RESUMEN

This study examines the overlap between indirect exposure to forms of interpersonal violence and suicidal behavior, and the impact of the co-occurrence of these exposures on indicators of depressed mood and substance use among adolescents. Participants were a national sample of 3,917 youth aged 14-15 years, recruited online between June 2018 and March 2020, including an oversample of sexual and gender minority youth. Eight in ten (81.3%) youth reported exposure to indirect interpersonal violence and/or suicidal behavior in their lifetimes: 39.5% reported only interpersonal violence exposure, 5.9% only suicidal behavior exposure, and 35.9% reported both. Youth who reported exposure to interpersonal violence were almost three times more likely (adjusted odds ratio [OR] = 2.78, p < .001) to also report suicidal behavior exposure. Compared with youth having no indirect violence exposure, those with only interpersonal violence exposure were 2.25 times more likely (p < .001), those with only exposure to suicidal behavior 2.93 times more likely (p < .001), and those with both were 5.63 times more likely to report recent depressed mood. The unadjusted odds of any substance use was significantly elevated for each type of indirect violence exposure, with the highest odds seen among youth with dual interpersonal violence and suicide exposure (OR = 4.87, p < .001). For both outcomes, significant findings remained but were attenuated after adjusting for demographic characteristics, non-victimization adversity exposure, and cumulative direct victimization. Findings suggest that the combination of exposure to interpersonal violence and suicidal behavior appears to be particularly impactful. Results highlight that assessment of trauma exposure among adolescents needs to be more comprehensive and include not only direct and indirect interpersonal violence, but also knowledge of other people's suicidal thoughts and behaviors.

Asunto(s)

RESUMEN

BACKGROUND: Mass shootings result in widespread psychological trauma for survivors and members of the affected community. However, less is known about the broader effects of indirect exposure (eg, media) to mass shootings. Crisis lines offer a unique opportunity to examine real-time data on the widespread psychological effects of mass shootings. OBJECTIVE: Crisis Text Line is a not-for-profit company that provides 24/7 confidential SMS text message-based mental health support and crisis intervention service. This study examines changes in the volume and composition of firearm-related conversations at Crisis Text Line before and after the mass school shooting at Robb Elementary School on May 24, 2022, in Uvalde, Texas. METHODS: A quasi-experimental event study design was used to compare the actual volume of firearm-related conversations received by Crisis Text Line post shooting to forecasted firearm conversation volume under the counterfactual scenario that a shooting had not occurred. Conversations related to firearms were identified among all conversations using keyword searches. Firearm conversation volume was predicted using a seasonal autoregressive integrated moving average model trained on the 3 months of data leading up to the shooting. Additionally, proportions of issue tags (topics coded post conversation by volunteer crisis counselors at Crisis Text Line after the exchange) were compared in the 4 days before (n=251) and after (n=417) the shooting to assess changes in conversation characteristics. The 4-day window was chosen to reflect the number of days conversation volume remained above forecasted levels. RESULTS: There was a significant increase in the number of conversations mentioning firearms following the shooting, with the largest spike (compared to forecasted numbers) occurring the day after the shooting (n=159) on May 25, 2022. By May 28, the volume reverted to within the 95% CI of the forecasted volume (n=77). Within firearm conversations, "grief" issue tags showed a significant increase in proportion in the week following the shooting, while "isolation/loneliness," "relationships," and "suicide" issue tags showed a significant decrease in proportions the week following the shooting. CONCLUSIONS: The results suggest that the Uvalde school shooting may have contributed to an increase in demand for crisis services, above what would be expected given historical trends. Additionally, we found that these firearm-related crises conversations immediately post event are more likely to be related to grief and less likely to be related to suicide, loneliness, and relationships. Our findings provide some of the first data showing the real-time repercussions for the broader population exposed to school shooting events. This work adds to a growing evidence base documenting and measuring the rippling effects of mass shootings outside of those directly impacted.

Asunto(s)

RESUMEN

Objectives: To explore the experiences and perceptions of school children of Karachi after the Army Public School (APS) attack. Methods: It was a qualitative transcendental phenomenological study. Data collection started nine months after the attack, in September 2015, and continued till November 2019. Study participants were school children from Army, Government, and Private schools. The sampling strategy was convenience. Data collection of 53 students was done by focus group discussions and in depth interviews. Data analysis was performed using the phenomenological analytical techniques of Colaizzi. Results: Inductive analysis of the qualitative data gave rise to three themes - The journey beyond fear, Response of parents and schools and Role of media. Conclusion: The study concluded that the APS attack was the source of emotional distress and fear for the school children of Karachi as they personalized the event due to the nature of the attack. Immediately after the incident, they were in anger, grief, and fear, which altered their daily life activities and caused apprehensions in socializing and attending school. However, later they became highly motivated to study and gained courage. This motivation is revenge from terrorists as they wanted to keep children away from schools.

RESUMEN

This study investigated the effects of nanoplastics on marine organisms via trophic transfer in the food chain. We designed a three-step food chain comprising microalga (Dunaliella salina), small crustaceans (Artemia franciscana), and fish (small yellow croakers; Larimichthys polyactis) and evaluated the effects of trophic transfer in marine organisms, as well as verified the possibility of nanoplastic transfer to humans via trophic transfer. Using amine-modified nanopolystyrene (nPS-NH2) as a pollutant, we conducted both direct-exposure and trophic transfer experiments to determine how pollutants move through the food chain (D. salina → A. franciscana). Exposure of D. salina to nPS-NH2, which was adsorbed on its cell wall, resulted in transfer to A. franciscana with alteration of gut permeability. Additionally, assessment of the adverse effects of nPS-NH2 via a dietary pathway (three-step food chain) on the L. polyactis digestive system revealed that nanoplastics adsorbed to the cell wall of microalgae are gradually transferred to higher trophic level organisms, such as via food resources consumed by humans, inducing the inhibition of digestive enzyme activity (α-amylase). It indicates that human could eventually be exposed to nanoplastics and experience toxicity.

Asunto(s)

RESUMEN

The restriction on legacy perfluoroalkyl substances (PFASs) has led to increasing application and contamination of their precursors and novel alternatives. However, the indirect contribution from precursors has not been well characterized. In this study, 24 PFASs were measured in the paired human blood and urine from general volunteers (n = 20), as well as their corresponding exposure matrices (7 day duplicate diet, drinking water and dust). Perfluorooctanoic acid (PFOA) was predominant, followed by 6:2 chlorinated polyfluoroalkyl ether sulfonate (6:2 Cl-PFESA), contributing 21.6-47.0 and 6.6-20.0% of the total concentrations, respectively. Total oxidable precursor (TOP) assay and isomeric analysis coupled with a toxicokinetic model suggested that around 19% of perfluorooctane sulfonate (PFOS) in human was contributed by its precursors. The strong correlation between the estimated daily intake (EDI) and human blood concentration for 6:2 Cl-PFESA suggested that it was mainly contributed by direct exposure. The bioavailability of 6:2 Cl-PFESA in the food matrices was estimated as 18.6% by comparing the estimated and measured blood concentrations, implying that human exposure might be overestimated if the bioavailability of PFASs in food was not considered. Assuming that they had a similar bioavailability, it was estimated that ca. 20% of PFOS body burden was from indirect exposure to its precursors, which was supported by TOP assay.

Asunto(s)

RESUMEN

The buildup of silver nanoparticles (AgNPs) in soil has raised mounting concerns on their impact on human health. Human are exposed to AgNPs in soils via hand-to-mouth activities (direct exposure) and food consumption (indirect exposure). However, the bioaccessibility of AgNPs under these exposure scenarios remains largely unknown. We used a physiologically based extraction test (PBET) to assess Ag bioaccessibility in AgNP-containing soils and in earthworms (Pheretima guillemi) cultured in these soils. Silver bioaccessibility was 1.2 - 8.4% and 8.1 - 78.7% upon direct exposure and indirect exposure, respectively. These results indicated greater Ag bioaccessibility in earthworms than in soils. Moreover, particle size decreased upon direct exposure, but remained constant upon indirect exposure in wetland soil, as revealed by single particle inductively coupled plasma-mass spectrometry (spICP-MS) analysis. Our results highlight the importance of indirect exposure to NPs.

Asunto(s)

RESUMEN

This study investigated the trophic transfer of nanoplastics in marine food chains. We fed nanoplastic-exposed Artemia franciscana (brine shrimp) to Larimichthys polyactis (small yellow croaker) daily for eight days. Subsequently, the overall health condition, histopathological damage to the liver and digestive tract, and swimming ability of the fish were measured. After the sub-acute exposure to nanoplastics via trophic transfer, the fish showed inhibited growth, severe liver damage, as well as a poorer swimming ability compared to the control. The swimming ability was especially affected, in terms of the overall movement as well as thigmotaxis. The results thus clarified that even an indirect exposure to nanoplastics could induce neurotoxic effects and affect the swimming ability of the fish. As fish are well-known human food resources, the possibility of such trophic transfers affecting higher trophic level organisms, such as humans, cannot be ruled out.

Asunto(s)

RESUMEN

STUDY OBJECTIVES: The aim of this study was to explore indirectly exposed soldiers' subjective experiences following an avalanche. Three decades after the trauma, this study describes the perceived impact of the disaster by peers of those who survived or died in the avalanche. METHOD: A qualitative, cross-sectional, study based on 17 individual interviews with persons indirectly exposed to an avalanche. Data was analysed according to qualitative content analysis. FINDINGS: The findings revealed 'being a significant first person' as the main theme. Two categories were developed: 1) Experience of closeness to the victims 2) Experience of distance post-disaster. The categories elaborated two subcategories each: 1) Could have been me 2) Sadness, grief, shame and guilt over losing friends and 1) Unorganized military service post-disaster 2) Anger towards the system. CONCLUSION: The soldiers indirectly exposed to the avalanche need to be seen both as a person and as a group. Both immediately following and decades after the disaster, the informants wanted the military to offer adequate follow-up.

Asunto(s)

RESUMEN

The acceleration of inactivating viable cells of Escherichia coli (E. coli), by using new direct and indirect innovative methods, is the targeted method of using an atmospheric pressure plasma jet (APPJ) operated by an AC high-voltage power source with variable frequency up to 60 kHz and voltage ranging from 2.5 to 25 kV. Discharges using dry argon (0% O2) discharges and different wet argon discharges using admixtures with O2/Ar ratios ranging from 0.25% to 1.5% were studied. The combined effects of dry and wet argon discharges, direct and indirect exposure using a mesh controller, and hollow magnets were studied to reach a complete bacterial inactivation in short application times. Survival curves showed that the inactivation rate increased as the wettability increased. The application of magnetized non-thermal plasma discharge with a 1.5% wetness ratio causes a fast inactivation rate of microbes on surfaces, and a dramatic decrease of the residual survival of the bacterial ratio due to an increase in the jet width and the enhanced ability of fast transport of the charges to viable cells, especially at the edge of the Petri dish. The membrane damage of E. coli mechanism factors in the activation process by APPJ is discussed.

RESUMEN

AIMS AND OBJECTIVES: The aim of this study was to investigate in detail the traumatic birth experiences of midwives in the delivery rooms, and their attitudes, reactions, and coping strategies. METHODS: The design of the study is descriptive and the purposive sampling method was used. This approach is ideal for a preliminary exploration of the nature of a phenomenon. Between October 2018 and January 2019, semi-structured interviews were conducted with a purposeful sample of midwives. The research was carried out with the participation of 29 midwives, who work in labour and birth room. They were asked to describe a particular stressful situation they had experienced during the birth process, their emotions about the event, and their coping strategies and support systems. All interviews were digitally recorded, stored in a database, and transferred to MAX Qualitative Data Analysis 18.1.0 for analysis. FINDINGS: As a result of the content analysis, three main themes emerged: psychological impact, defensive practice, and expectations in terms of support from the hospital. It was revealed that, after the traumatic birth, midwives experienced highly emotional exhaustion in the form of sadness, flashbacks, guilt, fear, and empathy, and they performed an increasingly defensive practice. During the interviews, we observed that 19 midwives needed psychological support. Besides, midwives explicitly stated that they were not prepared enough for traumatic events and that most traumatic births were simply ignored in their workplace. Eventually, it was determined that midwives received support mostly from their colleagues in case of a traumatic birth. CONCLUSION(S): Midwives need to feel valued and be supported by their institutions in coping with emotional stress. Therefore, performing clinical inspections by experienced or specialist midwives may serve as a supporting framework for reducing defensive interventions.

Asunto(s)

RESUMEN

Household air pollution (HAP) generated from solid fuel combustion is a major health risk. Direct measurement of exposure to HAP is burdensome and challenging, particularly for children. In a pilot study of the Household Air Pollution Intervention Network (HAPIN) trial in rural Guatemala, we evaluated an indirect exposure assessment method that employs fixed continuous PM2.5 monitors, Bluetooth signal receivers in multiple microenvironments (kitchen, sleeping area and outdoor patio), and a wearable signal emitter to track an individual's time within those microenvironments. Over a four-month period, we measured microenvironmental locations and reconstructed indirect PM2.5 exposures for women and children during two 24-h periods before and two periods after a liquefied petroleum gas (LPG) stove and fuel intervention delivered to 20 households cooking with woodstoves. Women wore personal PM2.5 monitors to compare direct with indirect exposure measurements. Indirect exposure measurements had high correlation with direct measurements (n = 62, Spearman ρ = 0.83, PM2.5 concentration range: 5-528 µg/m3). Indirect exposure had better agreement with direct exposure measurements (bias: -17 µg/m3) than did kitchen area measurements (bias: -89 µg/m3). Our findings demonstrate that indirect exposure reconstruction is a feasible approach to estimate personal exposure when direct assessment is not possible.

Asunto(s)

RESUMEN

BACKGROUND: Research has demonstrated that Post-Traumatic Stress Disorder (PTSD) is one of the most widely recognized mental disorders, but recognition is affected by trauma type. AIMS: The current study investigated the effect of direct versus indirect exposure to traumatic event and trauma types on Mental Health Literacy (MHL) of PTSD. METHODS: Two hundred and thirty-three participants were asked to identify the mental health problem after presentation of an unlabeled vignette describing a character experiencing PTSD symptoms. The six vignettes described the same symptoms but differed in directness (direct/indirect exposure) and trauma type (rape, military combat or man-made disaster). It was hypothesized that (1) recognition rate would be higher in direct than indirect conditions, and (2) higher in military combat, followed by man-made disaster, and lowest in rape condition. RESULTS: Overall, correct recognition of PTSD was 42.5%. Recognition in direct exposure vignettes was significantly higher than indirect, supporting the first hypothesis. The second hypothesis was only partly supported. While PTSD recognition in rape vignettes was significantly lower than the other two scenarios, no difference was found between combat and man-made disaster trauma types. CONCLUSIONS: Our findings implied under-recognition of PTSD, with lack of awareness of different causes of PTSD and of PTSD from indirect trauma exposure. The latter finding is important in the light of DSM-V revisions to diagnostic criteria for PTSD.

Asunto(s)

RESUMEN

Background: Life threat to children may induce severe posttraumatic stress reactions (PTSR) in parents. Troubled mothers and fathers may turn to their general practitioner (GP) for help. Objective: This study investigated frequency of GP visits in mothers and fathers of adolescent and young adult terrorism survivors related to their own PTSR and PTSR in their surviving children. Method: Self-reported early PTSR (4-5 months post-disaster) in 196 mothers, 113 fathers and 240 survivors of the 2011 Utøya terrorist attack were linked to parents' three years pre- and post-disaster primary healthcare data from a national reimbursement claims database. Frequency of parents' GP visits was regressed on parent and child PTSR, first separately, then in combination, and finally by including an interaction. Negative binominal regressions, adjusted for parents' pre-disaster GP visits and socio-demography, were performed separately for mothers and fathers and for the early (<6 months) and delayed (6-36 months) aftermath of the terrorist attack. Results: Parents' early PTSR were significantly associated with higher early frequency of GP visits in mothers (rate ratio, RR = 1.31, 95%CI 1.09-1.56) and fathers (RR = 1.40, 95%CI 1.03-1.91). In the delayed aftermath, early PTSR were significantly associated with higher frequency of GP visits in mothers only (RR = 1.21, 95%CI 1.04-1.41). Early PTSR in children were not significantly associated with an overall increase in GP visits. On the contrary, in mothers, child PTSR predicted significant decrease in GP visits the delayed aftermath (RR = 0.83, 95%CI 0.71-0.97). Conclusions: Our study suggests that GPs may play an important role in identifying and providing for parents' post-disaster healthcare needs. GPs need to be aware that distressed individuals are likely to approach them following disasters and must prepare for both short- and long-term healthcare needs.

Planteamiento: Las amenazas vitales a los niños puede inducir graves reacciones de estrés postraumático (PTSR, siglas en inglés de posttraumatic stress reactions) en los padres. Las madres y los padres preocupados pueden recurrir a su médico de cabecera (GP, siglas en inglés de general practitioner) en busca de ayuda. Objetivo: Este estudio investigó la frecuencia de visitas al GP por parte de madres y padres de adolescentes y adultos jóvenes supervivientes del terrorismo relacionados con las reacciones de estrés postraumático propias y de sus hijos supervivientes. Métodos: Los autoinformes de reacciones tempranas de estrés postraumático (4-5 meses después del desastre) en 196 madres, 113 padres y 240 supervivientes del ataque terrorista de Utøya de 2011 se enlazaron con los datos de atención primaria de salud de los padres (tres años antes y después del desastre) provenientes de una base de datos nacional de reclamaciones de reembolso. Se hizo una regresión de la frecuencia de las visitas al GP de los padres mediante regresiones binomiales negativas con las PTSR de los padres y el hijo, primero por separado, luego en combinación, y finalmente con la inclusión de una interacción. Los análisis se realizaron por separado para las madres y los padres con respecto a las consecuencias tempranas (<6 meses) y tardías (6-36 meses) después del ataque terrorista y se ajustaron para las visitas pre-desastre al GP de los padres y la sociodemografía. Resultados: Las PTSR tempranas de los padres se asociaron significativamente con una mayor frecuencia temprana de visitas al GP en las madres (RR = 1,31, IC del 95%: 1,09-1,56) y padres (RR = 1,40, IC del 95%: 1,03-1,91). En las consecuencias posteriores, las PTSR tempranas se asociaron significativamente con una mayor frecuencia de visitas al GP en madres solamente (RR = 1,21; IC del 95%: 1,04-1,41). Las PTSR tempranas en niños no se asociaron significativamente con un aumento general de las visitas al GP. De hecho, en las madres, las PTSR del hijo predijeron una disminución significativa en las consecuencias tardías (RR = 0,83; IC del 95%: 0,71-0,97). Conclusiones: Nuestro estudio sugiere que los médicos de cabecera pueden desempeñar un papel importante a la hora de identificar y la proporcionar las necesidades de atención médica de los padres después de un desastre. Los médicos de cabecera deben ser conscientes de que las personas angustiadas es probable que se acerquen a ellos después de los desastres y deben prepararse para las necesidades de salud a corto y largo plazo.

RESUMEN

BACKGROUND: The study aimed at evaluating effectiveness of the web-based intervention, "The Helpers' Stress," in reducing job burnout and enhancing work engagement among professionals working with trauma survivors. MATERIAL AND METHODS: Participants were randomly allocated to 1 of the 3 intervention modules: 1 - the self-efficacy enhancement (N = 87), 2 - the social support enhancement (N = 85), or to 3 - the educational module (comparison group, N = 81). Participants completed the online questionnaires before the intervention (T1), immediately after (T2), and 4 weeks after the intervention (T3). RESULTS: Due to high drop-out rate at T2 and T3 in social support enhancement module, we excluded from analysis participants assigned to this condition. Participants assigned to the self-efficacy enhancement module presented higher levels of self-efficacy (at T2 and T3), compared to those assigned to the educational module. Job burnout decreased significantly between T1 and T2, and between T2 and T3, and work engagement increased significantly between T1 and T2, and between T1 and T3, among participants assigned to both modules mentioned above. Self-efficacy (T2) mediated the relationship between the group assignment (educational module vs. self-efficacy enhancement module) and respectively job burnout (T3) or work engagement (T3). CONCLUSIONS: The results of our study highlight the role of self-efficacy in reducing job burnout and increasing work engagement. Med Pr 2016;67(2):223-237.

Asunto(s)

RESUMEN

The objective of this study was to examine the association between externalizing behaviors and indirect violence exposure, assessed both within the household and at the community level, as well as the interaction effect of indirect and direct violence exposure. A sample of parents of children ages 4-15 who have not been referred or enrolled in child welfare (n = 82) were recruited from the greater New Orleans community. Externalizing behavior was assessed with the Child Behavior Checklist (CBCL). The child's indirect exposure to violence included witnessing community violence, witnessing physical assault, and witnessing fighting or domestic violence at home. Direct exposure to violence included the child experiencing physical aggression from a caregiver. All assessments were based on caregiver reports. To decrease potential for confounding, children were matched for analysis based on age, Hurricane Katrina exposure, and their propensity to be exposed to high indirect violence. Cumulative indirect exposure to violence was significantly positively correlated with CBCL scores. After controlling for key covariates, CBCL externalizing T score increased significantly by approximately 1.25 points for each level increase in indirect violence exposure (ß = 1.25, SE = 0.57, p = 0.027). There also was a significant interaction between indirect and direct exposure to violence in the association with CBCL score (ß = -0.08, SE = 0.03, p = 0.002). These findings extend previous research by demonstrating that exposure to both direct and cross-contextual indirect violence influences externalizing behaviors in children. Additionally, the findings suggest that community and household social environments are both important targets for interventions designed to decrease externalizing behaviors and improve long-term outcomes for youth at risk of exposure to violence.

Asunto(s)

RESUMEN

BACKGROUND: Through their work midwives may experience distressing events that fulfil criteria for trauma. However, there is a paucity of research examining the impact of these events, or what is perceived to be helpful/unhelpful by midwives afterwards. OBJECTIVE: To investigate midwives' experiences of traumatic perinatal events and to provide insights into experiences and responses reported by midwives with and without subsequent posttraumatic stress symptoms. DESIGN: Semi-structured telephone interviews were conducted with a purposive sample of midwives following participation in a previous postal survey. METHODS: 35 midwives who had all experienced a traumatic perinatal event defined using the Diagnostic and Statistical Manual of Mental Disorders (version IV) Criterion A for posttraumatic stress disorder were interviewed. Two groups of midwives with high or low distress (as reported during the postal survey) were purposefully recruited. High distress was defined as the presence of clinical levels of PTSD symptomatology and high perceived impairment in terms of impacts on daily life. Low distress was defined as any symptoms of PTSD present were below clinical threshold and low perceived life impairment. Interviews were analysed using template analysis, an iterative process of organising and coding qualitative data chosen for this study for its flexibility. An initial template of four a priori codes was used to structure the analysis: event characteristics, perceived responses and impacts, supportive and helpful strategies and reflection of change over time codes were amended, integrated and collapsed as appropriate through the process of analysis. A final template of themes from each group is presented together with differences outlined where applicable. RESULTS: Event characteristics were similar between groups, and involved severe, unexpected episodes contributing to feeling 'out of a comfort zone.' Emotional upset, self-blame and feelings of vulnerability to investigative procedures were reported. High distress midwives were more likely to report being personally upset by events and to perceive all aspects of personal and professional lives to be affected. Both groups valued talking about the event with peers, but perceived support from senior colleagues and supervisors to be either absent or inappropriate following their experience; however, those with high distress were more likely to endorse this view and report a perceived need to seek external input. CONCLUSION: Findings indicate a need to consider effective ways of promoting and facilitating access to support, at both a personal and organisational level, for midwives following the experience of a traumatic perinatal event.

Asunto(s)

RESUMEN

BACKGROUND: There is evidence that a large-scale disaster may have indirect psychological impact on the individuals who were not involved with the disaster first hand. The 2011 earthquake and tsunami disasters in Japan provide an opportunity to investigate the potential global effect of indirect exposure associated with intense media coverage. OBJECTIVES: To compare the disaster's psychological impact between Japanese and non-Japanese students; to determine what factors are associated with higher psychological impact. DESIGN: A cross-sectional, anonymous online survey of university students in the Midwest. RESULTS: Japanese students scored significantly higher on the Impact of Event Scale-Revised (IES-R) hyperarousal subscale compared with non-Japanese students. Those who were in Japan when the disaster occurred exhibited significantly higher psychological impact levels. There were significant correlations between media exposure and two IES-R subscales: avoidance and hyperarousal. CONCLUSIONS: The results support the finding from 9/11 studies that indirect exposure is associated with stress-related psychological responses.

Asunto(s)