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Objectives: To describe the risk factors for SARS-CoV-2 infection in UK healthcare workers (HCWs).Methods: We conducted a prospective sero-epidemiological study of HCWs at a major UK teaching hospital using a SARS-CoV-2 immunoassay. Risk factors for seropositivity were analysed using multivariate logistic regression.Results: 410/5,698 (7·2%) staff tested positive for SARS-CoV-2 antibodies. Seroprevalence was higher in those working in designated COVID-19 areas compared with other areas (9·47% versus 6·16%) Healthcare assistants (aOR 2·06 [95%CI 1·14-3·71]; p=0·016) and domestic and portering staff (aOR 3·45 [95% CI 1·07-11·42]; p=0·039) had significantly higher seroprevalence than other staff groups after adjusting for age, sex, ethnicity and COVID-19 working location. Staff working in acute medicine and medical sub-specialities were also at higher risk (aOR 2·07 [95% CI 1·31-3·25]; p<0·002). Staff from Black, Asian and minority ethnic (BAME) backgrounds had an aOR of 1·65 (95% CI 1·32 - 2·07; p<0·001) compared to white staff; this increased risk was independent of COVID-19 area working. The only symptoms significantly associated with seropositivity in a multivariable model were loss of sense of taste or smell, fever, and myalgia; 31% of staff testing positive reported no prior symptoms.Conclusions: Risk of SARS-CoV-2 infection amongst HCWs is highly heterogeneous and influenced by COVID-19 working location, role, age and ethnicity. Increased risk amongst BAME staff cannot be accounted for solely by occupational factors. [ABSTRACT FROM AUTHOR]

Abstract There is a dearth of research evaluating the relationship between obsessive-compulsive (OC) phenomena and emotion regulation (ER) in youth. The current study bridges this gap by utilizing multiple informants to evaluate the relationship between ER processes (e.g., suppression) and OC features in 27 diagnostically-assessed youth. As predicted, after controlling for children's age and distress, obsessive beliefs (e.g., the importance of/need to control thoughts) and OCS dimensions (e.g., washing) possessed negative associations with adaptive skills (ER) and positive relationships with maladaptive processes (emotional lability). Notably, expressive suppression possessed the strongest relationship with obsessive beliefs and OCS domains, and mediated the relationship between these two constructs. Results are discussed in the context of experiential avoidance. Clinical recommendations and future directions are discussed. Highlights • Little research has examined the relation between emotion regulation (ER) and OCD in youth. • Obsessive beliefs and OC washing symptoms possessed negative associations with adaptive ER skills. • Obsessive beliefs and OC symptoms possessed positive associations with maladaptive ER skills. • Expressive suppression mediated the relationship between obsessive beliefs and OC symptoms. • Findings support integrating acceptance strategies and ER training into exposures for youth. [ABSTRACT FROM AUTHOR]

Objective: Preoccupation with perceived bodily odor has been described in neuropsychiatric disorders for more than a century; however, empirical research on olfactory reference syndrome (ORS) is scarce. This study investigated the phenomenology of ORS in a broadly ascertained, diverse sample.Method: Data were obtained from 253 subjects in an internet-based survey that operated from January - March 2010. Measures included the Yale-Brown Obsessive Compulsive Scale Modified for ORS (ORS-YBOCS), Work and Social Adjustment Scale (WSAS), Depression Anxiety Stress Scales (DASS), and symptom specific questionnaires developed for this study.Results: Individuals reported, on average, moderately severe ORS symptoms. The average age of onset of ORS symptoms was 21.1 years, with 54% reporting a chronic, unremitting course. Individuals endorsed a lifetime average of two malodorous preoccupations, most commonly stool, garbage, and ammonia. Odors were most often reported to emanate from the armpits, feet, and breasts. Nearly all participants engaged in time-consuming rituals to try to hide or fix their perceived malodor (e.g., checking and camouflaging). Eighteen percent reported poor or delusional insight and 64.0% reported ideas or delusions of reference. More severe ORS symptoms were moderately associated with female gender, poorer insight, and higher levels of impairment (in work, social leisure, ability to maintain close relationships, and consecutive days housebound).Conclusion: This is the largest study on ORS to date. Results underscore the clinical significance and psychosocial impact of this understudied disorder, and highlight the need for subsequent research to examine clinical features and inform treatment. [ABSTRACT FROM AUTHOR]

Stress has been implicated as a risk factor for hoarding, although past research has relied on cross-sectional and self-report designs. Using experimental methods and objective hypothetical behavioral hoarding paradigms, we investigated the direct effect of stress on in-the-moment saving and acquiring behavioral tendencies. We also evaluated whether distress tolerance (DT) and negative urgency interacted with stress to predict saving and acquiring behavioral tendencies. A sample of young adults (N=80) completed questionnaires about DT and negative urgency. Participants were randomized to either a psychosocial stressor or nonstressful control task prior to completing two hypothetical behavioral hoarding paradigms. The discarding task asked participants to choose between saving and disposing of items. For the acquiring task, participants completed a computer-simulated shopping spree that measured items acquired. Unexpectedly, participants in the stress condition saved and acquired fewer items than those in the control condition. As hypothesized, stress interacted with DT to predict saving tendencies. The current study should be replicated in a clinical sample. Longitudinal studies are needed to further examine the long-term effect of stress on hoarding. This is the first examination of the direct effect of stress on saving and acquiring tendencies. Although some study hypotheses were not supported, several results are consistent with our predictions and suggest a complex relationship between stress and hoarding. If findings are replicated in a clinical sample, it may be that hoarding patients could benefit from treatments incorporating DT strategies. [ABSTRACT FROM AUTHOR]

Facebook (FB) 1 Facebook = FB. 1 is a popular platform for interacting with others to establish or maintain relationships. Compared to other interpersonal exchanges, FB does not require in-person interactions. Therefore, FB may represent an important social sphere for individuals with social anxiety disorder (SAD). 2 Social anxiety disorder = SAD. 2 Examining the relationship between social anxiety symptoms and FB activity could inform future research on the benefits or consequences of FB use in SAD individuals. This study examined the relationship between social anxiety symptoms and different FB usage patterns. We also considered the role of brooding—a known risk factor for SAD. 75 nonclinical FB users completed questionnaires about psychological symptoms, FB usage, and brooding. Greater social anxiety symptoms were associated with spending more time on FB and passively using FB (i.e., viewing other’s profiles without interacting). Brooding mediated the relationship between passive FB use and social anxiety symptoms. An alternative model demonstrated that social anxiety symptoms mediated the association between passive FB use and brooding. This study was limited by its cross-sectional, self-report design. Future research should assess FB use with objective, real-time data and use experimental designs. Results have implications for the cognitive–behavioral model of SAD. [ABSTRACT FROM AUTHOR]

Hoarding is characterized by emotionally reinforced saving behaviors, which often combine with excessive acquisition to give rise to clutter, distress, and impairment. Despite the central role emotional processes are thought to play in hoarding, very little research has directly examined this topic. There is suggestive evidence linking hoarding with several facets of emotional intolerance and avoidance, though one key limitation of this past research has been the exclusive reliance on self-report questionnaires. The aim of the current study was to conduct a multimethod investigation of the relationship between hoarding and perceptions of, and cognitions about, negative emotional states. A large unselected sample of nonclinical young adults ( N = 213) completed questionnaires, behavioral tasks, and a series of negative mood inductions to assess distress tolerance (DT), appraisals of negative emotions, and emotional intensity and tolerance. Hoarding symptoms were associated with lowered tolerance of negative emotions, as well as perceiving negative emotions as more threatening. Individuals high in hoarding symptoms also experienced more intense emotions during the mood inductions than individuals low in hoarding symptoms, though there was no association with poorer performance on a behavioral index of DT. Across measures, hoarding was consistently associated with experiencing negative emotions more intensely and reporting lower tolerance of them. This relationship was particularly pronounced for the difficulty discarding and acquiring facets of hoarding. Our results offer initial support for the important role of emotional processes in the cognitive-behavioral model of hoarding. A better understanding of emotional dysfunction may play a crucial role in developing more effective treatments for hoarding. [ABSTRACT FROM AUTHOR]

Abstract: Hoarding is characterized by a persistent and extreme difficulty with discarding one’s possessions, often resulting in cluttered living spaces and marked distress or impairment. Despite being increasingly recognized as a substantial public health burden, much remains unknown about the etiology. One facet within the cognitive-behavioral model of hoarding that remains poorly understood is the strong emotional attachment to possessions. The tendency to anthropomorphize (i.e., see human-like qualities in non-human entities) may be one possible mechanism contributing to this emotional attachment. The current report is the first empirical study to examine the association between anthropomorphism and hoarding. Non-clinical participants (n =72) completed a battery of self-report measures focused on hoarding symptoms, saving cognitions, anthropomorphism, and emotional attachments to personal and novel items. Anthropomorphic tendencies were significantly associated with greater saving behaviors and the acquisition of free things. Levels of anthropomorphism moderated the relationship between specific hoarding beliefs and acquiring tendencies, as well as the emotional attachment towards a novel item. Results are discussed with regard to future research directions, and implications for the cognitive-behavioral model of hoarding. [Copyright &y& Elsevier]

Obsessive-compulsive disorder (OCD) commonly onsets in childhood. Given OCD's high comorbidity with other emotional disorders (e.g., depression, anxiety), transdiagnostic treatment that aims to enhance youth's tolerance and regulation of various negative emotions before starting exposure may facilitate simultaneous treatment of multiple comorbid symptoms. The current study examined the effects of transdiagnostic treatment in an open trial of clinical youth. Children and adolescents (N = 170) with any primary emotional disorder (e.g., an anxiety, depressive, or obsessive-compulsive spectrum disorder) started Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP–C/A) treatment. Youth (M age = 12; 50% female) were primarily white and Hispanic/Latinx. Youth and their parent(s) completed an intake and follow-up assessments (8, 16, and 24 weeks). The outcome measures were self- and parent-reported obsessive-compulsive symptoms (OCS), treatment engagement, and client satisfaction. Over the course of the UP-C/A, youths' OCS decreased significantly, across reporters, regardless of child age or gender. These findings provide preliminary support for utilizing the UP-C/A to treat OCS in youth. While these results do not imply equivalence with existent, exposure and response prevention treatments for pediatric OCD, it is possible that the flexible structure of the UP-C/A may be applied successfully to OCS. • We examined effects of transdiagnostic treatment on obsessive-compulsive symptoms. • Obsessive-compulsive symptoms decreased from baseline to 8, 16, and 24 weeks. • Significant changes were noted across both self and parent report of symptoms. • Neither age nor gender moderated obsessive-compulsive symptom change trajectories. • Treatment engagement and satisfaction was similar regardless of OCD diagnosis. [ABSTRACT FROM AUTHOR]

According to cognitive-behavioral models of hoarding disorder, positive and negative emotional processing biases may contribute to the core symptoms of clutter, acquiring, and difficulty discarding. In disorders commonly comorbid with hoarding (e.g., depression; anxiety), studies have revealed specific patterns of attentional biases that relate to central symptoms. However, links between hoarding symptoms and biased attention, particularly involving interpersonal content, remain empirically untested. In the present study, we aimed to conduct the first investigation of hoarding symptoms and attentional biases. A sample of 57 young adults viewed images of positive and negative facial expressions paired with neutral facial expressions. During stimulus presentation eye tracking data captured four measures of early-stage and late-stage attentional biases toward emotional stimuli. Hoarding symptoms were measured dimensionally using the Saving Inventory-Revised. Results yielded an association between early orientation toward negative stimuli and severity of acquiring symptoms. Conversely, difficulty discarding/saving was associated with multiple measures of late-stage positive attentional biases. Findings reinforce the importance of examining both positive and negative emotional systems in relation to specific hoarding symptom clusters, even at the basic information processing level. • Attentional biases for emotional stimuli relate to specific hoarding symptoms. • Difficulties discarding are linked with sustained attention toward positive stimuli. • Acquiring symptoms are associated with early attentional bias for negative stimuli. • Links between hoarding and attention are not explained by comorbid symptoms. [ABSTRACT FROM AUTHOR]

Objective Anxiety sensitivity (AS) has been identified as a transdiagnostic cognitive risk factor for a wide range of affective disorders, including conditions within the obsessive compulsive (OC) spectrum. A growing body of research has demonstrated that directly reducing AS leads to subsequent reductions of other psychiatric symptoms, including anxiety, worry, and mood. To date, no study has examined the efficacy of a brief AS intervention on reducing OC and hoarding symptoms. Method Non-treatment seeking young adults (N = 104; 83.7% female; 81.7% Caucasian) were selected for having elevated levels of AS, and were then randomized into a single-session, computer-assisted AS intervention or a control condition. OC and hoarding symptoms were assessed at post-treatment, as well as at one week and one month follow-ups. Results Results revealed that the intervention, but not the control condition, reduced OC symptoms across the post-intervention follow-up period. Mediation analysis demonstrated that changes in AS mediated changes in OC symptoms due to the intervention. In contrast, the intervention did not have a specific effect on reducing hoarding symptoms. Conclusions These findings have important ramifications for understanding the relationship between AS and OC spectrum symptoms, and raise interesting treatment and prevention implications. [ABSTRACT FROM AUTHOR]

Though research indicates that individuals with social anxiety disorder may experience elevated levels of thwarted belongingness and perceived burdensomeness, two interpersonal risk factors critical for the development of suicidal desire, it remains unclear why. The current investigation considered how shame and depression may help to explain the relationship between social anxiety and interpersonal suicide risk factors. Participants ( N =259), recruited using Amazon.com's Mechanical Turk, completed measures of social anxiety, interpersonal suicide risk factors, shame, and depression. Social anxiety was associated with greater thwarted belongingness and perceived burdensomeness. In addition, shame partially explained the association between social anxiety and thwarted belongingness, though the indirect effect was no longer significant after considering depression as a moderator. As predicted, shame was found to fully explain the association between social anxiety and perceived burdensomeness and this indirect effect was most pronounced among individuals with high comorbid depression. The clinical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Abstract Emotional disorders, encompassing a range of anxiety and depressive disorders, are the most prevalent and comorbid psychiatric disorders in adolescence. Unfortunately, evidence-based psychosocial therapies typically focus on single disorders, are rarely adopted by community mental health center clinicians, and effect sizes are modest. This article describes the protocol for a comparative effectiveness study of two novel interventions designed to address these challenges. The first intervention is a transdiagnostic treatment (the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents, UP-A), a promising new approach that uses a small number of common strategies to treat a broad range of emotional disorders, and their underlying shared emotional vulnerabilities. The second intervention is a standardized measurement feedback system, the Youth Outcomes Questionnaire (YOQ), designed to improve clinical decision making using weekly symptom and relational data. The three study arms are treatment as usual (TAU), TAU plus the YOQ (TAU+), and UP-A (used in combination with the YOQ). The primary aims of the study are to [1] compare the effects of the UP-A and TAU+ to TAU in community mental health clinics, [2] to isolate the effects of measurement and feedback by comparing the UP-A and TAU+ condition, and [3] to examine the mechanisms of action of both interventions. Design considerations and study methods are provided to inform future effectiveness research. [ABSTRACT FROM AUTHOR]

Substantial evidence suggests physical exercise may sustain cognitive function and perhaps prevent Alzheimer's Disease (1, 2). Current public health recommendations call for older adults to do at least 150 min a week of aerobic exercise (e.g. walking) and twice a week resistance exercise (e.g. weight lifting) for physical health. Yet, much remains unknown about how these exercise modalities support brain health independently or in combination. The COMbined Exercise Trial (COMET) is designed to test the combined and independent effects of aerobic and resistance training specifically focusing on exercise-related changes in 1) cognitive performance, 2) regional brain volume, 3) physical function, and 4) blood-based factors. To explore these questions, we will enroll 280 cognitively normal older adults, age 65–80 years, into a 52-week community-based exercise program. Participants will be randomized into one of four arms: 1) flexibility/toning- control 2) 150 min of aerobic exercise only, 3) progressive resistance training only, or 4) combined aerobic and progressive resistance training. Outcomes assessed include a comprehensive cognitive battery, blood biomarkers, brain magnetic resonance imaging, physiological biomarkers, cardiorespiratory fitness, physical function, and battery of psychosocial questionnaires is assessed at baseline, 6 and 12-months. COMET will provide rigorous randomized controlled trial data to understand the effects of the most common exercise modalities, and their combination (i.e., the standard public health recommendation), on brain health. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cytotoxic chemotherapy is widely used for advanced, unresectable pancreatic and other gastrointestinal foregut neuroendocrine tumours (NETs) and the most commonly used regimen combines 5-fluorouracil with streptozocin. The NET01 trial was designed to investigate whether capecitabine combined with streptozocin was an acceptable regimen with or without adding cisplatin. Methods: Patients with advanced, unresectable NETs of pancreatic, gastrointestinal foregut or unknown primary site were randomised to receive three-weekly capecitabine (Cap) 625mg/m2 twice daily orally, streptozocin (Strep) 1.0g/m2 intravenously on day 1, with or without cisplatin (Cis) 70mg/m2 intravenously on day 1. The primary outcome measure was objective response. Secondary outcome measures included progression-free and overall survival, quality of life, toxicity and biochemical response. Results: 86 (44 CapStrep, 42 CapStrepCis) patients were randomised. Best objective response rate was 12% (95% confidence interval (CI)=2–22%) with CapStrep and 16% (95% CI=4–27.4%) with CapStrepCis. Disease-control rate was 80% with CapStrep and 74% with CapStrepCis. The estimated median progression-free and overall survival were 10.2 and 26.7months for CapStrep and 9.7 and 27.5months for CapStrepCis. 44% of CapStrep and 68% of CapStrepCis patients experienced grade ⩾3 adverse events. Interpretation: The efficacies of the novel CapStrep±Cis regimens were very similar. CapStrep was better tolerated than CapStrepCis. The trial was registered as EudraCT: 2004-005202-71 and ISRCTN: 35124268. [ABSTRACT FROM AUTHOR]

Abstract: Recently, there has been a growing interest in the phenotypic, pathogenic, and pathophysiological overlap between autism spectrum disorders (ASD) and obsessive-compulsive spectrum disorders (OCSD). However, social competence impairment is one domain of overlap that has received less attention. Codified as one of three diagnostic categories in ASD, pathological social processing has also been demonstrated in OCSD. Yet, to date no reviews have synthesized the research literature on social competence impairments in OCSD, especially impairments that may parallel those found in ASD. The current review set out to examine the extant literature in this area in the service of advancing understanding of shared phenomenology between these two spectrums of conditions. Further, delineation of shared social competence impairments between ASD and OCSD might highlight candidate endophenotypes for further investigation. Ultimately, understanding the links between OCSD and ASD may aid in development of better intervention and prevention strategies, some of which may directly target maladaptive social processing. [Copyright &y& Elsevier]

Background: Hurricanes Katrina and Rita struck the Gulf Coast forcing unprecedented mass evacuation and devastation. Texas 2-1-1 is a disaster communication hub between callers with unmet needs and community services at disaster sites and evacuation destinations. Purpose: To describe the location and timing of unmet disaster needs collected in real-time through Katrina–Rita disaster phases. Methods: In 2008–2010, a total of 25 data sets of Texas 2-1-1 calls from August–December 2005 were recoded and merged. In 2011–2012, analysis was performed of unmet need types, with comparisons over time and location; mapping was adjusted by population size. Results: Of 635,983 total 2-1-1 calls during the study period, 65% included primary disaster unmet needs: housing/shelter (28%); health/safety (18%); food/water (15%); transportation/fuel (4%). Caller demand spiked on Mondays, decreasing to a precipitous drop on weekends and holidays. Unmet needs surged during evacuation and immediate disaster response, remaining at higher threshold through recovery. Unmet need volume was concentrated in metropolitan areas. After adjusting for population size, “hot-spots” showed in smaller evacuation destinations and along evacuation routes. Conclusions: New disaster management strategies and policies are needed for evacuation destinations to support extended evacuation and temporary or permanent relocation. Planning and monitoring disaster resources for unmet needs over time and location could be targeted effectively using real-time 2-1-1 call patterns. Smaller evacuation communities were more vulnerable, exhausting their limited resources more quickly. Emergency managers should devise systems to more quickly authorize vouchers and reimbursements. As 2-1-1s expand and coordinate disaster roles nationwide, opportunities exist for analysis of unmet disaster needs to improve disaster management and enhance community resiliency. [ABSTRACT FROM AUTHOR]