Current Health Problems Research Articles

PTSD as a consequence of past conflict experience, recent exposure to violence and economic marginalization in post-conflict contexts: A study from Nepal, Guatemala and Northern Ireland.

Exposure to war and conflict increases the risk of mental health problems. Poor living conditions are known to negatively impact mental health. It is hypothesized that exposure to negative events after armed conflict interacts with past negative experiences, socioeconomic factors and current mental health problems. A cross-sectional survey was carried out in three contexts of previous internal armed conflict: Nepal, Guatemala and Northern Ireland. Three nationally representative samples were drawn, comprising a net sample of 3,229 respondents. Both recent negative events and past negative events linked to the previous conflicts were found to be associated with elevated risk of post-traumatic stress syndrome (PTSD). Economic marginalization and urban residency also contributed to current risk of PTSD. The results support the study hypothesis that both past and recent negative events in combination with economic marginalization contribute to explain current risk of PTSD. It is necessary both to improve living conditions more broadly and to establish and develop health services that have the capacity to screen, prevent and treat mental health problems also in poor contexts, in particular against a background of previous armed conflict.

SAT-238 IDENTIFYING IMPORTANT OUTCOMES FOR YOUNG PEOPLE WITH CHRONIC KIDNEY DISEASE AND THEIR CAREGIVERS: FOCUS GROUPS WITH NOMINAL GROUP TECHNIQUE

ON BEHALF OF THE SONG-KIDS STEERING COMMITTEE AND INVESTIGATORS. Chronic kidney disease (CKD) has wide-ranging and long-term consequences for young people and their families. The omission of outcomes that are important to young people with CKD and their caregivers limits knowledge to guide shared decision-making in clinical care. We aimed to identify the outcomes that are important to young people with CKD and their caregivers. We used a combined focus group and nominal group technique whereby participants identified and ranked outcomes and discussed the reasons for their priorities. Importance scores were calculated (on a scale of 0 to 1), and the qualitative data were analyzed thematically. Young people with CKD (stage 1-5, dialysis or transplant) and their caregivers were purposively sampled from six centers across Australia, the United States and Canada. Thirty-four patients and 62 caregivers participated in 16 groups, and identified 48 outcomes. The five highest ranked outcomes for patients were survival (importance score = 0.25), physical activity/sports participation (0.24), fatigue (0.20), lifestyle restrictions (0.20) and growth (0.20), and for caregivers, kidney function (0.53), survival (0.28), infection (0.22), anemia (0.20) and growth (0.17). Twelve themes were identified reflecting their immediate and current priorities (wanting to feel normal, strengthening resilience, minimizing intrusion into daily life, imminent threats to life, devastating family burdens, and seeking control over health) and considerations regarding future impacts (protecting health and development, remaining hopeful, concern for limited opportunities, prognostic uncertainty, dreading painful and invasive procedures and managing expectations). Kidney function, infection, survival and growth were among the highest priorities for patients with CKD and their caregivers. Young people with CKD also prioritized highly the outcomes that directly affected their lifestyle, sense of normality or reflected immediate health concerns, while caregiver’s highest priorities concerned the long-term health of their child, as well as their current health problems, and the financial and family burdens of caring for a child with CKD.

Рецепторы, ассоциированные со следовыми аминами, 1-го подтипа как новая терапевтическая мишень в нейропсихофармакологии

Психоневрологические расстройства — одна из главных проблем современного здравоохранения. Данные клинических исследований свидетельствуют о том, что в группе риска возникновения психических расстройств находится каждый третий человек в мире. Поэтому поиск новых потенциальных мишеней для лекарственных средств — актуальная и важная задача современной экспериментальной психофармакологии. Одной из таких мишеней могут быть описанные в начале XXI века рецепторы, ассоциированные со следовыми аминами, 1-го подтипа (Trace Amine Associated Receptors 1, TAAR1). TAAR1 принадлежат к большому семейству рецепторов, сопряжённых с G-белком. Результаты недавних исследований доказали, что этот подтип рецепторов способен регулировать активность дофаминергической системы. В настоящем обзоре подробно рассмотрены эффекты TAAR1 лигандов в различных доклинических моделях психоневрологических расстройств.

Quality of Life and Anxiety in Military Personnel

AbstractThe quality of life of military personnel represents their self-evaluation of the quality of their own mental and physical health, social relations, and the environment in which they live and work. The aim of our study was to evaluate the relationship between quality of life and anxiety levels in military personnel of the Serbian Armed Forces.The cross-sectional study included a total of 311 randomly selected professional military personnel (officers, non-commissioned officers and professional soldiers) between 23 and 53 years of age (mean, 35.3±7 years) without current mental health problems. For the purpose of this study, we used the World Health Organization Abbreviated Instrument for Quality of Life Assessment (WHOQOL-BREF) and the Beck Anxiety Inventory (BAI). The statistical analysis included parametric and non-parametric descriptive statistics.Professional military personnel showed high satisfaction with their quality of life in the categories of social relations (82.52), psychological health (82.10) and physical health (81.68), while the satisfaction scores in the category environment category were the lowest (62.77). The average value for the total BAI score was 4.83±5.66. Quality of life decreased, while anxiety increased, with increasing age of the military personnel. Higher BREF score values were associated with lower scores on the BAI questionnaires in all subscales (p<0.001).Military personnel of the Serbian Armed Forces showed a high degree of satisfaction with their own quality of life. Learning techniques to easily overcome everyday stress would reducedreduce anxiety and improve the quality of life in military personnel of the Serbian Armed Forces.

The GLP-1 analog liraglutide attenuates acute liver injury in mice

Introduction and objectivesAcute liver injury is a current health problem with few effective treatments. The present study investigated the hepatoprotective and curative potential of the glucagon-like peptide-1 analog liraglutide against carbon tetrachloride (CCl4)-induced hepatotoxicity. Materials and methodsMale Swiss mice were subjected to two protocols. The first protocol (Pretreatment) consisted of intraperitoneal (i.p.) treatment with liraglutide (0.057 and 0.118mgkg−1) or vehicle (distilled water) once daily for 7 days. On days 6 and 7, the animals were challenged with 2% CCl4 (5mgkg−1, i.p.). The second protocol (Late treatment) began with an injection of 5% CCl4 (5mgkg−1, i.p.) and subsequent treatment with liraglutide (0.057mgkg−1) or vehicle (distilled water) for 1 day. In both protocols, 24h after the last administration, blood and bile were collected from anesthetized animals, followed by euthanasia and liver collection. Plasma and bile underwent biochemical analyses, and histological, oxidative stress, and metabolic parameters were evaluated in the liver. ResultsBoth liraglutide treatment protocols attenuated hepatotoxicity that was induced by CCl4, decreasing plasma levels of hepatic enzymes, stimulating the hepatic antioxidant system, and decreasing centrilobular necrosis, hepatic glycogen, and lipid accumulation. CCl4 tended to reduce bile lipid excretion, but liraglutide did not influence this parameter. ConclusionsThe present results demonstrated the hepatoprotective and therapeutic effects of liraglutide, which may be attributable to a decrease in liver oxidative stress and the preservation of metabolism. Liraglutide may have potential as a complementary therapy for acute liver injury.

Advantages of Negative Pressure Therapy in Local Diabetic Foot Treatment

Diabetic foot is a current public health problem and a late consequence of diabetes. Morbidity and mortality are significant, seriously affecting the patient�s quality of life. Treatment of the diabetic foot is a long-lasting, highly resource-consumption process. Using negative pressure therapy leads to shorter hospitalization periods, better functional outcomes, significantly contributes to decreasing the number of amputations and improving patient�s quality of life. 49 year-old patient is hospitalized with necrotizing at right foot and shank, neglected type II diabetes. It is performed amputation of atypical necessity, right leg, transtarsal, open stump. After successive debridements, negative pressure therapy is installed for a period of 24 days. This favors the formation of the granular bed, the remission of the infection, allowing grafting. The graft is partially integrated and plantar reconstruction is performed with sural reversal flap. The local and functional results are satisfactory, with the flap viability and the possibility of moving with support on the right leg, preventing the amputation of the shank. Negative pressure therapy has a multitude of advantages, it is preferable to conventional therapies, and it can have higher costs, but accelerates healing and improves the quality of life of the patient.

Gonococcal infection: An unresolved problem

Gonococcal infection is a current public health problem worldwide, being the second most prevalent bacterial sexually transmitted infection. The etiologic agent is Neisseria gonorrhoeae, a Gram-negative diplococcus, and mainly causes urethritis in men. In women up to 50% of infections can be asymptomatic. N. gonorrhoeae has a great ability to develop antibiotic resistance, so the last remaining therapeutic option are extended spectrum cephalosporins. Many guides recommend dual therapy with ceftriaxone and azithromycin, but in recent years the resistance to azithromycin is also increasing, so that dual treatment is being questioned by scientific societies.

Renal tuberculosis mimicking renal cell carcinoma: a\xa0case report

BackgroundUrogenital tuberculosis is still a frequent presentation, and it constitutes a current public health problem in endemic areas. The clinical presentation of this form of the disease may be misleading. The pseudotumoral type of renal tuberculosis is extremely uncommon.Case presentationWe present a case of a 52-year-old African woman who presented with urogenital tuberculosis in its pseudotumoral form. This case was initially diagnosed and managed as renal cancer. Histopathology confirmed the diagnosis of pseudotumoral renal tuberculosis.ConclusionsThe pseudotumoral form of urinary tuberculosis can be difficult to diagnose. Only bacteriological or histological confirmation allows diagnosis for adequate treatment.

Patients' understanding of health information in Germany.

Background: Patient–physician communication and textual health information are central to health care. Yet, how well patients understand their physicians and written materials is under-studied.Objectives: Focusing on outpatient health care in Germany, the aim of this research was to assess patients’ levels of understanding oral and written health information and to identify associations with socioeconomic variables.Methods: This analysis drew on a 2017 health survey (n=6,105 adults 18 years of age and above). Measures for the quality of patient–physician communication were derived from the Ask Me 3 program questions for consultations with general practitioners (GPs) and specialists (SPs), and for textual health information via a question on the comprehensibility of written materials. Correlations with socioeconomic variables were explored using bivariate and multivariable logistic regression analyses.Results: Over 90% of all respondents reported that they had understood the GP’s and SP’s explanations. A lack of understanding was most notably correlated with patients’ self-reported very poor health (odds ratio [OR]: 5.19; 95% confidence interval [CI]: 2.23–12.10), current health problem (OR: 6.54, CI: 1.70–25.12) and older age (65 years and above, OR: 2.97, CI: 1.10–8.00). Fewer patients reported that they understood written materials well (86.7% for last visit at GP, 89.7% for last visit at SP). Difficulties in understanding written materials were strongly correlated with basic education (OR: 4.20, CI: 2.76–6.39) and older age (65 years and above, OR: 2.66, CI: 1.43–4.96).Conclusions: In order to increase patients’ understanding of health information and reduce inequalities among patient subgroups, meeting the communication needs of patients of older age, low educational status and with poor health is essential.

Community-Academic Partnerships: Approaches to Engagement.

Current public health problems such as cancer have an expansive set of lifestyle and social circumstances that affect the cause and course of the disease. In response, over the past 7 years, the National Cancer Institute (NCI) has recognized the important role that cancer centers play in their community and has gradually increased the requirements and stringency of these sections in the Cancer Center Support Grant guidelines to include a plan for community outreach and engagement. Developing sustainable community-academic partnerships is an essential factor for the successful dissemination and implementation of promising interventions and programs aimed at decreasing barriers and improving cancer outcomes. Understanding how best to facilitate linkages and collaboration can expedite translation of research knowledge into practice and allow more evidence-based improvements to be implemented into practice as well as influence research agendas. This article will examine several examples of successful community-academic partnerships focused on cancer prevention and control and explore lessons learned.

Life Satisfaction and Insomnia among Elderly Community Dwellers of Lalitpur, Nepal

Introduction: Life satisfaction during elderly is essential in ageing process. Globally, insomnia is a problem that degrades the health of elderly people, which also interferes with the quality of life. Methods: A descriptive cross-sectional study was conducted to identify life satisfaction and insomnia among 501 community dwellers elderly of Lalitpur by using structured interview schedule on socio-demographic information, Satisfaction with Life Scale (SWLS) to measure a life satisfaction and Pittsburgh Insomnia Rating Scale (PIRS) to identify the prevalence of insomnia. Results: Data was edited, classified, and coded manually. Then, data entry and data cleaning were done using Epi data software and data analysis was done using SPSS software version 16. Descriptive and inferential statistics were used to analyze data. The study showed that 31.9% and 35.7% of respondents were highly satisfied and satisfied with their life respectively. However, 6% and 0.6% of respondents were dissatisfied and extremely dissatisfied with their life respectively. Study reveals that 50.5% of respondents had insomnia. Ethnicity, current job status, and health problems during night sleep were significantly associated with life satisfaction. Similarly, age, marital status, educational status, current job status, current physical health problems, presence of disease, taking medication at present and health problems during night sleep were significantly associated with insomnia. Conclusion: Most elderly people were satisfied with their life, but majority of them suffered from insomnia. Therefore, it is necessary to plan awareness program regarding life satisfaction and insomnia by concerned authority to help elderly to stay healthy and improve their quality of life.

Life Satisfaction and Insomnia among Elderly Community Dwellers of Lalitpur, Nepal

Introduction: Life satisfaction during elderly is essential in ageing process. Globally, insomnia is a problem that degrades the health of elderly people, which also interferes with the quality of life.
 Methods: A descriptive cross-sectional study was conducted to identify life satisfaction and insomnia among 501 community dwellers elderly of Lalitpur by using structured interview schedule on socio-demographic information, Satisfaction with Life Scale (SWLS) to measure a life satisfaction and Pittsburgh Insomnia Rating Scale (PIRS) to identify the prevalence of insomnia.
 Results: Data was edited, classified, and coded manually. Then, data entry and data cleaning were done using Epi data software and data analysis was done using SPSS software version 16. Descriptive and inferential statistics were used to analyze data. The study showed that 31.9% and 35.7% of respondents were highly satisfied and satisfied with their life respectively. However, 6% and 0.6% of respondents were dissatisfied and extremely dissatisfied with their life respectively. Study reveals that 50.5% of respondents had insomnia. Ethnicity, current job status, and health problems during night sleep were significantly associated with life satisfaction. Similarly, age, marital status, educational status, current job status, current physical health problems, presence of disease, taking medication at present and health problems during night sleep were significantly associated with insomnia.
 Conclusion: Most elderly people were satisfied with their life, but majority of them suffered from insomnia. Therefore, it is necessary to plan awareness program regarding life satisfaction and insomnia by concerned authority to help elderly to stay healthy and improve their quality of life.

Environmental Health Promotion of a Contaminated Site in Mexico.

Entangled in complex ecological, sociocultural, and economic systems, current environmental health problems require integrated participatory approaches. Alpuyeca, a semi-urban, highly marginalized community in South-Central Mexico burdened by lead and polychlorinated biphenyl (PCB) contamination, dengue fever, and intestinal diseases, illustrates this. Its residents are distinctive, however, for their concerted actions in the face of environmental problems and the presence of defenders of a prehispanic worldview based on the protection of nature. This article addresses the health impacts of an integrated environmental health promotion strategy implemented through a participatory action research intervention based on qualitative and quantitative methods. Different actors, sectors, dimensions, and knowledge types were harmonized in a collaborative space created specifically for our interdisciplinary research team, community residents and local authorities. Reflections, plans and actions were developed collectively in this space with the view of finding solutions anchored in the local culture. Results included sharp reductions in blood-lead concentrations among children, in entomological indices, and in PCB contamination, as well as capacity strengthening. Medium-level community participation was achieved. This work contributes evidence that participatory environmental health research can be effective in analyzing and reducing problems in communities with multiple environmental health concerns. It complements ecohealth and environmental health literacy approaches.

Patient-reported health problems and healthcare use after treatment for early-stage breast cancer

BackgroundA clear picture of treatment-related health problems following breast cancer treatment is useful in anticipating the informational and other needs of patients during follow-up. This study aimed to identify treatment-related health problems in breast cancer patients up to five years after diagnosis. Secondly, the use of care associated with these health problems was identified. Methods876 surgically-treated female patients diagnosed between 2012 and 2016 with early-stage breast cancer were asked to complete an online survey about their current health problems and use of care. Multivariate logistic regression analyses were applied to determine the effect of patient and treatment characteristics on health problems. Results404 patients responded (46%). The median age was 62.0 years (SD:10.9). Apart from breast surgery, patients had been treated with radiotherapy (72%), chemotherapy (49%), anti-hormonal therapy (57%), and axillary dissection (21%). Ninety-three percent experienced one or more health problems. Over 50% of respondents experienced fatigue, psychological problems, and health problems regarding the breast, and/or musculoskeletal, central nervous, and reproductive system. Treatment with chemotherapy was significantly associated (p < 0.05) with an increased risk of health problems, respectively fatigue (OR:2.00), respiratory (OR:1.81), gastrointestinal (OR:1.87), central nervous (OR:3.40), and skin problems (OR:2.62). Use of healthcare for one or more health problems was reported by 64% of respondents. DiscussionAlmost all patients experienced health problems up to five years after breast cancer diagnosis, with a range of complaints that were consistently present over time. Factors associated with the development of health problems are useful for better informing patients beforehand and targeting follow-up care.

A qualitative study of women's views on the acceptability of being asked about mental health problems at antenatal booking appointments

ObjectiveTo explore women's views on the acceptability of being asked about mental health problems at antenatal booking. DesignQualitative study. SettingBrief semi-structured qualitative interviews were conducted with women in a private setting at a hospital, or at women's homes. Interview discussions centered around three key questions: “What was it like for you answering the questions about your mood?”, “Were there any questions you found upsetting, distressing or confronting?” and “Did the midwife give you some feedback about your answers?” MeasurementsInterviews were audio-recorded, transcribed verbatim, and analysed using thematic and framework approaches. ParticipantsAn ethnically diverse sample [32% white British/Irish, 68% non-white, non-British] of 52 women living in the study area. FindingsMost women found mental health enquiry acceptable. A smaller proportion reported difficulties and many of these women had a past or current mental health problem and/or a history of abuse. These women reported difficulty due to the emotional responses triggered by the questions and the way disclosures were handled. In general, women wanted to be asked clear questions about mental health problems, to have sufficient time to discuss issues, and to receive responses from midwives which were normalising and well-informed about mental health. ConclusionsThis study highlights that women want midwives to ask clearly-framed questions about mental health problems [addressing past and current mental health concerns], and value responses from midwives that are normalising, well-informed and allow for discussion. Implications for practiceTraining should be provided to midwives on how to appropriately respond to women's distress during mental health enquiry, and on referral to support services.

Identifying Important Outcomes for Young People With CKD and Their Caregivers: A Nominal Group Technique Study

Chronic kidney disease (CKD) has wide-ranging and long-term consequences for young people and their families. The omission of outcomes that are important to young people with CKD and their caregivers limits knowledge to guide shared decision making. We aimed to identify the outcomes that are important to young people with CKD and their caregivers. We used the nominal group technique whereby participants identified and ranked outcomes and explained their priorities. Young people with CKD (stages 1-5, dialysis, or transplantation) and their caregivers were purposively sampled from 6 centers across Australia, the United States, and Canada. Importance scores were calculated (scale of 0-1), and qualitative data were analyzed thematically. 34 patients (aged 8-21 years) and 62 caregivers participated in 16 groups and identified 48 outcomes. The 5 highest ranked outcomes for patients were survival (importance score, 0.25), physical activity (0.24), fatigue (0.20), lifestyle restrictions (0.20), and growth (0.20); and for caregivers, kidney function (0.53), survival (0.28), infection (0.22), anemia (0.20), and growth (0.17). 12 themes were identified reflecting their immediate and current priorities (wanting to feel normal, strengthening resilience, minimizing intrusion intodaily life, imminent threats to life, devastating family burdens, and seeking control over health) and considerations regarding future impacts (protecting health/development, remaining hopeful, concern for limited opportunities, prognostic uncertainty, dreading painful and invasive procedures, and managing expectations). Only English-speaking participants were recruited. Kidney function, infection, survival, and growth were the highest priorities for patients with CKD and their caregivers. Young people with CKD also prioritized highly the outcomes that directly affected their lifestyle and sense of normality, while caregiver's highest priorities concerned the long-term health of their child, current health problems, and the financial and family burdens of caring for a child with CKD.

Carbon Nanofibers in Pure Form and in Calcium Alginate Composites Films: New Cost-Effective Antibacterial Biomaterials against the Life-Threatening Multidrug-Resistant Staphylococcus epidermidis.

Due to the current global health problem of antibiotic resistant recently announced by the World Health Organization, there is an urgent necessity of looking for new alternative antibacterial materials able to treat and impede multidrug-resistant infections which are cost-effective and non-toxic for human beings. In this regard, carbon nanofibers (CNFs) possess currently much lower cost than other carbon nanomaterials, such as graphene oxide, and exhibit excellent chemical, mechanical and electric properties. Furthermore, here, the first report on the antibacterial activity of CNFs was demonstrated. Thus, these nanomaterials, in pure form or incorporated in a minuscule amount into calcium alginate composite films to reduce production costs as much as possible, showed to be new weapons against a globally spreading multidrug-resistant pathogen, the methicillin-resistant Staphylococcus epidermidis (MRSE). This Gram-positive bacterium is becoming one of the most dangerous pathogens, due to its abundance on skin. In this study, these hollow filamentous materials, in direct contact with cells and loaded in the low-cost calcium alginate composite films, showed no cytotoxicity for human keratinocyte HaCaT cells, which render them very promising for biomedical applications. The CNFs used in this work were characterized by Raman spectroscopy and observed by high-resolution transmission electron with energy-disperse X-ray spectroscopy.

Post-Traumatic Stress Symptoms after Pediatric Injury: Relation to Pre-Frontal Limbic Circuitry.

Pre-frontal limbic circuitry is vulnerable to effects of stress and injury. We examined microstructure of pre-frontal limbic circuitry after traumatic brain injury (TBI) or extracranial injury (EI) and its relation to post-traumatic stress symptoms (PTSS). Participants aged 8 to 15 years who sustained mild to severe TBI (n = 53) or EI (n = 26) in motor vehicle incidents were compared with healthy children (n = 38) in a prospective longitudinal study. At the seven-week follow-up, diffusion tensor imaging was obtained in all groups; injured children completed PTSS ratings using a validated scale. Using probabilistic diffusion tensor tractography, pathways were seeded from bilateral amygdalae and hippocampi to estimate the trajectory of white matter connecting them to each other and to targeted pre-frontal cortical (PFC) regions. Microstructure was estimated using fractional anisotropy (FA) in white matter and mean diffusivity (MD) in gray matter. Pre-frontal limbic microstructure was similar across groups, except for reduced FA in the right hippocampus to orbital PFC pathway in the injured versus healthy group. We examined microstructure of components of pre-frontal limbic circuitry with concurrently obtained PTSS cluster scores in the injured children. Neither microstructure nor PTSS scores differed significantly in the TBI and EI groups. Across PTSS factors, specific symptom clusters were related positively to higher FA and MD. Higher hyperarousal, avoidance, and re-experiencing symptoms were associated with higher FA in amygdala to pre-frontal and hippocampus to amygdala pathways. Higher hippocampal MD had a central role in hyperarousal and emotional numbing symptoms. Age moderated the relation of white and gray matter microstructure with hyperarousal scores. Our findings are consistent with models of traumatic stress that implicate disrupted top-down PFC and hippocampal moderation of overreactive subcortical threat arousal systems. Alterations in limbic pre-frontal circuitry and PTSS place children with either brain or body injuries at elevated risk for both current and future psychological health problems.

“Growing your own herbs” and “cooking from scratch”: Contemporary discourses around good mothering, food, and class‐related identities

AbstractIn a cultural climate of “intensive parenting” and concerns about the “obesity epidemic,” parents are expected to take responsibility for their children's health, particularly through the provision of a “healthy” diet. This study involved intergenerational dyad interviews with both middle‐class and working‐class mothers and daughters from the United Kingdom. Analysing the data using discourse analysis informed by feminist poststructuralist theory, we found that mothers were positioned as having prime responsibility for the nurturing of family members, including the provision of a healthy diet. However, providing a healthy diet alone was insufficient; mothers needed to demonstrate that time and effort had been taken in the preparation of meals using fresh ingredients. Those who failed to do so were positioned as “lazy,” thus inviting the blaming of mothers for any current or future health problems encountered by family members (especially children). However, talk from some of the working‐class mothers pointed to the unattainable and “classed” ideals that are set by such cultural expectations.

Injury incidence and risk factors: a cohort study of 706 8-km or 16-km recreational runners

ObjectivesTo report (1) the injury incidence in recreational runners in preparation for a 8-km or 16-km running event and (2) which factors were associated with an increased injury risk.MethodsProspective cohort...