Cardiac defense response, cognitive flexibility and adaptative emotion regulation strategies

Treball Final de Màster Universitari en Investigació en Cervell i Conducta. Codi: SBM024. Curs: 2019/2020.Cardiac Defense Response (CDR) is a dynamic pattern of cardiac reactivity in response to aversive, intense and unexpected stimuli consisting of two successive accelerating/decelerating components, whose psychological significance is attributed to both attentional and motivational/emotional processes. According to the defense cascade model, the CDR second accelerative component indicates the activation of the aversivedefensive motivational system. This research aimed to analyze the relationship between CDR, levels of anxiety/depression, emotional regulation, and cognitive flexibility in a sample of healthy participants (N = 120). The experimental task consisted in the presentation of an intense aversive sound (500 ms, 105 dB) after an 8-minute rest period to prompt the CDR. A battery of questionnaires (HADS, CERQ, and CFI) was administered before the task began. Preliminary analyses did show no differences in the CDR pattern between subjects scoring high vs. low in anxiety and depression. We divided the sample into accelerators and decelerators according to their change scores obtained in the CDR second accelerative component. Significant differences were found in specific emotion regulation strategies and cognitive flexibility, with accelerators scoring significantly less in both self-report measures. Our findings suggest that cognitive flexibility and adaptive emotional regulation strategies might have an impact on cardiac defense response. It is possible that difficulties in regulating ongoing emotions might be associated with low cognitive flexibility, being key in the association of CDR and disease previously reported in the literature

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Does emotion regulation predict anxiety and depression in chronic pain?

Treball Final de Grau en Psicologia. Codi: PS1048. Curs: 2018/2019.Patients diagnosed with chronic pain are up to three times more likely to suffer from anxiety and depression. In this regard, recent research suggests that maladaptive emotion regulation, as well as anxiety and depression, would act as responsible factors for the potentiation and/or maintenance of chronic pain. Therefore, it seems relevant to clarify whether there is a positive relationship between these factors, and whether there are other psychological variables that could predict (and thus prevent) the onset of anxiety/depression in this clinical population. Precisely, the present study aimed to verify if the use of certain strategies of emotion regulation (reappraisal and suppression) would predict the level of anxiety and/or depression in chronic pain. The experimental sample consisted of 77 patients from the Pain Unit of the General Hospital of Castellón (Mean age = 55.25; SD = 9.67), who were administered a battery of self-report questionnaires in order to evaluate different psychological symptoms. Specifically, anxiety and depression (HADS), behavioral fear-avoidance (FAB), reevaluation and suppression (ERQ), catastrophism (PCS), pain intensity (item 5 of the BPI) and pain interference in daily life (subscale BPI-IA) were measured. Regression analyses showed that the variables that most predict anxiety/depression symptoms in these patients were catastrophism and pain interference in daily life, possibly due to a maladaptive reaction to social role change (the fact of becoming "patients"), which would increase their feelings of exclusion, helplessness and negative emotionality. In addition, our findings suggest that emotion regulation strategies were not related to anxiety/depression symptoms in this experimental sample. However, the questionnaire used in this study (ERQ) evaluates the frequency of use of two specific strategies (suppression and re-evaluation), without exploring other coping strategies (CERQ) or the difficulty of regulating their emotions (DERS). Similarly, it does not consider whether such strategies are adequately implemented according to the context.Los pacientes diagnosticados con dolor crónico tienen un riesgo hasta tres veces mayor de sufrir ansiedad y depresión. A este respecto, investigaciones recientes sugieren que la desregulación emocional, la ansiedad y la depresión actuarían como factores responsables de la potenciación y/o mantenimiento del dolor en estos pacientes. En consecuencia, parece relevante clarificar si existe una relación positiva entre dichos factores, y si concurren otras variables psicológicas que pueden ayudar a predecir (e incluso prevenir) la aparición de ansiedad/depresión en esta población clínica. Precisamente, el objetivo del presente trabajo era comprobar si el uso de determinadas estrategias de regulación emocional (reevaluación y supresión) puede predecir el nivel de ansiedad y/o depresión en dolor crónico. La muestra experimental fue de 77 pacientes de la Unidad del Dolor del Hospital General de Castellón (edad media = 55,25; DT = 9,67), a los que se les administró un batería de cuestionarios que evaluaban distintos síntomas psicológicos. Concretamente, se evaluó ansiedad y depresión (HADS), miedo-evitación conductual (FAB), revaluación y supresión (ERQ), catastrofismo (PCS), intensidad del dolor (ítem 5 del BPI) e interferencia del dolor en la vida diaria (subescala BPI-IA). Los análisis de regresión mostraron que las variables que mejor predicen síntomas de ansiedad/depresión en estos pacientes son el catastrofismo y la interferencia del dolor en la vida diaria, posiblemente debido a una reacción desadaptativa al cambio de rol social (i.e., convertirse en “pacientes”), lo que aumentaría sus sentimientos de exclusión, desamparo y emocionalidad negativa. Además, nuestros datos sugieren que las estrategias de regulación emocional no están relacionadas con los síntomas de ansiedad/depresión en esta muestra experimental. No obstante, el cuestionario utilizado (ERQ) evalúa la frecuencia de uso de dos estrategias específicas (supresión y reevaluación), sin explorar otras estrategias de afrontamiento (CERQ) o la dificultad para regular sus emociones (DERS). Igualmente, no considera si dichas estrategias se implementan de forma adecuada teniendo en cuenta el contexto