Morally distressing experiences, moral injury, and burnout in florida healthcare providers during the covid-19 pandemic

Because healthcare providers may be experiencing moral injury (MI), we inquired about their healthcare morally distressing experiences (HMDEs), MI perpetrated by self (Self MI) or others (Others MI), and burnout during the COVID-19 pandemic. Participants were 265 healthcare providers in North Central Florida (81.9% female, Mage = 37.62) recruited via flyers and emailed brochures that completed online surveys monthly for four months. Logistic regression analyses investigated whether MI was associated with specific HMDEs, risk factors (demographic characteristics, prior mental/medical health adversity, COVID-19 protection concern, health worry, and work impact), protective factors (personal resilience and leadership support), and psychiatric symptomatology (depression, anxiety, and PTSD). Linear regression analyses explored how Self/Others MI, psychiatric symptomatology, and the risk/protective factors related to burnout. We found consistently high rates of MI and burnout, and that both Self and Others MI were associated with specific HMDEs, COVID-19 work impact, COVID-19 protection concern, and leadership support. Others MI was also related to prior adversity, nurse role, COVID-19 health worry, and COVID-19 diagnosis. Predictors of burnout included Self MI, depression symptoms, COVID-19 work impact, and leadership support. Hospital administrators/supervisors should recognize the importance of supporting the HCPs they supervise, particularly those at greatest risk of MI and burnout

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Interactions between reward motivation and emotional processing

Much of the past research on how reward motivation and emotional information influence brain and behavior has been conducted separately. Recently, a few behavioral and brain imaging studies have investigated how reward and emotional information co-jointly impact brain and behavior. The present chapter reviews findings from this recent line of work to summarize our current knowledge about the influence of reward expectancy on brain and behavior in the context of emotional information. The available findings suggest that behaviorally reward counteracts the adverse impact of potent emotional distractors on task performance. Additionally, brain findings suggest that the ventral striatum plays an active role in upregulating attentional control processes to limit the influence of emotional distractors. Overall, task relevance seems to play an important role in shaping interactions between reward and emotional processing. We conclude by outlining a few open questions for future research

Attentional capture by simultaneous pleasant and unpleasant emotional distractors

Both high-arousal pleasant and unpleasant task-irrelevant stimuli capture attention and divert processing away from the main task leading to impaired behavioral performance in concurrent tasks. Most studies have separately investigated interference effects of unpleasant and pleasant stimuli on behavior. Thus, little is known about how pleasant and unpleasant task-irrelevant stimuli influence behavior simultaneously. In the present study, we investigated this question during a visual-letter search task. We tested two alternative hypotheses about the influence of simultaneous pleasant and unpleasant task-irrelevant stimuli on task performance. If behavior is purely determined by the intensity of the distractor stimuli (independent of valence), then we would expect the interference effect of simultaneous pleasant and unpleasant distractors to be similar to the influence of two pleasant or two unpleasant distractor stimuli. In contrast, because of opponent interactions between appetitive and aversive motivational systems, the interference effect of simultaneous pleasant and unpleasant stimuli might be weakened. We found that the interference effect of a compound pleasant-plus-unpleasant stimulus was greater than that of a neutral-plus-emotional stimulus and similar to that of two pleasant or two unpleasant stimuli. These results suggest that at the level of behavior, the influence of joint pleasant and unpleasant task-irrelevant stimuli during perception is mainly determined by the intensity of the stimuli, and independent of their valence