bluuebunny/crossref_metadata_2025 huggingface dataset:
The relationships between neuroglial alterations and neuronal changes in Alzheimer’s disease, and the related controversies I: Gliopathogenesis and glioprotection
Authors: Toledano-Díaz Adolfo , Álvarez M Isabel , Toledano Adolfo
Published: October 2022

Since Alois Alzheimer described the pathology of Alzheimer’s disease in 1907, an increasing number of studies have attempted to discover its causes and possible ways to treat it. For decades, research has focused on neuronal degeneration and the disruption to the neural circuits that occurs during disease progression, undervaluing in some extent the alterations to glial cells even though these alterations were described in the very first studies of this disease. In recent years, it has been recognized that different families of neuroglia are not merely support cells for neurons but rather key and active elements in the physiology and pathology of the nervous system. Alterations to different types of neuroglia (especially astroglia and microglia but also mature oligodendroglia and oligodendroglial progenitors) have been identified in the initial neuropathological changes that lead to dementia, suggesting that they may represent therapeutic targets to prevent neurodegeneration. In this review, based on our own studies and on the relevant scientific literature, we argue that a careful and in-depth study of glial cells will be fundamental to understanding the origin and progression of Alzheimer’s disease. In addition, we analyze the main issues regarding the neuroprotective and neurotoxic role of neuroglial changes, reactions and/or involutions in both humans with Alzheimer’s disease and in experimental models of this condition.
Drivers of variation in telemedicine use during the COVID-19 pandemic: The experience of a large academic cardiovascular practice
Authors: Koos Harrison , Parameswaran Vijaya , Claire Sahej , Chen Chelsea , Kalwani Neil , Osmanlliu Esli , Qureshi Lubna , Dash Rajesh , Scheinker David , Rodriguez Fatima
Published: October 2022

Background

COVID-19 spurred rapid adoption and expansion of telemedicine. We investigated the factors driving visit modality (telemedicine vs. in-person) for outpatient visits at a large cardiovascular center.

Methods

We used electronic health record data from March 2020 to February 2021 from four cardiology subspecialties (general cardiology, electrophysiology, heart failure, and interventional cardiology) at a large academic health system in Northern California. There were 21,912 new and return visits with 69% delivered by telemedicine. We used hierarchical logistic regression and cross-validation methods to estimate the variation in visit modality explained by patient, clinician, and visit factors as measured by the mean area under the curve.

Results

Across all subspecialties, the clinician seen was the strongest predictor of telemedicine usage, while primary visit diagnosis was the next most predictive. In general cardiology, the model based on clinician seen had a mean area under the curve of 0.83, the model based on the primary diagnosis had a mean area under the curve of 0.69, and the model based on all patient characteristics combined had a mean area under the curve of 0.56. There was significant variation in telemedicine use across clinicians within each subspecialty, even for visits with the same primary visit diagnosis.

Conclusion

Individual clinician practice patterns had the largest influence on visit modality across subspecialties in a large cardiovascular medicine practice, while primary diagnosis was less predictive, and patient characteristics even less so. Cardiovascular clinics should reduce variability in visit modality selection through standardized processes that integrate clinical factors and patient preference.
Preoperative evaluation and perioperative management of patients undergoing major vascular surgery
Authors: Lee Christopher , Columbo Jesse A , Stone David H , Creager Mark A , Henkin Stanislav
Published: October 2022

Patients undergoing major vascular surgery have an increased risk of perioperative major adverse cardiovascular events (MACE). Accordingly, in this population, it is of particular importance to appropriately risk stratify patients’ risk for these complications and optimize risk factors prior to surgical intervention. Comorbidities that portend a higher risk of perioperative MACE include coronary artery disease, heart failure, left-sided valvular heart disease, and significant arrhythmic burden. In this review, we provide a current approach to risk stratification prior to major vascular surgery and describe the strengths and weaknesses of different cardiac risk indices; discuss the role of noninvasive and invasive cardiac testing; and review perioperative pharmacotherapies.
Carotid Artery Stenting With Double-Layer Stent: A Systematic Review and Meta-Analysis
Authors: Pini Rodolfo , Faggioli Gianluca , Paraskevas Kosmas I. , Campana Federica , Sufali Gemmi , Rocchi Cristina , Palermo Sergio , Gallitto Enrico , Gargiulo Mauro
Published: October 2022

Background:

Carotid artery stenting (CAS) in the treatment of significant stenosis is a cause of stroke due to both plaque prolapse and cerebral embolization. New types of stents with a double-layer structure have been designed to minimize plaque prolapse and embolization; these double-layer stents (DLSs) should be able to reduce the stroke risk; however, definite data on their performance are scarce in the literature.

Methods:

A systematic search was performed through PubMed, Scopus, and Cochrane Library, according to PRISMA guidelines; all studies on CAS with DLS (Roadsaver/Casper or CGuard) up to January 1, 2022, with a cohort of at least 20 patients were considered eligible. The present meta-analysis was approved and registered on PROSPERO register (CRD42022297512). Patients with tandem lesions or complete carotid occlusion were excluded from the study. The 30-day stroke rate after CAS was analyzed evaluating the preoperative symptomatic status and DLS occlusion. The estimated pooled rate of events was calculated by random effect model and moderators were evaluated.

Results:

A total of 14 studies were included in the meta-analysis for a total of 1955 patients. The estimated overall (95% confidence interval [CI]) stroke rate was 1.4% (0.9%–2.2%, I2 = 0%), which was not influenced by the type of DLS used: CGuard 0.8% (0.4%–1.8%, I2 = 0%) versus Roadsaver/Casper 1.5% (0.7%–3.2%, I2 = 0%), p=0.30. The 30-day estimated stroke rate was 1.5% (0.8%–2.9%, I2 = 0%) in asymptomatic and 1.9% (1.0%–3.6%, I2 = 0%) in symptomatic patients, with no influence by moderators. The 30-day DLS occlusion rate was 0.8% (0.4%–1.8%, I2 = 0%). The publication bias assessment identified asymmetry in the asymptomatic populations.

Conclusion:

The overall 30-day stroke rate in CAS with DLS is low (1.4%), with similar results in symptomatic and asymptomatic patients. Acute occlusion of DLS is rare (0.8%). Further studies are necessary to reduce the publication bias for asymptomatic patients.

Clinical Impact

CAS with DLS is associated to a low rate of 30-day stroke in both symptomatic (1.9%) and asymptomatic (1.5%) patients. The type of DLS (CGuard or Roadsaver/Casper) did not affect the 30-day stroke rate.
A 47-Year-Old Man Presenting With Seizures and Prior Stroke
Authors: Camacho-Caballero Kiara , Malaga Marco , Peixoto de Barcelos Isabella , Prentice Anibal F. , Berkowitz Aaron L.
Published: October 2022

A 47-year-old man presented to his local hospital in Peru after a generalized tonic-clonic seizure. His family reported a history of prior stroke of unclear etiology. This case report discusses the approach to a first seizure (including in tropical regions like Peru), the relationship between stroke and seizures, the approach to stroke in the young, and how to diagnose rare diseases in resource-limited settings.
Risk, Determinants, and Pharmacologic Treatment of Depression Following Acute Ischemic Stroke
Authors: Stein Laura K. , Mayman Naomi , Jette Nathalie , Tuhrim Stanley , Dhamoon Mandip S.
Published: October 2022

Background and Purpose: We assessed risk and determinants of new-onset depression in acute ischemic stroke (AIS) patients of all ages and no known history of depression. Additionally, we assessed patterns of post-stroke depression (PSD) treatment with pharmacotherapy. Methods: Retrospective cohort study of de-identified Marketscan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits Datasets for adults age ≥18 years admitted with AIS from July 1, 2016-July 1, 2017. We created Kaplan-Meier curves of cumulative risk of PSD up to 1.5 years following index AIS admission. We performed Cox regression to report hazard ratios for determinants of PSD up to 1.5 years following AIS. We summarized proportions treated with pharmacotherapy and identified the most commonly prescribed medications. Results: Of 8089 AIS patients, 1059 were diagnosed with PSD. At 1 year, cumulative risk of PSD was 13.4% (standard error .4) and 15.3% (standard error .5) at 1.5 years. History of anxiety was most strongly associated with PSD and discharge home least. Among those with PSD, 68.8% were prescribed an antidepressant and 8.4% an antipsychotic. The most commonly prescribed antidepressant was sertraline (28.5%). Conclusions: Among AIS patients of all ages, there is a persistently elevated cumulative risk of new diagnosis of PSD in the 1.5 years following AIS. Of the >2/3 treated with an antidepressant, sertraline was most commonly prescribed. Screening and treatment strategies for PSD require further study.
Unplanned Admissions, Emergency Department Visits, and Epilepsy After Critical Neurological Illness Requiring Prolonged Mechanical Ventilation in Children
Authors: Spear Matthew B. , Miller Kristen , Press Craig , Ruzas Christopher , LaVelle Jaime , Mourani Peter M. , Bennett Tellen D. , Maddux Aline B.
Published: October 2022

Background and Purpose

Long-term outcomes after pediatric neurocritical illness are poorly characterized. This study aims to characterize the frequency and risk factors for post-discharge unplanned health resource use in a pediatric neurocritical care population using insurance claims data.

Methods

Retrospective cohort study evaluating children who survived a hospitalization for an acute neurologic illness or injury requiring mechanical ventilation for >72 hours and had insurance eligibility in Colorado’s All Payers Claims database. Insurance claims identified unplanned readmissions and emergency department [ED] visits during the post-discharge year. For patients without pre-existing epilepsy/seizures, we evaluated for post-ICU epilepsy identified by claim(s) for a maintenance anti-seizure medication during months 6-12 post-discharge. Multivariable logistic regression identified factors associated with each outcome.

Results

101 children, median age 3.7 years (interquartile range (IQR) .4-11.9), admitted for trauma (57%), hypoxic-ischemic injury (17%) and seizures (15%). During the post-discharge year, 4 (4%) patients died, 26 (26%) were readmitted, and 48 (48%) had an ED visit. Having a pre-existing complex chronic condition was independently associated with readmission and emergency department visit. Admission for trauma was protective against readmission. Of those without pre-existing seizures (n = 86), 25 (29%) developed post-ICU epilepsy. Acute seizures during admission and prolonged ICU stays were independently associated with post-ICU epilepsy.

Conclusions

Survivors of pediatric neurocritical illness are at risk of unplanned healthcare use and post-ICU epilepsy. Critical illness risk factors including prolonged ICU stay and acute seizures may identify cohorts for targeted follow up or interventions to prevent unplanned healthcare use and post-ICU epilepsy.
A qualitative study to explore the acceptability and usefulness of personalized biofeedback to motivate physical activity in cancer survivors
Authors: Brannon Grace E. , Ray Madison , Cho Patrick , Baum Miranda , Beg Muhammad Shaalan , Bevers Therese , Schembre Susan M. , Basen-Engquist Karen , Liao Yue
Published: October 2022

Objective

Many cancer survivors do not meet recommended levels of exercise, despite the benefits physical activity offers. This study aimed to understand experiences of insufficiently active overweight/obese breast or colorectal cancer survivors, in efforts to (1) examine regular physical activity barriers, and (2) determine perceptions and acceptability of a remotely delivered physical activity intervention utilizing wearable sensors and personalized feedback messages.

Methods

In-person and virtual small group interviews were conducted engaging overweight/obese cancer survivors ( n = 16, 94% female, 94% breast cancer survivors) in discussions resulting in 314 pages of transcribed data analyzed by multiple coders.

Results

All participants expressed needing to increase physical activity, identifying lack of motivation centering on survivorship experiences and symptom management as the most salient barrier. They indicated familiarity with activity trackers (i.e., Fitbit) and expressed interest in biosensors (i.e., continuous glucose monitors [CGMs]) as CGMs show biological metrics in real-time. Participants reported (1) personalized feedback messages can improve motivation and accountability; (2) CGM acceptability is high given survivors’ medical history; and (3) glucose data is a relevant health indicator and they appreciated integrated messages (between Fitbit and CGM) in demonstrating how behaviors immediately affect one's body.

Conclusions

This study supports the use of wearable biosensors and m-health interventions to promote physical activity in cancer survivors. Glucose-based biofeedback provides relevant and motivating information for cancer survivors regarding their daily activity levels by demonstrating the immediate effects of physical activity. Integrating biofeedback into physical activity interventions could be an effective behavioral change strategy to promote a healthy lifestyle in cancer survivors.
Exploring enablers and inhibitors of eHealth educational tools: The needs of women searching for HPV and cervical cancer information
Authors: Bitar Hind , Alismail Sarah
Published: October 2022

Objective

This study explored the information women want to know about HPV and cervical cancer, and the enablers or inhibitors that may contribute to, or prevent, seeking online health information.

Methods

Two focus groups were conducted with women from the general public, followed by interviews with 12 physicians practicing in Saudi Arabia. The data was analyzed by using a thematic analysis approach.

Results

Researchers of this study identified six topics of information that were need-related, ten that were enabling, and six inhibiting subthemes related to online information seeking about HPV and cervical cancer.

Discussion and conclusion

In accordance with the identified themes and sub-themes, we offer recommendations to optimize the health information-seeking task related to HPV and cervical cancer through eHealth educational solutions. User- and expert-based feedback can both strengthen and inform the design, development, and implementation of eHealth interventions.
Weight loss in a digital app-based diabetes prevention program powered by artificial intelligence
Authors: Graham Sarah A. , Pitter Viveka , Hori Jonathan H. , Stein Natalie , Branch OraLee H.
Published: October 2022

Objective

The National Diabetes Prevention Program (DPP) reduces diabetes incidence and associated medical costs but is typically staffing-intensive, limiting scalability. We evaluated an alternative delivery method with 3933 members of a program powered by conversational Artificial Intelligence (AI) called Lark DPP that has full recognition from the Centers for Disease Control and Prevention (CDC).

Methods

We compared weight loss maintenance at 12 months between two groups: 1) CDC qualifiers who completed ≥4 educational lessons over 9 months (n  =  191) and 2) non-qualifiers who did not complete the required CDC lessons but provided weigh-ins at 12 months (n  =  223). For a secondary aim, we removed the requirement for a 12-month weight and used logistic regression to investigate predictors of weight nadir in 3148 members.

Results

CDC qualifiers maintained greater weight loss at 12 months than non-qualifiers (M  =  5.3%, SE  =  .8 vs. M  =  3.3%, SE  =  .8; p  =  .015), with 40% achieving ≥5%. The weight nadir of 3148 members was 4.2% (SE  =  .1), with 35% achieving ≥5%. Male sex ( β = .11; P  =  .009), weeks with ≥2 weigh-ins ( β = .68; P < .0001), and days with an AI-powered coaching exchange ( β = .43; P < .0001) were associated with a greater likelihood of achieving ≥5% weight loss.

Conclusions

An AI-powered DPP facilitated weight loss and maintenance commensurate with outcomes of other digital and in-person programs not powered by AI. Beyond CDC lesson completion, engaging with AI coaching and frequent weighing increased the likelihood of achieving ≥5% weight loss. An AI-powered program is an effective method to deliver the DPP in a scalable, resource-efficient manner to keep pace with the prediabetes epidemic.
The role of phone-based triage nurses in supporting older adults with multimorbidity to digitally self-manage – Findings from the ProACT proof-of-concept study
Authors: Doyle Julie , McAleer Patricia , van Leeuwen Cora , Smith Suzanne , Murphy Emma , Sillevis Smitt Myriam , Galvin Mary , Jacobs An , Tompkins Lorraine , Sheerin James , Dinsmore John
Published: October 2022

Background

Achieving patient-centred care necessitates supporting individuals to have more involvement in the self-management of their care. Digital health technologies are widely recognised as a solution to empower more effective self-management. However, given the complexity of multiple chronic condition (multimorbidity) management, coupled with changes that occur as part of the normal ageing process, human support alongside digital self-management is often necessary for older people with multimorbidity (PwM) to sustain successful self-management.

Methods

The aim of the study was to explore the role played by a clinical, nurse-led telephone triage service in responding to alerts generated by older adults using a digital health platform, ProACT, to self-manage multiple chronic conditions over a period of 1 year. Semi-structured interviews with participants with multimorbidity were carried out across four time points during the trial, while interviews and focus groups were conducted with triage nurses at the end of the trial. Thematic analysis was conducted on the resulting transcripts.

Results

Themes found in the data include the work of triage nurses; the benefits of triage support; tensions such as anxiety due to patient monitoring; and the relationship between triage nurses and participants.

Discussion

This work contributes to an understanding of how older adults with multimorbidity and triage nurses collaborate in multiple chronic disease self-management. Findings are discussed within the context of Hudon et al.'s patient-centred care framework and indicate that patient-centred care was achieved, with both PwM and triage participants reporting positive experiences, relationships and several benefits of the triage support alongside digital self-management.
Popularising Vlogging in China: Bilibili’s Institutional Promotion of Vlogging Culture
Authors: Wang Xiaoxian
Published: October 2022

Vlogging culture has experienced rapid growth in China since 2018. Central to this expansion, social media platforms have played a dominant role in popularising vlogging culture. By conducting a digital ethnography of the Chinese user-generated content platform Bilibili from September 2019 to May 2022, this article explores the institutional power of platforms in promoting and shaping vlogging production and practices in China. Beyond the function of intermediating, Bilibili shapes vlogging as an intensive production and interactive practice with high performativity to compete for visibility. This article theorises four ways that Bilibili popularises vlogging culture in China: pillarising discourses, metric-based monetisation, advertising mediation and vlog-focused campaigns. In taking this approach, this study sheds light on the institutional power of platforms in promoting and shaping cultural production. In addition, it uncovers the precarity embedded in the promotion strategies, notably the interplay with the platform economy in the context of China.
Perceptions of the U.S. Police Among Latin-American Immigrants: A Bifocal Lens View
Authors: Lim Hyeyoung , Bontcheva-Loyaga Nadejda
Published: October 2022

The current study aimed to identify Latin-American immigrants’ bifocal lens views of the U.S. police and compare them to their contact experiences with their home-country police. We performed semi-structured interviews with twenty-one Latin-American immigrants who have resided in the Birmingham metropolitan area in Alabama. An inductive analysis approach was employed to analyze the qualitative data. The results showed that the Latin-American immigrants’ direct contact experience with the U.S. police has mainly been positive, but they still felt targeted. Even if their indirect experiences lead them to perceive a violent and biased image of the U.S. police force, participants appreciated the U.S. police as honest and not corrupt. Besides, while most participants expressed willingness to report crimes, they simultaneously recognized that other Latin-American immigrants would not feel comfortable reporting crimes due to the fear of deportation. Finally, we found that the perception of the U.S. police among Latin-American immigrants was primarily the result of the juxtaposition of the U.S. police's professionalism against their home-country police. We further discuss policy implications and study limitations in this study.
Strategic Responses to Navigating Police Encounters among Black Baltimore Residents
Authors: Bender Kimberly A. , Cobbina-Dungy Jennifer E. , Kerrison Erin M.
Published: October 2022

Research on police-citizen interactions has largely explored the treatment of citizens by the police with less attention paid to citizens’ behavior toward the police. Studies that have examined the behavior citizens’ exhibit during police encounters have found that citizen behavior affects how they are treated by the police; yet, little scholarly attention has been given to the strategic responses’ citizens use during their encounters with officers. The few studies that have examined how citizens manage encounters with police focus primarily on young Black males, making it difficult to identify similarities and differences across gender. The following study makes use of in-depth interview data collected from a sample of 25 Black adults residing in Baltimore City who shared their personal experiences and observations of local police prior to Freddie Gray's death. We draw on race, gender, and place literature to understand how participants interpret their encounters with police and the options available to individuals when dealing with the police. Our analyses reveal that some strategic responses differed by respondent gender as did the nature of the police-citizen outcomes. Findings have implications as to how men and women make sense of police actions and how citizens manage their interactions with the police.
Nature and Extent of Dohli Land Grant and Donations in the Territory of Kota State (1670–1820 CE)
Authors: Rao Narayan Singh
Published: October 2022

The Hada rulers of Kota state were devout followers of Hindu religion, but at the same time, they demonstrated their spirit of religious toleration towards all the other religions and sects. The archival documents give sufficient data and information that the Hada rulers liberally made land grants as well as cash donations to priestly class people and temples. The grants were liberally distributed by the state for the upkeep and maintenance of temples, the priestly class, intellectuals and Brahmins. The state also constructed temples and maintained and repaired them as per requirement from time to time. Priests, monks, sages and pandits were attached to the temples with financial assistance from the state exchequer. The state also ensured that regularly ritual worship is performed in temples, the lamp is lighted, prasad is distributed, havan ( yajnas) and special poojas are performed on festive occasions, and bhog [food items, sweet meat, coconut, etc.] is offered to the presiding deities of the temple. The state also deployed katha vachaks [preachers] to different villages and urban centres to recite religious texts and stories on the virtues of heavenly gods. This was aimed at preserving and upholding the moral social order in the society and Varnashrama Dharma, which was followed by the Hara rulers of the Harawati region. The percentage of land granted to temples and also for charitable purposes ranged between 3% and 15% in different parganas of the state, which was higher than the land grants made by Mughal rulers.
An Exploratory Study on the Mediating Effect of Clinical Competence in the Relationship Between Grit and Field Adaptation in Newly Graduated Nurses
Authors: Shin Eunhee
Published: October 2022

Introduction

Even under difficult situations, individuals with psychological resources such as positive psychological capital and resilience are less likely to consider turnover. Grit is a psychological factor that predicts success at work in other industries, but little is known about its impact on newly graduated nurses.

Objectives

The study’s purpose is to investigate newly graduated nurses’ grit, clinical competence, and field adaptation as well as the mediating effect of clinical competence in the relationship between grit and field adaptation.

Methods

A total of 102 nurses from university hospitals located in W city took part in this investigation. Data were collected using a self-questionnaire and were analyzed using descriptive statistics, Pearson’s correlation coefficient, multiple regression, and mediation analysis with the SPSS/26.0 program.

Results

Grit was remarkably related to clinical competence (r = .53, p < .001) and field adaptation (r = .30, p = .003). Clinical competence was significantly related to field adaptation (r = .24 p = .02). However, the role of clinical competence as a mediating factor in the relationship between grit and field adaptation was not found to be significant (β = .11, p = .32).

Conclusion

Grit boosted clinical competence and had a direct effect on field adaptation. In order for newly graduated nurses to retain a consistent level of enthusiasm in their work, it is necessary to develop a program or strategies to improve their grit.
A Descriptive Exploratory Study of the Causes and Effects of Hypertension Among Ghanaian Soldiers and Their Families
Authors: Dartey Anita Fafa , Lasidji Berlinda Narh , Baku Elizabeth , Worna Lotse Comfort , Kuug Anthony Kolsabilik , Dzansi Gladys
Published: October 2022

Introduction

The quality of life of any soldier can be affected by a simple diagnosis of Hypertension. Hypertension has not been directly linked to a single cause; however, knowing the associated risks and early diagnosis can help with its management. This study aimed to explore and describe the causes of hypertension among soldiers and its effects on their families.

Objective(s)

To explore and describe the causes of hypertension and its effects on soldiers and their families.

Methods

A qualitative technique and an exploratory descriptive design were used in this study. At saturation, a total of 10 soldiers were face-to-face interviewed and gathered data simultaneously transcribed and subjected to a content analytic method of analysis. Participants approved being audio recorded on tape with an audio recording device.

Results

Effects of hypertension on personal lives of soldiers, effects of hypertension on family life, and effects of hypertension on social life were identified as the causes and risk factors of hypertension among the soldiers. These themes are further expanded by their subthemes in the areas of decreased physical activity including sex life, decrease interaction with family, and isolation from friends.

Conclusion

This study revealed that hypertension does have effects on one's personal life, family life, and social life. Hence, it is recommended that frequent health education on hypertension and its effects should be organized in the various Garrisons by the public health department for all soldiers and their families. Screening programs should be organized for early hypertension detection. Soldiers should be educated on appropriate eating habits, weight and financial management, and reduction in tobacco and alcohol.
Social and Gender Differences in Informal Caregiving for Sick, Disabled, or Elderly Persons: A Cross-Sectional Study
Authors: Skinner Marianne Sundlisæter , Sogstad Maren
Published: October 2022

Introduction

Informal caregivers are in increasing demand to provide care for sick, disabled, and elderly persons in the years to come, also in the Nordic welfare states. Informal caregivers can provide different types of care, such as personal care, supervision, and practical help, and previous research has shown that women take on a heavier care burden than men. However, structural differences in care tasks and caregiver burden in the Norwegian population is an under-researched area of study.

Objective

The study objective is to explore different types of informal care and caregivers in the Norwegian population and assess how different types of caregivers are distributed across socio-demographic groups.

Methods

A cross-sectional population survey was conducted in 2014. A random sample of 20,000 people above 16 years of age was drawn from the national population register. The net sample consisted of 4,000 individuals, giving a response rate of 20.2%. Data were collected using telephone interviews. We used descriptive statistics, crosstabulations with chi-square tests and multinomial regression analyses.

Results

Fifteen and seven percent of the respondents reported that they regularly helped persons with special care needs outside and inside their own household, respectively. Women were more likely than men to give personal care, whereas men were overrepresented among caregivers providing practical help only. The mean age of caregivers providing practical help only was significantly lower than for caregivers providing personal care.

Conclusion

Our results indicate that women take on a heavier care load, both by providing more personal care then men and in that they spend more time caring. It is important that nurses and other healthcare professionals in community care have knowledge about structures of inequality in informal caregiver tasks and burden so that they can better identify opportunities for improved coordination between formal and informal care.
Baccalaureate Nursing Students’ Reflections on Professional Development Within the Nursing Leadership Role When Participating in Student-run Teams: A Qualitative Content Analysis of Student’s Reflection Notes
Authors: Reime Marit Hegg , Bell Karin , Albrigtsen Bente , Beisland Elisabeth Grov
Published: October 2022

Introduction

Studies show that nursing education institutions do not sufficiently prepare newly graduated nurses for the challenges they face when it comes to the leadership role. The direct relationship between leadership and quality of care makes it imperative to explore what contributes to prepare undergraduate nursing students to be effective future leaders.

Objective

To explore how second-year nursing students experience development of nursing leadership competence when participating in student-run teams (SRTs).

Methods

We used a qualitative approach with a descriptive, exploratory design to examine 37 reflective notes with a scope of 1000 words each, written while undertaking leadership training in 14 medical and surgical wards. An inductive, qualitative content analysis inspired by Lindgren et al. was used to give meaning and content to the students’ experiences.

Results

One overarching theme emerged when analyzing the reflective notes; nursing leadership skills are developed in a safe authentic clinical environment. This main theme evolved from an interpretation of three subthemes: (1) Discovery and recognition of the leadership role contributed to development of nursing identity, (2) Being challenged and given responsibility in the SRT contributed to development of nursing leadership skills, (3) The way nursing services are organized affects the quality of care and satisfaction in one’s own work situation.

Conclusion

SRTs can be a way of organizing clinical placement studies to strengthen nursing students’ competence in the nursing leadership role and may counteract the reality shock when transitioning from the student role to the professional role.
Proton Magnetic Resonance Spectroscopy in Post-Traumatic Stress Disorder—Updated Systematic Review and Meta-Analysis
Authors: Swanberg Kelley M. , Campos Leonardo , Abdallah Chadi G. , Juchem Christoph
Published: October 2022

A stressor-related disorder wherein traumatic experience precipitates protracted disruptions to mood and cognition, post-traumatic stress disorder (PTSD) is associated with wide-ranging abnormalities across the body. While various methods have investigated these deviations, only proton magnetic resonance spectroscopy (1H MRS) enables noninvasive measurement of small-molecule metabolites in the living human. 1H MRS has correspondingly been employed to test hypotheses about the composition and function of multiple brain regions putatively involved in PTSD. Here we systematically review methodological considerations and reported findings, both positive and negative, of the current 1H-MRS literature in PTSD (N = 32 studies) to communicate the brain regional metabolite alterations heretofore observed, providing random-effects model meta-analyses for those most extensively studied. Our review suggests significant PTSD-associated decreases in N-acetyl aspartate in bilateral hippocampus and anterior cingulate cortex with less evident effect in other metabolites and regions. Model heterogeneities diverged widely by analysis (I2 < 0.01% to 90.1%) and suggested regional dependence on quantification reference (creatine or otherwise). While observed variabilities in methods and reported findings suggest that 1H-MRS explorations of PTSD could benefit from methodological standardization, informing this standardization by quantitative assessment of the existing literature is currently hampered by its small size and limited scope.
Elevated vascular transformation blood biomarkers in Long-COVID indicate angiogenesis as a key pathophysiological mechanism
Authors: Patel Maitray A. , Knauer Michael J. , Nicholson Michael , Daley Mark , Van Nynatten Logan R. , Martin Claudio , Patterson Eric K. , Cepinskas Gediminas , Seney Shannon L. , Dobretzberger Verena , Miholits Markus , Webb Brian , Fraser Douglas D.
Published: October 2022

Background

Long-COVID is characterized by prolonged, diffuse symptoms months after acute COVID-19. Accurate diagnosis and targeted therapies for Long-COVID are lacking. We investigated vascular transformation biomarkers in Long-COVID patients.

Methods

A case–control study utilizing Long-COVID patients, one to six months (median 98.5 days) post-infection, with multiplex immunoassay measurement of sixteen blood biomarkers of vascular transformation, including ANG-1, P-SEL, MMP-1, VE-Cad, Syn-1, Endoglin, PECAM-1, VEGF-A, ICAM-1, VLA-4, E-SEL, thrombomodulin, VEGF-R2, VEGF-R3, VCAM-1 and VEGF-D.

Results

Fourteen vasculature transformation blood biomarkers were significantly elevated in Long-COVID outpatients, versus acutely ill COVID-19 inpatients and healthy controls subjects (P < 0.05). A unique two biomarker profile consisting of ANG-1/P-SEL was developed with machine learning, providing a classification accuracy for Long-COVID status of 96%. Individually, ANG-1 and P-SEL had excellent sensitivity and specificity for Long-COVID status (AUC = 1.00, P < 0.0001; validated in a secondary cohort). Specific to Long-COVID, ANG-1 levels were associated with female sex and a lack of disease interventions at follow-up (P < 0.05).

Conclusions

Long-COVID patients suffer prolonged, diffuse symptoms and poorer health. Vascular transformation blood biomarkers were significantly elevated in Long-COVID, with angiogenesis markers (ANG-1/P-SEL) providing classification accuracy of 96%. Vascular transformation blood biomarkers hold potential for diagnostics, and modulators of angiogenesis may have therapeutic efficacy.
Adverse childhood experiences, associated stressors and comorbidities in children and youth with fetal alcohol spectrum disorder across the justice and child protection settings in Western Australia
Authors: Tan Grace Kuen Yee , Symons Martyn , Fitzpatrick James , Connor Sophia G. , Cross Donna , Pestell Carmela F.
Published: October 2022

Background

Individuals with Fetal Alcohol Spectrum Disorder (FASD) are at risk of having adverse childhood experiences (ACEs), especially those with child protection and/or justice system involvement. The complex relationship between FASD and psychosocial vulnerabilities in the affected individual is an important clinical risk factor for comorbidity. This study (1) explored the ACEs and associated stressors in individuals with FASD; (2) investigated the association between ACEs and negative outcomes, i.e., justice/child protection system involvement; and (3) examined the relationship between ACEs and comorbid conditions such as mood and neurodevelopmental disorders.

Methods

Data were collected retrospectively via file review from diagnostic clinics in Western Australia. Life adversity was coded using a standardised ACEs questionnaire. A total of 211 participants (72% males) with FASD with a mean age of 11 years (range = 2–21) were included in the final sample. 70% of the total sample had been involved with the child protection system and 40% had trouble with the law.

Results

Exposure to drinking/substance misuse at home (70%) and domestic violence (52%) were the two most common ACEs across the total sample. In the entire cohort, 39% had four or more ACEs, indicating higher risks of poor health outcomes. Additional stressors recorded were disengagement from school (43%), transiency (19%), victims of bullying (12%), traumatic brain injury (9%) and homelessness (5%). ACEs such as drinking/substance misuse at home, emotional neglect and physical neglect were positively associated with child protection system involvement. Additionally, exposure to domestic violence was positively correlated with justice system involvement. Higher rates of life adversity in this clinical population were associated with an increased number of comorbidities. Specifically, those with FASD who had comorbidities such as attachment disorder, substance use disorder, and PTSD also reported higher ACEs scores.

Conclusion

ACEs were common in this clinical population. Increased ACEs in this sample were associated with increased comorbidities and involvement with the child protection and/or justice system. This highlights that prevention, intervention and early diagnosis of FASD are important for at risk children to reduce the negative effects of ACEs.
An explanatory model of depressive symptoms from anxiety, post-traumatic stress, somatic symptoms, and symptom perception: the potential role of inflammatory markers in hospitalized COVID-19 patients
Authors: Villarreal-Zegarra David , Paredes-Angeles Rubí , Mayo-Puchoc Nikol , Vilela-Estada Ana L. , Copez-Lonzoy Anthony , Huarcaya-Victoria Jeff
Published: October 2022

Background

The context of the COVID-19 pandemic has harmed the mental health of the population, increasing the incidence of mental health problems such as depression, especially in those who have had COVID-19. Our study puts forward an explanatory model of depressive symptoms based on subjective psychological factors in those hospitalized for COVID-19 with and without biological markers (i.e., inflammatory markers). Therefore, we aim to evaluate the hypotheses proposed in the model to predict the presence of depressive symptoms.

Method

We conducted a cross-sectional study, using a simple random sampling. Data from 277 hospitalized patients with COVID-19 in Lima-Peru, were collected to assess mental health variables (i.e., depressive, anxiety, post-traumatic stress, and somatic symptoms), self-perception of COVID-19 related symptoms, and neutrophil/lymphocyte ratio (NLR) such as inflammatory marker. We performed a structural equation modeling analysis to evaluate a predictive model of depressive symptoms.

Results

The results showed a prevalence of depressive symptoms (11.2%), anxiety symptoms (7.9%), somatic symptoms (2.2%), and symptoms of post-traumatic stress (6.1%) in the overall sample. No association was found between the prevalence of these mental health problems among individuals with and without severe inflammatory response. The mental health indicators with the highest prevalence were sleep problems (48%), low energy (47.7%), nervousness (48.77%), worry (47.7%), irritability (43.7%) and back pain (52%) in the overall sample. The model proposed to explain depressive symptoms was able to explain more than 83.7% of the variance and presented good goodness-of-fit indices. Also, a different performance between the proposed model was found between those with and without severe inflammatory response. This difference was mainly found in the relationship between anxiety and post-traumatic stress symptoms, and between the perception of COVID-19 related symptoms and somatic symptoms.

Conclusions

Results demonstrated that our model of mental health variables may explain depressive symptoms in hospitalized patients of COVID-19 from a third-level hospital in Peru. In the model, perception of symptoms influences somatic symptoms, which impact both anxiety symptoms and symptoms of post-traumatic stress. Thus, anxiety symptoms could directly influence depressive symptoms or through symptoms of post-traumatic stress. Our findings could be useful to decision-makers for the prevention of depression, used to inform the creation of screening tools (i.e., perception of symptoms, somatic and anxiety symptoms) to identify vulnerable patients to depression.
Lifting lockdown: Renewed access to arts and cultural activities
Authors: Worsley Joanne , Billington Josie , Balabanova Ekaterina , Chapple Melissa
Published: October 2022

Background

The effects of COVID-19 on mental health are profound. While there is a growing body of evidence on arts supporting mental health, the re-engagement with in-person arts and cultural activity has remained slow following the lifting of restrictions.

Methods

Interviews with 14 representatives, including providers and practitioners, from 12 arts and cultural organisations within the Liverpool City Region (LCR) were conducted. The aim was to examine the impact of COVID-19 restrictions easing on arts and cultural provision in the LCR, and on the mental health and wellbeing of those whom arts and cultural organisations serve, including those who would usually access arts through formal healthcare routes (e.g., those usually served via arts organisations’ partnership with health or social care providers). Data were analysed using framework analysis.

Results

Three overarching themes were identified: The new normal: ‘Out of crisis comes innovation’; Complexities of operating ‘in the new COVID world’; and Reimagining arts in mental healthcare.

Conclusion

As engagement in community and cultural activities plays a public health role, a hybrid delivery of arts and culture – ensuring continued online access alongside in-person provision – will be vital for people’s recovery. Alongside efforts to reimagine arts in mental healthcare in the wake of the crisis caused by the pandemic, the role of arts and culture in providing stigma-free environments to reconnect the vulnerable and isolated is more critical than ever. Recommendations on the role of arts and culture in sustaining the mental health and wellbeing of the population and embedding the arts within clinical care and public health prevention schemes are provided.
Is simultaneous bilateral total hip arthroplasty deleterious in a biomechanical point of view? A comparative gait analysis study
Authors: Caudron Martin , Detrembleur Christine , Van Cauter Maïté
Published: October 2022

Purpose

Uni- or bilateral hip osteoarthritis is a common disease generating pain, stiffness, and functional disabilities. Changes in the normal walking with higher energy expenditures are observed. Facing a cruel lack of biomechanical data, we decided to analyse the impact on the walking of single and simultaneous bilateral total hip arthroplasties (THA).

Method

We conducted a prospective monocentric study, comparing two matched groups of 15 patients able to walk with symptomatic isolated uni- (group 1) or bilateral HO (group 2) and treated respectively by unilateral THA (UTHA) or simultaneous bilateral THA (SBTHA). Surgery was performed by a single surgeon with a direct anterior approach and approved by local ethical committee. Walking was assessed by a « 3D Gait analysis motion» pre and at 6 months post operatively.

Result

In the UTHA group, recovery, i.e., efficiency of locomotor mechanism (p < 0.001) and pelvis sagittal balance (p = 0.031) improved, while external and total work (p = 0.010) decreased post operatively. In the SBTHA group, speed (p = 0.035), step length (p = 0.046), range of motion of knee sagittal stance (p = 0.009) and hip frontal (p = 0.031), and internal work are significatively higher (p < 0.001) post operatively.

Conclusions

This original study attests that THA has a positive impact on walking and energetics outcome in UTHA and SBTHA.
How, when and where? A systematic review on abortion decision making in legally restricted settings in sub-Saharan Africa, Latin America, and the Caribbean
Authors: Hinson Laura , Bhatti Anam M. , Sebany Meroji , Bell Suzanne O. , Steinhaus Mara , Twose Claire , Izugbara Chimaraoke
Published: October 2022

Background

With increasing global availability of medication abortion drugs, a safer option exists for many women to terminate a pregnancy even in legally restrictive settings. However, more than 22,000 women die each year from unsafe abortion, most often in developing countries where abortion is highly legally restricted. We conducted a systematic review to compile existing evidence regarding factors that influence women’s abortion-related decision making in countries where abortion is highly legally restricted.

Methods

We searched ten databases in two languages (English and Spanish) for relevant literature published between 2000 and 2019 that address women’s decision-making regarding when, where and how to terminate a pregnancy in sub-Saharan African, Latin American and the Caribbean countries where abortion is highly legally restricted.

Results

We identified 46 articles that met the review’s inclusion criteria. We found four primary factors that influenced women’s abortion-related decision-making processes: (1) the role of knowledge, including of laws, methods and sources; (2) the role of safety, including medical, legal and social safety; (3) the role of social networks and the internet, and; (4) cost affordability and convenience.

Conclusions

The choices women make after deciding to terminate a pregnancy are shaped by myriad factors, particularly in contexts where abortion is highly legally restricted. Our review catalogued the predominant influences on these decisions of when, where and how to abort. More research is needed to better understand how these factors work in concert to best meet women’s abortion needs to the full limit of the law and within a harm reduction framework for abortions outside of legal indications.