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Additional file 1. Supplementary statistical information.

This study investigates problematic smartphone attachment under conditions of short-term smartphone separation. Two experimental studies with randomized group allocation were designed to investigate effects of smartphone separation on anxiety and inhibitory control. Problematic smartphone use pathways were explored using a self-report measure. In the first experiment (N= 85) smartphone addicted participants showed an increase in state anxiety after 20 min of separation from their smartphones compared to a control group of non-addicted participants. There was no evidence for impaired inhibitory control based on a period of smartphone separation. In the second experiment the methodology was slightly varied, and the participants (N= 95) were provided with a task during a smartphone separation of 15 min. This led to a reduction of state anxiety for problematic attached participants but did not result in a change for unproblematic attached participants. Problematic attached participants showed a larger disturbance in inhibitory control undergoing a separation period than unproblematic attached participants. Moreover, the results provide supplementary evidence for the existence of specific problematic smartphone attachment pathways and further variables.

Additional file 1: Supplementary Analyses.

Additional file 3. Sensitivity analysis results: Logistic regression results without adjusting for depression and anxiety.

Additional file 2. Multivariable logistic regression results for SARS-CoV-2-related work outcomes among emergency medical services workers.

Additional file 4. Sensitivity analysis results: Logistic regression results after pooling data from both study waves.

BackgroundThe SARS-CoV-2 virus has spread rapidly around the globe since December 2019 creating much uncertainty among medical staff. Due to close patient contact, medical assistants are at increased risk of an infection. Several studies have investigated psychological consequences of the SARS-CoV-2 pandemic on medical staff, yet studies in the outpatient setting are scarce and studies addressing medical assistants are lacking. This study aimed to investigate pandemic-related stressors, attitudes, and work outcomes among medical assistants and to identify possible determinants.MethodsThe population under study were medical assistants across entire Germany. A self-devised online questionnaire was published between April 7th, 2020, and April 14th. including questions on pandemic-related stressors, attitudes and work outcomes. Additionally, symptoms of depression and anxiety disorder were measured by PHQ-2 and GAD-2, respectively. Logistic regression was performed to identify possible determinants.Results2150 medical assistants provided complete data (98.0% female, mean age 37.6 years). Major stressors were uncertainty about the temporal scope of the pandemic (95.1% agreement), about how to act correctly (77.5%), feelings of not being allowed to let patients down (75.9%), uncertainty about one's financial situation (67.4%) and about contact persons for further information (67.1%). One third (29.9%) of the study population screened positively for depression and 42.6% for anxiety disorder. Feeling burdened by one's financial situation was significantly associated with working in specialist practices (1.32 [1.08-1.62]), caring for children (1.51 [1.22-1.87]), depression (1.28 [1.01-1.62]), and anxiety disorder (1.93 [1.55-2.39]). Feeling burdened by thoughts about virus contraction at work was also significantly associated with working in specialist practices (1.33 [1.07-1.64]), caring for children (1.33 [1.07-1.66]), depression (1.54 [1.18-2.00]), and anxiety (4.71 [3.71-5.98]).ConclusionsThis study provides novel evidence regarding major SARS-CoV-2 pandemic-related stressors among medical assistants and suggests need for special support for medical assistants caring for children and working in specialist practices.

Additional file 1. Items of the English language study questionnaire.

Ungeachtet der heterogenen Befundlage bei Posttraumatischer Belastungs-störung (PTSD) während Symptomprovokation bei bildgebenden Verfahren wird ein neuronales Netzwerk angenommen, das eine erhöhte Amygdala- und Hippocampus-Aktivierung und eine verminderte medial präfrontale Cortex- (mPFC-) und anterior cinguläre Cortex- (ACC-) Aktivierung postuliert. Dieses Muster soll die Ängstlichkeit und unzureichende Emotionsregulation bei PTSD erklären. Dabei wird das für die PTSD typische Wiedererleben, in Form ungewollter und wiederkehrender Erin-nerungen und Bilder, nicht berücksichtigt. Neben diesen Hirnregionen gibt es Befunde zu Strukturen, denen bisher wenig Bedeutung beigemessen wurde, namentlich Precuneus und restroplenialer Cortex (Sartory, Cwik, Knuppertz, Schürholt, Lebens & Schulze, 2013). Auch gibt es wenige Erkenntnisse über neuronale Aktivierungsmuster kurz nach einer Traumatisierung und ihrer Entwicklung bei initialer Diagnose einer Akuten Belastungsstörung (ASD) hin zur Chronifizierung bzw. Remittierung. Um neue Erkenntnisse zu gewinnen, wurden in dieser Untersuchung 61 traumatisierte und gesunde Probanden eingeschlossen, in einem Drei-Gruppen-Vergleich (ASD, PTSD und KG) mittels funktioneller Magnetresonanztomographie (fMRT) und in einer whole-brain Analyse (WB-Analyse) hinsichtlich neuronaler Aktivierungsmuster bei der Symptomprovokation mit Traumabildern im Vergleich zu neutralen Bildern untersucht. Auch wurden 20 ASD-Probanden zu einem zweiten Messzeitpunkt, vier Wochen später, erneut gemessen und hinsichtlich ihrer neuronalen Aktivierungsmuster zum ersten Messzeitpunkt verglichen. Im Drei-Gruppen-Vergleich unterschieden sich die beiden Traumagruppen in ihren Aktivierungen nicht signifikant. Im Vergleich zur KG zeigte die ASD-Gruppe eine Hyperaktivierung im Cuneus, Declive und subgyral, wohingegen die PTSD-Gruppe mehr Aktivierung im ACC und dem mittleren frontalen Gyrus zeigte. Die KG zeigte eine Hyperaktivierung im Vergleich mit den ASD-Probanden in der Insula. Im Vergleich der beiden Messzeitpunkte gab es keine signifikanten Gruppenunterschiede. Die klassischen Aktivierungsmuster konnten nicht bestätigt werden. Die Ergeb-nisse deuten auf die Bedeutung cortikaler midline-Strukturen (CMS) bei Traumafolge-störungen, vor allem im Bereich des Precuneus und mPFC/ ACC, hin. Precuneus-Aktivierung weist auf eine frühe Bedeutung des Abrufs autobiographischer selbst-bezogener Informationen bei ASD hin und mPFC/ ACC-Aktvierung könnte eine Auf-merksamkeits- bzw. Monitoring-Funktion traumarelevanter Reize bei PTSD darstellen. Regardless of heterogeneous results concerning symptom provocation studies of posttraumatic stress disorder (PTSD) using functional imaging techniques, there is a broad agreement of an underlying neurocircuitry model consisting of amygdala and hippocampus hyperactivity and diminished medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC) activation. This activation pattern is thought to be responsible for the experience of fear and insufficient emotion regulation in PTSD. But it falls short in explaining the typical re-experiencing of unwanted and recurrent memories and images of the traumatic event. In addition to the earlier addressed brain regions, there is evidence for structures that have not gotten as much attention, namely precuneus and retrosplenial cortex (Sartory, Cwik, Knuppertz, Schürholt, Lebens & Schulze, 2013). In addition, there are only a few findings concerning neuronal activation patterns right after traumatic events addressing the initial diagnosis of acute stress disorder (ASD) leading either to chronic trauma symptoms or remission of the symptoms. To get new insights on the underlying neurocircuitry in ASD and PTSD, we included and examined 61 traumatized and healthy subjects divided into three groups (ASD, PTSD and HC = healthy controls) using functional magnetic resonance imaging (fMRI) in a whole-brain analysis (WB-analysis) comparing their neuronal activation patterns during symptom provocation with traumatic vs. neutral pictures. Furthermore, we compared 20 ASD patients at a second inquiry, four weeks later, and compared their neuronal activation patterns with those of their first examination. The comparisons between the two traumatized samples did not differ significantly in their activation patterns. ASD patients showed significantly more activation than HC in cuneus, declive and a subgyral region. PTSD patients showed significant hyperactivation compared to HC in cingular gyrus (ACC) and middle frontal gyrus. HC showed significantly more activation than ASD patients in the insula region. There were no significant group differences comparing the two measurements of the ASD patients. The classic activation patterns mentioned at the beginning could not be found in this study. However the results support the importance of cortical midline structures (CMS) in traumatized samples, especially concerning precuneus and mPFC/ ACC. Precuneus activation could point towards the early on relevance concerning recall of autobiographical and self-referential information in ASD and mPFC/ ACC activation could represent an attention or monitoring function for trauma relevant stimuli in PTSD.