Effectiveness of Hypnoanalgesia in Paediatric Dermatological Surgery

Background and objective. Stress in surgical settings has subtle psychological and physiological repercussions in children. The objective is to evaluate whether hypnosedation is effective in reducing the doses of sedation and analgesia required during the periprocedural period in children undergoing dermatological surgery, without negatively affecting pain and satisfaction. Patients and methods: A prospective, longitudinal, observational study where paediatric patients (aged 5–16 years) scheduled for dermatological surgery were analysed according to whether they received hypnosis or distraction during surgery (both common procedures at the centre). As outcome measurements we used sedation doses (propofol) during surgery and the need for analgesia; pain assessment post-surgery and at 24 h using a visual analogue scale (VAS) or revised face pain scale (FPS-r) (both 0–10) depending on age, as well as patient and guardian satisfaction (on a scale of 0–10). Results: Of the 68 patients eligible during the follow-up period, 65 were included. Of these, 33 were treated with hypnosis and 32 with distraction. Children who underwent hypnosis required less total propofol (45.5 ± 11.8 mg vs. 69.3 ± 16.8 mg; p < 0.001) and metamizole in the immediate postoperative period (34.4% vs. 65.6%; p = 0.018). After 24 h, they required less ibuprofen (9.1% vs. 28.1%; p = 0.048) and paracetamol (48.5% vs. 75.0%; p = 0.028). Mean pain according to VAS or FPS-r at 24 h was 3.1 with hypnosis vs. 4.3 with distraction (p < 0.001). Overall satisfaction was higher in the hypnosis group (8.7 ± 0.1 vs. 8.1 ± 0.2; p = 0.009). Conclusions: Hypnoanalgesia in children undergoing dermatological outpatient surgery could not only reduce sedation and analgesia requirements, but also improve child and guardian(s) satisfaction.

A Landscape of Subjective and Objective Stress in African American Dementia Family Caregivers

Stress is a significant part of daily life, and systemic social inequities, such as racism and discrimination, are well-established contributors of chronic stress for African Americans. Added exposure to the stress of caregiving may exacerbate adverse health outcomes. This secondary analysis describes subjective and objective stress in African American family caregivers, and relationships of subjective and objective stress to health outcomes. Baseline data from 142 African American dementia family caregivers from the “Great Village” study were described using means and frequencies; regression models and Pearson’s correlation were used to examine associations between demographics, social determinants of health, and health outcomes. Mixed models were used to examine change and change variation in cortisol. Most caregivers had moderate degrees of stress. Stress was associated with sleep disruption and depressive symptoms, and discrimination appeared to be an independent contributor to depressive symptoms. This work provides a foundation for interpreting subjective and objective indicators of stress to tailor existing multicomponent interventions.

P012 Maternal and infant stress during a bedtime separation: a pilot RCT

Background Behavioural sleep interventions to improve infant sleep disturbance commonly include extinction where an unwanted behaviour (night time crying) is periodically ignored. There have been conflicting findings regarding the impact of extinction methods on infant stress levels as measured with cortisol and as perceived by mothers and only one that measured cortisol at the time of the separation. This study aimed to compare a responsive method to extinction (controlled crying) and a control group evaluating subjective and objective stress for mother/infant dyads at the time of bedtime separation. Methods Mother/infant dyads were randomly allocated to behavioural sleep interventions (Responsive - n= 7, Controlled Crying - n=6 or Controls - n=4). Cortisol (two oral swabs on two nights at T2), maternal self-reported stress (Subjective Units of Distress - SUDS), and perceived infant distress (PIS) were compared over eight weeks. Correlations tested relationships between PIS, SUDS and infant cortisol levels. Mixed models analysis were used for cortisol analyses. Results There were no significant differences in cortisol levels between groups across time points but significant inter and intra-individual variability. Maternal stress was positively correlated with infant cortisol and PIS (p&lt;0.05) and mothers in the Responsive group were significantly less stressed (p=0.02). Conclusion In this small sample, infant cortisol during bedtime separation was variable, elevated in all sleep interventions and not significantly different. Mothers were less stressed in the Responsive group. Findings indicate responsive methods are comparable to extinction and less stressful for mothers offering a possible gentler choice at bedtime separation.

Safety and efficacy of surgical transobturator tape in the treatment of stress urinary incontinence in women - three years of follow-up

Introduction/Objective. Stress urinary incontinence (SUI) is defined as the complaint of involuntary loss of urine in effort or physical exertion, or on sneezing or coughing. It is a common clinical condition affecting 50% of middle-aged and elderly women. Mid-urethral slings (MUSs) are the gold standard in the treatment of SUI. The aim of this study was to investigate the success rate and complications of surgical treatment of SUI in women with transobturator tape (TOT) within the three years of follow-up. Methods. From January 2011 until January 2018, 86 women with predominantly SUI were operated by TOT procedure. In 61.6% of patients SUI was confirmed by preoperative urodynamic examination (cystometry, uroflowmetry, urethral presser profile) and in 38.4% of patients by clinical examination of stress test (cough provocation). All patients were invited for a follow-up examination 6, 12, 24 and 36 months after surgery. The result of the operation is defined as cured, improved or without success. Results. The average age was 55 (32-72) years. The most common complications were tape erosion (3.5%), incision bleeding (2.3%), transient leg pain (3.5%), dyspareunia (2.3%), vaginal erosion (3.5%) and de novo urge (5.8%). After three years of follow-up, 82.6% patients were cured. Conclusion. TOT is a safe, effective and successful procedure with 82.6% of cured patients during a three-year follow-up.

Performance pay and low-grade stress: An experimental study

BACKGROUND: Although recent economics literature suggests a link between performance-related pay (PRP) and ill health, this finding is contested on the grounds that this link is plagued by endogeneity between the two variables of interest. OBJECTIVE: This study investigates the adverse effects of performance-related pay on stress which is an important determinant of physical health. METHODS: Forty subjects were randomly assigned to two equal groups: either being paid by performance or being paid a flat fee. Both objective (saliva samples to measure cortisol elevation) and subjective (self-reported stress level) measures of stress were obtained before and after participation in the experiment. This experimental methodology purges the effects of self-selection into performance pay and identifies the direction of causation from performance-related pay to stress which is measured by cortisol levels. RESULTS: Those who were paid for their performance experienced higher levels of stress, both in terms of perceived stress and in terms of objectively measured cortisol levels, compared to those who were paid a flat fee for minimum performance. CONCLUSIONS: Performance-related pay induces objectively measurable stress. Self-reported stress levels and the objective stress measure obtained by measuring cortisol move in a similar direction for the PRP and non-PRP groups, but only the cortisol group shows statistically significant differences between the PRP and non-PRP. This also suggests that individuals underestimate the stress caused by performance pay.

Examining Risk and Protective Factors for Psychological Health during the COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted the lives of people globally, and the significant mental health consequences of this pandemic are beginning to be documented. In addition to sociodemographic and COVID-19 specific factors, psychological risk and protective mechanisms likely influence individual differences in mental health symptoms in the context of the COVID-19 pandemic. We examined associations between a broad set of risk and protective factors with symptoms of depression, anxiety, alcohol problems, and eating pathology, and investigated interactions between objective stress due to COVID-19 and risk/protective variables in predicting psychopathology. Methods: Participants were 877 adults (73.7% female) recruited via internet sources from around the globe, but primarily residing in North America (87.4%). Results: Structural equation modelling revealed that certain risk and protective factors (e.g., loneliness, latent protective factor, mindfulness) were broadly related to psychopathology, whereas others showed unique relations with specific forms of psychopathology (e.g., greater repetitive thinking and anxiety; low meaning and purpose and depression). COVID-19 objective stress interacted with risk factors, but not protective factors, to predict greater anxiety symptoms, but not other forms of psychopathology. Limitations: This is a cross-sectional study of non-randomly recruited participants who reported high levels of income and education. Rates of problematic alcohol use were low. Conclusions: Findings contribute to our understanding of psychological mechanisms underlying individual differences in psychopathology in the context of a global stressor. Strategies that reduce loneliness and increase mindfulness will likely impact the greatest number of mental health symptoms.

Consistent numerical implementation of hypoelastic constitutive models

In hypoelastic constitutive models, an objective stress rate is related to the rate of deformation through an elasticity tensor. The Truesdell, Jaumann, and Green–Naghdi rates of the Cauchy and Kirchhoff stress tensors are examples of the objective stress rates. The finite element analysis software ABAQUS uses a co-rotational frame which is based on the Jaumann rate for solid elements and on the Green–Naghdi rate for shell and membrane elements. The user subroutine UMAT is the platform to implement a general constitutive model into ABAQUS, but, in order to update the Jacobian matrix in UMAT, the model must be expressed in terms of the Jaumann rate of the Kirchhoff stress tensor. This study aims to formulate and implement various hypoelastic constitutive models into the ABAQUS UMAT subroutine. The developed UMAT subroutine codes are validated using available solutions, and the consequence of using wrong Jacobian matrices is elucidated. The UMAT subroutine codes are provided in the “Electronic Supplementary Material” repository for the user’s consideration.