Chronic Illness Research Articles

Energy Expenditure in Chronic Kidney Disease: Affecting Factors and Evaluation Methods.

Chronic kidney disease (CKD) is a chronic health problem whose prevalence is increasing. Nutrition and nutrition-related factors, one of the modifiable risk factors for CKD, are of primary importance. The key to planning optimal nutritional therapy is accurately determining energy requirements and total energy expenditure. Many health problems can accompany CKD, such as protein-energy malnutrition, sarcopenia, etc, and increase the mortality rate. This study aims to present the specific factors affecting energy expenditure specific to CKD in line with the current literature, to discuss the methods used to determine energy expenditure, and to examine these methods according to groups receiving and not receiving renal replacement therapy (hemodialysis, peritoneal dialysis, and renal transplantation).

National survey of financial burden and experience among patients with cancer and autoimmune disease receiving charitable copay assistance.

Little is known about the role that charitable copay assistance (CPA) plays in addressing access to care and financial distress. The study sought to evaluate financial distress and experience with CPA among patients with cancer and autoimmune disease. This is a national cross-sectional self-administered anonymous electronic survey conducted among recipients of CPA to cover the costs of a drug for cancer or autoimmune disease. Self-reported financial distress as measured by Comprehensive Score for Financial Toxicity as well as health care spending and experience with financial barriers to care were evaluated, as were perspectives on policy questions related to CPA and costs of care. Among 1566 respondents (1108 with cancer and 458 with autoimmune disease, median age 71, 51% female, 89% White, 69% household income <$60,000), 53% reported mild and 31% moderate/severe financial distress, despite CPA. Eighteen percent reported missing recommended care because of costs. Most respondents (96%) had Medicare, 55% reported supplemental insurance, and 66% believed that insurance would prevent them from facing high costs of health care. A total of 52% reported paying more than $100 monthly in drug costs and 41% spending more than 10% of monthly income on health care. Financial distress was similar among patients with cancer and autoimmune diseases. In multivariable regression analysis, younger age, less education, unemployment, higher comorbidity, and lower income were independently associated with higher financial distress. This study informs policy debate over the role of CPA foundations in the U.S. health insurance safety net and highlights the inadequacy of Medicare to guarantee access to care for older patients with chronic illness.

Effect of vortioxetine and fluoxetine on immunohistochemical expression of Caspase-8, RANKL, and IL-6 in testicular tissue in an experimental depression model.

The main symptoms of depression, a chronic mental illness, include sadness, low self-esteem, and a diminished sense of enjoyment in life. Many factors have been suggested to be associated with depression, one of which is low testosterone in men. The serotonin reuptake inhibitor fluoxetine (FLU), used to treat depression, has been reported to potentially have detrimental effects on spermatogenesis in rats after long-term use. The multimodal antidepressant vortioxetine (VTX) offers new promise for the treatment of depression. The chronic unpredictable mild stress (CUMS) model is widely known as an experimental paradigm used to study depression-like behaviors in rodents. Stress leads to various neurochemical and immune changes, affecting multiple organs. Our study aims to examine the histopathological findings in testicular tissue induced by CUMS and the immunohistochemical expression of Cas-8, IL-6, and RANKL using a depression model in rats. Rats were split into 4 groups of 7 animals each at random. Group 1 (control) did not experience any stress. Group 2 (CUMS) was exposed to chronic, unpredictable mild stress using a specific procedure. Group 3 (CUMS+VTX) and Group 4 (CUMS+FLU) underwent CUMS and received intraperitoneal drug treatment at a dose of 10 mg/kg during the final three weeks of the study. The rat testicles collected during necropsy were evaluated histopathologically and immunohistochemically for Cas-8, IL-6, and RANKL expressions using a light microscope. In Group 1, histological analysis showed normal tissue architecture in the testicles and epididymis. In Group 2, there was significant depletion of spermatozoa in the seminiferous tubules and empty tubules in the epididymis. In Groups 3 and 4, FLU and VTX treatment led to improvements in the testicles. Cas-8, RANKL, and IL-6 immunohistochemistry revealed increased expression in Group 2, primarily in interstitial cells. In Groups 1, 3, and 4, no or very slight expression of these markers was observed. The results of this study showed that sperm production in the testes is negatively affected in CUMS-induced depression and that Cas-8, IL-6, and RANKL expression is increased, particularly in interstitial cells. VTX and FLU, used in the treatment of depression, suggest potential for mitigating the adverse effects of CUMS on the testes.

Self-affirmation intervention for patients newly diagnosed with advanced cancer: a preliminary efficacy trial.

Cancer diagnosis represents a life crisis. It remains unclear whether/what psychosocial intervention may enhance cancer patients' quality of life (QoL) during existential plight. This study aimed to examine preliminary efficacy of a brief writing intervention for patients newly diagnosed with advanced cancer with a focus on affirming personally important values and beliefs. This is a single-arm pilot study testing effect of a 4-week home-based self-affirmation writing intervention for patients newly diagnosed with advanced cancer using interrupted time series design (NCT05235750). Patients were eligible if they were newly diagnosed (within 8 weeks) with advanced stage (III or IV) or recurrent cancer. Longitudinal analyses were performed using generalized linear mixed model incorporating the correlation of repeated measures. All statistical analyses were performed at 5% significance level using SAS® (version 9.4). Fifty-seven patients newly diagnosed with advanced stage cancer with a mean age of 63 years balanced in gender were enrolled. Intent-to-treat analysis revealed significant post-intervention change for Faith as measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12 item scale (FACIT-Sp-12) (ES 0.23, p = .05) and Ge6 "I worry that my condition will get worse" as measured by the Functional Assessment of Cancer Therapy - General (FACT-G) (ES 0.26, p = .10). When comparing changes pre- and post-intervention, Ge6 remained clinically significant (ESΔ 0.36, p = .27). Self-affirmation via writing showed initial short-term efficacy in relieving cancer-specific existential concerns (Ge6 "I worry that my condition will get worse") and may be a promising innovative intervention approach that warrant randomized experiments to verify. Further research is also needed to find out who may most likely benefit from this intervention.

Obesity and Different Effect Between Exercise and Diet for Weight Loss

The worldwide increase in obesity has become a significant public health issue, linked to a range of chronic illnesses, including diabetes, heart disease, and some types of cancer. This study investigates the effectiveness of combined dietary and exercise interventions in promoting weight loss, drawing on a systematic literature review and case analysis of recent peer-reviewed research. By examining various dietary approachesincluding low-carbohydrate, Mediterranean, and calorie-restricted dietsalongside different exercise modalities such as aerobic training and high-intensity interval training (HIIT), this research aims to identify the optimal strategies for weight management. Findings indicate that individuals participating in combined interventions experience significantly greater weight loss and improvements in metabolic health compared to those following diet or exercise regimens alone. Moreover, the study emphasizes the importance of personalized interventions that consider individual preferences and psychological factors, suggesting that integrating social support mechanisms and technological tools can enhance adherence and long-term success. The results emphasize the need for comprehensive weight management strategies that address the interplay of dietary and exercise components, psychological support, and social influences to effectively combat obesity and promote overall health.

Sex-specific contrasting role of BECLIN-1 protein in pain hypersensitivity and anxiety-like behaviors.

Chronic pain is a debilitative disease affecting 1 in 5 adults globally, and is a major risk factor for anxiety (Goldberg and McGee, 2011; Lurie, DI., 2018). Given the current dearth of available treatments for both individuals living with chronic pain and mental illnesses, there is a critical need for research into the molecular mechanisms involved in order to discover novel treatment targets. Cellular homeostasis is crucial for normal bodily functions and investigations of this process may provide better understanding of the mechanisms driving the development of chronic pain. Using the spared nerve injury (SNI) model of neuropathic pain, we found contrasting roles for BECLIN-1 in the development of pain hypersensitivity and anxiety-like behaviors in a sex-dependent manner. Remarkably, we found that male SNI mice with impaired BECLIN-1 function demonstrated heightened mechanical and thermal hypersensitivity compared to male wildtype SNI mice, while female SNI mice with impaired BECLIN-1 function demonstrated similar thresholds to the female wildtype SNI mice. We also found that disruptions of BECLIN-1 prevented SNI induced increases in anxiety-like behaviors in male mice. Our data thus indicate that BECLIN-1 is differentially involved in the nociceptive and emotion components of chronic pain in male but not female mice.Significance Statement One in five adults suffer from chronic pain, and it is a major risk factor for anxiety. Close to three quarters of the population suffering from chronic pain are women, yet the vast majority of pre-clinical research uses solely male models, and excludes females. In this manuscript, we use female and male mice to discover a novel role for BECLIN-1 in neuropathic pain, and comorbid anxiety-like behaviors in mice. We found that disruptions of Beclin-1 reduces nociceptive hypersensitivity whilst preventing pain-induced increases in anxiety-like behaviors. Notably, these effects were sex-dependent, where only males, but not females, showed BECLIN-1 mediated effects. Our data thus indicates that macroautophagy is differentially involved in nociception and anxiety, in male, but not female mice.

Betanin Mitigates Inflammation and Ankle Joint Damage by Subduing the MAPK/NF-κB Pathway in Arthritis Triggered by Type II Collagen in Rats.

Rheumatoid Arthritis (RA), a chronic inflammatory autoimmune illness, is characterized by synovitis, progressive joint damage, and bone erosion. Even though the potent drugs available contain biologics, several patients fail to react to them or cause hostile effects. Betanin (BTN), the betacyanin present in the red beetroot, has antioxidant, antiinflammatory, and apoptotic properties. In this study, we assessed the anti-inflammatory and apoptotic effect of BTN on collagen-induced arthritis (CIA). The rats were arbitrarily separated into four sets: Normal, CIA, CIA+BTN (25 mg/kg bw), and CIA+BTN (50 mg/kg bw). The hematological, biochemical markers, cytokines, inflammatory enzymes, histopathology of the ankle joint, and protein expression of inflammatory and apoptotic proteins were studied. Inflammatory enzymes, histopathological variations, cytokines generation, and joint inflammation were strongly alleviated, and apoptosis was augmented by BTN in a concentrationdependent manner. Bcl-2 and MAPK/NF-κB proteins were reduced, while the caspase-3, caspase- 9, and Bax were intensified. The anti-rheumatic action of BTN was correlated to the attenuation of the MAPK/NF-κB pathway, which suppresses cytokine production, inflammation, and reduced cartilage impairments. These outcomes recommend that BTN can be employed as a strong healing alternative for RA management.

Lived experiences of people with chronic kidney disease on maintenance dialysis: a systematic review and thematic synthesis of qualitative studies

AimChronic Kidney Disease (CKD) has emerged as a global public health concern. People with the most advanced stage of CKD require renal replacement therapies, either dialysis (the focus of this study) or a kidney transplant. Research on CKD has primarily focused on its clinical, epidemiological, and public health aspects. However, studies exploring the lived experiences of individuals on dialysis and the key factors influencing these experiences are limited, particularly in low- and middle-income settings. Therefore, this study aims to synthesize the existing literature on the illness experience of people living with CKD who are on maintenance dialysis across different country contexts.MethodsAdhering to PRISMA and PiCO guidelines for systematic review, we identified original studies published between 2000 and 2024, focusing on the lived experience of patients with CKD on dialysis, across PubMed, Web of Science, and Scopus databases. A thematic analysis was conducted based on two frameworks: Michael Bury’s biographical disruption model of chronic illness, and the framework on internal and external factors affecting self-care.ResultsA total of 59 studies were included, and the following key themes were identified: 1) disrupted biographies among people on dialysis, which included: (a) diagnosis and initiation of dialysis, (b) disabling physical symptoms and functional limitations, (c) impaired socio-occupational functioning, (d) uncertainty and psychological distress, and (e) changes in self-image and identity; and 2) biographical repair, which included: (a) coping with CKD and dialysis, (b) coping styles, and (c) coping strategies. The key internal factors influencing the lived experiences were personal beliefs and misconceptions about CKD, feelings of shame and guilt, financial constraints, and spirituality. The external factors included family and social support, information and treatment received from the clinical team, social stigma, availability and quality of dialysis services, and access to health insurance.ConclusionsThis review deepens our understanding of the lived experiences of individuals undergoing maintenance dialysis across diverse settings and illuminates the internal and external factors that shape these experiences. Our findings emphasize the necessity of a holistic and person-centred approach to dialysis care and highlight the need to make dialysis services more accessible and affordable in low- and lower-middle-income countries.

Quantifying the portrayal of alcohol-related A&E attendances and prevention in the British medical documentary series '24hours in A&E'.

Alcohol misuse is linked to numerous health and socioeconomic harms. Edutainment and docutainment television programmes can act as health promotion tools, influencing health perceptions and behaviours. Inaccurate portrayals can engender misinformation. Limited research has assessed alcohol-related illnesses and prevention in edutainment/docutainment, with none examining British medical documentaries. A quantitative content analysis assessed the portrayal of alcohol-related attendances (ARAs), behaviours, and prevention in the series 24hours in A&E. Main series episodes broadcast 2011-2022, depicting ARAs, were coded. Descriptive statistics and a Fisher's exact were then undertaken. ARAs featured 38 patients in 23 episodes (8.3% episodes total). Significantly more ARA episodes were broadcast from 2011 to 2016 than 2017-2022 (P=0.002). ARAs were mainly portrayed in males (63.2%), young adults (73.7%) and White ethnic groups (78.9%). Binge drinking and pubs/bar/nightclubs/'nights out' were the main behaviours and settings depicted. ARAs encompassed predominantly accidents/injuries (72.7%). Prevention featured infrequently (15.8% patients) and involved secondary (50.0%) or tertiary prevention (50.0%) for alcohol-use disorders (AUDs). ARAs were under-portrayed. While prevention portrayals and demographics were largely consistent with reality, ethnic minority groups, AUDs and chronic alcohol-related illnesses were underrepresented. Binge drinking and night-time economy settings were over-portrayed. Inaccurate depictions could lead to misperceptions of alcohol-related health harms.

Determining the Preceptors' Participation in Influencing the Acquisition of Clinical Competencies Among Undergraduate Nursing Students in Government and Private Universities in Uganda

Like other developing countries, Uganda grapples with the critical challenge of equipping nursing students with essential clinical competencies. This happens in both government and private institutions. These competencies encompass vital nursing skills, knowledge, attitudes, and behaviors crucial for effective nursing practice. Students must improve their competencies in a clinical environment or get frustrated, suffer from low esteem, have poor clinical judgment, and face the dangers of compromising the care and safety of patients. Central to these competencies are clinical skills, such as medication administration and patient assessment, forming the basis for safe, high-quality patient care. A profound understanding of complex healthcare, including disease management and evidence-based practice, is equally crucial. Uganda's patient population confronts various chronic and acute illnesses. Addressing these challenges demands skilled nurses for patient safety and outcomes. Urgent action is required to prepare clinically competent nurses. These challenges underscore the significance of nursing students gaining proficiency in clinical competencies. The main objective of this study was to determine the influence of preceptors' participation in enabling undergraduate nursing students to acquire clinical competencies in government and private universities in Uganda. Government and private universities allows for a more comprehensive understanding of how preceptors operate in different educational contexts. Each type of institution may have unique characteristics regarding its clinical training environments, which can influence how preceptors engage with nursing students and facilitate their learning. The study site was at the eight participating universities in Uganda. The study employed a descriptive research design incorporating quantitative and qualitative methods. The participants included 101 students, eight supervisors, and 48 preceptors. Probability and non-probability sampling were done, and a sampling frame was used to select the universities and distribute the participants. Self-administered questionnaires were used for data collection after piloting. Cronbach’s alpha, median, and interquartile range were calculated using SPSS 22. A P-value less or equal to 0.05 was taken as statistically significant. Results are presented in frequencies, percentages, and tables. Qualitative data was thematically analyzed. Chi-square tests were conducted to assess associations. The study showed that the acquisition of clinical competencies is positively correlated with preceptors’ participation (r=0.783) (p=0.000), students’ perceptions (r=0.775) (p=0.000), Institutional factors(r=0.668) (p=0.000), and the clinical learning environment (r=0.556) (p=0.000). The study further shows that 69.9% (n=70) had adequate clinical learning experience, while 31% (n=31) had inadequate clinical learning experience. This implies moderate student supervision and an unfavorable clinical learning environment. Competency acquisition in student nurses is positively influenced by the active involvement of preceptors, students' perceptions, institutional factors, and a supportive clinical learning environment. A sufficient amount of clinical experience is pivotal in developing competent student nurses. Inadequate time for clinical practice, overcrowding, insufficient supervision and feedback, and limited resources result in incompetencies. Nursing students should receive more time to practice, and resource availability must be improved. Overcrowding of students in clinical settings should be monitored. Supervision and feedback should be provided to nursing students.

Examining the use of interoceptive exposure exercises in people with and without a history of chronic physical health problems

ABSTRACT Interoceptive exposure (IE) exercises are underused, especially in people with chronic physical health problems. Secondary data analyses were conducted to examine the use of and acute responses to IE exercises in individuals with and without a history of chronic physical health problem(s). Participants (N = 413; Mage = 38.6, 56.1% with chronic physical health problems) enrolled in a 6-month randomized controlled trial that aimed to reduce anxiety and depression. Participants had access to a smartphone-based intervention that included on-demand access to IE exercises: head rush, straw breathing, chair spinning, fast breathing, and running in place. Utilization of the IE exercises and acute responses to the exercises were evaluated in the context of chronic physical health problem history. Participants with versus without a chronic physical health problem completed statistically significantly more IE exercises. Acute effects of IE exercises on distress and physical sensations were similar for those with and without a history of chronic physical health problems, as well as those who were versus were not taking medication. There is no evidence that chronic disease history influences the acute response to IE exercises. Continued research is needed to further assess the safety of IE exercises in people with various medical conditions.

The antibacterial capabilities of alginate encapsulated lemon essential oil nanocapsules against multi-drug-resistant Acinetobacter baumannii

Controlling microbial pollutants is a significant public health concern as they cause several chronic microbial infections and illnesses. In recent years, essential oils (EOs) have become intriguing alternatives for synthetic antimicrobials due to their biodegradability, natural source extraction, and strong antibacterial properties. The bactericidal properties of alginate containing lemon essential oil were examined in this investigation. Following the screening of the MDR strains, the morphological properties of the produced nanoparticles were examined using SEM, DLS, and FTIR. Additionally, the durability, effectiveness, and drug dispersion of encapsulation were assessed. Bacterial virulence factor gene amounts were measured using Q-real-time PCR. Concurrently, the cytotoxic effect of the nanomaterials was evaluated using MTT techniques. Nanoparticles of lemon essential oil encapsulated in alginate, measuring 500 ± 19.32 nm in size, with entrapment efficiency of 77.73 ± 1.78% and were stable for 60 days at 4 °C. Alginate encapsulated with lemon essential oil nanoparticles (ALN) exhibited potent antibacterial qualities, according to the biological investigation. Their ability to decrease the transcription of bacterial virulence genes at least statistically significantly (P ≤ 0.05) served as evidence for this. Between 1.56 and 100 µg/mL (P ≤ 0.01), ALN exhibited lower cytotoxicity against CCD841CoN than free lemon essential oil. The findings show that ALN nanoparticles have the potential to be a breakthrough in the fight against highly resistant illnesses. ALN nanoparticles’ potent antibacterial efficacy against MDR strains of Acinetobacter baumannii may inspire new directions in antibacterial research.

Profiles of physician follow-up care, correlates and outcomes among patients affected by an incident mental disorder

ObjectivesThis study identified profiles of outpatient physician follow-up care and other practice features, mostly after detection of incident mental disorders (MD), and associated these profiles with patient characteristics and subsequent adverse outcomes.MethodsA cohort of 170,957 patients age 12 + with a new or recurrent MD detected in 2019-20 was investigated based on data from the Quebec Integrated Chronic Disease Surveillance System. Latent class analysis was performed to identify follow-up care profiles, mostly within one year of MD detection. Bivariate analyses tested associations between profiles and patient characteristics; logistic regressions examined relationships between profiles and adverse outcomes after one year.ResultsFive profiles were identified: Profiles 2 and 5 (64%) offered low mental health (MH) outpatient follow-up care, while the others dispensed higher MH follow-up care. Profiles differed in patient characteristics and related outcomes. Labelled “Follow-up care by usual psychiatrist”, Profile 1 (1% of sample) included younger patients with the most health and social issues. Profile 2 (50%), “Low MH follow-up care but high prior consultations for physical reasons”, mostly integrated older patients with chronic physical illnesses. Profile 3 (11%), “Follow-up care by general practitioners (GP) and psychiatrists”, referred to physicians other than the usual ones (e.g., walk-in practice) and encompassed patients with severe MD conditions. Profile 4 (23%), “High follow-up care by usual GP and prior consultations for physical reasons”, showed the typical characteristics of patients treated in primary care (more common MD, women, less materially and socially deprived). Profile 5 (15%), “Low MH follow-up care and prior consultations for physical reasons”, integrated more younger men, materially deprived patients, and with substance-related disorders (SRD) or co-occurring MD-SRD. More Profile 1 and 3 patients lived in university regions – those of Profile 4 were the least numerous in such regions. More Profile 5 patients lived in metropolitan and rural areas. Risk of death was higher in Profiles 5, 2, 3, and risk of frequent ED use and hospitalization higher in Profiles 1, 3, and 5 – patients with severe health and social issues.ConclusionThe study confirmed the need to improve prompt, adequate and continuous follow-up care for patients with incident MD.

Machine Learning in Healthcare System

Machine learning (ML) is transforming healthcare by improving diagnosis accuracy, customizing treatment regimens, and reducing administrative procedures. Its capacity to analyze large datasets and detect complex patterns has resulted in major improvements in patient care and operational efficiency. In diagnostics, ML algorithms have shown extraordinary skill in analyzing medical pictures such as X-rays and MRIs, frequently outperforming humans. For example, ML models in radiology may detect abnormalities with amazing precision, aiding early illness identification and increasing patient outcomes. Beyond diagnostics, ML helps to customize medicine by assessing patient data and tailoring treatment strategies. By taking into account individual features and reactions, ML-driven models may prescribe medicines that improve efficacy while reducing negative effects. This tailored approach is especially useful for controlling chronic illnesses and complicated situations. Operationally, machine learning optimizes healthcare management by anticipating patient admissions, controlling hospital resources, and enhancing supply chain logistics. Predictive analytics enables healthcare institutions to predict patient demands, assuring proper staffing and resource allocation, so improving patient care while lowering operating expenses. Despite these advances, incorporating machine learning into healthcare offers a number of hurdles, including data privacy issues, the requirement for big, high-quality datasets, and the need for openness in algorithmic decisions. Addressing these concerns is critical to the ethical and successful use of ML technology in healthcare contexts. In conclusion, machine learning has enormous potential to improve healthcare by improving diagnoses, customizing treatments, and increasing operational efficiency. Continuous research and development are required to overcome current hurdles and fully exploit the benefits of ML in healthcare systems. Keywords: Machine Learning, Artificial Intelligence, SMEs, healthcare- sector, Ecommerce, E- commerce.

Current concepts of high intensity interval training: a clinical commentary

Abstract Regular exercise produces a variety of physiological changes that improve exercise capacity and health, regardless of age, gender, or chronic illness status. Despite widespread physical inactivity due to time restrictions, High-Intensity Interval Training (HIIT) has evolved as a popular and time-saving strategy for strenuous exercise that improves physical fitness by increasing maximum oxygen uptake (VO2max) and muscle power. HIIT, which consists of brief bursts of intense activity at or near peak effort interspersed with intervals of rest or low-intensity exercise, causes a variety of physiological changes that improve exercise capacity and metabolic health in both clinical and healthy populations. Given the expanding scientific understanding and broad use of HIIT, this clinical commentary seeks to thoroughly investigate its definition, parameters, scientific foundations, multifarious benefits, and evidence across varied groups and situations.

Revealing Stachybotrys-like fungal growth in buildings - Possible exposure highlighted through three case studies.

Genus Stachybotrys (Stachybotryaceae, Hypocreales) requires high humidity to grow and represents one of the most notorious fungi associated with suspected illness in moist buildings. If Stachybotrys conidia are found in settled indoor dusts, their presence may indicate water intrusion and mold infestation revealed after dismantling the building structures. This study describes detection of Stachybotrys growth hidden inside the structures of three buildings in Finland. First, a novel microscopic screening method concentrating Stachybotrys conidia from settled dust was developed. The method is based on enrichment of conidia floating in the solution of saturated NaCl, separating them from sinking dust particles. Captured conidia were identified based on morphology and cultivated isolates were identified to species or genus level. The second part of the study describes the records of two persons sickened with asthma after exposure to long lasting growth of Stachybotrys in two of the buildings. After 38years of the diagnosis the one person's asthma was declared cured in a medical report. The asthma of the other person developed into chronic illness, diagnosed by The Insurance Court as occupational asthma caused by a moisture-damaged workplace. Diversity and the metabolic activity of the microbes exposing the two persons in rural versus urban environments after their asthma diagnosis is offered as a preliminary and hypothetical explanation of the different outcome of the illnesses.

Optimising healthcare queues: a case study on chronic respiratory illness

Optimising healthcare queues: a case study on chronic respiratory illness

The pathogenesis of depression: roles of connexin 43-based gap junctions and inflammation.

Depression is a leading chronic mental illness worldwide, characterized by anhedonia and pessimism. Connexin is a kind of widely distributed protein in the body. Connexin 43 (Cx43) plays an important role in the pathogenesis of depression. Growing evidence has indicated that inflammation is closely associated with neuropsychiatric diseases such as depression. Inflammation occurs in patients with mood disorders, and symptomatic relief after multiple treatments is often accompanied by proinflammatory restoration. In this study, we sought to determine the upstream and downstream relationship of Cx43 abnormalities and peripheral inflammation in inducing depression. Gap27, as a Cx43 mimetic peptide, specifically blocks Cx43 gap junction channels in the brain. The mice were treated with injection of Gap27 into the prefrontal cortex (PFC), conditional knockout of Cx43 in the PFC, and lipopolysaccharide (LPS) intraperitoneal injection. Our results revealed that the treatments gave rise to the depressive-like behavior occurrence in mice, including reducing the sucrose preference and spontaneous activities, and increasing immobility time in the forced swimming test. Functional blockade of Cx43 induced abnormal expression of peripheral inflammatory cytokines including interleukin (IL)-1β, IL-6, tumor necrosis factor-α, IL-2, IL-10, and IL-18. Furthermore, depression associated with peripheral inflammation derived from LPS intraperitoneal injection significantly reduced the Cx43 expression and the diffusion distance of gap junction channel permeability dye in the PFC. These results showed that blockade of Cx43 in the PFC and peripheral inflammation are complicatedly intertwined, and reinforcing each other during the induction of depression.

Felt stigma as a determinant of health-related quality of life among community-dwelling stroke survivors in China: A cross-sectional study.

To assess the role of felt stigma versus enacted stigma in the health-related quality of life of community--dwelling stroke survivors in China. A sample of 189 community--dwelling stroke survivors were investigated with the Stigma Scale for Chronic Illness (SSCI), 12-item Short Form-12 Health Survey (SF-12), modified Barthel index (MBI), Zung Self-Rating Depression Scale (ZSDS), and demographic and disease-related characteristics. Hierarchical multiple regression analysis was used to estimate the influence of felt stigma and enacted stigma on quality of life after controlling for depression, activities of daily living, and patient characteristics. In total, 189S survivors were included in the study. Overall stigma, felt stigma, and enacted stigma were moderately and strongly positively and significantly correlated with quality of life, depression, and activity in daily living (P<0.05). Felt stigma significantly explained 2.2% (P<0.01) of the variance in the physical component summary (PCS). Felt stigma significantly explained 8.6% (P<0.01) of the variance in the mental component summary (MCS). However, enacted stigma had no effect on PCS or MCS. Felt stigma significantly and independently contributed to the PCS and MCS quality of life of community-dwelling stroke survivors after adjustment for depression, activity of daily living and patient characteristics.

Influence of Digital Health Literacy on Blood Pressure and Hemoglobin A1c in Patients With Comorbid Type 2 Diabetes and Hypertension.

Digital health literacy is emerging as an important element in chronic illness management, yet its relationship with clinical outcomes remains unclear. Utilizing data from the ongoing EXpanding Technology-Enabled, Nurse-Delivered Chronic Disease Care trial, this cross-sectional, correlational study explored the association between digital health literacy, health literacy, and patient outcomes, specifically blood pressure and hemoglobin A1c levels in 76 patients managing comorbid type 2 diabetes and hypertension. Results indicate patients had moderate digital health literacy, which was not significantly correlated with health literacy (r = 0.16, P = .169). Both bivariate and covariate-adjusted regression models indicated that digital health literacy was not significantly associated with patient outcomes (all P > .05, small effects). These findings suggest that although patients from diverse sociodemographic backgrounds may possess the digital health literacy to engage with digital health tools, this alone may not improve clinical outcomes. Although digital health literacy may not be directly related to improved clinical outcomes, future research should explore how digital health tools can be optimized to enhance patient engagement and address complex challenges in diverse populations managing chronic conditions.