Psychiatric and Mental Health Commons^™

Fibrinogen; A Predictor Of Injury Severity And Mortality Among Patients With Traumatic Brain Injury In Sub-Saharan Africa: A Cross-Sectional Observational Study, Michael Devereaux, Martha Sajatovic

Faculty Scholarship

Studies show that fibrinogen concentrations <2 g/L in patients with traumatic brain injury (TBI) is associated with increased mortality. However, little is known regarding fibrinogen levels and TBI severity as well as mortality in sub-Saharan Africa despite shouldering a high burden of TBI. We therefore set out to determine whether fibrinogen levels are associated with TBI severity and outcome. To determine the sensitivity and specificity of fibrinogen levels and the association with severity and mortality among TBI patients at Mulago Hospital. We prospectively enrolled 213 patients with TBI aged between 13 and 60 years of age and presenting within 24 hours of injury. Patients with preexisting coagulopathy, concurrent use of anticoagulant or antiplatelet agents, preexisting hepatic insufficiency, diabetes mellitus and who were pregnant were excluded. Fibrinogen levels were determined using the Clauss fibrinogen assay. Logistic regression analyses were conducted to identify the association between fibrinogen level and 7-day outcomes. Majority of the patients were male (88.7%) and nearly half were aged 30 or less (48.8%). Fibrinogen levels <2 g/L were observed in 35.1% of the study participants. The average time spent in the study was 3.7 ± 2.4 days. The sensitivity and specificity using fibrinogen <2 g/L was 56.5% and 72.9% respectively. Fibrinogen levels predict TBI severity with an AUC = 0.656 (95% CI 0.58-0.73: P = .000) Fibrinogen levels <2 g/L (hypofibrinogenemia) were independently associated with severe TBI. (Adjusted odds ratio 2.87 CI, 1.34-6.14: P = .007). Levels above 4.5 g/L were also independently associated with injury severity (adjusted odds ratio 2.89, CI 1.12-7.48: P < .05) Fibrinogen levels more than 4.5 g/L were independently associated with mortality (OR 4.5, CI; 1.47-13.61, P < .05). The fibrinogen level is a useful tool in predicting severity including mortality of TBI. Fibrinogen levels may be used as an additional tool to screen TBI patients for injury severity especially among patients with Glasgow coma scale scores of <14.

The Social Anxiety Stigma Scale (Sass): Development, Factor Structure, And Validation, Ruba Rum

USF Tampa Graduate Theses and Dissertations

The primary reason people with social anxiety disorder (SAD) do not seek treatment is due to stigma concerns. Yet, our understanding of SAD stigma hinges heavily on measures that assess general mental illness stigma, which may not capture the distinct aspects of SAD. The goal of this research program was to develop and validate a measure of social anxiety stigma that assesses personal stigma towards people with SAD: the Social Anxiety Stigma Scale (SASS). The SASS was evaluated across three studies. In Study 1 (N = 221), an initial item analysis was conducted on 33 items to remove weak items …

Blood Pressure Variability And Early Neurological Outcomes In Acute And Subacute Stroke In Southwestern Uganda, Shirley M. Moore, Martha Sajatovic

Faculty Scholarship

Background: Greater blood pressure variability has detrimental effects on clinical outcome after a stroke; its effects are controversial and have not been evaluated in Sub-Saharan Africa (SSA). Methods: We conducted a prospective study of patients with CT head confirmed ischemic and hemorrhagic strokes admitted to a tertiary hospital within 7 days of onset of unilateral neurological deficits. Blood pressure variability indices, standard deviation (SD) and coefficient of variation (CV) of systolic and diastolic blood pressure between day 0 and day 7, were calculated with a subsequent modified Rankin Scale (mRS) score on day 14 post-stroke. Linear regression was performed to …

Well-Being And Resilience: A Survey Of Physician Needs During Covid-19, Delta, And Omicron, Melinda M. Wilding

Research Colloquium

Background: Physician moral distress during COVID-19, Delta, and Omicron has resulted in a decrease in self-care and a reduction in empathy for patients. Determining physician well-being and resilience assists clinicians in maintaining pliancy during times of uncertainty.

Methods: An IRB quantitative survey aims to illustrate levels of moral distress, self-care tactics, and physician fortitude during the three waves of the pandemic from 2020-2022. The questionnaire elicits responses regarding how physicians have pivoted to remain healthy during the pandemic, what measures physicians have engaged in maintaining empathy and ethics towards patients, and what physicians need in the future to retain self-care. …

Mental Health Suicide In Alabama, Michael Schurdell

University Faculty and Staff Publications

Mental health and suicide are significant issues in Alabama, a state that ranks 46th out of the 50 states and Washington D.C. in access to mental health services. Alabama’s suicide rate is 59% higher than its homicide rate of 8.3%. This crisis is particularly acute among Caucasian males aged 45-54, who account for 71% of suicides; this demographic is four times more likely to commit suicide than females and three times more likely than African Americans. High suicide rates correlate to a lack of available resources across the state, especially in rural communities. The closure of mental health facilities has …

Centros De Inclusión Social Bajo Gestión Asociada Y La Salud Mental De Las Personas En Situación De Calle, Kien Phan

Independent Study Project (ISP) Collection

Esta investigación se enfoca en analizar las acciones del gobierno de la Ciudad Autónoma de Buenos Aires (CABA) para abordar la salud mental de las personas en situación de calle en 2023. Se examina el estado actual de esta población, identificando factores clave y evaluando las medidas gubernamentales. El marco teórico aborda determinantes sociales y derechos humanos, subrayando la importancia de cambios legislativos para abordar la falta de vivienda. La metodología combina análisis de datos gubernamentales, estudios previos y entrevistas con profesionales de Centros de Inclusión Social. Las organizaciones de la sociedad civil, como Cáritas y la Asociación Civil Isauro …

Longitudinal Associations Between Cognitive Functioning And Depressive Symptoms Among Couples In The Mexican Health And Aging Study, Joan K Monin, Gail Mcavay, Katie Newkirk, Rafael Samper-Ternent

Faculty, Staff and Student Publications

OBJECTIVE: To examine the bidirectional associations between older adult spouses' cognitive functioning and depressive symptoms over time and replicate previous findings from the United States (US) in Mexico.

DESIGN: Longitudinal, dyadic path analysis with the actor-partner interdependence model.

SETTING: Data were from the three most recent interview waves (2012, 2015, and 2018) of the Mexican Health and Aging Study (MHAS), a longitudinal national study of adults aged 50+ years in Mexico.

PARTICIPANTS: Husbands and wives from 905 community-dwelling married couples (N = 1,810).

MEASUREMENTS: The MHAS cognitive battery measured cognitive function. Depressive symptoms were assessed using a modified nine-item Center …

Illness Trajectory From Prodromal Symptoms To Incident Bipolar Disorder And Schizophrenia, Manuel A. Gardea Resendez, Javier Ortiz-Orendain, Brandon J. Coombes, Aysegul Ozerdem, Monica J. Taylor-Desir, Balwinder Singh, Alastair J. Mckean, Mark Frye

Research Symposium

Background: The concept of prodrome is highly variable but, when applied retrospectively in cohorts who progress to meet diagnostic criteria for bipolar disorder (BD) and schizophrenia (SZ), it can contribute to clarify early origins and trajectory of the illness. In the context of race and ethnicity, studies with population-based and registry-based cohorts, such as the Rochester Epidemiology Project (REP), can potentially identify, through retrospective assessment of the prodromes of BD and SZ, differences while addressing the heterogeneous nature of the illness.

Objective: We aim to describe and compare the illness trajectories of individuals with BD or SZ prior to the …

The Role Of Organizational Messages About Mental Health In Disclosure And Support-Seeking Decisions Among First Responders: A Qualitative Investigation, Erin S. Craw, Michelle Miller-Day

Communication Faculty Articles and Research

First responders, especially those without adequate support, are at heightened risk for experiencing adverse mental health outcomes. Workplace mental health interventions for first responders are becoming more common. However, systematic research within the field of communication has not typically informed the development of these workplace interventions. The current study conducted interviews with 26 first responders to examine the messages they receive about mental health from their organizations and how those messages affect their support-seeking decisions. Analysis of the interviews revealed that first responders receive inconsistent messages from their departments about whether to seek support for mental health-related problems, creating confusion …

Representation Of Racial And Ethnic Minorities And Their Preferences For Mood Stabilizing Treatment Selection For Bipolar Disorder: A Systematic Review, Francisco J. Barrera, Manuel Gardea, Juan Garzon, Ryan Toledo, Ana Paula Bonner, Andrea Maraboto, Mark Frye, Ihsan Salloum

Research Symposium

Background: The use of second-generation antipsychotics for bipolar disorder (BD) has increased in the past years¹Concerns on potential serious medical side effects and need for blood level monitoring of some traditional mood stabilizers along with other factors have influenced this change. Shared decision-making (SDM) strategies have been implemented in clinical settings due to their ability to engage patients in the process of treatment selection.² Within minority groups with mental illnesses, socioeconomic factors, individual concerns, and cultural variations in clinical presentations, are often overlooked or misrepresented when assessing the patient’s treatment preferences. Although several studies evaluating the …

Adverse Childhood Experiences And Resilience In Medical School Students: A Scope Of Medical Literature, Andrea Soto Abarca, Yvette Cortino, Juan Carlos Lopez Alvarenga, Maya Guevara

Research Symposium

Background: Adverse childhood experiences (ACEs) represent types of childhood trauma that are associated with long-term negative effects on health and wellbeing. An elevated number of ACEs can lead to depression, suicidality, alcoholism, and substance use. Factors that can protect a person from increased health risks include resilience, which is broadly defined as the ability to bounce back from adversity. Few studies have analyzed the exposure of ACEs in medical students, however, there is extensive literature on how low levels of resilience are linked to higher rates of depression, fatigue, and burnout among medical students. Little is known about the …

Making Mindfulness More Accessible: A Practical Guide To Trauma-Informed Mindfulness, Leslie Formby

Mindfulness Studies Theses

Mindfulness is currently embedded in a growing understanding of how trauma permeates and adversely impacts peoples’ physical and psychological well-being. Increased awareness of the prevalence of trauma and its harmful effects has led to renewed interest in mindfulness to help manage the challenges generated by the detrimental effects of trauma.

These effects may draw people to mindfulness and, in turn, may make the benefits of mindfulness out of reach. Mindfulness methods and practice adaptations have been found to help trauma survivors experience the benefits of what the Buddha taught. As a support for those engaging in mindfulness and meditation, this …

Characteristics Of Patients Diagnosed With Pancreatic Cancer Who Access Palliative Care: An Observational Study, Nadia N Khan, Sue M Evans, Liane J Ioannou, Charles H C Pilgrim, Megan Blanchard, Barbara Daveson, Jennifer Philip, John R Zalcberg, Luc Te Marvelde

Faculty, Staff and Student Publications

PURPOSE: Despite the benefits of palliative care (PC) in pancreatic cancer, little is known about patients who access PC. This observational study examines the characteristics of patients with pancreatic cancer at their first episode of PC.

METHODS: First-time, specialist PC episodes captured through the Palliative Care Outcomes Collaboration (PCOC), in Victoria, Australia between 2014 and 2020, for pancreatic cancer, were identified. Multivariable logistic regression analyses examined the impact of patient- and service-level characteristics on symptom burden (measured through patient-reported outcome measures and clinician-rated scores) at first PC episode.

RESULTS: Of 2890 eligible episodes, 45% began when the patient was deteriorating …

Mental Health First Aid Training In Rural Maryland During The Covid-19 Pandemic: Program Implementation Through Virtual Delivery, Jee Hun Yoo, Alexander E. Chan, Stephanie Hutter-Thomas, Mariama Lukulay, Anna Kim, Alyssa K. Lucero, Ghaffar Hurtado Choque, Jinhee Kim

Journal of Human Sciences and Extension

The growing mental health concerns during COVID-19, particularly among rural residents, is a public health emergency. Rural residents are at an elevated risk, as rurality has been associated with various disparities, including lower accessibility to mental health services. Maryland Rural Opioid Technical Assistance (ROTA; Maryland Extension) aimed to address this issue by delivering evidence-based programs on opioid misuse and mental health to rural community members and practitioners throughout Maryland when the COVID-19 pandemic hit the U.S. and all research activities had to transition to the virtual setting. The current study provides an overview of the implementation process of the Mental …

Stop-Bang Questionnaire For Screening Obstructive Sleep Apnea Syndrome Among Hypertensive Patients In Kenya, Salim Abdallah, Jasmit Shah, Jumaa Bwika, Sayed Karar

Internal Medicine, East Africa

Introduction: Obstructive sleep apnea (OSA) is a type of breathing problem during sleep caused by the blockage of the upper airway, which can cause cessation of airflow. There is limited research on the prevalence of OSA in hypertensive patients in sub-Saharan Africa (SSA). The study aimed to describe the prevalence and clinical characteristics of OSA among hypertensive patients at a tertiary hospital in Nairobi, Kenya.

Methods: This cross-sectional study was conducted at the Aga Khan University Hospital in Nairobi, Kenya. Two hundred and fifty-one hypertensive patients were screened for OSA risk using the STOP-Bang questionnaire (SBQ). Patients with a SBQ …

Perceived Stress, Severity Of Xerostomia, And Periodontal Status In Undergraduate Dental Students, Engku Ahmad Muzhaffar, Zurairah Berahim, Norsila Abdul Wahab, Norkhafizah Saddki

Journal of Dentistry Indonesia

Dentistry is a highly stressful program; stress is associated with xerostomia and periodontal disease.

Objective: This study aims to investigate the association of perceived stress, severity of xerostomia, and periodontal status in dental students.

Methods: This was a two-phase cross-sectional study of 245 Universiti Sains Malaysia (USM) undergraduate dental students. Phase 1 involved administration of the Perceived Stress Scale (PSS-10) and Summated Xerostomia Inventory (SXI). In phase 2, the Community Periodontal Index (CPI) was performed on 150 students to determine their periodontal status.

Results: Mean PSS-10 and SXI scores were 19.6 (SD 5.47) and 7.9 (SD 2.04), respectively. …

Mental Health And Experiences Of Pregnancy Among Black Women And Birthing People With Type 1 Diabetes (T1d), Madeleine E. Marcus

Doctoral Dissertations

This dissertation explored the potential effects of intersections of oppression (i.e., anti-Black racism, diabetes discrimination, and sexism) on mental health and pregnancy experiences among Black women and birthing people with Type 1 diabetes (T1D). Previous studies about pregnancy and T1D have included mainly white, cisgender women. Three participants qualified for inclusion in the present study and participated in semi-structured interviews, which the researcher analyzed using an interpretative phenomenological analysis (IPA) framework. Participants described feeling uncertain about whether aspects of their pregnancy experiences were related to obstetric and/or medical racism. Similarly, participants sometimes seemed uncertain about how racism may affect their …

Utilization Of Wellness Practices For Burnout And Stress During Covid-19 Among An Interdisciplinary Cohort Of Emergency Healthcare Workers, Michael J. Zdradzinski, Sheri-Ann O. Kaltiso, Roslyn Seitz, Timothy P. Moran, Jennifer Clements, Sheryl L. Heron, Michelle D. Lall

Journal of Wellness

Introduction: The Coronavirus Disease (COVID-19) introduced additional stress to the baseline occupational stressors of emergency care workers. The objectives of this study were to evaluate perceived stress and burnout and the utilization and perceived benefit of wellness practices among emergency healthcare workers (EHCWs), including: emergency physicians, advanced practice providers (APPs), nurses, and departmental administrative staff during the COVID-19 pandemic.

Methods: A cross-sectional 28-item electronic survey of EHCWs at three hospitals in a major United States city was used to measure participants’ utilization and perceived benefit of wellness practices, burnout (2-item measure), overall stress (perceived stress scale), and stress …

Prenatal Exposure To Maternal Mood Entropy Is Associated With A Weakened And Inflexible Salience Network In Adolescence, Robert J. Jirsaraie, Anton M. Palma, Steven L. Small, Curt A. Sandman, Elysia Poggi Davis, Tallie Z. Baram, Hal S. Stern, Laura M. Glynn, Michael A. Yassa

Psychology Faculty Articles and Research

Background

Methods

Safety And Efficacy Of Adjunctive Esketamine Vs. Maois In Trd In Adults, Riley Guinan

Master of Science in Physician Assistant Studies Capstone Presentations (Center City)

Background:

Depression affects millions globally - Treatment-resistant depression (TRD) is defined as failure to respond to two antidepressant trials of adequate dose and duration

Traditional Treatment for TRD:

Switching or adding medications atypical antipsychotics - Limitations include delayed action, side effects, and limited efficacy

Alternative Treatment Options:

- Ketamine:

• A dissociative anesthetic with potential antidepressant effects
• Targets the NMDA receptor and activates AMPA receptor.
• Shows rapid and potent antidepressant effects; however, not FDA-approved for depression

- Monoamine Oxidase Inhibitors (MAOIs):

• Antidepressants used since the 1950s
• Inhibits the enzyme metabolizing neurotransmitters.
• Limitations: Dietary restrictions and drug interactions and longstanding safety concerns …