Risultati per: Come stress e attacchi di cuore sono collegati

Objectives
To find predictors of burn-out in a cohort of rescuers.

Design
Cross-sectional study.

Setting
Republican Rescue Squad (N=105) and Republican Mudslide Rescue Service under the Ministry of Emergency Situations (N=480) in Almaty, Kazakhstan.

Participants
In total, we included 268 (80% men, median age 38 (IQR 22) years) rescuers from both organisations.

Primary and secondary outcome measures
We offered a questionnaire to rescuers, which included Maslach Burnout Inventory, quantifying emotional exhaustion (EX), cynicism (CY) and professional efficacy (PE) along with fatigue, stress and health-related quality of life (HRQL) tools.

Results
Lower scores of HRQL (Physical Component Score (PCS) beta –0.04 (95% CI –0.06 to –0.02); Mental Component Score beta –0.03 (95% CI –0.05 to –0.01)), higher fatigue (Fatigue Severity Scale (FSS) score beta 0.03 (95% CI 0.03 to 0.04)) and stress (Perceived Stress Score-10 beta 0.04 (95% CI 0.02 to 0.06)) independently predicted greater EX. Lower PCS (beta –0.03 (95% CI –0.06 to –0.01)) and FSS (beta 0.02 (95% CI 0.01 to 0.03)) could predict more CY burn-out. In addition to stress, higher education (beta 0.86 (95% CI 0.40 to 1.32)) was positively associated with lower burn-out severity in PE domain.

Conclusions
Fatigue, stress and HRQL were associated with burn-out in rescuers. Addressing these predictors may help guide further interventions to reduce occupational burn-out.

Aim
To investigate experiences of stress, feelings of safety, trust in healthcare staff and perceptions of the severity of a SARS-CoV-2 infection among inpatients discharged from Valais Hospital, Switzerland, during the COVID-19 pandemic’s first wave.

Methods
Discharged patients aged 18 years or more (n=4665), hospitalised between 28 February and 11 May 2020, whether they had been infected by SARS-CoV-2 or not, were asked to complete a self-reporting questionnaire, as were their informal caregivers, if available (n=866). Participants answered questions from Cohen’s Perceived Stress Scale (PSS) (0=no stress, 40=severe stress), Krajewska-Kułak et al’s Trust in Nurses Scale and Anderson and Dedrick’s Trust in Physician Scale (10=no trust, 50=complete trust), the severity of a SARS-CoV-2 infection (1=not serious, 5=very serious), as well as questions on their perceived feelings of safety (0=not safe, 10=extremely safe).

Results
Of our 1341 respondents, 141 had been infected with SARS-CoV-2. Median PSS score was 24 (IQR1–3=19–29), median trust in healthcare staff was 33 (IQR1–3=31–36), median perceived severity of a SARS-CoV-2 infection was 4 (IQR1–3=3–4) and the median feelings of safety score was 8 (IQR1–3=8–10). Significant differences were found between males and females for PSS scores (p

Objective
This study aims to determine the burden and factors associated with perceived stress in the Pakistani population amidst the COVID-19 pandemic.

Setting
A web-based cross-sectional survey was conducted from April to August 2020.

Population
This survey was broadcasted on the web using a Google form link and 1654 Pakistani residents had completed this survey. Individuals belonging to any province, city, village, or district of Pakistan irrespective of any age, having internet access and a link of Google form, with English/Urdu competency, consent to participate, and currently residing in Pakistan were eligible to participate.

Outcome measure
Perceived stress was measured using a validated tool of perceived stress scale-10. Multiple ordinal regression was used, and an adjusted OR along with a 95% CI are reported.

Results
The mean score of perceived stress was 19.32 (SD ±6.67). Most of the participants screened positive for moderate (69%) and high levels (14%) of stress, respectively. The odds of high-perceived stress among severely anxious participants were 44.67 (95% CI: 21.33 to 93.53) times than participants with no/minimal generalised anxiety during the complete lockdown. However, the odds of high levels of perceived stress among moderately anxious respondents were 15.79 (95% CI: 10.19 to 24.28) times compared with participants with no/minimal anxiety during the smart lockdown.

Conclusion
This study evidence that the pandemic was highly distressing for the Pakistani population causing the maximum level of perceived stress in more than half of the population. Adequate and timely interventions are needed before high-stress levels culminate into psychological disorders.

Mentre i farmaci esistenti agiscono riducendo la sintesi di colesterolo e prevenendo la formazione di nuovi accumuli, questa terapia ha un obiettivo più ambizioso e mai raggiunto prima: aggredire le placche già presenti

Objective
This study aimed to assess the prevalence of depression, anxiety and stress, associated factors and stress-coping strategies among traffic police officers in Kathmandu, Nepal.

Design
Cross-sectional survey.

Setting
Kathmandu Valley, Nepal.

Participants
A total of 300 traffic police officers working under the different traffic units of Kathmandu Valley for at least 6 months were recruited via a simple random sampling procedure.

Primary outcome measures
State of depression, anxiety and stress among traffic police officers based on the Depression, Anxiety and Stress Scale.

Secondary outcome measures
Coping strategies under stressful conditions based on the Coping Orientation to Problems Experienced Inventory (Brief-COPE) tool.

Results
Altogether 124 (41.3%) traffic police officers had symptoms of depression, 141 (47%) had anxiety symptoms and 132 (44%) had symptoms of stress. Smoking was significantly associated with an increased likelihood of experiencing symptoms of depression (adjusted OR (AOR): 10.7, 95% CI: 4.8 to 23.6), anxiety (AOR: 7.1, 95% CI: 3.4 to 14.9) and stress (AOR: 6.8, 95% CI: 3.3 to 14.1). Similarly, longer working hours was significantly associated with higher odds of experiencing symptoms of depression (AOR: 3.4, 95% CI: 1.8 to 6.4), anxiety (AOR: 2.3, 95% CI: 1.3 to 3.9) and stress (AOR: 1.9, 95% CI: 1.1 to 3.4), and lack of physical exercise was associated with an increased likelihood of exhibiting depressive symptoms (AOR: 2.3, 95% CI: 1.1 to 4.7). Participants in this study used positive coping strategies more than negative coping strategies.

Conclusion
Our study found a high prevalence of depression, anxiety and stress symptoms among traffic police officers in Kathmandu Valley, Nepal. Smoking and longer working hours were associated with an increased likelihood of experiencing symptoms of depression, anxiety and stress, and lack of physical exercise was associated with an increased likelihood of depressive symptoms.

Stroke, Ahead of Print. Background:Individuals with sickle cell anemia have heightened risk of stroke and cognitive dysfunction. Given its high prevalence globally, whether sickle cell trait (SCT) is a risk factor for neurological injury has been of interest; however, data have been limited. We hypothesized that young, healthy adults with SCT would show normal cerebrovascular structure and hemodynamic function.Methods:As a case-control study, young adults with (N=25, cases) and without SCT (N=24, controls) underwent brain magnetic resonance imaging to quantify brain volume, microstructural integrity (fractional anisotropy), silent cerebral infarcts (SCI), intracranial stenosis, and aneurysms. Pseudocontinuous arterial spin labeling and asymmetric spin echo sequences measured cerebral blood flow and oxygen extraction fraction, respectively, from which cerebral metabolic oxygen demand was calculated. Imaging metrics were compared between SCT cases and controls. SCI volume was correlated with baseline characteristics.Results:Compared with controls, adults with SCT demonstrated similar normalized brain volumes (SCT 0.80 versus control 0.81,P=0.41), white matter fractional anisotropy (SCT 0.41 versus control 0.43,P=0.37), cerebral blood flow (SCT 62.04 versus control, 61.16 mL/min/100 g,P=0.67), oxygen extraction fraction (SCT 0.27 versus control 0.27,P=0.31), and cerebral metabolic oxygen demand (SCT 2.71 versus control 2.70 mL/min/100 g,P=0.96). One per cohort had an intracranial aneurysm. None had intracranial stenosis. The SCT cases and controls showed similar prevalence and volume of SCIs; however, in the subset of participants with SCIs, the SCT cases had greater SCI volume versus controls (0.29 versus 0.07 mL,P=0.008). Of baseline characteristics, creatinine was mildly elevated in the SCT cohort (0.9 versus 0.8 mg/dL,P=0.053) and correlated with SCI volume (ρ=0.49,P=0.032). In the SCT cohort, SCI distribution was similar to that of young adults with sickle cell anemia.Conclusions:Adults with SCT showed normal cerebrovascular structure and hemodynamic function. These findings suggest that healthy individuals with SCT are unlikely to be at increased risk for early or accelerated ischemic brain injury.

La campagna di prevenzione promossa dall’Istituto nazionale per le ricerche cardiovascolari

BackgroundThe study aimed to investigate whether a bystander’s emotional stress state affects DA-CPR in OHCA. The primary outcome was time from recognition of OHCA by the medical dispatcher until first chest compression delivered. Secondarily, we investigated time from recognition of OHCA until initiation of CPR-instructions as well as quality of DA-CPR instructions according to the caller’s emotional stress state.MethodThe study was a retrospective and observational study of OHCA emergency call recordings from the Capital Region of Denmark. Callers were evaluated by five raters using a simplified emotional content and cooperation score (ECCS).Results894 call were included of which 250 callers were registered as emotional stressed. We found a significantly longer time from recognition of OHCA until first chest compression delivered in the emotional stressed callers vs. the not emotional stressed callers (65 s vs.38 s; P < 0.001). There was no significant difference in time from recognition of OHCA until initiation of CPR-instructions (P = 0.12). Furthermore, there was a significant higher incidence of the medical dispatcher being assertive and encouraging when instructing, and of the medical dispatcher instructing on speed and depth of chest compressions in calls with an emotional stressed caller (P = 0.006, P < 0.001 and P < 0.001).ConclusionThe emotional stressed callers had a significantly longer time from recognition of OHCA by the medical dispatcher until first chest compression was delivered. In addition, the quality of DA-CPR instructions given was significantly higher in the emotional stressed group.Conflict of interestNone.FundingNone.

Concluso il progetto pilota messo a punto da Maior-Ama in collaborazione con l’Asl di Teramo per ridurre stress, ansia e burnout

Comunicato del 11/03/2022 n°13

Stroke, Ahead of Print. Background:Posttraumatic stress disorder (PTSD) can be triggered by life-threatening medical emergencies, such as stroke. Data suggest that up to 25% of stroke survivors will develop PTSD symptomatology, but little is known about predisposing factors. We sought to examine whether neuroimaging measures and coping styles are related to PTSD symptoms after stroke.Methods:Participants were survivors of first-ever, mild-moderate ischemic stroke, or transient ischemic attack from the TABASCO study (Tel Aviv Brain Acute Stroke Cohort). All participants underwent a 3T magnetic resonance imaging at baseline and were examined 6, 12, and 24 months thereafter, using neurological, neuropsychological, and functional evaluations. At baseline, coping styles were evaluated by a self-reported questionnaire. PTSD symptoms were assessed using the PTSD checklist. Data were available for 436 patients.Results:Forty-eight participants (11%) developed probable PTSD (PTSD checklist ≥44) during the first year after the stroke/transient ischemic attack. Stroke was more likely to cause PTSD than transient ischemic attack. Stroke severity, larger white matter lesion volume, and worse hippocampal connectivity were associated with PTSD severity, while infarct volume or location was not. In a multivariate analysis, high-anxious and defensive coping styles were associated with a 6.66-fold higher risk of developing poststroke PTSD ([95% CI, 2.08–21.34];P

Stroke, Volume 53, Issue Suppl_1, Page AWP219-AWP219, February 1, 2022. Background:Stroke is a sudden-onset, unexpected life event over which individuals have little control. These features can make the experience of having a stroke extremely stressful, which may potentiate its debilitating effects. Yet the role of lifetime stress/trauma exposure (LSE) and post-stroke acute stress (AS) have received limited attention in research seeking to identify factors influencing stroke-related disability.Hypothesis:Higher lifetime trauma and AS symptoms are associated with poorer post-stroke modified Rankin (mRS) and Fugl-Meyer scores.Method:Multi-site national study of patients admitted for a new stroke. Interviews were conducted at 2-10 days (N=763) & 3 months (N=513) post-stroke. Assessments included admission Acute Stress Disorder Interview, day-90 mRS, day-90 upper extremity motor Fugl-Meyer scale (affected side), and LSE. Structural Equation Modeling examined relationships among LSE, AS, and outcomes, controlling for admission NIHSS score, IV TPA treatment, and demographics.Results:After controlling for key covariates, AS immediately post-stroke and LSE were both associated with poorer day-90 mRS scores (p

Stroke, Volume 53, Issue Suppl_1, Page ATMP116-ATMP116, February 1, 2022. Background:The endoplasmic reticulum (ER) is responsible for cellular protein synthesis and folding. Cellular stimuli that perturb ER homeostasis create an imbalance between the protein-folding load and capacity of ER, causing unfolded or misfolded proteins to accumulate in the ER lumen, known as ER stress. Recent studies suggested that ER stress plays significant roles in the pathogenesis of inflammatory vascular diseases. Since inflammation is emerging as a vital component of the pathophysiology of intracranial aneurysms, we hypothesized that ER stress promotes the development of aneurysm rupture by inducing sustained vascular wall inflammation. We tested this hypothesis utilizing pharmacological approaches in mice.Methods:We used 10-week-old male C57BL/6J mice and induced intracranial aneurysms by combining an elastase injection and hypertension. We tested the effects of an ER stress activator (Tunicamycin) and inhibitor (4-phenylbutyric acid, 4-PBA) on the development of aneurysmal rupture. In addition, we assessed the roles of ER stress induced via deactivation of epidermal growth factor receptor (EGFR) by Erlotinib on aneurysm rupture.Results:The pharmacological inhibition of ER stress significantly decreased the rupture rate (P

Stroke, Volume 53, Issue Suppl_1, Page ATP17-ATP17, February 1, 2022. Background:Major depressive disorder (MDD) is one of the fastest-growing disability disorders in the US and worldwide. Extensive clinical data suggest that MDD is associated with an increased risk of hypertension, coronary heart disease, and other cardiovascular diseases. A close relation between cardiovascular and cerebrovascular diseases and clinical evidence presents a potential link between depression and stroke. MDD when combined with other comorbidities, makes the prognosis worse. Dysregulation of the sympathetic nervous system, impaired hypothalamic-pituitary-adrenal axis, and increased inflammatory response are plausible mechanisms that have been linked to depression-induced cardio- and cerebrovascular complications. In the current study, we investigated cardiac structural and functional alterations in a mouse model of chronic mild stress (CMS) exhibiting depression-like behavior.Methods and Results:The mice were divided into control (CT) and CMS groups. The CMS mice were subjected to various mild, unpredictable stressors for 7 weeks. Depression-like traits were confirmed in the CMS group by analyses of behavioral changes using open field and forced swim tests and a decrease in hippocampal brain-derived neurotrophic factor (BDNF) protein level. To evaluate depression-associated neuronal damage and neuronal plasticity, Fluoro-Jade C staining and expression of microtubule-associated protein 2 were examined. However, we did not observe neuronal damage in the CMS mice as compared to the CT mice. We also observed a decrease in cardiac BDNF expression and upregulation of IL-6 in the CMS mice compared to the CT group. Echocardiographic and histological analyses showed an increase in ventricular wall thickness with increased cardiomyocyte size in the CMS group. However, we did not find changes in fetal gene expression or fibrosis markers. Investigation of underlying mechanisms showed a significant upregulation in ERK1/2 signaling in the left ventricles of the CMS mice as compared to the control group, with no changes in phospho-p38, NFATc3, or JNK levels.Conclusion:In conclusion, these data suggest that ERK1/2 signaling might have an important role in cardiac hypertrophic response during the CMS-induced depression in mice.

Stroke, Volume 53, Issue Suppl_1, Page ATP1-ATP1, February 1, 2022. Background:Excess reactive oxygen species (ROS) generated by nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) promotes apoptotic cell death following ischemic/reperfusion injury. Effect of chlorpromazine and promethazine (C+P) on brain activity was reported to induce neuroprotection. The current study was designed to evaluate the inhibitory function of C+P on oxidative injury after stroke.Methods:Adult male Sprague-Dawley rats were subjected to 2 h middle cerebral artery occlusion (MCAO) followed by 6 or 24 h of reperfusion. At the onset of reperfusion, rats received C+P, or apocynin (NOX inhibitor), or rottlerin [protein kinase C (PKC) δ inhibitor]. Brain damage was evaluated using infarct volumes and neurological deficits as well as apoptotic cell death (TUNEL). The enzymatic activity of NOX and ROS production as well as protein expressions of NOX subunits (gp91phox, p67phox, p47phox, and p22phox), phosphorylation of PKC δ (p-PKC δ)/PKC δ and manganese superoxide dismutase (MnSOD) was examined. Neural SHSY5Y cells were used under 2 h of oxygen-glucose deprivation (OGD) followed by reoxygenation for 6 and 24 h with or without C+P treatment. ROS and protein levels of NOX subunits, p-PKC δ/PKC δ and MnSOD were detected. Moreover, measurement of PKC δ membrane translocation and detection of the interaction of p47phoxand PKC δ through co-immunoprecipitation were performed.Results:C+P reduced cerebral infarct volumes, neurological deficits, and apoptotic cell death in the ischemic rats, as well observed in the presence of NOX and PKC δ inhibitors. ROS production, NOX activity, expression of NOX subunits, p-PKC δ/PKC δ and MnSOD were significantly reduced by C+P. In ischemic rats administered with NOX and PKC δ inhibitors, ROS, activity of NOX and the NOX subunits protein levels were all decreased. In the OGD/R model, C+P decreased ROS and protein levels of NOX subunits, p-PKC δ/PKC δ and MnSOD. Furthermore, C+P reduced the PKC δ membrane translocation and the interaction of p47phoxand PKC δ.Conclusion:C+P treatments confers neuroprotection in severe stroke by suppressing oxidative stress and ROS production. PKC δ/NOX/MnSOD may be the vital regulators and the potential targets for an efficacious therapy following ischemic stroke.