Fear of getting infected and infecting other people, feeling responsible for the physical and mental well-being of their patients, working in a novel and unpredictable context subject to work overload and shortage of personal protective equipment are just a few of the difficult situations that frontline healthcare professionals are facing in the ongoing fight against COVID-19 (Figure 1A) (Liu et al., 2020). When this experience is superimposed on the typical baseline stressors of the profession such as low morale and low wages, it can contribute to increasing the burden of mental health problems experienced by healthcare professionals during the pandemic and will probably persist even after the COVID-19 crisis has passed. According to Lai et al. (2020), of 1,257 health workers involved with the diagnosis and treatment of COVID-19 patients who were surveyed in China, a considerable proportion experienced symptoms of anxiety (44%), depression (50%), insomnia (34%), and general distress (71%). A similar study carried out in Italy points to the same results: out of 1,379 health professionals surveyed, a high proportion presented symptoms associated with posttraumatic stress disorder (49%), major depressive disorder (25%), anxiety (20%), insomnia (8%), and perceived stress (22%) (Rossi et al., 2020). Posttraumatic stress disorder (PTSD), in particular, though commonly linked with war veterans, is expected to have a surge of occurrences in frontline health professionals after the pandemic (Dutheil et al., 2020). This adds to the realization that both during and after a pandemic, the number of people affected in their mental health tend to be greater than the number of people affected by the infection itself (Reardon, 2015). HIV, Ebola, Zika, H1N1, SARS, and MERS are just a few recent examples of pandemic diseases with such characteristics (Kisely et al., 2020;Ornell et al., 2020).An acute stressful situation causes the immediate activation of the sympathetic nervous system (SNS) and the hypothalamus-pituitary-adrenal axis (HPA) and kicks off the release of catecholamines (adrenaline and noradrenaline) and cortisol in the bloodstream that prepares the body for action, enabling physiological and behavioral fight or flight responses geared for the organism's survival (Godoy et al., 2018) (Figure 1B). These responses include heart rate acceleration, increased myocardial contraction force, arterial vasodilation in skeletal muscles, arterial vasoconstriction in the digestive system, and relaxation of smooth muscles in the pupils and bronchi, among others (Mendoza and Foundas, 2007). The body stays on high alert as long as cortisol and adrenaline levels remain high. After a while, the parasympathetic nervous system (PNS) brakes those responses through the vagus nerve and promotes the "rest and digest" phase that restores the body after the danger has subsided.
The heart and brain are reciprocally interconnected and engage in two-way communication for homeostatic regulation. Epilepsy is considered a network disease that also affects the autonomic nervous system (ANS). The neurovisceral integration model (NVM) proposes that cardiac vagal tone, indexed by heart rate variability (HRV), can indicate the functional integrity of cognitive neural networks. ANS activity and the pattern of oscillatory EEG activity covary during the transition of arousal states and associations between cortical and autonomic activity are reflected by HRV. Cognitive dysfunction is one of the common comorbidities that occur in epilepsy, including memory, attention, and processing difficulties. Recent studies have shown evidence for the active involvement of alpha activity in cognitive processes through its active role in the control of neural excitability in the cortex through top-down modulation of cortical networks. In the present pilot study, we evaluated the association between resting EEG oscillatory behavior and ANS function in patients with refractory epilepsy. Our results show: (1) In patients with refractory epilepsy, there is a strong positive correlation between HRV and the power of cortical oscillatory cortical activity in all studied EEG bands (delta, theta, alpha, and beta) in all regions of interest in both hemispheres, the opposite pattern found in controls which had low or negative correlation between these variables; (2) higher heartbeat evoked potential amplitudes in patients with refractory epilepsy than in controls. Taken together, these results point to a significant alteration in heart-brain interaction in patients with refractory epilepsy.
Aim: To evaluate how gelotophobia correlates with trait anxiety in a sample of Brazilian college students. Methods: We evaluated the association of GELOPH < 15 > scores with both selfreported experiences of bullying victimization and trait anxiety measures assessed by the State-Trait Anxiety Inventory (STAI). The study consisted of a sample of 65 adult volunteers (M = 21.48, SD = 2.54 years, 38 females), recruited through social media or flyer distribution, and submitted to online versions of the gelotophobia assessment instrument (GELOPH < 15 >) and the STAI. Results: Most participants (N = 56, 86.15%) had an STAI-T score indicative of high trait anxiety. The average GELOPH < 15 > score of the sample was 2.69 (0.65) and 39 of the subjects (60%) were considered gelotophobes. There was a strong positive correlation between the GELOPH < 15 > and STAI-T scores but no correlation betweenbullying and either the STAI-T and GELOPH < 15 > scores. However, the great majority of subjects with gelotophobia reported been previously bullied. Conclusion:In our sample, all gelotophobes had trait anxiety, but only a fraction of anxious subjects had gelotophobia. These preliminary findings expand on previous reports underscoring the high prevalence of mental health problems afflicting higher education students in Brazil.
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