Prevalence of moral injury in Canadian Forces members deployed to Afghanistan

Moral injury is a relatively new area of study within military mental health care, as such, prevalence estimates for both moral injury and exposure to potentially morally injurious events (PMIE; a moral injury precursor) are unknown for many of the world’s militaries. PMIE is commonly defined as the perpetrating, failing to prevent, witnessing, or learning about acts or events that transgress an individual’s deeply held moral belief(s). The primary purpose of this study was to estimate the prevalence of PMIE in a population of Canadian Armed Forces (CF) members who served in support of the recent mission to Afghanistan. How exposure to PMIE may affect these individuals’ self-reported rates positive mental health served as a secondary research question. To this end, a secondary data analysis was conducted using the results of the 2013 Canadian Forces Mental Health Survey, a cross-sectional survey of over 8,000 active-duty CF members conducted by Statistics Canada for the Department of National Defence and the CF. Statistical analysis revealed that over 65% of CF members reported exposure to at least one event that would be considered a PMIE. The most commonly reported PMIE types included seeing ill or injured women and children that they were unable to help (48%), being unable to distinguish between combatants and non-combatants (44%), and finding themselves in a threatening situation where they were unable to respond due to the rules of engagement they were required to operate under (35%). Results of the second research question revealed that the positive mental health status of CF members overall differed slightly from the Canadian population as a whole. However, when CF members’ positive mental health statuses were compared according to PMIE exposure status those exposed were found to be 37% less likely to be flourishing, and 138% more likely to be languishing when compared to those who were not exposed. These findings provide support for both the presence of exposure to PMIE in CF members who were deployed in support of the mission to Afghanistan, and the detrimental effect that such exposure has on their mental health. The implications and limitations of these findings and potential directions for future research into moral injury and PMIE are also discussed

But i see old people everywhere : Dispelling the myth that eldercare is learned in nongeriatric clerkships

Purpose: To test the assumption that knowledge, attitudes, and skills (KAS) in geriatrics are learned via exposure to elderly patients in nongeriatric clerkships. In the developed world, the proportion of adults ≥65 years old will soon surpass the proportion of children \u3c14. However, clinical clerkships containing geriatric rotations are not mandated by the Liaison Committee for Medical Education. Method: The authors assessed differences in geriatrics-focused KAS between medical students who completed a rotation in eldercare and those who completed a traditional nongeriatric clerkship. Over two academic years, the authors randomly assigned 263 clinical clerks to a clerkship year that did (eldercare group) or did not contain a two-week rotation focused on geriatrics. All students completed questionnaires that assessed their knowledge of and attitudes toward geriatric patients before and after their clerkships. Before graduation, all students completed an objective structured clinical examination (OSCE) including a clinical station focused on geriatrics. Results: Questionnaire and OSCE station response rates were 74.8% and 100%, respectively. The eldercare group had significantly higher knowledge scores (P = .004). Students\u27 attitudes toward older adults worsened over the clerkship year in both groups, but slightly less in the eldercare group; that group had significantly higher OSCE geriatric station scores and overall pass rates (both: P \u3c .001). Conclusions: Geriatrics is often regarded as a nonessential discipline. This study showed, however, that a clerkship year containing a specialized geriatric rotation is significantly more effective than a traditional clerkship year in preparing students to care for an aging population. © by the Association of American Medical Colleges

Molecular Identification of Synanthedonini Members (Lepidoptera: Sesiidae) Using Cytochrome Oxidase I

Many North American sesiid moths within Synanthodonini have been studied extensively because their feeding activity can cause detrimental economic and esthetic impacts to many commercially important ornamental and native plant species. Recent discoveries of nonnative clearwing moth pest introductions [e.g., Synanthedon myopaeformis (Borkh.)], reinforce the need for reliable and accurate molecular diagnostic tools that can be used by nontaxonomic experts, particularly when juvenile life stages are recovered from infested host-plant tissues. Cytochrome oxidase I (cox I) previously has been used to successfully identify species and resolve species complexes. In this study, the cox I phylogeny inferred from sequences generated from 21 species of sesiid moths classified within Synanthedonini confirms the close evolutionary relationship between sesiid species. As other authors have suggested in previous works, we observed that Synanthedon rileyana H. Edwards appears atypical for the genus, as it paired with Carmenta bassiformis (Walker) one node removed from, but not sister to, a large well-supported Synanthedon-rich clade. Sannina uroceriformis Walker and Podosesia MXöschler were observed nested deeply within the aforementioned well-supported clade (posterior probability [PP] of clade = 100) comprised of all Synanthedon species sampled, except S. rileyana. Placement of these two taxa conflicts with results from previous morphological studies. These placements were immune from repeated attempts to delete perceived nearby long branches within the data set. Despite these few conflicts and overall low statistical support for most interspecific and higher relationships, our data suggest that all species examined possess unique genetic signatures that lend themselves to accurate identification of all life history stages of these clearwing pests

Impact of the COVID-19 pandemic on the mental health and well-being of Veterans’ spouses: a cross sectional analysis

Background COVID-19 has negatively impacted the mental health and well-being of both Canadians and the world as a whole, with Veterans, in particular, showing increased rates of depression, anxiety, and PTSD. Spouses and common-law partners often serve as primary caregivers and sources of support for Veterans, which may have a deleterious effect on mental health and increase risk of burnout. Pandemic related stressors may increase burden and further exacerbate distress; yet the effect of the pandemic on the mental health and well-being of Veterans’ spouses is currently unknown. This study explores the self-reported mental health and well-being of a group of spouses of Canadian Armed Forces Veterans and their adoption of new ways to access healthcare remotely (telehealth), using baseline data from an ongoing longitudinal survey. Methods Between July 2020 and February 2021, 365 spouses of Veterans completed an online survey regarding their general mental health, lifestyle changes, and experiences relating to the COVID-19 pandemic. Also completed were questions relating to their use of and satisfaction with health-care treatment services during the pandemic. Results Reported rates of probable major depressive disorder (MDD), generalized anxiety disorder (GAD), alcohol use disorder (AUD), and PTSD were higher than the general public, with 50–61% believing their symptoms either directly related to or were made worse by the pandemic. Those reporting being exposed to COVID-19 were found to have significantly higher absolute scores on mental health measures than those reporting no exposure. Over 56% reported using telehealth during the pandemic, with over 70% stating they would continue its use post-pandemic. Conclusions This is the first Canadian study to examine the impact of the COVID-19 pandemic specifically on the mental health and well-being of Veterans’ spouses. Subjectively, the pandemic negatively affected the mental health of this group, however, the pre-pandemic rate for mental health issues in this population is unknown. These results have important implications pertaining to future avenues of research and clinical/programme development postpandemic, particularly relating to the potential need for increased support for spouses of Veterans, both as individuals and in their role as supports for Veterans

Toward a Decision Support System for Mitigating Urban Heat

With the continuous rise of global urbanization, city planners and policymakers are increasingly concerned with urban heat islands (UHI), which are metropolitan areas that are significantly warmer than their surrounding rural areas. We address the United Nation’s Sustainable Development Goal 11 “Sustainable Cities and Communities,” and we design and develop a decision support system (DSS), which will help city planners and policymakers to overcome economic barriers to reach environmental sustainability goals

Engineered IL-7 synergizes with IL-12 immunotherapy to prevent T cell exhaustion and promote memory without exacerbating toxicity

Cancer immunotherapy is moving toward combination regimens with agents of complementary mechanisms of action to achieve more frequent and robust efficacy. However, compared with single-agent therapies, combination immunotherapies are associated with increased overall toxicity because the very same mechanisms also work in concert to enhance systemic inflammation and promote off-tumor toxicity. Therefore, rational design of combination regimens that achieve improved antitumor control without exacerbated toxicity is a main objective in combination immunotherapy. Here, we show that the combination of engineered, tumor matrix-binding interleukin-7 (IL-7) and IL-12 achieves remarkable anticancer effects by activating complementary pathways without inducing any additive immunotoxicity. Mechanistically, engineered IL-12 provided effector properties to T cells, while IL-7 prevented their exhaustion and boosted memory formation as assessed by tumor rechallenge experiments. The dual combination also rendered checkpoint inhibitor (CPI)–resistant genetically engineered melanoma model responsive to CPI. Thus, our approach provides a framework of evaluation of rationally designed combinations in immuno-oncology and yields a promising therapy

Exposure to moral stressors and associated outcomes in healthcare workers:Prevalence, correlates, and impact on job attrition

Introduction: Healthcare workers (HCWs) often experience morally challenging situations in their workplaces that may contribute to job turnover and compromised well-being. This study aimed to characterize the nature and frequency of moral stressors experienced by HCWs during the COVID-19 pandemic, examine their influence on psychosocial-spiritual factors, and capture the impact of such factors and related moral stressors on HCWs’ self-reported job attrition intentions.Methods: A sample of 1204 Canadian HCWs were included in the analysis through a web-based survey platform whereby work-related factors (e.g. years spent working as HCW, providing care to COVID-19 patients), moral distress (captured by MMD-HP), moral injury (captured by MIOS), mental health symptomatology, and job turnover due to moral distress were assessed.Results: Moral stressors with the highest reported frequency and distress ratings included patient care requirements that exceeded the capacity HCWs felt safe/comfortable managing, reported lack of resource availability, and belief that administration was not addressing issues that compromised patient care. Participants who considered leaving their jobs (44%; N = 517) demonstrated greater moral distress and injury scores. Logistic regression highlighted burnout (AOR = 1.59; p &lt; .001), moral distress (AOR = 1.83; p &lt; .001), and moral injury due to trust violation (AOR = 1.30; p = .022) as significant predictors of the intention to leave one’s job.Conclusion: While it is impossible to fully eliminate moral stressors from healthcare, especially during exceptional and critical scenarios like a global pandemic, it is crucial to recognize the detrimental impacts on HCWs. This underscores the urgent need for additional research to identify protective factors that can mitigate the impact of these stressors.Introducción: Los trabajadores de la salud (TS) a menudo experimentan situaciones moralmente desafiantes en sus lugares de trabajo que pueden contribuir a la rotación laboral y comprometer su bienestar. Este estudio tuvo como objetivo caracterizar la naturaleza y frecuencia de los estresores morales experimentados por los TS durante la pandemia por COVID-19, examinar su influencia en los factores psicosociales-espirituales y capturar el impacto de dichos factores y los estresores morales relacionados a las intenciones de abandono laboral de los TS.Métodos: Se incluyó en el análisis una muestra de 1.204 TS canadienses a través de una encuesta en plataforma web en la que se analizaron factores relacionados con el trabajo (p. ej., años trabajados como TS, brindando atención a pacientes con COVID-19), angustia moral (evaluado con MMD-HP), daño moral (evaluado con MIOS), sintomatología de salud mental y rotación laboral debido a angustia moral.Resultados: Los estresores morales con mayor frecuencia reportados y tasas de angustia incluyeron requerimientos de atención al paciente que excedieron la capacidad en la que los TS se sentían seguros/cómodos de manejarlos, falta de disponibilidad de recursos y la creencia de que la administración no estaba abordando los problemas que comprometían la atención al paciente. Los participantes que consideraron dejar sus trabajos (44%; N = 517) demostraron mayores puntuaciones de angustia y daño moral. La regresión logística destacó el burnout (AOR = 1,59; p &lt; 0,001), la angustia moral (AOR = 1,83; p &lt; 0,001) y el daño moral debido a la violación de la confianza (AOR = 1,30; p = 0,022) como predictores significativos asociados a la intención de dejar el trabajo.Conclusión: Si bien, es imposible eliminar por completo los estresores morales de la atención sanitaria, especialmente durante escenarios críticos y excepcionales como una pandemia global, es crucial reconocer los impactos perjudiciales para los TS. Esto subraya la necesidad urgente de realizar investigaciones adicionales para identificar factores protectores que puedan mitigar el impacto de estos factores estresantes.</div

Exposure to moral stressors and associated outcomes in healthcare workers:Prevalence, correlates, and impact on job attrition

Introduction: Healthcare workers (HCWs) often experience morally challenging situations in their workplaces that may contribute to job turnover and compromised well-being. This study aimed to characterize the nature and frequency of moral stressors experienced by HCWs during the COVID-19 pandemic, examine their influence on psychosocial-spiritual factors, and capture the impact of such factors and related moral stressors on HCWs’ self-reported job attrition intentions.Methods: A sample of 1204 Canadian HCWs were included in the analysis through a web-based survey platform whereby work-related factors (e.g. years spent working as HCW, providing care to COVID-19 patients), moral distress (captured by MMD-HP), moral injury (captured by MIOS), mental health symptomatology, and job turnover due to moral distress were assessed.Results: Moral stressors with the highest reported frequency and distress ratings included patient care requirements that exceeded the capacity HCWs felt safe/comfortable managing, reported lack of resource availability, and belief that administration was not addressing issues that compromised patient care. Participants who considered leaving their jobs (44%; N = 517) demonstrated greater moral distress and injury scores. Logistic regression highlighted burnout (AOR = 1.59; p &lt; .001), moral distress (AOR = 1.83; p &lt; .001), and moral injury due to trust violation (AOR = 1.30; p = .022) as significant predictors of the intention to leave one’s job.Conclusion: While it is impossible to fully eliminate moral stressors from healthcare, especially during exceptional and critical scenarios like a global pandemic, it is crucial to recognize the detrimental impacts on HCWs. This underscores the urgent need for additional research to identify protective factors that can mitigate the impact of these stressors.Introducción: Los trabajadores de la salud (TS) a menudo experimentan situaciones moralmente desafiantes en sus lugares de trabajo que pueden contribuir a la rotación laboral y comprometer su bienestar. Este estudio tuvo como objetivo caracterizar la naturaleza y frecuencia de los estresores morales experimentados por los TS durante la pandemia por COVID-19, examinar su influencia en los factores psicosociales-espirituales y capturar el impacto de dichos factores y los estresores morales relacionados a las intenciones de abandono laboral de los TS.Métodos: Se incluyó en el análisis una muestra de 1.204 TS canadienses a través de una encuesta en plataforma web en la que se analizaron factores relacionados con el trabajo (p. ej., años trabajados como TS, brindando atención a pacientes con COVID-19), angustia moral (evaluado con MMD-HP), daño moral (evaluado con MIOS), sintomatología de salud mental y rotación laboral debido a angustia moral.Resultados: Los estresores morales con mayor frecuencia reportados y tasas de angustia incluyeron requerimientos de atención al paciente que excedieron la capacidad en la que los TS se sentían seguros/cómodos de manejarlos, falta de disponibilidad de recursos y la creencia de que la administración no estaba abordando los problemas que comprometían la atención al paciente. Los participantes que consideraron dejar sus trabajos (44%; N = 517) demostraron mayores puntuaciones de angustia y daño moral. La regresión logística destacó el burnout (AOR = 1,59; p &lt; 0,001), la angustia moral (AOR = 1,83; p &lt; 0,001) y el daño moral debido a la violación de la confianza (AOR = 1,30; p = 0,022) como predictores significativos asociados a la intención de dejar el trabajo.Conclusión: Si bien, es imposible eliminar por completo los estresores morales de la atención sanitaria, especialmente durante escenarios críticos y excepcionales como una pandemia global, es crucial reconocer los impactos perjudiciales para los TS. Esto subraya la necesidad urgente de realizar investigaciones adicionales para identificar factores protectores que puedan mitigar el impacto de estos factores estresantes.</div