telemedicine can play a monumental role in minimizing the number of people who come in direct exposure to the patient. For an acute stroke or thrombectomy code, one person in protective equipment can be with the patient, while another coordinates care via computer or phone.

Remote tele-stroke technology can also be used to obtain history, perform neurological exams and monitor the patient after the stroke has been treated.

"Telemedicine in neurology has evolved over the last 10 years to meet the needs of a consultation," said Dr. Liebeskind. "In stroke, imaging becomes incredibly important, and that becomes integrated as well. We can do the examination very easily via telemedicine, using a video link at the patient bedside. And, through that same link we can access the imaging information as well. At UCLA, we also have dedicated robots that can travel through the hospital that can do all of this."

A head CT or computerized tomography scan is typically the first test performed in the event of a stroke. A chest CT can be performed at the same time, to check the lungs for COVID-19, if this does not unduly delay stroke treatment. Angiography is another imaging technique that allows doctors to look at the blood vessels.

"The use of specific imaging approaches in planning endovascular therapy, and the decision-making regarding the use of intubation and general anesthesia, is always a case specific medical decision in any clinical environment," Dr. Liebeskind said.

Where possible, conscious sedation can be an alternative to general anesthesia and intubation. This could protect patients from unnecessary intubation and conserves mechanical ventilators, he said.

Finally, after thrombectomy or surgery to remove the blood clot, doctors should consider relocating patients back to primary stroke centers to recover, especially for hospitals overwhelmed with critical care or intensive care unit bed shortages. This can help maintain thrombectomy access, Dr. Liebeskind said.

"Our ability to deliver comprehensive stroke care, including endovascular therapy for acute ischemic stroke, remains an intact valuable resource for patients everywhere," he added.

https://www.sciencedaily.com/releases/2020/05/200507145351.htm

Researchers offer ways to address life under COVID-19

New analysis outlines evidence-based approaches to combat bias and fake news, increase cooperation, and cope with stress and isolation

April 30, 2020

Science Daily/New York University

An international team of researchers has outlined ways to manage different facets of life under the spread of the COVID-19 virus, ranging from how we can combat racially driven bias and fake news to how we can increase cooperation and better manage stress.

Its work, which appears in the journal Nature Human Behaviour, considers research stretching over the past half century to offer insights about how to address current circumstances.

"The COVID-19 pandemic represents a massive, global health crisis," observes Jay Van Bavel, an associate professor in New York University's Department of Psychology, who led the project with Stanford's Robb Willer. "Because the crisis requires large-scale behavior change and poses significant psychological burdens on individuals, insights from the social and behavioral sciences are likely going to be very helpful for optimizing pandemic response."

"This interdisciplinary review points to several ways in which research can be immediately applied to optimize response to this pandemic, but also points to several important gaps that researchers should move quickly to fill in the coming weeks and months," adds Willer, a sociologist.

The analysis, drawn from the expertise of over 40 researchers at more than 20 colleges and universities, focuses on phenomena linked to COVID-19, connecting existing scholarship to potential courses of action in several areas, including the following: "Group Threat," "Fake News and Misinformation," "Social Norms," and "Stress and Coping."

Group Threat

The authors, referring to recent attacks on ethnic Asians in predominantly white countries, note that "Europe's most deadly disease, the bubonic plague of the 14th century, unleashed massive violence, including the murder of Catalans in Sicily, clerics and beggars in some locations, and pogroms against Jews, with over a thousand communities eradicated."

However, they point to research that indicates pandemics may, in fact, present opportunities to reduce religious and ethnic prejudice: "coordinated efforts across individuals, communities, and governments to fight the spread of disease send strong signals of cooperation and shared values, which allow people to re-cast others who were previously considered out-group members as in-group members."

The authors recount cooperative acts currently unfolding: More than 20 countries donated medical supplies to China in February, and China has reciprocated. "Government officials can highlight events like these to improve out-group attitudes," they write, adding that other studies have shown that making people feel safer can reduce prejudice.

Fake News and Misinformation

Fake news and conspiracy theories about COVID-19 have undoubtedly proliferated on social media, but new research has explored social-science based solutions to counter the spread of fake news. Fact-checking and correction offer potential remedies, as does source expertise, bipartisanship in messaging, and messages from "unlikely sources" -- those who benefit from the original misinformation.

But the researchers acknowledge that fact-checking and corrections may not keep up with the vast amount of false information produced in moments of crisis like a pandemic and that approaches beyond debunking are necessary.

In response, they offer what scholars term a "pre-bunking approach," which centers on psychological inoculation. Studies have found that preemptively exposing people to small doses of misinformation techniques (including scenarios about COVID-19) can reduce susceptibility to fake news. Another preventative approach involves subtle prompts that emphasize accuracy (for instance, asking users to judge the veracity of a single neutral headline). Such prompts have been found in prior work to improve the quality of the content users share and could be easily implemented by social media platforms.

"To effectively counter fake news about COVID-19 around the world, governments and social media companies must rigorously develop and test interventions in collaboration with independent behavioral scientists," the authors advocate. "This includes identifying treatments that effectively reduce belief in misinformation, while not undermining belief in accurate information -- a particularly salient concern given evidence that most exposure to and sharing of fake news in the U.S. has been concentrated among relatively small sub-sections of the population."

Social Norms

"How much people change will be influenced by aspects of the social and cultural context," the researchers write. "The fact that people tend to follow social norms and cultural mores can sometimes have undesirable consequences. For example, continuous exposure to news examples of people going out might explain why it was difficult to convince Italians to stay at home after the COVID-19 lockdown of March 11." But they also report that "understanding these features of the social environment, such as social norms, social inequality, culture, and polarization, can help identify risk factors and successful messages and interventions."

Prior studies have found that our decisions are influenced by social norms -- what we perceive others are doing or approve/disapprove of -- and that "informational influence" occurs when people use others' behavior as input for reasonable interpretations and responses. Notably, this effect is stronger when people are uncertain and outcomes are important -- as in during a pandemic.

However, the authors caution that although we are influenced by perceptions of norms, research has shown that our estimates of behavior are frequently inaccurate. For example, people can underestimate the frequency others engage in health-promoting behaviors (e.g., hand washing) and overestimate their unhealthy ones (e.g., not properly covering one's mouth when coughing). In order to most effectively change behaviors by correcting misperceptions, the authors point to the importance of public messages that reinforce health-promoting norms (e.g., social distancing and hand-washing) and not highlighting extreme or uncommon behaviors, such as panic buying or young adults gathering.

Stress and Coping

Public health experts have said that one of the most vital strategies for slowing the spread of COVID-19 is "social distancing" -- a practice that, while beneficial, "clashes with the deep-seated human instinct to connect with others, especially during emotional times," the authors observe. Studies have shown social connection "helps people regulate affect, cope with stress, and remain resilient during difficult times" while other scholarship has revealed that "loneliness and social isolation worsen the burden of stress, and produce deleterious effects on mental, cardiovascular, and immune health."

However, the researchers list ways we can diminish the ill effects of isolation.

One, they advocate replacing the term "social distancing" -- when possible -- with "physical distancing." This change, they say, would "highlight the fact that deep social connection with a broader community is possible even when people are physically apart through the use of technology."

Two, they cite the value of online forums, which have long served as hubs for mutual support -- in particular, among individuals with rare illnesses -- and psychological well-being. Other technologies, such as FaceTime and Zoom, have been found to be valuable in generating empathy and connection.

Van Bavel and Willer recognize potential barriers to these tools for seniors.

"Special attention should be placed on helping older adults -- who might be less familiar with these technologies -- to learn and acclimate to the potential richness of digital connections. COVID-19 will leave many of us confused, anxious, and lonely," they write.

Conclusion

"Urgent action is needed to mitigate the potential devastation of COVID-19, and drawing from existing knowledge can help ensure we are taking constructive steps," Van Bavel says. "In addition, the lessons from past studies should be relevant to future pandemics and other public health crises. Whether policy makers are trying to increase vaccination rates or reduce the harm of climate change, they will be fundamentally facing many of the same issues in the future."

"By applying the knowledge gained from earlier research, we hope that public health experts will be better equipped to communicate effectively and drive behavior change in a manner that yields global benefits," adds Willer.

https://www.sciencedaily.com/releases/2020/04/200430113048.htm

COVID-19: The downside of social distancing

April 24, 2020

Science Daily/Ludwig-Maximilians-Universität München

When faced with danger, humans draw closer together. Social distancing thwarts this impulse. Professor Ophelia Deroy from Ludwigs-Maximilians Universitaet in Munich (LMU) and colleagues argue that this dilemma poses a greater threat to society than overtly antisocial behavior.

The corona crisis presents countries around the globe with what is perhaps the greatest challenge most have faced since the Second World War. For one thing, the virus constitutes a truly global threat. In the absence of a vaccine, our primary defense against it consists in what is now termed 'social distancing' -- minimizing our contacts with others in public spaces. In an essay that appears in the leading journal Current Biology, an interdisciplinary team of authors that includes Professor Ophelia Deroy, who holds a Chair in the Philosophy of Mind at LMU and is affiliated with the Munich Neuroscience Center, underline the dilemma posed by measures designed to promote social distancing. "Hazardous conditions make us more -- not less -- social," Deroy says. "Coping with this contradiction is the biggest challenge we now face."

Seen from this point of view, our current problem lies not in egoistic reactions to the crisis or a refusal to recognize the risks, as images of banks of empty shelves in supermarkets or throngs of strollers in our public parks would have us believe. Deroy and her co-authors Chris Frith (a well-known social neurobiologist based at University College London) and Guillaume Dezecache (a social psychologist at the Université Clermont Auvergne) argue that such scenes are not representative. They emphasize that people instinctively tend to huddle together when faced with an acute danger -- in other words, they actively seek closer social contacts. Studies in the fields of neuroscience, psychology and evolutionary biology have already shown that we are not as egoist as some disciplines think. They continue to produce evidence which demonstrates that threatening situations make us even more cooperative and more likely to be socially supportive than we usually are.

"When people are afraid, they seek safety in numbers. But in the present situation, this impulse increases the risk of infection for all of us. This is the basic evolutionary conundrum that we describe," says Dezecache. The demands now being made by governments to self-isolate and follow social distancing guidelines are fundamentally at odd with our social instincts, and therefore represent a serious challenge for most people. "After all," says Deroy, "social contacts are not an 'extra', which we are at liberty to refuse. They are part of what we call normal." The essay's authors therefore contend that, because social distancing stands in opposition to our natural reaction to impending hazards, our social inclinations -- rather than antisocial reactions to rationally recognized threats -- now risk exacerbating the danger.

How then might we escape from this dilemma? According to Deroy, we need to revise what the Internet can offer. The argument goes as follows. In the pre-pandemic world, the Internet and social media were often looked upon as being decidedly unsocial. But in times like the present, they provide an acceptable and effective alternative to physical contact -- insofar as they enable social interactions in the absence of physical contiguity. Social media make it possible for large numbers of people to reach out virtually to neighbors, relatives, friends and other contacts. "Our innate inclinations are cooperative rather than egoistic. But access to the Internet makes it possible for us to cope with the need for social distancing," says Chris Frith.

"How well, and for how long, our need for social contact can be satisfied by social media remains to be seen," says Deroy. But she and her co-authors do have two important recommendations for policy-makers. First of all, they must acknowledge that the demand for social distancing is not only politically highly unusual : It runs counter to the evolved structure of human cognition. Secondly, nowadays, free access to the Internet is not only a prerequisite for freedom of speech. In the present situation, it is also making a positive contribution to public health. "This is an important message, given that the most vulnerable sections of society are often those who, owing to poverty, age and illness, have few social contacts." https://www.sciencedaily.com/releases/2020/04/200424132539.htm

Troubling connection between workplace pregnancy discrimination and health of mothers, babies

Researcher shares practical steps for managers to combat discrimination

July 7, 2020

Science Daily/Baylor University

Perceived pregnancy discrimination indirectly relates to increased levels of postpartum depressive symptoms for mothers and lower birth weights, lower gestational ages and increased numbers of doctor visits for babies, according to a management study led by Baylor University.

The study -- "Examining the Effects of Perceived Pregnancy Discrimination on Mother and Baby Health" -- is published in the Journal of Applied Psychology.

"Despite being illegal, pregnancy discrimination still takes place in the workplace," said lead author Kaylee Hackney, Ph.D., assistant professor of management in Baylor University's Hankamer School of Business. "Obviously, this is troublesome. Our research highlights the negative impact that perceived pregnancy discrimination can have on both the mother's and the baby's health."

The researchers surveyed 252 pregnant employees over the course of two studies. They measured perceived pregnancy discrimination, perceived stress, demographics and postpartum depressive symptoms. The second study included the measurements of the babies' health outcomes, including gestational age (number of weeks of pregnancy when the baby was delivered), Apgar score (heart rate, respiration, muscle tone, reflex response and color), birth weight and visits to the doctor.

Sample survey statements and questions used to measure perceived discrimination, perceived stress and postpartum depressive symptoms included: "Prejudice toward pregnant workers exists where I work," "In the last month, how often have you felt nervous or stressed?" and "I am so unhappy that I cry." Mothers also logged their babies' health outcomes.

"I think the biggest surprise from this research is that pregnancy discrimination not only negatively impacted the mother, but also negatively impacted the baby she was carrying while experiencing the discrimination," Hackney said. "This just shows the far-reaching implications of workplace discrimination and highlights the importance of addressing it."

More than 50,000 discrimination claims in a decade

The study noted that over the last decade, more than 50,000 pregnancy discrimination claims were filed with the Equal Employment Opportunity Commission and Fair Employment Practices Agencies in the United States.

Pregnancy discrimination is defined as unfavorable treatment of women at work due to pregnancy, childbirth or medical conditions related to pregnancy or childbirth, Hackney said. Pregnant women perceive discrimination when they experience subtly hostile behaviors such as social isolation, negative stereotyping and negative or rude interpersonal treatment.

Examples might include lower performance expectations, transferring the pregnant employee to less-desirable shifts or assignments or inappropriate jokes and intrusive comments.

Practical steps for managers

Given that pregnancy discrimination led to adverse health outcomes through increased stress, the researchers believe managers are in a unique position to provide the support that pregnant employees need to reduce stress.

Some steps managers might take include:

• Providing flexible schedules

• Keeping information channels open and the employee in the loop, specifically with regards to work-family benefits and expectations leading up to leave/returning from leave

• Accommodating prenatal appointments

• Helping to plan maternity leave arrangements

• Normalizing breastfeeding in the workplace

"Overall, I would suggest that managers 1) strive to create a workplace culture where discrimination does not take place and 2) not make assumptions about what pregnant employees want," Hackney said. "The best approach would be to have an open dialogue with their employees about what types of support are needed and desired."

Healthcare partnerships

In addition, Hackney said the findings suggest that healthcare organizations may find opportunities to provide guidance and outreach to workplaces to help pregnant workers reduce stress via reduced pregnancy discrimination and enhanced work-family support for pregnant women.

Some steps may include training managers to be more family supportive and less biased against expectant mothers, she said.

https://www.sciencedaily.com/releases/2020/07/200707120650.htm

Control over work-life boundaries creates crucial buffer to manage after-hours work stress

June 25, 2020

Science Daily/University of Illinois at Urbana-Champaign, News Bureau

Workers with greater boundary control over their work and personal lives were better at creating a stress buffer to prevent them from falling into a negative rumination trap, says a new study by experts who study occupational stress and employee well-being.

When work intrudes after hours in the form of pings and buzzes from smartphone alerts, it can cause spikes of stress that lead to a host of adverse effects for workers, including negative work rumination, poor affect and insomnia.

But according to research co-written by a team of researchers at the University of Illinois at Urbana-Champaign who study occupational stress and employee well-being, those who have greater "boundary control" over their work and personal lives were better at creating a stress buffer that helped protect them from falling into a negative-rumination trap.

Information communication technologies such as smartphones and tablets enable employees to work anywhere and anytime, thereby blurring work and nonwork boundaries. But that convenience comes at the expense of increased stress and mental health woes for workers unless they have control over the boundaries between work and nonwork life, said YoungAh Park, a professor of labor and employment relations at Illinois.

"Most people simply can't work without a smartphone, tablet or laptop computer," she said. "These technologies are so ubiquitous and convenient that it can lead some people to think that employees have to be always on or always available. Clearly, this kind of after-hours intrusion into the home or personal life domain is unhealthy, and our research shows that an always-on mentality has a big downside in the form of increased job stress."

In the study, Park and co-authors surveyed more than 500 full-time public school teachers in grades K-6 to measure their off-the-clock work intrusion via technologies on a weekly basis for five consecutive weeks.

"We asked about their weekly work intrusion involving technology, specifically their after-hours work -- whether they were expected to respond to work-related messages and emails immediately, and whether they were contacted about work-related issues after hours," she said.

The researchers found that teachers' adoption of technological boundary tactics such as keeping work email alerts turned off on smartphones was related to lower perceptions of the weekly work intrusion.

The study builds on recent scholarship on how coping with off-hours occupational demands is becoming an increasingly important issue for workers, said Yihao Liu, a professor of labor and employment relations at Illinois and a co-author of the study.

"Managing your work-life balance through boundary control is not only helpful for you and your family, it also could be a benefit for your co-workers, because they also have to potentially read and respond to the back-and-forth messages that people are sending after the workday is done," he said. "Setting a good boundary between work and regular life is going to help more people and more stakeholders. Overall, it's critical that individuals manage their work-life boundaries for their own health and well-being, but also for their own productivity and their colleagues' productivity."

Moreover, the researchers found that teachers' boundary control softened the work intrusion-negative rumination link and that this boundary control was an important mechanism by which two "border keepers" -- principals, who effectively functioned as supervisors in the study; and parents, who could be thought of as clientele -- can affect teachers' weekly stress experiences.

In other words, the weekly strain symptoms involving work intrusion can be alleviated by a supervisor who supports employees' work-life balance, Park said. Or conversely, it can be aggravated by clientele who expect employees to be always accessible and available.

"A really important point around the sense of boundary control is that stakeholders can influence employees' control," she said. "Our study suggests that school principals can play a positive role in that their support for work-life balance was associated with the teachers' greater sense of boundary control. When you have supportive leaders who model behaviors for work-life balance and work effectively with employees to creatively solve work-life conflicts, that translates into less stress for teachers through boundary control."

Although the study only included elementary school teachers in its sample, the findings about drawing clear boundaries after work ought to apply to most workers, especially now that more are working remotely due to the COVID-19 pandemic, the researchers said.

"Our initial motivation was to study teachers because we tend to assume that their work and nonwork lives are separate and distinct," Park said. "Teachers have set schedules in a physical building, along with discrete blocks of free time over the weekends. But even with this working population, we found that after-hours work intrusion via technology can be really stressful for them. So although this finding is particular to teachers, a class of employees who we tend to assume have clear work-life boundaries, it's now an issue for everyone who is electronically tethered to their work after regular hours."

https://www.sciencedaily.com/releases/2020/06/200625122734.htm

Elite gamers share mental toughness with top athletes

June 11, 2020

Science Daily/Queensland University of Technology

In one of the first studies to investigate mental toughness and stress and coping in high performing esports athletes, researchers have found similarities to traditional elite athletes.

High performing esports professionals may require the same mental stamina it takes to be a top Olympian, according to latest QUT research.

A new study, published in Frontiers in Psychology, indicated an overlap between the mental toughness and stress-coping processes in traditional sports and competitive esports athletes.

• Competitive esports athletes appear to cope with stressors similarly to high-performing sports athletes

• esports players with higher ranks tended to have higher levels of mental toughness

• sports psychology interventions for high-performing sports athletes may also be beneficial to competitive esports athletes.

QUT esports researcher Dylan Poulus said 316 esports players aged 18 and over were studied from among the top 40 per cent of players.

"A disposition considered to be influential in sporting success is mental toughness and it appears to be important for success in esports," Mr Poulus said.

"To be a millionaire esports gamer you deal with stress similar as if you are getting ready to go to the Olympics.

"It is one of the fastest growing sports in the world, and with the coronavirus pandemic there has been huge interest."

The study used athletes who played Overwatch, Counter-Strike: Global Offensive, Rainbow Six: Siege, Defence of the Ancients 2 and League of Legends competitively.

Events can draw more than 60 million online views.

Mr Poulus said the study identified some of the mental skills required for optimal performance among gamers, including high levels of mental toughness, emotional control, and life control.

"Similar to traditional sports athletes, esports athletes with higher mental toughness employed more problem-focused coping strategies which aided in their success," he said.

However, the findings also showed how esports athletes with high mental toughness employed emotion-focused coping strategies like acceptance coping.

"By accepting the elements of their game that are beyond their control could lead to better performance," Mr Poulus said.

"Everything we see in sports psychology interventions that work with traditional sports is likely going to work with esports athletes."

Mr Poulus is completing his PhD at QUT's Faculty of Health school of Exercise and Nutrition Sciences.

The research, titled Stress and Coping in Esports and the Influence of Mental Toughness, was co-authored by Michael Trotter, Dr Tristan Coulter and Professor Remco Polman.

This study was one of the first studies to investigate mental toughness and stress and coping in performing esports athletes.

Further research is investigating what specifically causes stress to high performing esports athletes.

https://www.sciencedaily.com/releases/2020/06/200611104801.htm

Exposure to air pollution impairs cellular energy metabolism

June 15, 2020

Science Daily/University of Eastern Finland

Exposure to air particulate matter impairs the metabolism of olfactory mucosal cells, according to a recent study from the University of Eastern Finland. The results can contribute to a better understanding of how air pollutants may harm brain health, as the olfactory mucosa can act as a key pathway to the brain.

In the last decade, the adverse effects of ambient air pollutants, including particulate matter, on the central nervous system is increasingly reported by epidemiological, animal and post-mortem studies. Exposure to air pollutants has been associated with neurodegenerative disorders, among other things. The association of air pollutant exposure with deteriorating brain health is speculated to be driven by particulate matter entry via the olfactory mucosa, a neural tissue located at the upper part of the nasal cavity. The olfactory mucosa consists of a mixture of diverse cell types that are important for the sense of smell, as the only neural tissue outside of the brain. It acts as a first line of defence against inhaled agents, including air pollutants. How air pollutant exposure affects this key brain entry site remains elusive.

The original research article published in Particle and Fibre Toxicology by the research group of Associate Professor Katja Kanninen from the University of Eastern Finland, sheds light on how exposure to particulate matter impacts the function of the human olfactory mucosa. The study was carried out with a new cellular model based on primary human olfactory mucosal cells.

Using sophisticated functional measurements and transcriptomic analyses, the researchers found that particulate matter exposure causes critical impairment in the metabolism of olfactory mucosal cells. These functions of mitochondria, the cellular organelles responsible for energy production, are disturbed by air pollutants. The researchers also identified the mitochondria-targeted NPTX1 gene, which has been shown previously to be associated with brain disorders, as a key driver of mitochondrial dysfunction upon particulate matter exposure.

According to Associate Professor Kanninen, the research carried out at the University of Eastern Finland may provide important insight into the effects of harmful environmental agents on the brain.

"Given the importance of the nasal cavity as a potential gateway to the brain by particles and external invaders, I believe that more studies should focus on discovering how exposure to environmental agents and factors affects the olfactory mucosa. This may one day lead to new ways of limiting the adverse health effects of airborne particle exposure," Associate Professor Kanninen notes.

https://www.sciencedaily.com/releases/2020/06/200615100929.htm

Vision and balance issues are common in elementary school-age children with a concussion

June 4, 2020

Science Daily/Children's Hospital of Philadelphia

Head injuries that lead to concussions can happen at any age, and children impacted by concussions have different needs and recovery patterns. In a new study, researchers at Children's Hospital of Philadelphia (CHOP) have performed the most comprehensive characterization of elementary school-age concussions to date, revealing an opportunity to improve outcomes for this age group through more consistent visio-vestibular assessments at the initial health care visit. The findings were published today in the Journal of Pediatrics.

Many recent studies on pediatric concussions have focused on adolescent athletes, leading to changes in how clinicians diagnose and actively manage their concussions. But little is known about delivery of clinical care for young children with concussion who are different developmentally and in their goals for recovery than older youth.

"Since one-third of pediatric and adolescent concussion injuries occur in elementary school-age children, we set out to provide a comprehensive description of children ages 5-11 years who were diagnosed with concussion to pinpoint opportunities to improve the quality of diagnosis and care for this age group," said lead author Christina L. Master, MD, a sports medicine pediatrician at CHOP, a senior fellow at the Center for Injury Research and Prevention (CIRP), and Co-Director of the CHOP's Minds Matter Program.

The Minds Matter team collaborated with colleagues from with the U.S. Centers for Disease Control and Prevention (CDC), utilizing CHOP's single, linked electronic health records (EHR) system to analyse retrospective data on more than 1,500 patients ages 5-11 years and diagnosed with a concussion over a recent one-year period.

The study found that vision and balance issues were as common in this population as they are in adolescents. However, specific visio-vestibular assessments were not consistently performed at the time of diagnosis. In particular, these assessments occurred much less frequently outside of specialty care practices. Initial visits were evenly split between a primary care physician (49%) and an emergency department or urgent care (49%), with the remaining 2.1% seen in specialty care first, although it's important to note that 24.7% of all patients saw a specialist at some point in their care. Additionally, 21% of patients saw a school nurse, highlighting the important role nurses play in the identification and proper monitoring and management of these patients.

Approximately two-thirds of patients in this study (66.1%) self-reported visio-vestibular problems. Overall, 74.3% of patients had a visio-vestibular assessment at some point in their care and among these patients, 62.7% had identifiable deficits.

When it comes to providing concussion recovery planning to families, less than half (43.8%) of all concussed patients were provided with a letter recommending school accommodations, such as taking breaks for symptoms, extra time for assignments, or use of larger print or audio books. The vast majority (95%) of patients seen only in the emergency department were not provided with a letter for school accommodations.

In total, 56.2% of patients received documentation of clearance to return to play or recreational activities. While this may represent the proportion of children participating in organized sports, virtually all of these children are returning to physical activity of some type, like free play or gym class, and therefore all concussed children in this age group would benefit from guidance on how to return to physical activity.

"Children ages 5 to 11 years diagnosed with a concussion had similar rates of visio-vestibular deficits to adolescents and we know that adolescents who have visio-vestibular deficits also have a greater likelihood of persistent symptoms and poorer outcomes," Master said. "Our older youth really benefit from early intervention in the form of school accommodations, return to school and physical activity plans, and vestibular or vision therapy. We believe intervening early can also improve outcomes for younger children diagnosed with visio-vestibular deficits."

Master and her co-authors recommend that clinicians conduct visio-vestibular assessments at the initial health care visit and let the results guide the next steps for concussion management, such as providing a letter or discharge instructions specifying targeted school accommodations, return to physical activity plans and referrals to specialists for patients who have deficits and are therefore at risk of persistent symptoms and longer recovery times. Additionally, the researchers stressed the need to develop proper clinical support tools that aid clinicians in closing the gap to improve early identification and management of these deficits for younger children who have suffered concussions.

https://www.sciencedaily.com/releases/2020/06/200604095626.htm

Study ties stroke-related brain blood vessel abnormality to gut bacteria

June 4, 2020

Science Daily/NIH/National Institute of Neurological Disorders and Stroke

In a nationwide study, NIH funded researchers found that the presence of abnormal bundles of brittle blood vessels in the brain or spinal cord, called cavernous angiomas (CA), are linked to the composition of a person's gut bacteria. Also known as cerebral cavernous malformations, these lesions which contain slow moving or stagnant blood, can often cause hemorrhagic strokes, seizures, or headaches. Current treatment involves surgical removal of lesions when it is safe to do so. Previous studies in mice and a small number of patients suggested a link between CA and gut bacteria. This study is the first to examine the role the gut microbiome may play in a larger population of CA patients.

Led by scientists at the University of Chicago, the researchers used advanced genomic analysis techniques to compare stool samples from 122 people who had at least one CA as seen on brain scans, with those from age- and sex-matched, control non-CA participants, including samples collected through the American Gut Project. Initially, they found that on average the CA patients had more gram-negative bacteria whereas the controls had more gram-positive bacteria, and that the relative abundance of three gut bacterial species distinguished CA patients from controls regardless of a person's sex, geographic location, or genetic predisposition to the disease. Moreover, gut bacteria from the CA patients appeared to produce more lipopolysaccharide molecules which have been shown to drive CA formation in mice. According to the authors, these results provided the first demonstration in humans of a "permissive microbiome" associated with the formation of neurovascular lesions in the brain.

Further analysis showed that some gut bacteria compositions could identify aggressive versus non-aggressive forms of the disease as well as those with recent symptomatic hemorrhages. Also, for the first time, they showed how combining gut bacteria data with results from blood plasma tests might help doctors better diagnose the severity of a brain disorder. The results, published in Nature Communications, support a growing body of evidence for the role of gut bacteria in brain health.

https://www.sciencedaily.com/releases/2020/06/200604095640.htm

Nitrous oxide may bring relief to veterans suffering from PTSD

July 7, 2020

Science Daily/University of Chicago Medical Center

A small pilot study provides an early glimpse of how some veterans struggling with PTSD may benefit from one simple, inexpensive treatment involving nitrous oxide, commonly known as laughing gas.

For military veterans suffering from post-traumatic stress disorder (PTSD), symptoms such as anxiety, anger and depression can have a devastating impact on their health, daily routine, relationships and overall quality of life.

A new pilot study by the University of Chicago Medicine and the Stanford University School of Medicine team from the VA Palo Alto Health Care System (principal investigators Carolyn Rodriguez, MD, and David Clark, MD, PhD) provides an early glimpse of how some of these veterans may benefit from one simple, inexpensive treatment involving nitrous oxide, commonly known as laughing gas.

"Effective treatments for PTSD are limited," said anesthesiologist Peter Nagele, MD, chair of the Department of Anesthesia & Critical Care at UChicago Medicine and co-author of the paper. "While small in scale, this study shows the early promise of using nitrous oxide to quickly relieve symptoms of PTSD."

The findings, based on a study of three military veterans suffering from PTSD and published June 30 in the Journal of Clinical Psychiatry, could lead to improved treatments for a psychiatric disorder that has affected thousands of current and former members of the U.S. military.

For this new study, three veterans with PTSD were asked to inhale a single one-hour dose of 50% nitrous oxide and 50% oxygen through a face mask. Within hours after breathing nitrous oxide, two of the patients reported a marked improvement in their PTSD symptoms. This improvement lasted one week for one of the patients, while the other patient's symptoms gradually returned over the week. The third patient reported an improvement two hours after his treatment but went back to experiencing symptoms the next day.

"Like many other treatments, nitrous oxide appears to be effective for some patients but not for others," explained Nagele, who is himself a veteran of the Austrian Army and grateful to have identified an opportunity to help other veterans. "Often drugs work only on a subset of patients, while others do not respond. It's our role to determine who may benefit from this treatment, and who won't."

Nagele is a pioneer in the field of using nitrous oxide to treat depression. Most commonly known for its use by dentists, nitrous oxide is a low-cost, easy-to-use medication. Although some patients may experience side effects like nausea or vomiting while receiving nitrous oxide, the reactions are temporary.

Exactly how and why nitrous oxide relieves symptoms of depression in some people has yet to be fully understood. Most traditional antidepressants work through a brain chemical called serotonin. Nitrous oxide, like ketamine, an anesthetic that recently received FDA-approval in a nasal spray form to treat major depression, works through a different mechanism, by blocking N-methyl-D-aspartate (NMDA) receptors.

A 2015 landmark study by Nagele found that two-thirds of patients with treatment-resistant depression experienced an improvement in symptoms after receiving nitrous oxide.

For his next study, Nagele is researching the ideal dose of nitrous oxide to treat intractable depression. Study participants with treatment-resistant depression received different doses of nitrous oxide so that Nagele and his team could compare each dose's effectiveness and side effects. The study is being funded by the Brain & Behavior Research Foundation.

"Does nitrous oxide help veterans with post traumatic stress disorder" was funded by the VA Office of Research and Development Clinical Science Research & Development Service.

https://www.sciencedaily.com/releases/2020/07/200702113647.htm

How experiencing traumatic stress leads to aggression

Strengthened amygdala pathways increase aggression, may be targets for PTSD treatment

May 18, 2020

Science Daily/Society for Neuroscience

Traumatic stress can cause aggression by strengthening two brain pathways involved in emotion, according to research recently published in JNeurosci. Targeting those pathways via deep brain stimulation may stymie aggression associated with post-traumatic stress disorder.

The consequences of traumatic stress linger long after the stress ends. People suffering from post-traumatic stress disorder often display heightened aggression, caused by unknown changes in the amygdala. An almond-shaped structure nestled deep inside the brain, the amygdala plays an essential role in emotion, social behaviors, and aggression.

Nordman et al. examined how different amygdala circuits changed in male mice after traumatic stress. Two connections strengthened, resulting in more attacks on other mice: the circuitry connecting the amygdala to the ventromedial hypothalamus and the bed nucleus of the stria terminalis. The former modulates the frequency of attacks, while the latter controls the length of attacks. The research team then used low frequencies of light to stop the pathways from strengthening, preventing an increase in aggressive behavior. Deep brain stimulation may elicit the same effect in humans.

https://www.sciencedaily.com/releases/2020/05/200518145022.htm