The association between loneliness and other constructs of social connectedness and the probability of desire for hastened death, euthanasia and assisted suicide: systematic review

Background Euthanasia and assisted suicide (EAS) requests are common in countries where they are legal. Loneliness and social isolation are modifiable risk factors for mental illness and suicidal behaviour and are common in terminal illness. Our objective was to summarise available literature to clarify whether these and related measures of social connectedness might contribute to requests for EAS. Methods We conducted a pre-registered (PROSPERO CRD42019160508) systematic review and narrative synthesis of quantitative literature investigating associations between social connectedness and a) requested/actual EAS, b) attitudes towards EAS, and c) a desire for hastened death (DHD) by searching six databases (PsycINFO, MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar) from inception to November 2022, rating eligible peer-reviewed, empirical studies using the QATSO quality assessment tool. Results We identified 37 eligible studies that investigated associations with a) requested/actual EAS (n = 9), b) attitudes to EAS (n = 16), and c) DHD (n = 14), with limited overlap, including 17,359 participants. The majority (62%) were rated at medium/high risk of bias. Focussing our narrative synthesis on the more methodologically sound studies, we found no evidence to support an association between different constructs of social connectedness and requested or actual EAS, and very little evidence to support an association with attitudes to EAS or an association with DHD. Conclusions Our findings for all age groups are consistent with a those of a previous systematic review focussed on older adults and suggest that poor social connectedness is not a clear risk factor for EAS or for measures more distally related to EAS. However, we acknowledge low study quality in some studies in relation to sampling, unvalidated exposure/outcome measures, cross-sectional design, unadjusted analyses, and multiple testing. Clinical assessment should focus on modifying established risk factors for suicide and EAS, such as hopelessness and depression, as well as improving any distressing aspects of social disconnectedness to improve quality of life

Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the Coronavirus Disease 2019 (COVID-19) Pandemic: An ACC /SCAI Consensus Statement

The COVID-19 pandemic has strained health care resources around the world causing many institutions to curtail or stop elective procedures. This has resulted in the inability to care for patients valvular and structural heart disease (SHD) in a timely fashion potentially placing these patients at increased risk for adverse cardiovascular complications including congestive heart failure and death. The effective triage of these patients has become challenging in the current environment as clinicians have had to weigh the risk of bringing susceptible patients into the hospital environment during the COVID-19 pandemic versus the risk of delaying a needed procedure. In this document, we suggest guidelines as to how to triage patients in need of SHD interventions and provide a framework of how to decide when it may be appropriate to proceed with intervention despite the ongoing pandemic. In particular, we address the triage of patients in need of trans-catheter aortic valve replacement and percutaneous mitral valve repair. We also address procedural issues and considerations for the function of structural heart disease teams during the COVID-19 pandemic

Triage Considerations for Patients Referred for Structural Heart Disease Intervention During the COVID-19 Pandemic: An ACC/SCAI Position Statement

The coronavirus disease-2019 (COVID-19) pandemic has strained health care resources around the world, causing many institutions to curtail or stop elective procedures. This has resulted in an inability to care for patients with valvular and structural heart disease in a timely fashion, potentially placing these patients at increased risk for adverse cardiovascular complications, including CHF and death. The effective triage of these patients has become challenging in the current environment as clinicians have had to weigh the risk of bringing susceptible patients into the hospital environment during the COVID-19 pandemic against the risk of delaying a needed procedure. In this document, the authors suggest guidelines for how to triage patients in need of structural heart disease interventions and provide a framework for how to decide when it may be appropriate to proceed with intervention despite the ongoing pandemic. In particular, the authors address the triage of patients in need of transcatheter aortic valve replacement and percutaneous mitral valve repair. The authors also address procedural issues and considerations for the function of structural heart disease teams during the COVID-19 pandemic

Neuroendocrine Stress Response in Female and Male Youths With Conduct Disorder and Associations With Early Adversity

Objective: Conduct disorder (CD) involves aggressive and antisocial behavior and is associated with blunted cortisol stress response in male youths. Far less is known about cortisol stress responsivity in female youths with CD or other neuroendocrine responses in both sexes. Although CD is linked to early adversity, the possibility that neuroendocrine alterations may mediate the relationship between early adversity and CD has not been systematically investigated. Method: Within the European FemNAT-CD multi-site study, salivary cortisol, testosterone, the testosterone/cortisol ratio, oxytocin, and psychological stress response to a standardized psychosocial stress test (the Trier Social Stress Test [TSST]), together with common pre- and postnatal environmental risk factors, were investigated in 130 pubertal youths with CD (63% female, 9-18 years of age) and 160 sex-, age-, and puberty-matched healthy controls (HCs). Results: The TSST induced psychological stress in both CD and HCs. In contrast, female and male youths with CD showed blunted cortisol, testosterone, oxytocin, and testosterone/cortisol stress responses compared to HCs. These blunted stress responses partly mediated the relationship between environmental risk factors and CD. Conclusion: Findings from this unique sample, including many female youths with CD, provide evidence for a widespread attenuated stress responsivity of not only stress hormones, but also sex hormones and neuropeptides in CD and its subgroups (eg, with limited prosocial emotions). Results are the first to demonstrate blunted neuroendocrine stress responses in both female and male youths with CD. Early adversity may alter neuroendocrine stress responsivity. Biological mechanisms should be investigated further to pave the way for personalized intervention, thereby improving treatments for CD.</p

Sex differences in risk-based decision making in adolescents with conduct disorder

Altered decision making processes and excessive risk-seeking behaviours are key features of conduct disorder (CD). Previous studies have provided compelling evidence of abnormally increased preference for risky options, higher sensitivity to rewards, as well as blunted responsiveness to aversive outcomes in adolescents with CD. However, most studies published to date have focused on males only; thus, it is not known whether females with CD show similar alterations in decision making. The current study investigated potential sex differences in decision making and risk-seeking behaviours in adolescents with CD. Forty-nine adolescents with CD (23 females) and 51 control subjects (27 females), aged 11-18 years, performed a computerised task assessing decision making under risk—the Risky Choice Task. Participants made a series of decisions between two gamble options that varied in terms of their expected values and probability of gains and losses. This enabled the participants’ risk preferences to be determined. Taking the sample as a whole, adolescents with CD exhibited increased risk-seeking behaviours compared to healthy controls. However, we found a trend towards a sex-by-group interaction, suggesting that these effects may vary by sex. Follow-up analyses showed that males with CD made significantly more risky choices than their typically developing counterparts, while females with CD did not differ from typically developing females in their risk-seeking behaviours. Our results provide preliminary evidence that sex may moderate the relationship between CD and alterations in risk attitudes and reward processing, indicating that there may be sex differences in the developmental pathways and neuropsychological deficits that lead to CD

Resting autonomic nervous system activity is unrelated to antisocial behaviour dimensions in adolescents: Cross-sectional findings from a European multi-centre study

Purpose: Autonomic nervous system (ANS) functioning has long been studied in relation to antisocial behaviour, but relevant measures (heart rate, heart rate variability, pre-ejection period, respiration rate) have rarely been considered together. This study investigated the relationship between these measures and antisocial behaviour. Methods: Using a sample of 1010 youths with (47.8%) and without conduct disorder (52.2%) aged between 9 and 18. years (659 females, 351 males, mean age = 14.2. years, SD = 2.4), principal component analysis (PCA) was applied to various measures of psychopathology and antisocial behavior. Structural equation modelling was performed in order to test whether the ANS measures predicted PCA-dimensions. Cluster analysis was used in order to classify patterns of ANS activity. Analyses were performed separately for males/females and controlled for body-mass-index, age, caffeine use, cigarette smoking, sports, socioeconomic status, medication, cardiac problems. Results: The PCA yielded three components: antisocial behaviour/comorbid psychopathology, narcissistic traits, and callous-unemotional traits. ANS measures were only weakly correlated with these components. Cluster analysis yielded high and low arousal clusters in both sexes. When controlling for covariates, all associations disappeared. Conclusion: Our findings suggest that resting ANS measures are only weakly related to antisocial behaviour and indicate that smoking should be considered as an important covariate in future psychophysiological studies

Geoscience Education Perspectives on Integrated, Coordinated, Open, Networked (ICON) Science

Practitioners and researchers in geoscience education embrace collaboration applying ICON (Integrated, Coordinated, Open science, and Networked) principles and approaches ICON principles and approaches have been used to create and share large collections of educational resources, to move forward collective priorities, and to foster peer-learning among educators. These strategies can also support the advancement of coproduction between geoscientists and diverse communities. For this reason, many authors from the geoscience education community have co-created three commentaries on the use and future of ICON in geoscience education. We envision that sharing our expertise with ICON practice will be useful to other geoscience communities seeking to strengthen collaboration. Geoscience education brings substantial expertise in social science research and its application to building individual and collective capacity to address earth sustainability and equity issues at local to global scales The geoscience education community has expanded its own ICON capacity through access to and use of shared resources and research findings, enhancing data sharing and publication, and leadership development. We prioritize continued use of ICON principles to develop effective and inclusive communities that increase equity in geoscience education and beyond, support leadership and full participation of systemically non-dominant groups and enable global discussions and collaborations

Healthcare workers’ exposure to work-related traumatic events, secondary traumatic stress and coping: avenues for organisational and individual level intervention

Healthcare workers (HCWs) can be routinely exposed to work-related stressors, traumatic events, and a plethora of difficult decisions in emotionally charged, intensive and, often, trauma-laden environments. Resulting negative impacts can include traumatic stress responses such as Secondary Traumatic Stress (STS), Post-Traumatic Stress Disorder (PTSD) and associated emotional wellbeing and mental health difficulties. This can apply to HCWs working across a range of healthcare settings. An improved understanding of the nature of work-related traumatic events, the resulting negative impacts, as well as risk and protective factors is required for the whole workforce. Such research is important, not only for the wellbeing of the individual healthcare worker, but for the potential unintended and negative consequences to patients in their care. Paper 1 is a systematic review that drew together the available qualitative research to explore and further understand the experiences and perceptions of HCWs working in Paediatric Intensive Care Units (PICUs), with a particular focus on coping. High rates of burnout, traumatic stress and moral distress are reported for HCWs working in PICUs (Jones et al., 2020; Colville et al., 2017), with existing reviews highlighting the negative impact working in PICU can have. Understanding what enables people to cope is important for this at-risk workforce (Highfield, 2019). Five electronic databases were systematically searched, and from the initial 4648 papers found, 15 qualitative studies were reviewed. A series of inter-rater reliability checks were taken throughout the screening, data extraction and quality appraisal stages. In order to meet the aims of the review, data from the 15 studies were synthesised using Thomas and Hardens (2008) thematic synthesis framework. The synthesised findings resulted in five analytical themes, which were generated from the experiences of 223 HCWs working in PICU: (1) Individual-level coping, (2) Interpersonal (dis-)connections, (3), Team-level coping, (4) Organisational resource and (5) The vantage of time. Eleven subthemes were also generated. Connecting to the meaning of the work, acceptance of certain aspects of the work and self-reflection were important in facilitating HCWs coping. A balance of approach and avoidant coping was noted, as were self-nurturing activities, breaks and ventilating one’s emotions. Being listened to and truly heard by others enabled coping, whereas (dis-)connection from social networks outside of PICU was highlighted. Team-level coping was important, as were ideas of ‘collective care.’ Findings suggest there may be a systemic nature to what helps HCWs cope, with existing theories such as the Job-Demand-Resource Model (Demerouti et al., 2001), the Job-Demand-Control-Support Model (Karasak,1979) and Systems Theory (von Bertanlanffy,1967) providing a backdrop to the themes generated. Findings from this review suggest that support for HCWs needs to be flexible and targeted at all levels within an organisational system, especially in relation to adequate resource, control and autonomy. Paper 2 was an empirical research study that investigated rates of exposure to work-related traumatic material and rates of Secondary Traumatic Stress (STS), Post-Traumatic Stress Disorder (PTSD), and Complex Post-Traumatic Stress Disorder (CPTSD) within both clinical and non-clinical HCWs. Whilst the impact of work-related trauma exposure is well documented within clinical HCWs, such as nurses, doctors, psychologists and first-responders, far less research focuses on non-clinical HCWs, such as administrative and clerical staff. Non-clinical HCWs are vital team members in the running of healthcare systems and can also be exposed to traumatic material in the workplace. A cross-sectional online survey was used to collect data from clinical (n = 180) and non-clinical HCWS (n = 74) working in UK-based healthcare settings. Participants reported rates of STS, PTSD, CPTSD and work-related trauma exposure alongside individual and organisational risk factors associated with the development of STS. These factors included perceived preparedness, social support, workplace culture and coping. Data were analysed using descriptive and inferential statistics. The study helped quantify some of the ways HCWs can be exposed to traumatic material, particularly for non-clinical HCWs whom have been under-researched as a professional group. Findings indicate that non-clinical HCWs experience STS associated with work-related traumatic material, of which 35.1% met the threshold for probable STS caseness. Whilst STS severity was significantly higher in clinical compared to non-clinical HCWs, there was no statistical difference in terms of C/PTSD between the two groups. This study helped identify how risk and protective factors typically associated with STS within clinical HCWs are also important for non-clinical HCWs. Potential targets for intervention and future research for all HCWs include developing a supportive workplace culture, minimising trauma exposure, addressing avoidant coping styles and behaviours, and where possible, preparing staff for exposure to work-related traumatic material