Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

South Australia is presently in the throes of major changes to its regulatory system governing land use, development of land and the development of planning policy against which development assessment decisions are to be made. Eventually the planning and development control system established under the Development Act 1993 (SA) will be replaced by a new system implemented by the Planning, Development and Infrastructure Act 2016 (SA) (the new Act).

COVID-19 Generated Changes to Planning and Development Controls in South Australia (preprint)

Handbook of attachment: Theory, research, and clinical applications

A large-scale survey study was conducted to assess trauma, burnout, posttraumatic growth, and associated factors for nurses in the COVID-19 pandemic. The Trauma Screening Questionnaire, Maslach Burnout Inventory, and Posttraumatic Growth Inventory-Short Form were utilized. Factors associated with trauma, burnout, and posttraumatic growth were analysed using logistic and multiple regressions. In total, 12 596 completed the survey, and 52.3% worked in COVID-19 designated hospitals. At the survey's conclusion in April, 13.3% reported trauma (Trauma ≥ 6), there were moderate degrees of emotional exhaustion, and 4,949 (39.3%) experienced posttraumatic growth. Traumatic response and emotional exhaustion were greater among (i) women (odds ratio [OR]: 1.48, 95% CI 1.12-1.97 P = 0.006; emotional exhaustion OR: 1.30, 95% CI 1.09-1.54, P = 0.003), (ii) critical care units (OR: 1.20, 95% CI 1.06-1.35, P = 0.004; emotional exhaustion OR: 1.23, 95% CI 1.12-1.33, P < 0.001) (iii) COVID-19 designated hospital (OR: 1.24, 95% CI 1.11-1.38; P < 0.001; emotional exhaustion OR: 1.26, 95% CI 1.17-1.36; P < 0.001) and (iv) COVID-19-related departments (OR: 1.16, 95% CI 1.04-1.29, P = 0.006, emotional exhaustion only). To date, this is the first large-scale study to report the rates of trauma and burnout for nurses during the COVID-19 pandemic. The study indicates that nurses who identified as women, working in ICUs, COVID-19 designated hospitals, and departments involved with treating COVID-19 patients had higher scores in mental health outcomes. Future research can focus on the factors the study has identified that could lead to more effective prevention and treatment strategies for adverse health outcomes and better use of resources to promote positive outcomes.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/inm.12796

A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic.

The COVID-19 pandemic and its social and economic consequences have had adverse impacts on physical and mental health worldwide and exposed all segments of the population to protracted uncertainty and daily disruptions. The CoRonavIruS health and Impact Survey (CRISIS) was developed for use as an easy to implement and robust questionnaire covering key domains relevant to mental distress and resilience during the pandemic. Ongoing studies using CRISIS include international studies of COVID-related ill health conducted during different phases of the pandemic and follow-up studies of cohorts characterized before the COVID pandemic. In the current work, we demonstrate the feasibility, psychometric structure, and construct validity of this survey. We then show that pre-existing mood states, perceived COVID risk, and lifestyle changes are strongly associated with negative mood states during the pandemic in population samples of adults and in parents reporting on their children in the US and UK. These findings are highly reproducible and we find a high degree of consistency in the power of these factors to predict mental health during the pandemic.

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The Coronavirus Health and Impact Survey (CRISIS) reveals reproducible correlates of pandemic-related mood states across the Atlantic.

A comprehensive plausible conceptual model of Gender Discrimination (GD) and accurate measures of its components are lacking. Current study developed a conceptual model of GD derived from the development-based trauma framework (DBT) and constructed measures for GD and its coping dynamics and tested them in two studies on Egyptian female college students. The first study conducted on a sample of 150, and the second study conducted on 311 participants. Exploratory factor analysis in the first sample, and confirmatory factor analysis in the second sample confirmed three components of GD (GD by parents attitudes, GD by parents behavior, and GD by society), and three components of GD coping dynamics (gender identity conflict (GIC), internalized GD, and GD resistance). GD measures are found to have generally good reliability and stability, good construct, and predictive validity. Using path analysis in the second study, GD, controlling for other life traumas, predicted a significant decrease in self-esteem and self-efficacy and increase in existential anxiety, which mediated its effects on PTSD and complex PTSD. GIC and internalized GD further moderated GD effects. GD inventory that includes 6 measures with 33 items can be a parsimonious tool for future research on GD.

/pdf/gender-discrimination-gd-a-conceptual-trauma-based-framework-w3mkylqbts.pdf

Gender Discrimination (GD): A Conceptual Trauma-Based Framework for GD and the Development of Gender Discrimination Inventory

The current research aims to test the new measurement model of COVID-19 stressors which includes four stressor types: infection fears, lockdown, economic, and grief in one second-order factor. Usin...

Measuring COVID-19 Stressors and Their Impact: The Second-Order Factor Model and Its Four First-Order Factors: Infection Fears, Economic, Grief, and Lockdown Stressors

“Will to Exist, Live and Survive” (WTELS): Measuring its role as master/metamotivator and in resisting oppression and related adversities.

Existential (annihilation) anxiety (EAA) and its significant role in PTSD, complex PTSD and mental and physical health, were a long ignored variable in the mainstream clinical science. Further collective EAA is one of the important dimensions missing in the theory and measurement of EAA. The study evaluated the psychometric properties of an existing measure of existential annihilation scale (EAA) (Kira et al., 2012b), that had previously developed based on an integrative framework of identity-based existential annihilation anxiety (EAA) that include most of the personal and collective dimensions of EAA. We reanalyzed the data in seven studies that utilized the measure, conducting exploratory and confirmatory factor analysis for the pooled data (N = 2436), as well as path analysis with EAA as a mediator of the effects of cumulative stress and trauma on PTSD. We conducted Multigroup invariance to test the invariance of the measurement model as well as the predictive structural model across groups. The short measure found to have good internal consistency and test-retest stability, as well as construct, convergent, divergent and predictive validity and is strongly invariant across the main groups. As hypothesized, by the integrated model of EAA, EAA fully mediated the effects of cumulative trauma on PTSD. The results confirm at least in part the validity and utility of the integrative conceptual framework. Further development of the measurement model in future studies was proposed to include fear of death that was not included in the evaluated measure and is one of the components of integrated framework of EAA. The importance of integrating EAA in the mainstream clinical science and intervention was discussed.

/pdf/a-conceptual-model-and-measurement-of-identity-based-2ek9xyoc32.pdf

A Conceptual Model and Measurement of Identity-Based, Existential Annihilation Anxieties (EAA)

Compelling evidence of gender differences in authoritarianism, self-esteem, and mental disorders can be found in the psychology literature. However, researchers have not yet identified their etiologies. The traumatology perspective proposes that gender discrimination (GD) contributes to such differences. GD promotes internalized male superiority and enhanced self-esteem that increase authoritarianism and impact men’s behavior. GD promotes internalized gender inferiority in women and decreased self-esteem, predicting internalizing disorders. In 2 samples (Sample 1, N = 319 women; Sample 2, N = 204 men), using path analysis, we tested this perspective. In the men’s sample, externalizing accounted for about .75 of the variance. GD predicted internalized male superiority, increased externalizing, addiction, psychoticism, authoritarianism, and self-esteem, and decreased internalizing. In the women’s sample, GD predicted increased internalized female inferiority, internalizing, and lowered self-esteem. Internalizing accounted for .415 of the variance. The results identified some etiologies and dynamics that contribute to gender differences. We then discussed the implications of these findings for advocating for gender equality.

Ibrahim A. Kira

Papers

Gender Discrimination (GD): A Conceptual Trauma-Based Framework for GD and the Development of Gender Discrimination Inventory

Measuring COVID-19 Stressors and Their Impact: The Second-Order Factor Model and Its Four First-Order Factors: Infection Fears, Economic, Grief, and Lockdown Stressors

“Will to Exist, Live and Survive” (WTELS): Measuring its role as master/metamotivator and in resisting oppression and related adversities.

A Conceptual Model and Measurement of Identity-Based, Existential Annihilation Anxieties (EAA)

Toward identifying the etiologies of gender differences in authoritarianism and mental health: An Egyptian study.