Burden Of Chronic Illness Research Articles

Anesthesia in Obese Patients and Complications

Background: Almost all ages and socioeconomic categories are affected by the complex illness known as obesity, which has major social and psychological ramifications. Global obesity rates have reached epidemic proportions and obesity plays a significant role in the burden of chronic illnesses and disabilities worldwide. The aim of the study was to assess the Anesthesia in obese patient and its Complications in a tertiary care hospital. Materials and mathods: This cross-sectional observational study was carried out in the Department of Anesthesiology, Bangabandhu Memorial Hospital (BBMH) from July 2020 to June 2022.Total sample size was 200. Adult in-patients who had undergone non-cardiac surgery and were older than 18 with a BMI greater than 30 kg/m2 met the inclusion criteria. Pregnancy, ambulatory surgery and missing or insufficient data on the desired outcomes were the exclusion criteria. Results: Mean age ±SD was 32 ± 0.9 years. About 55% of the patients were female and 45% were male. Regarding ASA classification 53.5% had 2, 45.5% had 3 and 1.0% had 4 score. Regarding coexisting disease 42.5% had hypertension, 14% had dyslipidemia, 18% had DM type-2 and 7.5% had obstructive sleep apnea. Here, type of anesthesia was 55% general anesthesia, 6% normal mask ventilation, 25% regional anesthesia, 4% total intravenous anesthesia and 10% LMA (Laryngeal Mask Airway). Regarding complication 4.5% was Reintubation, 5.5 %Pneumonia, 7.5% Upper airway obstruction, 0.5% Delay emergence respectively. 2.5% Urinary retention, 5% Oliguria, 2% Wound infection. 0.5% myocardial infarction and 0.5% Cardiac arrest occurred and no death occur inpatient respectively. Conclusion: Obesity has long been seen from a surgical standpoint as a risk factor for unfavorable post-surgical outcomes. Patients who are morbidly obese may experience respiratory adverse effects following surgery as a result of physiological disruption. The undesirable effects range depending on the surgical population. IAHS Medical Journal Vol 7(1), June 2024; 97-101

Effects of Web-Based Psychotherapeutic Interventions on Depression in Mood Disorders: A Meta-Analysis Study.

To investigate the effects of web-based psychotherapeutic interventions on depression among individuals with mood disorders. For this meta-analysis study, data were obtained from October to December 2023 by searching PubMed, Web of Science, EBSCOhost, Google Scholar, and YÖK Thesis Center for articles published in the past 5 years. In the first stage of the search, 12,056 records were obtained. After removing duplicate studies, 4,910 records were considered for title and abstract review. After this evaluation, 139 studies were identified for full-text review. After the review, six studies reporting results on the effectiveness of web-based psychotherapeutic interventions on depression among individuals with mood disorders were ultimately included. Web-based interventions had significant positive effects and provided decreases in depression levels (standardized mean difference = -0.168, 95% confidence interval [-0.315, -0.021]; Z = -2.243; p < 0.05). Web-based interventions for mood disorders may play an effective role in reducing the burden of chronic mental illness and improving patient outcomes. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Excess Mortality in Persons with Concurrent HIV and Cancer Diagnoses: A Retrospective Cohort Study.

With extended lifespans for people with human immunodeficiency virus (PWH), there is a corresponding increased burden of chronic illnesses, including cancer. Our objective was to estimate the excess mortality for PWH with cancer compared with people without HIV (PWoH), accounting for the higher background mortality in the general PWH population. We identified 39,000 PWH and 387,767 demographically-matched PWoH in three integrated healthcare systems from 2000-2016. We estimated excess mortality for PWH with cancer, computed as the cancer mortality rate difference-in-difference comparing PWH and PWoH. We evaluated five cancer groups: any cancer; virus-, human papillomavirus-, and Epstein-Barr virus (EBV)-related cancers; virus-unrelated cancers, and common individual cancers. We fitted a multivariable additive Poisson model to estimate excess mortality for PWH with cancer. PWH with any cancer had excess mortality compared with PWoH (41.3/1000 person-years [py], 95% Confidence Interval [CI] 34.0, 48.7). The highest excess mortality was observed for EBV-related cancers (63.2/1000 py, 95% CI 47.8, 78.7), lung cancer (147.7/1000 py, 95% CI 41.1, 254.3) and non-Hodgkin lymphoma (70.5/1000 py, 95% CI 51.4, 89.6). Excess mortality for PWH was attenuated 2009-2016, and PWH with cancer had no excess mortality 5 years after diagnosis. PWH in care may have excess mortality from certain cancer types, although disparities may have attenuated over time and do not persist beyond 5 years after diagnosis. Findings may guide improved clinical practice, and suggest further research is needed to investigate whether cancer treatment or other factors contribute to mortality disparities for PWH with cancer.

The interplay between aging and inflammation and its role in chronic disease development

This paper explores the complex relationship between aging and inflammation and its impact on the development of chronic diseases. Aging is an important contributor to elevated levels of inflammation, with mechanisms including changes in immune regulatory function, chronic low-grade inflammation, cellular aging and tissue damage, changes in gene expression, and increased oxidative stress. These inflammatory processes not only accelerate aging itself, but also promote the development of chronic diseases such as cardiovascular disease (CVD) and Alzheimers disease (AD). The article goes on to address other modern anti-inflammatory treatment approaches, such as biologics, JAK inhibitors, and nonsteroidal anti-inflammatory medications. These treatments help manage and mitigate aging-related pathologies by targeting key molecules and pathways of inflammation. A better comprehension of the relationship between inflammation and aging may serve as the foundation for the creation of novel therapeutic approaches that, in addition to reducing inflammatory reactions, may also prevent or slow the advancement of illnesses associated with age. This article aims to improve medical and scientific understanding of the relationship between inflammation and aging and to encourage the development and use of more potent therapies to lessen the burden of chronic illnesses and enhance the quality of life for the aged.

Experiences of homeless individuals using ambulance services: a narrative review

Background: Homeless individuals are vulnerable and have a higher burden of illness. Barriers to care exist and experiences can be negative, contributing to increased morbidity and mortality. The experiences of homeless individuals accessing healthcare through ambulance services is underexplored. Aims: The study aims to describe why homeless individuals access healthcare through ambulance services and identify lived experiences. Methods: A narrative literature review was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology, with Critical Appraisal Skills Programme tools used to assess quality before thematic synthesis. Results: Twenty-three studies were included. Six themes were identified including frequency of ambulance use and clinical characteristics, why healthcare is accessed through ambulance services and the experiences of homeless individuals and paramedics. Conclusions: Evidence relating to homeless individuals accessing healthcare through ambulance services is limited. However, it is clear this group uses these services more often than non-homeless individuals, likely because of their higher chronic illness burden. Services should be developed to meet the needs of homeless individuals and to help ensure demand on ambulance services is manageable and affordable.

The Impact of Chronic Diseases on Mental Health: AnOverview and Recommendations for Care Programs.

The current achievement of medical advancement is noteworthy; however, the occurrence of chronic diseases is increasing day by day, with a significant percentage of affected people aresuffering from a mental health crisis. This article aims to present a thorough yet brief review of methods that can be employed to build the emotional wellness of chronic patients. The mental health carestrategies include resilience-building, coping skills training, professional counseling, and lifestyle adaptations. Additionally, the article highlightsthe efficacy of several modern interventions, such as mindfulness-based therapies, cognitive behavioral therapy, eye movement desensitization, andrecovery from stress therapy. The global burden of chronic illness emphasizes the pressing need to mitigate mental health problems among chronic patients. By providing actionable insights, our study clears the path for targeted interventions and holistic approaches for chronic disease patients. Moreover, the article suggests to policymakers and clinicians the need for collaboration and multifaceted interventions.

Early identification of thyroid illness and its intricate relationship to renal function may be crucial for therapy planning

An epidemiological shift has occurred in India, where the burden of chronic illnesses is increasing, and communicable diseases are declining. Chronic diseases such as diabetes mellitus, cancer, and chronic respiratory disorders are on the rise, and this trend has been attributed to unhealthy lifestyles, increased urbanization, and changes in society and the environment. Such a category did not include chronic kidney disease (CKD). End-stage renal disease (ESRD) is defined as glomerular filtration rate (GFR) &amp;#60;15 ml/min/1.73 m2, while chronic kidney disease (CKD) is defined as a sustained eGFR of &amp;#60;60 ml per minute per 1.73 m2 of body-surface area for more than three months irrespective of the underlying cause while glomerular filtration rate (GFR) &amp;#60;15 ml/min/1.73 m2 is considered as end-stage renal disease (ESRD). CKD is classified into five stages ranging from mild dysfunction to complete failure. Globally, CKD is a significant cause of morbidity and death and there is a 38% increase in mortality linked to renal failure in developing nations like India. It has been shown that the epidemiology of CKD in India differs from that in the West; patients in India were, on average, five to twenty years younger Pregnancy-related malnutrition, environmental variables, genetics, or postponed medical care that accelerates the course of CKD are among the likely reasons and birth weight.The present hospital-based, cross-sectional, observational study was conducted in the a tertiary care teaching hospital in South India from December 2020 to January 2024. The study comprised 50 patients of CKD between 30 and 70 years of age of both sexes with no previous history of any thyroid dysfunction, while 50 apparently healthy age and sex-matched individuals from the same ethnic population with normal renal function and no past history of thyroid disorders served as a control group.The results of this study and most others, there is a possibility that abnormal thyroid hormone activity may result in a decline in renal function. Early identification of thyroid illness and its intricate relationship to renal function may be crucial for therapy planning.The current cross-sectional hospital-based observational study discovered that uremic patients had considerably lower mean TT3 and TT4 and higher mean TSH when compared to healthy controls, regardless of the kind of medication or duration of the disease. Based on the results of this study and most others, there is a possibility that abnormal thyroid hormone activity may result in a decline in renal function. Early identification of thyroid illness and its intricate relationship to renal function may be crucial for therapy planning.

Exploring Factors Influencing Caregiver Burden: A Systematic Review of Family Caregivers of Older Adults with Chronic Illness in Local Communities.

This study aimed to systematically review and analyze factors contributing to caregiver burden among family caregivers of older adults with chronic illnesses in local communities. Specific objectives included exploring the characteristics of older adults with chronic illness and caregiver burden through an extensive literature review and identifying factors influencing caregiver burden in this population. Using Korean (RISS, KISS, and KoreaMed) and international (EMBASE, MEDLINE, CINAHL, and the Cochrane Library) databases, this study employed systematic search methods to identify relevant literature. The inclusion and exclusion criteria were systematically applied in accordance with the PRISMA guidelines, focusing on studies that addressed caregiver burden among family caregivers of older adults with chronic illnesses in local communities. Following the database search, 15,962 articles were identified. After eliminating duplicates and applying the selection criteria, 18 studies were included in this review. These studies, representing various countries, contribute to a diverse dataset covering caregiver and care-recipient characteristics, including age, sex, chronic conditions, and various caregiver burden assessment tools. This systematic review provides a comprehensive understanding of the factors that influence caregiver burden among family caregivers of older adults with chronic illness in local communities. These findings emphasize the need for integrated nursing interventions and community efforts to address the welfare concerns of this population and support their caregivers.

The chronically ill in the labour market – are they hierarchically sorted by education?

BackgroundThe chronically ill as a group has on average lower probability of employment compared to the general population, a situation that has persisted over time in many countries. Previous studies have shown that the prevalence of chronic diseases is higher among those with lower levels of education. We aim to quantify the double burden of low education and chronic illness comparing the differential probabilities of employment between the chronically ill with lower, medium, and high levels of education and how their employment rates develop over time.MethodsUsing merged Norwegian administrative data over a 11-year period (2008–2018), our estimations are based on multivariable regression with labour market and time fixed effects. To reduce bias due to patients’ heterogeneity, we included a series of covariates that may influence the association between labour market participation and level of education. To explicitly explore the ‘shielding effect’ of education over time, the models include the interaction effects between chronic illness and level of education and year.ResultsThe employment probabilities are highest for the high educated and lowest for chronically ill individuals with lower education, as expected. The differences between educational groups are changing over time, though, driven by a revealing development among the lower-educated chronically ill. That group has a significant reduction in employment probabilities both in absolute terms and relative to the other groups. The mean predicted employment probabilities for the high educated chronic patient is not changing over time indicating that the high educated as a group is able to maintain labour market participation over time. Additionally, we find remarkable differences in employment probabilities depending on diagnoses.ConclusionFor the chronically ill as a group, a high level of education seems to “shield” against labour market consequences. The magnitude of the shielding effect is increasing over time leaving chronically ill individuals with lower education behind. However, the shielding effect varies in size between types of chronic diseases. While musculoskeletal, cardiovascular and partly cancer patients are “sorted” hierarchically according to level of education, diabetes, respiratory and mental patients are not.

Patient factors associated with telehealth quality and experience among adults with chronic conditions.

To evaluate patient-reported experiences of telehealth and disparities in access, use, and satisfaction with telehealth during the COVID-19 pandemic. We examined data from the fifth wave of the COVID-19 & Chronic Conditions (C3) study conducted between December 2020 and March 2021. Of the 718 participants, 342 (47.6%) reported having a telehealth visit within the past 4months. Participants who had a recent telehealth visit were younger, reported worse overall health and chronic illness burden, and living below poverty level. Among participants who had a telehealth visit, 66.7% reported telephone visits and most participants (57.6%) rated telehealth quality as better-or-equal-to in-person visits. Inadequate health literacy was associated with lower likelihood of reporting telehealth quality and usefulness. In multivariable analyses, lower patient activation (adjusted odds ratio (AOR) 0.19, 95% CI, 0.05-0.59) and limited English proficiency (AOR 0.12, 95% CI, 0.03-0.47) were less likely to report telehealth as being better than in-person visits; lower patient activation (AOR 0.06, 95% CI, 0.003-0.41) and income below poverty level (AOR 0.36, 95% CI, 0.13-0.98) were associated with difficulty remembering telehealth visit information. Most participants reported usefulness and ease of navigating telehealth. Lower socioeconomic status, limited English proficiency, inadequate health literacy, lower educational attainment, and low patient activation are risks for poorer quality telehealth. The COVID pandemic has accelerated the adoption of telehealth, however, disparities in access and self-reported visit quality persist. Since telemedicine is here to stay, we identify vulnerable populations and discuss potential solutions to reduce healthcare disparities in telehealth use.

Cost-effectiveness of Traditional Persian Medicine-Based Diet on NonAlcoholic Fatty Liver Disease

Background: In the context of Persian traditional medicine, there are several therapeutic strategies for managing diseases, ranging from lifestyle changes to herbal remedies.&#x0D; Objectives: Given the application of Persian traditional medicine in the management of chronic diseases, the burden of chronic illnesses, and the public’s recourse to traditional medicine specialists, this study aimed to assess the cost-effectiveness of traditional medicine dietary regimens for the treatment of non-alcoholic fatty liver disease from the perspective of the payer.&#x0D; Methods: In this study, we investigated the cost-effectiveness of providing nutrition counseling for lifestyle modification (changes in the aforementioned Setteh-e-Zarurieah) by a traditional medicine specialist compared to receiving counseling from a nutritionist for nonalcoholic fatty liver disease from the payer’s perspective. The outcomes measured were changes in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) enzymes, body mass index (BMI), and the grade of fatty liver. Cost and effectiveness data were entered into Excel software, and the ICER ratio was calculated&#x0D; Results: The results indicated that the dietary regimen prescribed by Persian traditional medicine when compared to the nutritionist’s recommended diet, resulted in a lower decrease in AST and ALT enzymes but led to a greater decrease in BMI (mean change = 0.42) and a significant change in the grade of fatty liver (OR = 9.75). Since the costs of tests, ultrasounds, and visits were equal in both groups, the cost difference was zero. In the first scenario, where traditional medicine is considered an alternative therapy and liver enzymes are the primary focus, providing nutritional counseling services by Persian traditional medicine may not be cost-effective. However, if we consider the grade of fatty liver and BMI as the primary variables, providing nutritional counseling services by Persian traditional medicine may be cost-effective.&#x0D; Conclusions: Based on the available evidence, the treatment of fatty liver using Persian traditional medicine can be considered an effective and cost-effective complementary (or alternative) intervention. Considering the long-term costs imposed by the health system and insurance organizations, it is predicted that adding visits to Persian traditional medicine specialists may reduce overall healthcare system costs.

Current State of Food Prescriptions Used to Treat Cardiometabolic Risk Factors in the US Adult Population.

Cardiometabolic syndrome is unfortunately widely prevalent in medically underserved areas with one possible non-pharmacological solution being food prescriptions from food pharmacies. Food prescriptions are defined as when a physician prescribes certain foods as a treatment for health conditions. There seems to be a promising future for food prescriptions; however, there is a huge literature gap. Given this lack of knowledge regarding this burgeoning practice, we decided to review the current state of food prescriptions used to treat cardiometabolic conditions in the US adult clinical setting. A thorough search of PubMed and Google Scholar databases for articles written about food prescriptions' impact on cardiometabolic risk factors was done. The keywords used included "food prescriptions, vegetables prescription, produce prescription, fruit prescriptions, food pharmacy, food as medicine, cardiometabolic, blood pressure, glucose, insulin, cholesterol, obesity, BMI, body mass index, triglycerides, and microalbuminuria." Of the 637 articles found with the associated keywords, 115 were kept after being screened by title and abstract. Finally, after a full-text record screening, 30 articles were deemed eligible based on our inclusion criteria. We analyzed the health markers, patient populations, methods of food procurement, and financial incentives in food prescription programs. On average, the implementation of food prescription programs decreased participants' BMI, waist circumference, blood pressure,and HbA1c. Participants in the programs were primarily comprised of African American, Hispanic, underinsured, low-income, older, and women groups. Programs with subsidies and vouchers had a higher compliance rate, and food sourced from farmers' markets, grocers, and mobile vendors had the best program compliance rates. According to the literature, adherence to food prescription programs on average decreases the BMI, blood pressure, waist circumference, and Hb1Ac of participants. However, those are the only biomarkers being studied currently, and future studies should incorporate other markers of chronic conditions. For example, a reliable indicator of cardiometabolic health is total cholesterol/HDL cholesterol, which should be measured in future experiments. Additionally, insulin, glucose, triglycerides, and LDL cholesterol are all great markers of cardiometabolic health that can be measured in the future. The current implementation of many food prescription programs is in medically underserved areas. The patient populations are typically low-income, under- or uninsured, food insecure, and originating from diverse ethnic backgrounds. In the future, food prescription studies should be done on other ethnic populations including but not limited to Native Americanswho also carry a large burden of preventable and chronic illnesses.

The effect of a post-anaesthesia high-care unit (PAHCU) admission on mobilization, length of stay and in-hospital mortality post-surgery in low energy neck of femur fracture patients

Purpose/aimWith an ageing population and an increase in fragility fractures of the hip (FFH), the role of an anaesthetist is evolving to include more peri-operative care. A post-anaesthesia high-care unit (PAHCU) should enhance care in post-operative patients. To our knowledge, there are no studies that have investigated the effect of a PAHCU admission on post-operative outcomes after FFH. This study aimed to compare post-operative outcomes of FFH patients admitted to PAHCU versus a standard post-operative orthopaedic ward (POOW).MethodologyA retrospective cohort study was conducted on adult patients with FFH who underwent surgery between January 2019 and December 2020 at our institution. Data were sourced from electronic medical records. SPSS version 28 was used to analyse data.ResultsA total of 231 patients were included. The PAHCU group (n = 35) displayed a higher burden of chronic illness and higher peri-operative risk scores as compared to the POOW group (n = 196). Median time to mobilize (TTM) in PAHCU was 84 h vs. 45 h in POOW group (p = 0.013). Median length of stay (LOS) in PAHCU was 133 h vs. 94 h in POOW (p = 0.001). The in-hospital mortality was 2.9% (n = 1) for PAHCU and 3.6% (n = 7) for POOW (p = 1). The 30-day mortality was 11.8% (n = 4) for PAHCU and 10.1% (n = 19) in POOW.ConclusionPAHCU admission resulted in delayed time to surgery and TTM, together with prolonged LOS, compared to those managed in POOW. However, these mortality rates remained comparable in both groups. This study contributes valuable insights into post-operative care of FFH patients in a resource-poor setting.

Chronic Illness, Nutritional Status, and Factors Associated with Malnutrition among Various Age Groups Residing in Urban Areas of Telangana and Rural Areas of Andhra Pradesh.

Malnutrition includes both under-nutrition and over-nutrition, which have negative health impacts and social consequences. The present study aims to understand the demographic dynamics, burden of chronic illnesses, and risk factors associated with malnutrition (stunting, thinness, and obesity) among different age groups in urban and rural areas. Data were collected through a cross-sectional study conducted in an urban area in Hyderabad and four rural villages in Andhra Pradesh. A multivariable mixed-effect logistic regression was used to assess the risk factors associated with malnutrition among different age groups. The final analysis included the data of 10,350 individuals, consisting of 8317 (80.4%) from urban areas and 2033 (19.6%) from rural areas. The number of known cases of hypertension in the urban area was 926 (11.1%) and 114 (5.6%) in the rural areas, and that of diabetes was 511 (6.1%) in the urban area and 104 (5.1%) in the rural areas. The burden of stunting among under-five children and obesity among adults was 33.7% (95% CI; 29.7-37.9) and 47.4% (95% CI; 45.8-49.1), respectively. Adults aged 40-59 years (AOR 1.91; 1.59-2.28) and belonging to a clerical/skilled (AOR 1.32; 1.03-1.71) occupation were at higher odds of obesity compared to their counterparts. Policymakers and health practitioners should consider the insights from our findings to tailor effective interventions to address malnutrition.

What is the impact of one’s chronic illness on his or her spouse’s future chronic illness: a community-based prospective cohort study

BackgroundIntegrating a joint approach to chronic disease management within the context of a couple has immense potential as a valuable strategy for both prevention and treatment. Although spousal concordance has been reported in specific chronic illnesses, the impact they cumulatively exert on a spouse in a longitudinal setting has not been investigated. We aimed to determine whether one’s cumulative illness burden has a longitudinal impact on that of their spouse.MethodsData was acquired from a community-based prospective cohort that included Koreans aged 60 years and over, randomly sampled from 13 districts nationwide. Data from the baseline assessment (conducted from November 2010 to October 2012) up to the 8-year follow-up assessment was analyzed from October 2021 to November 2022. At the last assessment, partners of the index participants were invited, and we included 814 couples in the analysis after excluding 51 with incomplete variables. Chronic illness burden of the participants was measured by the Cumulative Illness Rating Scale (CIRS). Multivariable linear regression and causal mediation analysis were used to examine the longitudinal effects of index chronic illness burden at baseline and its change during follow-up on future index and spouse CIRS scores.ResultsIndex participants were divided based on baseline CIRS scores (CIRS < 6 points, n = 555, mean [SD] age 66.3 [4.79] years, 43% women; CIRS ≥ 6 points, n = 259, mean [SD] age 67.7 [4.76] years, 36% women). The baseline index CIRS scores and change in index CIRS scores during follow-up were associated with the spouse CIRS scores (β = 0.154 [SE: 0.039], p < 0.001 for baseline index CIRS; β = 0.126 [SE: 0.041], p = 0.002 for change in index CIRS) at the 8-year follow-up assessment. Subgroup analysis found similar results only in the high CIRS group. The baseline index CIRS scores and change in index CIRS scores during follow-up had both direct and indirect effects on the spouse CIRS scores at the 8-year follow-up assessment.ConclusionsThe severity and course of one’s chronic illnesses had a significant effect on their spouse’s future chronic illness particularly when it was severe. Management strategies for chronic diseases that are centered on couples may be more effective.

A Peaceful Passage

India bears a significant portion of the worldwide burden of chronic and terminal illnesses. Nevertheless, there is a dearth of a standardized approach in delivering optimal end-of-life care (EOLC) to a substantial proportion of patients who have reached the terminal phase of their lives. Health-care providers are urged by health-care professionals to be aware of the cultural and spiritual beliefs and practices that can shape patients' and their families' perspectives on EOLC. They should also emphasize the importance of providing support for religious and cultural practices and involving family members in the EOLC process. Holistic care is discussed as an approach that considers the physical, emotional, spiritual, and social aspects of a patient's well-being. Healthcare providers must address ethical and legal issues when delivering EOLC and prioritize personalized care that respects patients' choices. Language and communication barriers in multicultural EOLC are identified as significant challenges. In a nutshell, the authors discuss the importance of incorporating cultural and spiritual practices in bereavement support to help patients and their families process grief and celebrate the patient's life and legacy. Overall, this article provides a comprehensive overview of the importance of cultural and spiritual awareness in EOLC for elderly patients. It emphasizes the necessity for health-care providers to deliver inclusive and culturally sensitive care, ultimately enhancing the quality of life for both individuals and their loved ones. The significance of cultural and spiritual awareness in improving EOLC for older individuals is underscored in this context.

No heat, no eat: (Dis)entangling insecurities and their implications for health and well-being

This study explores the associations between energy poverty, food insecurity, and a set of outcomes—including the self-reported burden of chronic illness, physical disabilities, and mental health—among social-aid recipients across Israel. We highlight the socio-demographic characteristics and housing conditions of energy-poor households and analyze the association between energy poverty and health and well-being using multivariate regression models. Of 1390 aid-recipient respondents, more than 85% met the criteria for living in an energy-poor household, and almost all of them also struggled with food insecurity and were raised in poor households as children. In addition, the severity of energy poverty was positively and significantly associated with the occurrence of diabetes, hypertension, and mental illness, and, as compared with energy-secure households, severely energy-poor households were more prone to forgo acquiring prescription medications, medical aid, or required health treatments due to financial hardships. These findings highlight the nuanced negotiation over necessities that aid-supported households make; despite being at greater risk of being sick, energy-poor households are more likely to forgo buying medicines and seeking healthcare so as to pay the electricity bills. Hidden energy poverty, coupled with what might be hidden morbidity, may have significant implications for healthcare systems, and a climate-sensitive health policy at both the municipal and national levels is required to strengthen resilience among low-income households.

Triage Procedures for Critical Care Resource Allocation During Scarcity

During the COVID-19 pandemic, many US states issued or revised pandemic preparedness plans guiding allocation of critical care resources during crises. State plans vary in the factors used to triage patients and have faced criticism from advocacy groups due to the potential for discrimination. To analyze the role of comorbidities and long-term prognosis in state triage procedures. This cross-sectional study used data gathered from parallel internet searches for state-endorsed pandemic preparedness plans for the 50 US states, District of Columbia, and Puerto Rico (hereafter referred to as states), which were conducted between November 25, 2021, and June 16, 2023. Plans available on June 16, 2023, that provided step-by-step instructions for triaging critically ill patients were categorized for use of comorbidities and prognostication. Prevalence and contents of lists of comorbidities and their stated function in triage and instructions to predict duration of postdischarge survival. Overall, 32 state-promulgated pandemic preparedness plans included triage procedures specific enough to guide triage in clinical practice. Twenty of these (63%) included lists of comorbidities that excluded (11 of 20 [55%]) or deprioritized (8 of 20 [40%]) patients during triage; one state's list was formulated to resolve ties between patients with equal triage scores. Most states with triage procedures (21 of 32 [66%]) considered predicted survival beyond hospital discharge. These states proposed different prognostic time horizons; 15 of 21 (71%) were numeric (ranging from 6 months to 5 years after hospital discharge), with the remaining 6 (29%) using descriptive terms, such as long-term. In this cross-sectional study of state-promulgated critical care triage policies, most plans restricted access to scarce critical care resources for patients with listed comorbidities and/or for patients with less-than-average expected postdischarge survival. This analysis raises concerns about access to care during a public health crisis for populations with high burdens of chronic illness, such as individuals with disabilities and minoritized racial and ethnic groups.

Racial-ethnic, gender identity, and sexual orientation disparities in COVID-19-related social and health outcomes: A decomposition analysis

Despite the growing literature on racial-ethnic disparities during the pandemic, less is known about the explanatory mechanisms of these disparities and inequalities across other axes, such as gender and sexual identities. We studied the levels and sources of racial-ethnic, gender identity, and sexual minority disparities in social (i.e., unmet resource needs) and health (i.e., hospitalization) outcomes among individuals diagnosed with COVID-19, hypothesizing differential age structure, underlying health, and work and living arrangements as contributors to inequalities. Using large-scale administrative data from Chicago and adjusting for covariates, we found substantial racial-ethnic and gender identity disparities in both outcomes, and weak evidence of sexual minority disparities in unmet needs. Subsequent decomposition analyses revealed that living in larger households, having a higher share of non-adult cases, and facing higher burdens of chronic illness, obesity, and unemployment each statistically significantly drove racial-ethnic disparities in unmet needs, but these together explained less than 15% of the disparities. Similarly, about 20% of the Black-White gap in hospitalization resulted from disparities in underlying health and unemployment, whereas a higher proportion of non-adult cases or higher unemployment rates respectively proved the only significant pathways to partially explain transgender individuals’ disadvantages in unmet needs (12%) or hospitalization (6%). These findings highlight the importance of considering multiple dimensions of social differences in studying health disparities, the vulnerabilities of transgender and non-adult communities during the pandemic, and the valid yet quite limited roles of previously suggested sociodemographic factors in accounting for COVID-19-related categorical inequalities.

The impact of psychological resilience on chronic patients’ depression during the dynamic Zero-COVID policy: the mediating role of stigma and the moderating role of sleep quality

ObjectiveChronic patients are experiencing depression caused by themselves or the surrounding environment, how to cope with the change of mentality and adjust the psychological stress response, especially under the background of the current dynamic Zero-COVID policy in China, is a problem worth further discussion. The researchers constructed a mediating regulation model to test the influence of psychological resilience on depression of chronic patients during dynamic Zero-COVID, as well as the mediating role of stigma and the moderating role of sleep.MethodFrom October 2021 to February 2022, this study used a multi-stage sampling method and random number table method to collect data in the Shang Cheng District of Hangzhou City, Zhejiang Province. Firstly, the Second Affiliated Hospital of the Zhejiang University School of Medicine, a third-class hospital was randomly selected from the Shang Cheng District. Secondly, three departments were strategically selected from this hospital: endocrinology, dermatology, and traditional Chinese medicine. Thirdly, survey points were set up in each department, and chronic patients were strategically selected for questionnaire surveys. Finally, a face-to-face survey was conducted on 398 chronic patients who met the criteria for inclusion. In addition, chronic medical illness burden was assessed using the Cumulative Illness Rating Scale-Geriatrics (CIRS-G), psychological resilience was measured by the Conner-Davidson Resilience Scale (CD-RISC), stigma was measured by the Stigma Scale for Chronic Illness (SSCI), sleep was measured by the Pittsburgh Sleep Quality Index(PSQI) and depression was estimated by the Patient Health Questionaire-9(PHQ-9). SPSS (version 25.0) and PROCESS (version 4.0) were used for correlation analysis, mediation analysis, and mediated moderation analysis.ResultsPsychological resilience was negatively correlated with depression, stigma, and sleep. Depression was positively correlated with stigma and sleep. Stigma and sleep were positively correlated; Stigma played a mediating role in the relationship between psychological resilience and depression; Sleep moderated the first half of the pathway “psychological resilience to stigma to depression”.ConclusionPsychological resilience affected depression directly and indirectly through stigma. At the same time, sleep played a moderating role between psychological resilience and depression. The correlation between psychological resilience and stigma was stronger when levels of sleep levels were higher.