Men with early and curable stages of prostate cancer miss opportunities for cancer detection, because of media health campaigns and national guidelines that focus on urinary symptoms, experts at the University of Cambridge in the United Kingdom said.

Despite a lack of evidence that links prostate cancer and urinary symptoms, many continue to promote this link, according to investigators.

, investigators said that this link could deter men from coming forward for earlier testing and detection of potentially treatable cancer.

“When most people think of the symptoms of prostate cancer, they think of problems with peeing or needing to pee more frequently, particularly during the night,” Vincent Gnanapragasam, professor of urology at the University of Cambridge, said in a statement. “This misperception has lasted for decades, despite very little evidence, and it’s potentially preventing us picking up cases at an early stage.”

Screening programs can detect cancers at early stages. However, in the case of prostate cancer, some contend that these programs could potentially overwhelm health services and cause individuals to be treated for benign disease.

Testing includes a blood test that looks for a prostate-specific antigen (PSA) that is made only in the prostate gland, though this is not always accurate, according to investigators.

PSA density has been shown to be significantly more accurate than PSA alone.

Evidence shows that there is a misconception that prostate cancer is always symptomatic, with a previous study citing that 86% of the public associated prostate cancer with symptoms, and just 1% were aware that it could be asymptomatic, investigators said.

“We need to emphasize that prostate cancer can be a silent or asymptomatic disease, particularly in its curable stages. Waiting out for urinary symptoms may mean missing opportunities to catch the disease when it’s treatable,” Gnanapragasam said in the statement.

“Men shouldn't be afraid to speak to their [physicians] about getting tested and about the value of a PSA test, especially if they have a history of prostate cancer in their family or have other risk factors, such as being of Black or mixed Black ethnicity,” he said.

Individuals are not advocating for immediate screening programs, investigators said.

They also acknowledged that changes in messaging could mean more men approaching their physicians for a PSA test, which they said could potentially result in unnecessary treatment.

However, they also said there are ways to reduce the risk of this happening, including the use of algorithms to assess an individual’s risk and whether they need to be referred to a specialist and for those who are referred, MRI scans could help rule out mild disease or negative findings.

“If men were aware that just because they have no symptoms doesn’t necessarily mean they are cancer-free, then more might take up offers for tests. This could mean more tumors identified at an earlier stage and reduce the numbers of men experiencing late presentation with incurable disease,” Gnanapragasam said.

Prostate cancer cases risk being detected too late due to misleading focus on urinary problems. News release. ScienceDaily. August 3, 2022. Accessed August 10, 2022. https://www.sciencedaily.com/releases/2022/08/220803203926.htm

Articles

Men with early, curable stages of the disease are missing opportunities for detection, according to an analysis by investigators at the University of Cambridge.

Prostate Cancer Cases Risk Late Detection Because of Misguided Focus on Urinary Problems 

Retaining staff and facility administrators in long-term care facilities continues to be challenging after the height of the COVID-19 pandemic, despite the importance of care continuity for patients, according to researchers.

The pandemic exacerbated and drew attention to staffing challenges for nursing home residents, their families, and other health care workers in long-term care environments. Further, recruiting and retaining staff have become significant challenges in recent years.

Researchers from the Regenstrief Institute and Indiana University School of Medicine noted that continuity of staff and leadership has been associated with improving quality of resident care in long-term care facilities, including onsite treatment, post-hospital care, assistance with basic care needs, and more. To discuss the issue further, researchers Jennifer L. Carnahan, MD, MPH, and Kathleen Unroe, MD, MHA, wrote an editorial published in the 

Journal of the American Geriatrics Society.

According to Carnahan and Unroe, building trust between patients, their families, and long-term care staff allows residents to feel comfortable with the very personal care that they receive. In addition to focusing on tasks, caregivers in such environments must know and interact personally with residents.

In addition to impacting the trust with patients, staff turnover can affects patients’ families as well. Family members rely on staff to care for their loved ones and keep them apprised of changes to their family members’ health and lifestyle. Changes in patients in long-term care can be subtle, including mood changes, loss of interest in activities, or inability to perform a task that they could previously accomplish, necessitating close attention from long-term care staff.

“Doctors and nurses are obviously important, but it should be recognized that frontline nursing home staff deliver 90% of care and thus are critical to creating a high-quality long-term care system,” Unroe said in a press release. “Everyone agrees we have a recruitment and retention problem. We need to devise incentives to attract and keep people in this workforce who enjoy working with older adults and are well trained, especially in the needs of people with dementia.”

Unroe, a geriatrician and past chair of the American Geriatrics Society Public Policy Committee, currently serves as a member of the technical expert panel of the Centers for the Medicare & Medicaid Services Five-Star Quality Rating System. In the editorial, Unroe said the tool provides more than 100 quality metrics divided into 5 categories: mortality, safety of care, readmission to hospitals, patient experience, and timely and effective care. These measurements allow patients, their families, social services, and others to compare quality of care at facilities.

“We need to prioritize nurturing and supporting staff so that they can deliver the hands-on care nursing home residents require,” Carnahan said in the press release. “Given the importance of continuity to quality of care for this vulnerable population and the current lack of viable solutions to improve staff and leadership recruitment and retention, researchers, in partnership with nursing home operators, must take the lead in developing and testing practical and reproduceable strategies to attract and keep a talented workforce and leadership.”

Staff and facility administrator retention has been challenging for long-term care facilities. News release. Regenstrief Institute; August 4, 2022. Accessed August 10, 2022. 

https://www.regenstrief.org/article/staff-retention-challenging-for-long-term-care-facilities/

Building trust between patients, their families, and long-term care staff allows residents to feel comfortable with the very personal care that they receive.



Staff Retention Continues to Be Challenging in Long-Term Care Facilities

Excessive heat during the night may interrupt the normal physiology of sleep and have a predicted climate-change related mortality risk on a global scale, according to the authors of a study from the UNC Gillings School of Public Health.

Less sleep due to heat can lead to immune system damage and a higher risk of cardiovascular disease, chronic illnesses, inflammation, and mental health conditions. Additionally, results showed that the average intensity of hot night events will nearly double by 2090 across 28 cities in east Asia, which will increase the burden of disease due to excessive heat that can disrupt normal sleeping patterns.

The findings of the study also demonstrated that the burden of mortality could be significantly higher than previously estimated due to the lack of consideration regarding the impact of average daily temperature increases on mortality estimates.

“The risks of increasing temperature at night were frequently neglected,” said study co-author Yuqiang Zhang, PhD, a climate scientist in the Department of Environmental Sciences and Engineering at the Gillings School, in a press release. “However, in our study, we found that the occurrences of hot night excess (HNE) are projected to occur more rapidly than the daily mean temperature changes. The frequency and mean intensity of hot nights would increase more than 30% and 60% by the 2100s, respectively, compared with less than 20% increase for the daily mean temperature.”

During the study, the research team estimated mortality rates due to excess heat in 28 cities in China, South Korea, and Japan between 1980 and 2015 and applied it to 2 climate change modeling scenarios that aligned with carbon-reduction models adapted by each city’s respective national government.

Between the years 2016 and 2100, the team estimated the risk of death from excessively hot nights increased nearly 6-fold.

“From our study, we highlight that, in assessing the disease burden due to non-optimum temperature, governments and local policymakers should consider the extra health impacts of the disproportional intra-day temperature variations. A more complete health risk assessment of future climate change can help policymakers for better resource allocation and priority setting,” corresponding study author Haidong Kan, PhD, a professor at Fudan University in China, said in the press release.

Further, the study authors found that regional differences in temperature accounted for many of the variances in nighttime temperature, and areas with the lowest average temperature were projected to have the largest warming potential.

“To combat the health risk raised by the temperature increases from climate change, we should design efficient ways to help people adapt,” Zhang said in the press release. “Locally, heat during the night should be taken into account when designing the future heatwave warning system, especially for vulnerable populations and low-income communities who may not be able to afford the additional expense of air conditioning. Also, stronger mitigation strategies, including global collaborations, should be considered to reduce future impacts of warming.”

Risk of death rises as climate change causes nighttime temperatures to climb. UNC Gillings School of Global Public Health; August 8, 2022. Accessed August 9, 2022. 

https://sph.unc.edu/sph-news/risk-of-death-rises-as-climate-change-causes-nighttime-temperatures-to-climb/

The study authors found that regional differences in temperature accounted for many of the variances in nighttime temperature.

Study: Climate Change Predicted to Cause Increase in Mortality Rate of More Than 60% by 2100s

Researchers discovered hundreds of links between the cultural ecosystem services (CESs) of nature and human wellbeing, identifying contributions that could be used in future policy for real-world impact.

CESs are the nonmaterial benefits that humans receive from nature. Current studies on CESs make it difficult to explore any patterns or commonalities of their effects on wellbeing. This research is often fragmented by method, measurement, demographic, or place.

Lam Huynh, a PhD candidate in Sustainability Science at the University of Tokyo, gathered a team to capture a “big-picture” view of CESs and wellbeing. The team performed a systematic literature review of 301 academic articles that identified hundreds of links between the intangible benefits of nature on human health.

"We identified 227 unique linkages between a single CES (such as recreation or aesthetic value) and a single constituent of human wellbeing (such as connectedness, spirituality, or health). We knew that there are many linkages, but we were surprised to find quite so many of them," explained Huynh in the press release. "Then, through further critical reading, we could identify major commonalities."

Underlying these 227 unique links are 16 mechanisms, or ways in which a person’s interaction with nature affects their wellbeing, according to Huynh. Specifically, “cohesive," "creative," and "formative" mechanisms facilitated positive interactions with nature, while "irritative" and "destructive" mechanisms facilitated negative ones.

Based on the researchers’ analysis, the degradation or loss of CESs contributed to worse wellbeing, as well as annoying wildlife noises, which were found to negatively impact some people’s mental health. Conversely, “recreation,” “tourism,” and “aesthetic value” were CESs that contributed significant positive affects on mental and physical health.

"It is particularly interesting to note that the identified pathways and mechanisms, rather than affecting human wellbeing independently, often interact strongly," co-author Alexandros Gasparatos, PhD, an associate professor at the Institute for Future Initiatives (IFI) at the University of Tokyo, said in the press release. "This can create negative trade-offs in some contexts, but also important positive synergies that can be leveraged to provide multiple benefits to human wellbeing."

However, the research team noted that they still may not have found all the links between nature and wellbeing. They acknowledged the possibility that there are missing pathways among traditional and indigenous communities and their independent relationships with nature.

Huynh also explained that there is a knowledge gap in existing literature on the individual’s relationship with nature and personal wellbeing. This could make it hard to identify trade-offs in ecosystem management research and practice.

Having received a grant, Huynh and the other members of the research team will study CESs and human wellbeing in urban spaces in Tokyo next.

"This project is a logical follow-up to test whether and how some of the identified pathways and mechanisms unfold in reality and intersect with human wellbeing," Gasparatos said in the press release.

“An improved understanding of nature's many connections to human wellbeing and the underlying processes mediating them, can help policymakers to design appropriate interventions,” study co-author Kensuke Fukushi, PhD, a professor and vice director of the IFI, said in the press release. "Such coordinated action could leverage the positive contributions of these connections and become another avenue to protect and manage ecosystems sustainably.”

The many ways nature nurtures human well-being. University of Tokyo; Aug 5, 2022. Accessed on Aug 9, 2022. 

https://www.sciencedaily.com/releases/2022/08/220805154349.htm

Researchers observed 227 pathways that show how interacting with nature affects human wellbeing.

Study: Researchers Discover ‘Mechanisms’ Underlying Nature’s Influence on Wellbeing

Better mental health for veterans with posttraumatic stress disorder (PTSD) is associated with several factors, including easy care of a service dog and the closeness of the bond between dogs and veterans, according to the results of an analysis from Purdue University.

The findings of the study, conducted by Clare Jensen and colleagues, were published in the open-access journal 

“This study provides new information about how and why service dogs may improve mental health for some veterans with PTSD. We are especially grateful to the military veterans who made this possible by sharing their time and experiences with us,” Jensen, a research assistant in the Department of Comparative Pathobiology at Purdue University’s College of Veterinary Medicine, said in a statement.

Previous research results showed that there was an association between a veteran being paired with a service dog and lower severity of PTSD, though it was unclear why.

To better understand the link, the investigators studied 82 military members or veterans and their service dogs. The dogs were all trained to alleviate PTSD symptoms.

The veterans completed several different surveys shortly before the pairing and again after 3 months together. Investigators used this to make additional observations for the dog-veteran interactions.

First, they analyzed the results of the surveys and records related to personal characteristics of the service dogs and veterans as well as the closeness of the bonds.

The investigators found that most of the dog characteristics were not associated with better or worse veteran mental health outcomes, except for lower dog excitability. This was linked to a closer veteran-dog relationship and lower severity of PTSD symptoms.

Additionally, the investigators probed potential mechanisms that could help alleviate mental health symptoms. To do this, they analyzed the results of observations and surveys that captured dog behavior, training methods, and the use of specific trained tasks.

Better mental health was associated with several factors, including the close bond between the dogs and veterans and perception of easy care for the dog.

The analysis also showed that there was a link between more frequently asking service dogs to initiate the social greeting and worse depression. Additionally, veterans who more frequently asked the dogs to alert them to individuals approaching them from behind were more likely to have greater anxiety but less severe PTSD symptoms.

further research is needed to expand on the findings, investigators said.

This could lead to a better understanding of how to identify veterans who could benefit from service dogs and how to best select and train the dogs.

How service dogs reduce PTSD symptoms: factors and mechanisms. News release. Science Daily. July 27, 2022. Accessed August 1, 2022. https://www.sciencedaily.com/releases/2022/07/220727141337.htm

New analysis highlights factors and mechanisms that underlie the mental health effects for veterans.

Service Dogs Reduce PTSD Symptoms, Study Results From Purdue Show

Individuals aged 63 to 84 years who were exposed to any amount of light while sleeping at night were significantly more likely to be obese, have diabetes, and have high blood pressure compared with adults who were not exposed to any light during the night, according to data from a Northwestern Medicine study.

In the real-world study that was published in 

, investigators used wrist-worn devices to measure and track light exposure over 7 days.

“Whether it be from one’s smart phone, leaving a TV on overnight, or light pollution in a big city, we live among an abundant number amount of artificial sources of light that are available 24 hours of a day,” Minjee Kim, MD, assistant professor of neurology at Northwestern University Feinberg School of Medicine and physician at Northwestern Medicine, said in a statement.“Older adults already are at higher risk for diabetes and cardiovascular disease, so we wanted to see if there was a difference in frequencies of these diseases related to light exposure at night.”.

The study results showed that less than half the 552 individuals in the study consistently had a 5-hour period of complete darkness per day. The rest of the individuals were exposed to some light, even during their darkest 5-hour periods of the day, which were usually in the middle of their sleep.

Because of the nature of the study, investigators did not know if diabetes, hypertension, and obese cause individuals to sleep with the light on or if the light contributed to the development of these conditions.

Individuals with the former conditions may be more likely to use the bathroom with the light on in the middle of the night or may have another reason to keep the light on. For example, an individual with foot numbness related to diabetes might leave the light on to reduce the risk of falling.

Investigators are considering an intervention study to test whether a restoration of natural light-dark cycles improves health outcomes including cognition.

“It’s important for people to avoid or minimize the amount of light exposure during sleep,” Phyllis Zee, MD, PhD, chief of sleep medicine at Feinberg and a Northwestern Medicine physician, said in the statement.

The investigators offered tips to reduce light during sleep, including keeping the lights off or having a dim light on closer to the floor; using amber or red/orange light instead of blue or white light when sleeping; and using blackout curtains or eye masks if needed to reduce the amount of light.

The individuals in the study were enrolled in the Chicago Heart Association Detection project in Industry, a public health program and epidemiologic study conducted to identify individuals at high risk for heart disease in workplaces throughout the Chicago, Illinois, area.

In addition, investigators included a detailed examination of known risk factors for heart disease.

Light during sleep in older adults linked to obesity, diabetes, high blood pressure. EurekAlert. News release. June 22, 2022. Accessed June 30, 2022. https://www.eurekalert.org/news-releases/956625

Study results show that there is a link between leaving the television on, night lights, and smart phones and higher disease rates.

Study: Light During Sleep in Older Adults Is Linked to Diabetes, High Blood Pressure, Obesity

Following a new diagnosis from the World Health Organization (WHO) for complex post-traumatic stress disorder (PTSD), experts have summarized the symptoms and issued guidelines for clinical assessment and treatment.

PTSD is one of the most widely known responses to trauma, characterized by intrusive memories or flashbacks that may overwhelm patients with this condition. However, experts have noted for decades that some trauma survivors exhibit a broader pattern of psychological changes, particularly following prolonged or repetitive events, such as exposure to war, sexual abuse, or domestic violence. This broader group of symptoms is now known as complex PTSD.

According to the authors of the current study, complex PTSD affects up to 8% of the world population, including up to 50% of those who receive treatment in mental health facilities.2 According to data from the US Department of Veterans Affairs, approximately 12 million adults in the United States have PTSD during a given year, including approximately 8% of all women who will have PTSD sometime in their lives, compared to about 4% of all men.

With decades of observational data, many experts have called for the diagnostic requirements for PTSD to be adapted. Earlier in 2022, the WHO issued a new version of its International Classification of Diseases, which now includes a new diagnosis for complex PTSD.

New symptoms, such as self-organization disturbances, were added to the previous symptoms of PTSD, which include flashbacks, nightmares, avoidance, social withdrawal, and hypervigilance. Key features of self-organization disturbances include excessive or heightened emotional responses, feelings of worthlessness, and persistent challenges in sustaining relationships and feeling close to others.

Following this diagnosis, an international team has published a study in 

 describing how to diagnose complex PTSD based on patient symptoms. The study includes descriptions of challenges that may occur, distinct features of complex PTSD in children and adolescents, and the diagnostic differences that need to be made to differentiate between complex PTSD and similar mental health disorders, such as severe depression, bipolar disorders, psychoses, or personality disorders.

The study also covers the latest findings on biopsychosocial correlations based on systematic selection criteria. Furthermore, the researchers analyzed the evidence for all available therapeutic studies and developed guidelines for treating complex PTSD.

“We elaborate how the complex PTSD diagnosis can be made in routine situations in emergency medical facilities and in regions with under-developed health care systems, for example,” first author Andreas Maercker, PhD, MD, said in a press release.

According to the researchers, 2 important goals of their study are to develop assessments for clinical use and to develop psychosocial therapies that could help patients manage or resolve their disorder. Future research should include multifactorial therapies including a focus on safety, psychoeducation, and collaboration between patients and providers, as well as treatment components that include self-regulatory strategies and trauma-focused interventions.

1. New Sibling Diagnosis for Post-Traumatic Stress Disorder. News release. University of Zurich. July 1, 2022. Accessed July 11, 2022. https://www.media.uzh.ch/en/Press-Releases/2022/Trauma.html

2. Maercker A, Cloitre M, Bachem R, Schlumpf Y, et al. Complex post-traumatic stress disorder. 

; July 2, 2022. Accessed July 11, 2022. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00821-2/fulltext

3. PTSD: National Center for PTSD. US Department of Veterans Affairs. Accessed July 11, 2022. 

https://www.ptsd.va.gov/understand/common/common_adults.asp

Complex PTSD is characterized by a broad pattern of psychological changes, particularly following prolonged or repetitive traumatic events.

Researchers Release New Guidelines for Identifying, Treating Patients With New Complex PTSD Diagnosis

When transgender patients pursue gender-affirming facial surgery to treat gender dysphoria, insurers often classify these insurance claims as cosmetic only due to a lack of evidence supporting their medical basis. However, a study conducted by the University of California, Los Angeles (UCLA) provided the first evidence showing the medical basis for gender-affirming facial surgery. Specifically, the surgeries were found to significantly improve quality of life for transgender patients based on psychosocial assessments.

"Access to facial gender-affirming surgeries under health insurance coverage in the United States is more limited than gender-affirming surgeries of other anatomic regions due to a lack of data on mental health quality-of-life outcomes," said the study’s lead author Justine Lee, a Bernard G. Sarnat professor of craniofacial biology and an associate professor of surgery at the David Geffen School of Medicine at UCLA, in a press release. "Our findings have the potential to change health insurance policies for the better for transgender patients."

In order to assess the impact of gender-affirming facial surgery on the quality of life for transgender patients, the researchers compared the results of mental health assessments in 107 patients awaiting facial surgery versus those of 62 patients who had already completed their surgeries, the latter of which were conducted at an average of approximately 6 and a half months following their procedures. Based on the results of this comparison, the researchers found that 7 of 11 patients who had received their gender-affirming facial surgery reported higher scores in their psychosocial health, including in their experience of anxiety, anger, depression, global mental health, positive affect, social isolation, and meaning and purpose.

Based on the data, the researchers observed that gender-affirming facial surgery may be one of the most important procedures in terms of improving the quality of life of patients with gender dysphoria, which is defined as the psychological distress that results from the incongruence between one's sex assigned at birth and one's gender identity, according to the press release.

Notably, the experience of dysphoria was found to be higher among transgender patients who were assigned male at birth, with facial characteristics reported as the most significant source of that dysphoria. Lee explained that in her experience, the majority of patients seeking gender-affirming facial reconstruction are assigned male at birth and identify as either female or nonbinary.

For transgender patients who were assigned male at birth, facial feminization surgery is a procedure they may pursue to support the pursuit of gender-affirming facial characteristics. This type of surgery encompasses procedures that include feminizing the brow bone area, reducing the jaw area, augmenting the cheeks, and reshaping the nose.

Furthermore, the data showed that facial surgery alone was a standalone predictor of higher psychosocial scores among transgender patients, even when considering and adjusting for the effects of factors such as the duration of gender-affirming hormone therapy, whether the patient had undergone previous gender-affirming surgeries, pre-existing mental health diagnoses, and the quality of the patients' social relationships.

"In the future, providers may want to consider incorporating psychosocial assessments over a period of time as a standard of care in the treatment of gender dysphoria," Lee said in the press release.

After facial feminization surgery, transgender people report better psychosocial health. Los Angeles, CA: University of California – Los Angeles Health Sciences; July 6, 2022. Accessed July 12, 2022. 

https://www.sciencedaily.com/releases/2022/07/220706165355.htm

Insurance companies often classify gender-affirming facial surgery as a cosmetic procedure, but a new study provides the first evidence demonstrating the medical basis for transgender patients experiencing gender dysphoria.

Data Show Gender-Affirming Facial Surgery Was a Standalone Predictor of Higher Psychosocial Health Scores in Transgender Patients

Older individuals with untreated sight conditions could be at an increased risk of dementia, according to a new systematic review and meta-analysis of 16 studies involving a total of 76,373 individuals.

, highlights the need for further research to investigate the impact of correcting sight problems in older adults to prevent cognitive problems and dementia, according to the authors.

"This study is among the first to evaluate the association between sight problems and cognitive outcomes in older adults through a comprehensive examination of all available population-based studies in English. Our findings add to the growing evidence that fading eyesight is a risk factor for developing dementia," Beibei Xu, associate professor from the Medical Informatics Center at Peking University, said in a statement. "Although the reasons behind this remain unclear, it suggests that diagnosing and treating eye conditions may be beneficial—both to improve a person's quality of life and also to potentially slow down or stop memory loss.”

The analysis was made up of 5 cross-sectional studies and 11 longitudinal studies published before April 2020. From the studies, investigators examined the relationship between visual impairment and cognitive outcomes.

They found that individuals with a sight problem had an increased risk of cognitive impairment and dementia, regardless of whether their visual impairment was self-reported or diagnosed using objective measures.

Additionally, they found the likelihood of having cognitive impairment was 137% higher among individuals who had a sight problem compared to those who did not. The investigators also found that those who had a sight problem at baseline had a 41% increased risk of developing impairment and a 44% risk of dementia compared to those who did not.

"Finding ways to prevent or delay the onset of dementia could help reduce its devastating impact on the lives of affected individuals and their families, especially in light of the growing burden of the disease. Identifying modifiable risk factors is the first critical step for developing effective interventions to achieve this goal," Xu said in the statement. "Our new results highlight the importance of regular eye examinations for older adults, enabling any potential problems with their vision to be spotted and treated early. They also suggest that any self-reported changes to a person's eyesight should not be ignored.”

The investigators recommend future research to examine the effectiveness of treating sight problems in older adults to prevent cognitive impairment and dementia.

Nearly 1 million individuals are estimated to have dementia in the United Kingdom and is set to increase over the next few decades as the population ages.

According to the statement, it is predicted that individuals living with dementia in the United Kingdom will jump to 1.6 million by the year 2050. Additionally, the cost of dementia is expected to almost double over the same time from £25 billion today to £47 billion in 2050.

Sight problems may increase dementia risk in older adults. Science Daily. June 24, 2022. Accessed June 29, 2022. https://www.sciencedaily.com/releases/2022/06/220624104935.htm

The study highlights the need for further research to investigate the impact of correcting sight problems in older adults to prevent cognitive problems and dementia.

Study: Sight Conditions in Older Adults Associated with Increased Risk of Dementia

New results from a large, prospective study suggest that the presence of dissociation in individuals who experience trauma may indicate a high risk of developing severe post-traumatic stress disorder (PTSD), depression, anxiety, physical pain, and social impairment.

Dissociation is a profound feeling of detachment from one’s sense of self or surroundings, according to the study. Based on these findings, researchers said it is essential to screen for feelings of detachment to identify individuals who may benefit from preventive care.

“Dissociation may help someone cope in the aftermath of trauma by providing some psychological distance from the experience, but at a high cost—dissociation is often linked with more severe psychiatric symptoms,” said lead author Lauren Labois, PhD, in a press release. “Despite this, dissociative symptoms remain under-studied and under-diagnosed due to a relative lack of understanding in medical and clinical practice.”

To understand dissociative reactions, investigators examined data from the Advancing Understanding of Recovery After Trauma (AURORA) Study. The data pertained to 1464 adults treated at 22 different emergency departments across the United States who reported whether they experienced a severe type of dissociation called derealization. Furthermore, 145 of the patients underwent brain imaging during an emotional task. Three months after the survey, the researchers collected follow-up reports of post-traumatic stress, depression, pain, anxiety symptoms, and functional impairment.

The researchers found that patients who reported experiencing derealization tended to have higher levels of post-traumatic stress, anxiety, depression, pain, and functional impairment at the 3-month follow-up. Furthermore, both self-reported survey results and brain imaging results that were indicative of derealization predicted worse PTSD symptoms at the follow-up exam, even after accounting for PTSD symptoms at the start of the study and histories of childhood trauma.

Derealization was also associated with altered activity in certain brain regions detected through brain imaging. These findings underline the importance of screening patients for dissociation-related symptoms following trauma.

“Persistent derealization is both an early psychological marker and a biological marker of worse psychiatric outcomes later, and its neural correlates in the brain may serve as potential future targets for treatments to prevent PTSD,” said senior author Kerry J. Ressler, MD, PhD, in the press release.

These findings could help increase awareness of these symptoms and their potential impacts, according to the study. Lebois said this knowledge could also help clinicians connect more empathetically and communicate thoughtfully with patients.

“These latest findings add to the growing list of discoveries from AURORA to help improve understanding about how to better prevent and treat adverse mental health outcomes after trauma,” Samuel McLean, MD, organizing principal investigator of the AURORA Study, in the press release. “Studies such as AURORA are critical because adverse post-traumatic mental health outcomes cause a tremendous global burden of suffering, and yet historically there have been very few large-scale longitudinal studies evaluating the underpinning neurobiology of these conditions.”

Feelings of Detachment Predict Worse Mental Health Outcomes After Trauma. News release. McLean; June 22, 2022. Accessed July 7, 2022. 

https://www.mcleanhospital.org/news/feelings-detachment-predict-worse-mental-health-outcomes-after-trauma

It is essential to screen for feelings of detachment to identify individuals who may benefit from preventive care.

Study: Dissociation Predicts Worse Mental Health Outcomes After Trauma

Probiotics can support the effect of antidepressants and help alleviate depression, the results of a study from the University of Basel and the University of Psychiatric Clinics Basel (UPK) showed.

Investigators have been researching ways to improve existing therapies and develop new ones for individuals with depression. Medication and psychotherapy can help. However, symptoms persist for some individuals.

It is known from the results of previous studies that individuals with depression show an above-average prevalence of digestive and intestinal problems.

If the intestinal flora of individuals with depression is implanted in mice raised in sterile conditions, then the animals also developed depressive-like behavior, including less energy and a decreased level of interest in their surroundings compared with their peers, investigators said.

The microbiome-gut-brain axis is a promising approach.

The investigators suspected that the composition of the bacterial community in the gut plays an important role in depressive symptoms. They systemically investigated the effects of probiotics on individuals with depression.

All the individuals included in the study were inpatients at UPK and were given a probiotic or a placebo, for 21 and 26individuals, respectively, for 31 days, in addition to antidepressants. The participants nor the study staff members knew which preparation the individuals were taking throughout the study period.

Investigators carried out a series of tests on the individuals immediately before treatment, at the end of the 31 days, and again 4 weeks later.

They found that the composition of their intestinal flora changed, at least temporarily. In the probiotic group, an analysis of stool samples showed an increase in lactic acid bacteria at the end of the treatment, an effect that was accompanied by a reduction in depressive symptoms.

However, they found that the levels of these health-promoting gut bacteria decreased over the following 4 weeks.

“It may be that 4 weeks of treatment is not long enough and that it takes longer for the new composition of the intestinal flora to stabilize,” Anna-Chiara Schaub, MSc, 1 of the lead authors of the study from UPK, said in a statement.

Additionally, the investigators found that the effect of taking probiotics was seen in relation to brain activity using magnetic resonance imaging when viewing fearful or neutral faces. In individuals with depression, certain brain regions for emotional processing behave differently than in individuals who have good mental health.

After 4 weeks of probiotics, they found that the brain activity normalized in the probiotic group but not in the placebo group.

:With additional knowledge of the specific effect of certain bacteria, it may be possible to optimize the selection of bacteria and to use the best mix in order to support treatment for depression,” Schaub said.

The investigators think that it is important to use a wide range of bacteria in the form of probiotics. They also emphasized that probiotics are not suitable as sole treatment for depression.

'Good' bacteria to tackle depression. Science Daily. News release. June 9, 2022. Accessed June 23, 2022. https://www.sciencedaily.com/releases/2022/06/220609155718.htm

Results of analysis confirm that intestinal flora play an important role in health, including mental health.

Study: Probiotics Can Support Effects of Antidepressants and Help Alleviate Depression

 interviewed April Kapu, RN, a professor at Vanderbilt University; acute care nurse practitioner based in Nashville, TN; and president of the American Association of Nurse Practitioners (AANP), on the future of the nurse practitioner workforce amid growth in the field and simultaneous extreme fatigue and stress among health care workers.

. Joining me is April Kapu, RN, a Vanderbilt professor; acute care nurse practitioner based in Nashville, TN; and president of the American Association of Nurse Practitioners, or AANP, which represents over 350,000 nurse practitioner, who is here to discuss the future of the nurse practitioner workforce amid simultaneous growth in the field and extreme fatigue and stress among health care workers following the COVID-19 pandemic.

So what is the future of the nurse practitioner workforce amid ongoing challenges relating to burnout and extreme fatigue and stress?

 I think that's an excellent question. We know that we are growing at a rate of 9% to 10% per year, and that our growth rate in the upcoming years will continue because nurse practitioners are in high demand.

We've shown that we provide very high quality, very valuable, and vital health care services to everyone everywhere, [and] we've increased access to care. Especially in those states that I had mentioned that have full practice authority, we've seen in those states the workforce increase, we've seen more access, more NPs moving to rural areas. Nebraska alone—when they moved to full practice authority, 25 of their counties that had historically been known as provider shortage areas, 25 of those counties saw an increase in nurse practitioners moving to rural areas. So this is substantial.

In order to keep our workforce supported and growing and meeting those needs, we need states to update their laws so nurse practitioners can practice to the full extent of their education and training. We mentioned mental health and the health and wellbeing of nurse practitioners, we can fall to the ‘Future of Nursing’ report 2020 to 2030—recommendation number 3 [is] we need to support the health and wellbeing of our nursing workforce, so that they can achieve all that is important to providing health care for healthy lives for everyone everywhere. Health equity is huge, understanding social determinants of health, access to care—these are very important matters in the future in the direction of nursing and all of health care, and to do that we need to support the health and wellbeing of our caregivers and surround them with infrastructures and support that destigmatize mental health services that support mental health and all those things that we had talked about earlier.

 Kind of looking beyond that to the nurse practitioner workforce more broadly speaking, what is your outlook on the future based on your work supporting nurse practitioners at AANP?

 So the American Association of Nurse Practitioners—we are the largest nurse practitioner organization in the world. It's a member-driven organization, so it's members speaking up and voicing what their needs are for their practice. So we have lots of practice tools to support voicing their needs in terms of education. We have workshops, online courses, continuing education, conferences, journals—so many different ways for nurse practitioners to immediately access education—podcasts—lots, and lots of ways to immediately have access to education and advocacy—we have an amazing state and federal advocacy team.

For research—not often do we mention how engaged AANP is in research to better patient care outcomes, but also to continually demonstrate our impact to health care and continually demonstrate the quality outcomes of NP practice.

Then leadership—we have so many opportunities for NPs to take different paths to lead. They want to be more of an executive leader, if they want to lead in health policy, if they want to lead more in the educational realm. We have lots and lots of resources to help develop those relationship skills. So a lot of resources for support and much of this is just really driven by the voice of our members.

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April Kapu, RN, president of the American Association of Nurse Practitioners (AANP), discusses the future of the nurse practitioner workforce amid ongoing challenges relating to burnout and extreme fatigue and stress.

Future of Nurse Practitioner Workforce During Ongoing Burnout, Extreme Fatigue, Stress

New research has found strong evidence that dispatching mental health professionals instead of police officers to some nonviolent 911 emergencies could have significant benefits.

Researchers at Stanford studied a pilot 911 response program in Denver, Colorado, in which mental health specialists responded to calls involving trespassing and other nonviolent events. According to the study results, researchers found a 34% decrease in reported crimes during the 6-month trial. The study also found that direct costs of the alternative 911 approach were 4 times lower than police-only responses.

“We provide strong, credible evidence that providing mental health support in targeted, nonviolent emergencies can result in a huge reduction in less serious crimes without increasing violent crimes,” said researcher Thomas Dee, PhD, in the press release. “In our politically divisive times, this first-responder innovation provides a rare opportunity for consensus on meaningfully improving public safety and health.”

National discussions around police reform and first responders have become highly controversial, including growing awareness of the need for experts in situations involving mental health or substance abuse. Currently, a small but growing number of cities around the country are exploring programs that embed mental health care and other social services in first responder procedures. Despite the controversy, Dee said the study’s findings suggest that there are sensible ways to reinvent first responder services in approaches that could have universal appeal.

Several cities—including New York City; Austin, Texas; San Francisco and San Mateo, California; and Washington, DC—are experimenting with new approaches to responding to mental health emergencies through little or no law enforcement involvement. According to the study, cities have been motivated by not only high-profile cases of police brutality, but also by data suggesting that police spend more time responding to “low-priority” calls than any other type of emergency. According to the study authors, as many as two-thirds of these types of 911 calls could be directed to mental health experts.

Cities are generally exploring 3 alternative responses. In one model, police officers are trained to direct people in crisis situations to appropriate services. A second approach involves partnering law enforcement with mental health professionals. Finally, a third reform approach removes police altogether from some 911 calls.

Descriptive evidence from other studies suggests that these models may be effective, but until now, no studies have tied the cause-and-effect of these alternative approaches with empirical evidence that they work. However, a pilot program in Denver could offer this much-needed empirical evidence.

For 6 months in 2020, officials in Denver tested the third, more radical approach by removing police officers from specific 911 calls. In emergencies involving low-risk infractions, such as public intoxication, welfare checks, trespassing, and public disorder, the dispatchers would send a mobile team with 1 mental health specialist and 1 paramedic. The program was called the Support Team Assistance Response (STAR).

The initiative covered 8 precincts in Denver’s downtown neighborhoods, where 911 calls involving low-income, at-risk individuals in nonviolent situations were expected to be high. The team of responders handled nearly 750 incidents involving mental health, homelessness, and/or substance abuse issues during the pilot period.

Interestingly, not all incidence started with a 911 call. In some cases, STAR teams were contacted directly by police officers or they responded to situations that they encountered on their own. In each case, the STAR team would direct individuals to substance abuse treatment centers or other support services as needed.

Using granular crime data publicly released by the city, researchers were able to track all of the adult criminal offenses reported across the 36 police precincts from the period before STAR operations began as well as the time in which the program was active.

The investigators found that dispatching mental health workers made a dramatic difference. Over the span of the pilot program, reports of less serious crimes in STAR-patrolled neighborhoods fell by 34% relative to crime levels observed in neighborhoods where STAR was unavailable. This drop in crime is attributed to fewer citations for public intoxication and other low-level infractions, as well as the likelihood that potential repeat offenders were now getting necessary help.

“The community-response program has 2 benefits,” Dee explained in the press release. “One, it directs people in crisis to appropriate mental health care instead of directing them to the criminal justice system. Two, it prevents future criminal activity because the people who are now receiving mental health care are not committing more offenses.”

In a quality check of their data, the researchers also examined reports of more serious crimes that police, not STAR teams, responded to in the precincts covered. They found no detectable increase in those crime rates, which suggests that the STAR program drove the decrease in low-level criminal activity, according to the researchers.

The STAR program also saved money, with the direct cost of responding to each offense at $151 on average, which is 4 times less than the estimated average of $646 direct cost per minor criminal offense, according to the study.

“These results are extraordinarily promising,” Dee said in the press release, although he noted that more pilots and studies are needed to make sure that any permanent reforms are correctly implemented. “This is not something that every 911 system should be implemented tomorrow. This reform requires thoughtful and detailed implementation—from training people who field 911 calls to hiring the right kind of mental health interventionists and coordinating carefully with law enforcement agencies.”

A new Stanford study shows benefits to dispatching mental health specialists in nonviolent 911 emergencies. News release. Stanford News; June 8, 2022. Accessed June 23, 2022. 

https://news.stanford.edu/2022/06/08/stanford-study-shows-benefits-reinventing-911-responses/

Reports of less serious crimes in neighborhoods with the pilot program fell by 34% relative to crime levels observed in neighborhoods where the program was unavailable.



Dispatching Mental Health Specialists to Nonviolent 911 Emergencies Shows Benefits

New research has found that a person’s mood will decrease over the course of a conversation the more they look at themselves while taking part in an online chat, according to a press release from Illinois News Bureau.

These findings strengthen the challenges of online meeting platforms and raise the issue of the psychological problems that may be occurring in people participating in online activities, such as anxiety and depression.

“We used eye-tracking technology to examine the relationship between mood, alcohol and attentional focus during virtual social interaction,” said Talia Ariss, a University of Illinois (U of I) Urbana-Champaign doctoral candidate who led the research with U of I psychology professor Catharine Fairbairn, in the press release. “We found that participants who spent more time looking at themselves during the conversation felt worse after the call, even after controlling for pre-interaction negative mood. And those who were under the influence of alcohol spent more time looking at themselves.”

Additionally, the new study adds to previous studies that suggest that people who focus more on themselves than on external realities may be susceptible to mood disorders, according to the study authors.

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