Patient Health Research Articles

Understanding social determinants of health and physical therapy outcomes in patients with low back pain: A scoping review.

Low back pain (LBP) is the number one cause of disability worldwide; however, it is not clear how social determinants of health (SDOH) impact care management and outcomes related to physical therapy (PT) services for patients with LBP. The purposes of this scoping review are to examine and assimilate the literature on how SDOH and PT care relate to non-specific LBP outcomes and identify gaps in the literature to target for future research. Data were extracted from eight electronic databases from January 2011 to February 2022. Reviewers independently screened all studies using the PRISMA extension for scoping review guidelines. Data related to study design, type of PT, type of non-specific LBP, patient demographics, PT intervention, SDOH, and PT outcomes were extracted from the articles. A total of 30,523 studies were screened, with 1961 articles undergoing full text review. Ultimately, 76 articles were identified for inclusion. Sex and age were the most frequent SDOH examined (88% and 78% respectively) followed by education level (18%). Approximately half of the studies that examined age, sex, and education level identified no effect on outcomes. The number of studies examining other factors was small and the types of outcomes evaluated were variable, which limited the ability to pool results. Sex and age were the most frequent SDOH examined followed by education level. Other factors were evaluated less frequently, making it difficult to draw conclusions. Study design and heterogeneity of determinants and outcomes were barriers to examining the potential impact on patients with LBP.

Vestibular Schwannoma Management: Patient Perspectives and Health Literacy

Objective: To assess medical decision-making, reasons for attrition, and health literacy among vestibular schwannoma (VS) patients last seen in clinic more than 2 years ago. Study Design: Survey. Setting: Tertiary skull base center. Patients: Adults with sporadic VS last evaluated more than 2 years ago. Methods: Survey including Brief Health Literacy Screen (BHLS), a validated 3-question measure of health literacy, and open-ended questions on care; retrospective chart review. Main Outcome Measures: BHLS score, patient reasons for attrition. Results: Of 1011 patients contacted, 205 (20.3%) patients responded and met all criteria for analysis. At initial evaluation, mean patient age was 50.6 ± 12.8 years, roughly half (51.4%) were female, and the majority (80.2%) identified as White. At the time of the survey, 48 (23%) continued to observe their tumor. The remaining 160 (76.9%) patients previously underwent treatment (surgery and/or radiation). Of those treated, 34 (21.3%) underwent intervention elsewhere. Symptoms since the last patient visit did not differ between observed and treated patients. About 94.7% of the cohort displayed high health literacy (BHLS > 9), though rates of inadequate health literacy were higher among observed patients (12.5% versus 3.1% in those treated). The most common reasons for opting not to follow-up included counseling issues, personal decisions, and social/life stressors (including the COVID-19 pandemic). Conclusions: Despite being a highly health-literate cohort, patients cited multiple reasons for attrition. Regardless of whether they were observed or treated, patients described follow-up visits as burdensome and perceived them to be of minimal benefit.

An Argument for Decentralized Clinical Trials in Gynecologic Oncology

To evaluate factors that may influence clinical trial enrollment, we compared demographics, clinical characteristics, and patient-reported social determinants of health for patients with advanced ovarian cancer who were approached for enrollment in a prehabilitation trial. Although no significant differences were found in the majority of demographic and clinical characteristics, distance to study institution was associated with decision to enroll; 21.9% of enrolled compared with 42.2% of not enrolled patients lived 200 miles or more from the study institution (P< .05). In addition, compared with not enrolled patients, enrolled patients were more likely to be receiving neoadjuvant chemotherapy within the study institution compared with a nonstudy institution clinician (81.2% vs 53.1%, P=.02). These findings highlight barriers to enrollment that can be addressed through decentralization of clinical trials.

Mental health after the COVID-19 pandemic among Finnish youth: a repeated, cross-sectional, population-based study

High levels of mental health problems among young people were reported during the COVID-19 pandemic, but studies of the post-pandemic period are scarce. We assessed mental health problems among Finnish youth before, during, and after the COVID-19 pandemic using nationwide population-based samples. Our aim was to examine in which direction the heightened levels of adolescent mental health problems have developed after the pandemic. In this national, repeated cross-sectional, population-based study in Finland, we recruited students at lower and upper secondary level (aged 13-20 years) who were taking part in the Finnish School Health Promotion (SHP) survey in 2015-23 (119 681-158 897 participants per round). The SHP is based on total sampling and conducted biennially between March and May. Self-reports covered the seven-item Generalized Anxiety Disorder Scale; the two-item Patient Health Questionnaire for depression; the Mini Social Phobia Inventory for social anxiety; the Short Warwick-Edinburgh Mental Wellbeing Scale for mental wellbeing; loneliness; the Sick, Control, One Stone, Fat, Food measure for disordered eating; and suicidality (suicidal ideation, deliberate self-harm, and suicide attempts). Scales were dichotomised using validated cutoffs. Presence of any and comorbid mental health problems was assessed. Logistic (for dichotomised outcomes) and linear (for Short Warwick-Edinburgh Mental Wellbeing Scale) mixed effects models were used to analyse the effect of survey year on mental health, controlling for sociodemographic background factors and stratified by gender and school level. Cisgender and transgender youth were compared. Between 2015 and 2023, the SHP study recruited 722 488 students (371 634 [51·6%] girls and 348 857 [48·4%] boys) with a mean age of 15·8 years (SD 1·3) who were either in the eighth and ninth grades of comprehensive school or the first and second years of general and vocational upper secondary schools in Finland. The proportion of participants with generalised anxiety, depression, and social anxiety symptoms above the cutoff increased from pre-COVID-19 levels to 2021 and remained at these higher levels in 2023 among all study groups. Among girls in lower secondary education, prevalence of generalised anxiety, depression, and social anxiety symptoms increased from 2021 to 2023, as did social anxiety among girls in upper secondary education. Among boys, the proportion with social anxiety symptoms decreased between 2021 and 2023. Mental wellbeing scores decreased in all groups between 2021 and 2023, and disordered eating increased in girls, and in boys in lower secondary education. Suicidality increased in girls but not in boys. Loneliness was the only measure to show improvement in all groups from 2021 to 2023. In 2023, 55 895 (72·6%) of 76 994 girls and 22 718 (32·8%) of 69 205 boys reported at least one mental health problem, and 37 250 (48·4%) girls and 9442 (13·6%) boys reported comorbid mental health problems. Among both transfeminine and transmasculine youth, the prevalence of generalised anxiety and depression symptoms decreased from 2021 to 2023, but compared with cisgender youth, the proportions were significantly higher throughout. The effects of the COVID-19 pandemic on youth mental health could be long lasting. In this study, the substantial change for the better among transgender youth was a positive exception. Providing adequate support and treatment for young people with poor mental health is essential, but solutions to the mental health crisis need to address a wider societal perspective and should be developed in partnership with young people. NordForsk, Research Council of Finland. For the Finnish and Swedish translations of the abstract see Supplementary Materials section.

Resuscitation for out-of-hospital cardiac arrest in Ireland 2012–2020: Modelling national temporal developments and survival predictors

AimTo explore potential predictors of national out-of-hospital cardiac arrest (OHCA) survival, including health system developments and the COVID pandemic in Ireland. MethodsNational level OHCA registry data from 2012 through to 2020, relating to unwitnessed, and bystander witnessed OHCA were interrogated. Logistic regression models were built by including predictors through stepwise variable selection and enhancing the models by adding pairwise interactions that improved fit. Missing data sensitivity analyses were conducted using multiple imputation. ResultsThe data included 18,177 cases. The final model included seventeen variables. Of these nine variables were involved in pairwise interactions. The COVID-19 period was associated with reduced survival (OR 0.61, 95%CI 0.43, 0.87), as were increasing age in years (OR 0.96, 95% CI 0.96, 0.97) and call response interval in minutes (OR 0.97, 95% CI 0.96, 0.99). Amiodarone administration (OR 3.91, 95% CI 2.80, 5.48), urban location (OR 1.40, 95% CI 1.12, 1.77), and chronological year over time (OR 1.14, 95% CI 1.08, 1.20) were associated with increased survival. ConclusionsNational survival from OHCA has significantly increased incrementally over time in Ireland. The COVID-19 pandemic was associated with decreased survival even after accounting for potential disruption to key elements of bystander and EMS care. Further research is needed to understand and address the discrepancy between urban and rural OHCA survival. Information concerning pre-event patient health status and inpatient care process may yield important additional insights in future.

Designing a Care System based on the Internet of Things for Patients with Multiple Sclerosis

Abstract: Multiple sclerosis (MS) is a neurodegenerative disease that is a major health problem. This issue requires the development of new tools to control patients' activity and reduce care costs. The monitoring system based on the Internet of things is a suitable solution for this concern. In this study, the researchers developed a tool that uses an Arduino board and four accelerometer sensors, heart rate and pulse oximetry sensors, temperature sensors, and Bluetooth modules to monitor the factors related to the health of multiple sclerosis patients. In this method, the information obtained from the sensors connected to the patient's body is placed on the memory board and displayed with the help of an LCD. In the next step, the Bluetooth module transmits the information obtained from these sensors to a mobile application. This application has the ability to share and store information. This information, together with the date display on the LCD, in addition to notifying the person of the resulting changes; it is also sent periodically to the doctor. In general, this tool, together with a mobile device, helps to increase the selfcare of patients, increases the interaction between the patient and the doctor, reduces the frequeI. nt visits of patients to care centers, and helps to improve the quality of life of patients..

A machine learning framework for interpretable predictions in patient pathways: The case of predicting ICU admission for patients with symptoms of sepsis.

Proactive analysis of patient pathways helps healthcare providers anticipate treatment-related risks, identify outcomes, and allocate resources. Machine learning (ML) can leverage a patient's complete health history to make informed decisions about future events. However, previous work has mostly relied on so-called black-box models, which are unintelligible to humans, making it difficult for clinicians to apply such models. Our work introduces PatWay-Net, an ML framework designed for interpretable predictions of admission to the intensive care unit(ICU) for patients with symptoms of sepsis. We propose a novel type of recurrent neural network and combine it with multi-layer perceptrons to process the patient pathways and produce predictive yet interpretable results. We demonstrate its utility through a comprehensive dashboard that visualizes patient health trajectories, predictive outcomes, and associated risks. Our evaluation includes both predictive performance - where PatWay-Net outperforms standard models such as decision trees, random forests, and gradient-boosted decision trees - and clinical utility, validated through structured interviews with clinicians. By providing improved predictive accuracy along with interpretable and actionable insights, PatWay-Net serves as a valuable tool for healthcare decision support in the critical case of patients with symptoms of sepsis.

Effectiveness of Ceftazidime/Avibactam treatment for infections caused by Klebsiella pneumoniae Carbapenemase (KPC), a 30-day mortality perspective. Comparison of results with control groups treated with other antibiotics

Introduction: Infections caused by Klebsiella pneumoniae carbapenemase (KPC) pose a significant clinical challenge due to increasing antibiotic resistance. This study analyzes the effectiveness of ceftazidime/avibactam treatment for KPC infections, focusing on 30-day mortality and comparing results with control groups treated with different antibiotics. Material and methods: We conducted a retrospective analysis of six cohort studies, comparing thirty-day mortality in patients treated with ceftazidime/avibactam with control groups using other antibiotics. The studies included patients infected with KPC, and the analysis focused on therapeutic effectiveness. Aim of the study: The aim of the study is to compare the results in terms of 30-day mortality in groups treated with ceftazidime/avibactam compared to control groups using different antibiotics. Conclusions: Data analysis from various studies revealed varied 30-day mortality outcomes in groups treated with ceftazidime/avibactam compared to control groups using different antibiotics. Ceftazidime/avibactam proved to be more effective in all studies, reducing mortality rates compared to other treatment regimens. We emphasize that emerging antibiotic resistance, especially in the case of KPC, requires a comprehensive therapeutic approach. Despite promising ceftazidime/avibactam results, factors such as overall patient health and treatment delays may influence final therapy outcomes. We also highlight controversies regarding combination therapy vs. monotherapy, necessitating further research. Our work underscores the importance of monitoring the effectiveness of KPC infection treatment and exploring new therapeutic strategies. Further clinical studies are essential to develop a fuller understanding and optimal therapeutic protocols in the face of the growing antibiotic resistance problem.

A SCOPING REVIEW TO DETERMINE THE EFFICACY OF MUSCLE ENERGY TECHNIQUE ON LOW BACK PAIN

Background: Low back pain has shown detoriation in patient health. Absenteeism has found to be increased in work place. There is a high need to find a effective treatment for the cause. Objective: The aim of the study is to find out whether muscle energy technique is effective in case of low back pain. Study design: Systemic review Method: Around 65 articles were screened for the study with the help of google scholar, PubMed and Cochrane. Out of which 10 articles were considered for the review on the basis of inclusion criteria. These articles were verified and read thoroughly. Results: Muscle energy technique came out to be effective in treatment of low back pain. As it aimed to decrease pain and improve functional disability. Conclusion: This study conclude that the muscle energy found to be effective in individual with low back pain. It helps in improving the joint range of motion, managing the pain, improves stability, strengthening weak muscles. MET has shown effect in LBP in chronic condition, involvement of SI joint, mechanical LBP and also non-specific low back pain. KEYWORDS: low back pain, muscle energy technique, non-specific back pain

Intersectional HIV- and Depression-Related Stigma Among People with HIV Entering HIV Care in Cameroon.

Mental health-related stigma is a prominent barrier to improved mental health outcomes globally and may be particularly harmful to populations with other stigmatized identities. We aimed to understand intersectional depression- and HIV-related stigma among people with HIV (PWH) entering HIV care in Cameroon. Using baseline data from a cohort of PWH entering HIV care in Cameroon between 2019 and 2020, we characterized depression- and HIV-related stigma in the population overall and by sociodemographic sub-group. We also explored substantively meaningful variation in stigma endorsement by depressive symptom severity (Patient Health Questionnaire-9 [PHQ-9]) and causal attribution of depression. Among those with elevated depressive symptoms (PHQ-9 scores > 4), we estimated the association between stigma type and depressive symptom severity using binomial regression. Among 398 participants, 49% endorsed low HIV- and depression-related stigma (N = 195), 10% endorsed high HIV- and depression-related stigma (N = 38), 29% endorsed high depression-related stigma only (N = 116), and 12% endorsed high HIV-related stigma only (N = 49). Respondents with and without heightened depressive symptoms commonly believed depressive symptoms were caused by HIV (N = 140; 32.9%). Among those with elevated depressive symptoms, the prevalence of moderate to severe symptoms was higher among those endorsing high HIV-related stigma only (prevalence ratio 1.55; 95% confidence interval: 1.01, 2.37) compared to those reporting low HIV- and depression-related stigma. HIV- and depression-related stigma are both common among PWH entering HIV care in Cameroon. The consistent association between HIV-related stigma and poor psychosocial well-being among people with HIV necessitates the urgent scale-up of evidence-based HIV-related stigma interventions specifically.

Psychiatry Resident Physicians Experience Personal and Professional Grief, Burnout and Depression: Results From a National Survey.

Resident physicians experience personal and professional stressors throughout training. These experiences may increase levels of burnout, depression, and grief. Understanding how these stressors impact trainees is essential for improving wellbeing during residency. We examined the prevalence and associations between burnout, depression, and grief among a national sample of psychiatry resident physicians. A survey including validated scales for burnout (Modified Maslach Burnout Inventory-Health Services Survey [MBI]), depression (Patient Health Questionnaire-9 [PHQ-9]), and grief (Traumatic Grief Inventory Self Report [TGSIR]) was distributed to 296 psychiatry program directors in January 2023 for dispersal to their respective residents. Fifty-seven participants completed the survey out of 245 participants who opened and started the survey (23.3%). All participants were current psychiatry residents. MBI scores averaged 21.2 (SD 6.5, range 11-40); 11 participants reported high levels of burnout (scores >27; 19.3%). PHQ-9 scores averaged 3.42 (SD 3.0, range 0-14), with 8 responses meeting the criteria for moderate depressive symptoms (scores >10-14; 14.0%). Suicidal ideation was reported by 5 of 57 participants (8.7%). TGISR scores averaged 12.2 (SD 11, range 0-43); no participants met the criteria for pathologic grief. TGISR scores were correlated with MBI (r = .30; P = .02) and PHQ-9 scores (r = .53; P < .0001). MBI scores were also correlated with PHQ-9 scores (r = .54; P < .0001). Non-pathological grief was correlated with burnout and depression. 14% to 20% of psychiatry residents reported clinically significant levels of burnout and depression. Future studies should aim to further characterize burnout, depression, and grief in larger samples of trainees.

Health and Wellbeing of Regional and Rural Australian Healthcare Workers during the COVID-19 Pandemic: Baseline Cross-Sectional Findings from the Loddon Mallee Healthcare Worker COVID-19 Study—A Prospective Cohort Study

Background: Coronavirus 19 (COVID-19) has created complex pressures and challenges for healthcare systems worldwide; however, little is known about the impacts COVID-19 has had on regional/rural healthcare workers. The Loddon Mallee Healthcare Worker COVID-19 Study (LMHCWCS) cohort was established to explore and describe the immediate and long-term impacts of the COVID-19 pandemic on regional and rural healthcare workers. Methods: Eligible healthcare workers employed within 23 different healthcare organisations located in the Loddon Mallee region of Victoria, Australia, were included. In this cohort study, a total of 1313 participants were recruited from November 2020–May 2021. Symptoms of depression, anxiety, post-traumatic stress, and burnout were measured using the Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7), Impact of Events Scale-6 (IES-6), and Copenhagen Burnout Inventory (CBI), respectively. Resilience and optimism were measured using the Brief Resilience Scale and Life Orientation Test—Revised (LOT-R), respectively. Subjective fear of COVID-19 was measured using the Fear of COVID-19 Scale. Results: These cross-sectional baseline findings demonstrate that regional/rural healthcare workers were experiencing moderate/severe depressive symptoms (n = 211, 16.1%), moderate to severe anxiety symptoms (n = 193, 14.7%), and high personal or patient/client burnout with median total scores of 46.4 (IQR = 28.6) and 25.0 (IQR = 29.2), respectively. There was a moderate degree of COVID-19-related fear. However, most participants demonstrated a normal/high degree of resilience (n = 854, 65.0%). Based on self-reporting, 15.4% had a BMI from 18.5 to 24.9 kgm2 and 37.0% have a BMI of 25 kgm2 or over. Overall, 7.3% of participants reported they were current smokers and 20.6% reported alcohol consumption that is considered moderate/high-risk drinking. Only 21.2% of the sample reported consuming four or more serves of vegetables daily and 37.8% reported consuming two or more serves of fruit daily. There were 48.0% the sample who reported having poor sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI). Conclusion: Regional/rural healthcare workers in Victoria, Australia, were experiencing a moderate to high degree of psychological distress during the early stages of the pandemic. However, most participants demonstrated a normal/high degree of resilience. Findings will be used to inform policy options to support healthcare workers in responding to future pandemics.

Building Trustworthy Generative Artificial Intelligence for Diabetes Care and Limb Preservation: A Medical Knowledge Extraction Case.

Large language models (LLMs) offer significant potential in medical information extraction but carry risks of generating incorrect information. This study aims to develop and validate a retriever-augmented generation (RAG) model that provides accurate medical knowledge about diabetes and diabetic foot care to laypersons with an eighth-grade literacy level. Improving health literacy through patient education is paramount to addressing the problem of limb loss in the diabetic population. In addition to affecting patient well-being through improved outcomes, improved physician well-being is an important outcome of a self-management model for patient health education. We used an RAG architecture and built a question-and-answer artificial intelligence (AI) model to extract knowledge in response to questions pertaining to diabetes and diabetic foot care. We utilized GPT-4 by OpenAI, with Pinecone as a vector database. The NIH National Standards for Diabetes Self-Management Education served as the basis for our knowledge base. The model's outputs were validated through expert review against established guidelines and literature. Fifty-eight keywords were used to select 295 articles and the model was tested against 175 questions across topics. The study demonstrated that with appropriate content volume and few-shot learning prompts, the RAG model achieved 98% accuracy, confirming its capability to offer user-friendly and comprehensible medical information. The RAG model represents a promising tool for delivering reliable medical knowledge to the public which can be used for self-education and self-management for diabetes, highlighting the importance of content validation and innovative prompt engineering in AI applications.

Postpartum depression symptoms: prevalence, risk factors, and childbirth experiences in Palestine

BackgroundWorldwide mothers are suffering from postpartum depression (PPD) which impairs mothers’ well-being, children, and families, and leads to adverse outcomes for mothers and their growing newborns. Low and middle-income countries have a higher prevalence of PPD and limited studies about it. This study assessed the percentage of Palestinian mothers experiencing PPD nationally, identified mothers at a higher risk of PPD, and studied the correlation between PPD and mistreatment during childbirth.MethodsThe study is based on a secondary data analysis from a cross-sectional study in the occupied Palestinian territory (oPt). A total of 745 telephone-based interviews with mothers were done within 2–4 weeks post-childbirth. The Patient Health Questionnaire (PHQ-9) was used as a screening tool for PPD. The Statistical Package for Social Science (SPSS) was used for analyzing the data.ResultsIn the context of descriptive epidemiology, we observed that 12.6% of the selected Palestinian mothers experienced PPD, with a higher occurrence of PPD among mothers living in the Gaza Strip, a politically and economically unstable region in Palestine, compared to mothers living in the West Bank (Adjusted Odd Ratio (AOD: 2.2, Confidence Interval (CI): 1.4–3.44). Older mothers were two times more likely to develop PPD compared to young mothers (AOR: 2.03, CI: 1.070–3.84). Mothers who experienced disrespectful behaviors represented by any abuse, negligence, abandonment, ineffective communication, or poor pain management in childbirth settings were more likely to report PPD than those who were not exposed to the disrespect.ConclusionA notable percentage of Palestinian mothers were identified as experiencing PPD, especially among mothers who experienced mistreatment in childbirth settings. It is essential to support healthcare providers to improve their practices and attitudes to eliminate mistreatment and abusive behaviors of mothers during childbirth.

Prevalence and risk factors of depression among patients with perianal fistulizing Crohn’s disease

BACKGROUND Psychological distress, especially depression, associated with perianal fistulizing Crohn’s disease (PFCD) is widespread and refractory. However, there is a surprising paucity of studies to date that have sought to identify the prevalence and risk factors of depression associated with PFCD. AIM To estimate the prevalence of depressive symptoms and investigate the depression-related risk factors in patients with PFCD. METHODS The study was conducted in the form of survey and clinical data collection via questionnaire and specialized medical staff. Depressive symptoms, life quality, and fatigue severity of patients with PFCD were assessed by Patient Health Questionnaire-9, Inflammatory Bowel Disease Patient Quality of Life Questionnaire (IBDQ), and Inflammatory Bowel Disease (IBD) Fatigue Patient Self-assessment Scale. The basic demographic information, overall disease features, perianal clinical information, and laboratory inflammation indicators were also gathered. Multivariate regression analysis was ultimately used to ascertain the risk factors of depression associated with PFCD. RESULTS A total of 123 patients with PFCD were involved, and 56.91% were suffering from depression. According to multivariate logistic regression analysis, Perianal Disease Activity Index (PDAI) score [odds ratio (OR) = 0.69, 95% confidence interval (CI): 0.50 to 0.95], IBDQ score (OR = 0.93, 95%CI: 0.88 to 0.97), modified Van Assche index (OR = 1.24, 95%CI: 1.01 to 1.53), and IBD Fatigue score (OR = 1.72, 95%CI: 1.23 to 2.42) were independent risk factors of depression-related prevalence among patients with PFCD (P &lt; 0.05). Multiple linear regression analysis revealed that the increasing perianal modified Van Assche index (β value = 0.166, 95%CI: 0.02 to 0.31) and decreasing IBDQ score (β value = -0.116, 95%CI: -0.14 to -0.09) were independently associated with the severity of depression (P &lt; 0.05). CONCLUSION Depressive symptoms in PFCD patients have significantly high prevalence. PDAI score, modified Van Assche index, quality of life, and fatigue severity were the main independent risk factors.

Identifying Internet addiction profiles among adolescents using latent profile analysis: Relations to aggression, depression, and anxiety

BackgroundWhile many studies have established a positive correlation between adolescents' internet addiction and mental health problems, most of these studies have overlooked the internal heterogeneity of Internet addiction. This study aims to identify latent profiles among adolescents based on their Internet addiction and to examine the differences in aggression, depression, and anxiety across these profiles. MethodsWe conducted a survey involving 7422 adolescents and administered the Young's Internet Addiction Test, Aggression Behavior Questionnaire, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Scale. Latent profile analysis was utilized to categorize Internet addiction profiles among adolescents. Associations between Internet addiction profiles and related factors were examined using the Bolck-Croon-Hagenaars method. ResultsLatent profile analysis suggested four profiles of Internet addiction, which were labeled: Regular, Risk, Low Internet addiction, and Internet addiction. The Internet addiction profile showed higher levels of aggression, depression, and anxiety than the Low Internet addiction profile. The Low Internet addiction profile had higher levels of aggression, depression, and anxiety than the Risk profile. The Risk profile demonstrated higher levels of aggression, depression, and anxiety when compared to the Regular profile. LimitationsLimitations include the cross-sectional design and the self-report measures. ConclusionsThe identified Internet addiction profiles offer differential predictions for aggression, depression, and anxiety. These results underscore the significance of employing latent profile analysis when exploring the associations between Internet addiction and mental health issues.

Mental health and insomnia problems in healthcare workers after the COVID-19 pandemic: A multicenter cross-sectional study

BACKGROUND Healthcare workers (HCWs) are at increased risk of contracting coronavirus disease 2019 (COVID-19) as well as worsening mental health problems and insomnia. These problems can persist for a long period, even after the pandemic. However, less is known about this topic. AIM To analyze mental health, insomnia problems, and their influencing factors in HCWs after the COVID-19 pandemic. METHODS This multicenter cross-sectional, hospital-based study was conducted from June 1st, 2023 to June 30th, 2023, which was a half-year after the end of the COVID-19 emergency. Region-stratified population-based cluster sampling was applied at the provincial level for Chinese HCWs. Symptoms such as anxiety, depression, and insomnia were evaluated by the Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Insomnia Severity Index. Factors influencing the symptoms were identified by multivariable logistic regression. RESULTS A total of 2000 participants were invited, for a response rate of 70.6%. A total of 1412 HCWs [618 (43.8%) doctors, 583 (41.3%) nurses and 211 (14.9%) nonfrontline], 254 (18.0%), 231 (16.4%), and 289 (20.5%) had symptoms of anxiety, depression, and insomnia, respectively; severe symptoms were found in 58 (4.1%), 49 (3.5%), and 111 (7.9%) of the participants. Nurses, female sex, and hospitalization for COVID-19 were risk factors for anxiety, depression, and insomnia symptoms; moreover, death from family or friends was a risk factor for insomnia symptoms. During the COVID-19 outbreak, most [1086 (76.9%)] of the participating HCWs received psychological interventions, while nearly all [994 (70.4%)] of them had received public psychological education. Only 102 (7.2%) of the HCWs received individual counseling from COVID-19. CONCLUSION Although the mental health and sleep problems of HCWs were relieved after the COVID-19 pandemic, they still faced challenges and greater risks than did the general population. Identifying risk factors would help in providing targeted interventions. In addition, although a major proportion of HCWs have received public psychological education, individual interventions are still insufficient.

Development and Validation of a Nomogram for Predicting Nutritional Risk Based on Frailty Scores in Older Stroke Patients

BackgroundIn older stroke patients with frailty, nutritional deficiencies can amplify their susceptibility, delay recovery, and deteriorate prognosis. A precise predictive model is crucial to assess their nutritional risk, enabling targeted interventions for improved clinical outcomes.ObjectiveTo develop and externally validate a nutritional risk prediction model integrating general demographics, physical parameters, psychological indicators, and biochemical markers. The aim is to facilitate the early identification of older stroke patients requiring nutritional intervention.MethodsThis was a multicenter cross-sectional study. A total of 570 stroke patients were included, 434 as the modeling set and 136 as the external validation set. The least absolute shrinkage selection operator (LASSO) regression analysis was used to select the predictor variables. Internal validation was performed using Bootstrap resampling (1000 iterations). The nomogram was constructed based on the results of logistic regression. The performance assessment relied on the receiver operating characteristic curve (ROC), Hosmer–-Lemeshow test, calibration curves, Brier score, and decision curve analysis (DCA).ResultsThe predictive nomogram encompassed seven pivotal variables: Activities of Daily Living (ADL), NIHSS score, diabetes, Body Mass Index (BMI), grip strength, serum albumin levels, and depression. Together, these variables comprehensively evaluate the overall health and nutritional status of elderly stroke patients, facilitating accurate assessment of their nutritional risk. The model exhibited excellent accuracy in both the development and external validation sets, evidenced by AUC values of 0.934 and 0.887, respectively. Such performance highlights its efficacy in pinpointing elderly stroke patients who require nutritional intervention. Moreover, the model showed robust goodness of fit and practical applicability, providing essential clinical insights to improve recovery and prognosis for patients prone to malnutrition.ConclusionsElderly individuals recovering from stroke often experience significant nutritional deficiencies. The nomogram we devised accurately assesses this risk by combining physiological, psychological, and biochemical metrics. It equips healthcare providers with the means to actively screen for and manage the nutritional care of these patients. This tool is instrumental in swiftly identifying those in urgent need of targeted nutritional support, which is essential for optimizing their recovery and managing their nutrition more effectively.

Burden and preparedness of care partners of people living with amyotrophic lateral sclerosis at home in Korea: A care partner survey.

The care burden of people living with amyotrophic lateral sclerosis (pALS) increases with disease progression. This study aimed to investigate the home care status and preparedness of care partners of pALS (cALS) in Korea. An online survey was conducted with family care partners of patients diagnosed with ALS for over 1 year in 2022. The data collected included care time, depression evaluated using the patient health questionnaire-9 (PHQ-9), preparedness for caregiving scale (PCS), and caregiver competence scale (CCS). Results were compared based on whether the pALS underwent a tracheostomy or not. Ninety-eight cALS of 98 pALS participated in the study, of whom 59 pALS had undergone tracheostomy. Among the cALS, 60.2% were spouses, and 34.7% were children. The cALS took care of the patients for 13 (8-20) hours/day (median, interquartile range [IQR]) on weekdays and 15 (10-24) h/day on weekends. Among the cALS, 91.8% were depressed, and 28.6% had severe depression. The median (IQR) PCS and CCS scores were low (11/32 (8-15) and 8/20 (8-11), respectively), and both were lower in those caring for patients without than with tracheostomy (p < .001 and p < .02, respectively). Most cALS (77.6%) wished to continue caring for their pALS at home. Family care partners of pALS spend more than half of each day caring for patients and are often depressed. Most cALS preferred providing care at home, but felt ill-prepared. Designing home-based medical care is necessary for pALS to thrive at home.

Factors affecting the oral health of patients on maintenance hemodialysis and recommendations for standardized nursing care: a multicenter study.

To determine the oral health status of patients on maintenance hemodialysis (MHD) and to identify the factors influencing their oral health. This observational study included 1,186 patients with chronic kidney disease who received MHD across 33 hospitals in China. The patients were recruited for a questionnaire survey between April and August 2023 at Beijing Chaoyang Hospital using stratified sampling. Data collection tools included the General Information Questionnaire for Maintenance Hemodialysis Patients, the Oral Health Assessment Tool, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale. Spearman's rank correlation coefficients were used to assess the relationships between the oral health of patients on MHD and continuous variables such as sleep quality and emotional status. Multiple linear regression analysis was employed to explore the relationship between oral health and various variables. The oral health scores of the patients ranged from 8 to 22, with a mean score of 12.54 ± 2.63. The final model of the multiple linear regression analysis indicated a goodness of fit of 22.19%. Independent factors affecting the oral health of patients included smoking, the proportion of medical expenses, water consumption, sleep quality, and anxiety scores (all P < 0.05). High levels of smoking, substantial medical expenses, poor sleep quality, and elevated anxiety scores were risk factors for poor oral health (all P < 0.05). Adequate daily water intake served as a protective factor for oral health (P < 0.05). This study proposes targeted interventions to enhance the management and improvement of oral health in patients on hemodialysis, aiming to provide highly personalised and effective oral health care. These interventions are expected to improve oral health outcomes in future clinical practice.