Patient Health Research Articles

COVID-19 Pandemic Increases the Risk of Anxiety and Depression among Adolescents: A Cross-Sectional Study in Rural West Bengal, India

About 14% of adolescents experience mental illnesses globally. The rate increased after the COVID-19 pandemic. This study aimed to estimate the prevalence of COVID-related major mental illnesses (depression and anxiety) and their predictors among adolescents. This community-based cross-sectional study was conducted among 350 adolescents aged 10–19 years, recruited from rural communities in West Bengal, India. The study areas included 27 subcenters in the Budge Budge II Block, which comprised 191,709 population and 45,333 households. Data were collected from randomly selected households by trained research assistants through house-to-house interviews. Pretested standardized questionnaires, Patient Health Questionnaire (PHQ) for depression, Generalized Anxiety Disorder (GAD) for anxiety, and a demographic questionnaire were used for data collection. The prevalence of anxiety was 35.7% (125 out of 350), and the prevalence of depression was 30.0% (105 out of 350). Females had significantly higher scores of anxiety (6.67 ± 4.76 vs. 3.42 ± 3.17, respectively, p < 0.001) and depression (5.51 ± 4.99 vs. 3.26 ± 3.86, respectively, p < 0.001) compared to males. Adolescents who had COVID-19 cases or deaths in the family had significantly higher scores of anxiety and depression compared to those who did not have these events. In multivariate analysis, the statistically significant predictors of anxiety were COVID-19 death in the family, COVID-19 cases in the family, female gender, and a lower income group (p < 0.001 for all). For depression, the significant predictors included COVID-19 death in the family, COVID-19 cases in the family, female gender, a lower income group, and a higher age group in adolescents (p < 0.001 for all). Based on the study results, we recommend that immediate attention is needed for adolescents’ mental health support and coping with stresses following COVID-19.

Resolution of infertility following hydatid cyst removal: a case report

Introduction and Importance: Human echinococcosis, also known as ‘Hydatid cyst,’ constitutes a zoonotic parasitic disease attributed to Echinococcus granulosus or Echinococcus multilocularis. Primary afflictions occur in the liver and lungs, whilst the implication of alternative organs remains infrequent. The clinical presentation can vary and large cysts may cause compression symptoms and complications. This case involved a 21-year-old Palestinian female with three large hydatid cysts in the liver, causing compression of adjacent structures and unique clinical manifestations. Case Presentation: A female-aged 21 arrived with signs of heart palpitations, shortness of breath, tiredness, and pain in the right upper abdomen, alongside a background of infertility. During routine pre-IVF ultrasound, three liver hydatid cysts were unexpectedly found, leading to a referral to the surgical department. Laboratory tests and imaging confirmed this diagnosis. Surgery involved cyst aspiration, hypertonic saline injection, and marsupialization. Postsurgical complications were managed as they occurred. The symptoms lessened afterwards, and a successful pregnancy was achieved nine months post-surgery. Clinical Discussion: Zoonotic infection by cystic echinococcosis (CE) primarily engages liver and lungs. The progression of symptoms is contingent upon cyst placement and resultant pressure on adjacent tissues. Diagnosis requires imaging alongside serological assays, while large cysts necessitate surgical intervention. Conclusion: The presented case underscores the complexity in managing multiple extensive liver hydatid cysts, highlighting the necessity to consider hydatid disease amidst patients presenting with indeterminate symptoms, particularly within endemic zones. An extensive surgical strategy produced positive outcomes, illustrating the significance of prompt intervention for symptom alleviation and sustained patient health.

Disparities in mental health screening for veteran women with a new diagnosis of breast cancer.

222 Background: Compared to the general population, mental health disorders, including depression, are higher for Veteran women. Breast cancer (BC) is the most commonly diagnosed cancer in this population and up to 50% of women will experience depressive symptoms after diagnosis, associated with poor prognosis and survival. An increasing number of Veteran women live in rural areas, where access to behavioral health care may be limited. This study sought to evaluate rural disparities in mental health screening and follow-up evaluation after a new BC diagnosis. Methods: Women Veterans with a new BC diagnosis were identified between 2017 and 2021. Data for mental health screenings [Patient Health Questionnaire (PHQ)-2, PHQ-9, General Anxiety Disorder-7] were collected subsequent to the first BC diagnosis. Rurality was defined per the USDA Rural-Urban Commuting Area (RUCA) codes framework to determine rurality based on population density and commuting patterns. Data were abstracted from several large VA and non-VA datasets, including the Corporate Data Warehouse (CDW) Outpatient files, non-VA Care Medical and Pharmacy System files, Program Integrity Tool, and VA Informatics and Computing Infrastructure for Oncology. Rurality data was specified using CDW designations combined with ZIP-code-level USDA RUCA information. All categorical variables were analyzed using chi-square tests. Means were tested using t-tests. Results: 14,225 Veteran women with a new BC diagnosis were identified. The mean age was 63.4 (SD 11.7). The most common documented race was White (30.6%), followed by Black (15.7%). 59.6% lived in an urban setting as opposed to rural setting (40.4%). In the entire population, only 14% had a mental health screening within 3 months of a cancer diagnosis. Veteran women living in an urban setting were more likely to be screened compared to those living in a rural setting (17.4% vs 9.2%, p < 0.001). For women screened within 3 months, most screened negative, regardless of rurality (76.1% rural, 75.7% urban). Of women who had a positive mental health screen within 3 months, only approximately one-third (31.8% rural, 34.2% urban) had additional screening regardless of rurality. However, for those with a negative initial screen, urban Veterans were more likely to have any additional screening (17% vs 10.2%, p = 0.001). PHQ-2 was the most common mental health screening tool used (73.8%) followed by a combination of PHQ-9 and GAD-7 (9.6%). Conclusions: Mental health screening within 3 months of breast cancer diagnosis is low for Veteran women. There is a significant difference in screening between rural and urban populations. It is critical to both improve mental health screening overall in this population and bridge the disparity gap between screening in rural and urban Veteran women. This may impact not only mental health but also breast cancer outcomes during the period encompassing treatment and survivorship.

A genome-wide gene-environmental interaction study identified novel loci for the relationship between ambient air pollution exposure and depression, anxiety

BackgroundGenetic factors and environmental exposures, including air pollution, contribute to the risk of depression and anxiety. While the association between air pollution and depression and anxiety has been established in the UK Biobank, there has been limited research exploring this relationship from a genetic perspective. MethodsBased on individual genotypic and phenotypic data from a cohort of 104,385 participants in the UK Biobank, a polygenic risk score for depression and anxiety was constructed to explore the joint effects of nitric oxide (NO), nitrogen dioxide (NO2), particulate matter (PM) with a diameter of ⩽2.5 μm (PM2.5) and 2.5–10 μm (PMcoarse) with depression and anxiety by linear and logistic regression models. Subsequently, a genome-wide gene-environmental interaction study (GWEIS) was performed using PLINK 2.0 to identify the genes interacting with air pollution for depression and anxiety. ResultsA substantial risk of depression and anxiety development was detected in participants exposed to the high air pollution concomitantly with high genetic risk. GWEIS identified 166, 23, 18, and 164 significant candidate loci interacting with NO, NO2, PM2.5, and PMcoarse for Patient Health Questionnaire-9 (PHQ-9) score, and detected 44, 10, 10, and 114 candidate loci associated with NO, NO2, PM2.5, and PMcoarse for General Anxiety Disorder (GAD-7) score, respectively. And some significant genes overlapped among four air pollutants, like TSN (rs184699498, PNO2 = 3.47 × 10−9; rs139212326, PPM2.5 = 1.51 × 10−8) and HSP90AB7P(rs150987455, PNO2 = 1.63 × 10−11; rs150987455, PPM2.5 = 7.64 × 10−11), which were common genes affecting PHQ-9 score for both NO2 and PM2.5. ConclusionOur study identified the joint effects of air pollution with genetic susceptibility on the risk of depression and anxiety, and provided several novel candidate genes for the interaction, contributing to an understanding of the genetic architecture of depression and anxiety.

Indonesian Patient Health Questionnaire's Clinical Utility in Psychiatric Outpatients: Ruling Out Conditions per ICD-11 Criteria

This study aimed to assess the diagnostic accuracy of the Patient Health Questionnaire (PHQ) for identifying common mental disorders in an outpatient clinical psychologist office setting in Indonesia. A total of 661 outpatients from a clinical psychology office in Jakarta, Indonesia, participated in the study. The complete PHQ was administered, and its results were compared with diagnoses made by clinical psychologists based on ICD-11 criteria, including somatoform disorder (n = 6), depression (n = 117), Generalized Anxiety Disorder (GAD, n = 50), panic disorder (n = 42), bulimia nervosa (n = 2), binge eating disorder (n = 2), and other diagnoses such as OCD and BPD (n = 442). Receiver operating characteristics were computed to examine cut-off points, and optimal cut-off points based on the Youden Index were identified for somatoform disorder (PHQ-15 ≥ 13), depression (PHQ-9 ≥ 13), GAD (GAD- 7 ≥ 10), and panic disorder (PHQ-PD ≥ 7). Cut-off points for the alcohol abuse and eating disorder modules of the PHQ could not be determined due to a lack of sample, and AUC was suboptimal for PHQ-9, GAD-7, and PHQ-ED. The Indonesian PHQ demonstrated good sensitivity but low specificity in identifying somatoform disorder, depression, GAD, and panic disorders based on ICD-11 criteria among Indonesian clinical psychologist office outpatients. In the Indonesian outpatient psychiatric context, the utility of the Indonesian PHQ appeared to be most effective in ruling out diagnoses.

Artificial intelligence in action: Improving breast disease management through surgical robotics and remote monitoring

ObjectivesThis article aims to discuss the transformative impact of artificial intelligence (AI) on the identification and management of breast diseases, with a specific focus on breast cancer. Materials and methodsHealthcare providers have integrated AI technologies such as surgical robots and remote monitoring systems to improve the accuracy and efficiency of breast disease diagnosis and treatment. ResultsSurgical robots equipped with AI algorithms provide real-time guidance to surgeons, analyze imaging data, and ensure precise procedures for better outcomes in breast cancer surgeries. AI-driven remote monitoring systems allow for close monitoring of patient health data, disease progression prediction, and personalized treatment recommendations. ConclusionsThe incorporation of AI technology into healthcare practices for breast diseases has revolutionized patient care delivery, enhancing outcomes, promoting patient engagement, and improving overall quality of care. These advancements offer personalized and tailored healthcare strategies that meet the unique needs of each patient, reshaping the healthcare industry.

Associations of symptom burden with patient-reported outcomes (PROs) and clinical outcomes among early phase cancer clinical trial (EP-CT) participants.

244 Background: Individuals with cancer often endure a substantial physical and psychological symptom burden. However, little is known about the baseline symptom burden of patients with cancer participating in EP-CTs or the associations of this symptom burden with other PROs and clinical outcomes. Methods: We prospectively enrolled adults with cancer participating in EP-CTs at Massachusetts General Hospital from 4/2021-1/2023. Participants completed baseline surveys prior to EP-CT initiation that assessed symptoms (Edmonton Symptom Assessment System [ESAS]), quality of life (QOL; Functional Assessment of Cancer Therapy-General), hope (Herth Hope Index), depression/anxiety symptoms (Patient Health Questionnaire-4 [PHQ-4]), and financial wellbeing (COST tool, higher scores indicate greater financial wellbeing). We used regression models to explore associations of baseline symptom burden with other PROs (QOL, hope, depression/anxiety, financial wellbeing) and clinical outcomes (time on trial, hospitalizations, overall survival). Results: Among 205 participants (median age=63.3 [range: 31.8-88.6], 57.1% female), the most common cancer types were gastrointestinal (34.6%), breast (20.0%), and head and neck (10.2%). Based on the ESAS, approximately half of participants reported moderate/severe fatigue (50.2%) and poor wellbeing (49.5%). Under half reported moderate/severe drowsiness (35.7%), pain (25.9%), lack of appetite (25.4%), shortness of breath (20.0%), anxiety (18.0%), depression (15.4%), and nausea (9.2%). Higher baseline ESAS total, physical, and psychological scores were associated with worse QOL, lower hope, greater PHQ-4 depression/anxiety symptoms, and worse financial wellbeing (see Table). Higher baseline ESAS scores were associated with decreased time on trial and worse overall survival (see Table). Conclusions: In this study of EP-CT participants, we found associations of baseline symptom burden with other important PROs and clinical outcomes. Specifically, higher baseline symptom burden was associated with decreased QOL, lower hope, increased depression/anxiety symptoms, and diminished financial wellbeing as well as greater risk for shorter time on trial and worse survival. Interventions seeking to enhance care delivery and outcomes for EP-CT participants should strive to address the symptom burden of this population. Outcomes ESAS Total ESAS Physical ESAS Psychological PROs Beta P Beta P Beta P QOL -0.55 <0.001 -0.68 <0.001 -1.93 <0.001 Hope -0.10 <0.001 -0.09 <0.001 -0.53 <0.001 PHQ-4 Depression/Anxiety 0.06 <0.001 0.06 <0.001 0.39 <0.001 Financial Wellbeing -0.13 0.003 -0.16 0.009 -0.36 0.032 Clinical Outcomes HR P HR P HR P Hospitalizations 1.01 0.066 1.02 0.059 1.03 0.290 Time on Trial 1.01 0.069 1.01 0.208 1.04 0.046 Overall Survival 1.02 <0.001 1.03 <0.001 1.04 0.088

Development of a predictive model for the U-shaped relationship between the triglyceride glycemic index and depression using machine learning (NHANES 2009-2018)

BackgroundAt present, the relationship between depression and the triglyceride glycemic (TyG) index remains a topic of debate. This study sought to elucidate the relationship between depression and the TyG index to create a predictive model that would help doctors diagnose patients. MethodsWe conducted a cross-sectional study utilizing the National Health and Nutrition Examination Survey (NHANES) dataset, which comprises data from 2009 to 2018. The analysis involved 11,222 adults with a Patient Health Questionnaire-9 (PHQ-9) score of 5 or higher, indicating the presence of depression. As part of the analysis, multiple regression models were used to test whether a linear relationship existed between the TyG index and depression. A threshold effects analysis was used to generate smoothed curves and detect nonlinear correlations. Additionally, the Least Absolute Shrinkage and Selection Operator (LASSO) regression were employed to identify the key risk factors associated with depression. The factors identified were then used to construct the risk prediction nomogram. Finally, Receiver Operating Characteristic (ROC) curves were used to evaluate the discriminative performance of the model. ResultsMultivariable linear regression analysis indicated a strong positive correlation between depression and the TyG index (β: 0.38, 95% CI: 0.16‒0.60, p=0.0008). A U-shaped relationship with an inflection point was observed at a TyG index of 8.16. The nomogram model, constructed using risk factors identified by LASSO, exhibited a significant predictive value (AUC=0.888). ConclusionsThe results of this investigation point to a U-shaped association between depression risk and the TyG index among Americans. Those with a TyG index of over 8.16 are significantly more likely to develop depression. These results suggest a possible causal relationship and emphasize the importance of monitoring the TyG index in depression risk assessment.

THE EFFECTS OF EXERCISE INTENSITY ON METABOLIC HEALTH IN PATIENTS WITH NAFLD AND TYPE 2 DIABETES: A COMPARATIVE STUDY

Introduction: Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are chronic metabolic disorders that are increasingly prevalent globally, posing significant health challenges. Both conditions are linked to obesity, insulin resistance, and sedentary lifestyles, leading to severe complications such as cardiovascular diseases and liver cirrhosis. Exercise is a crucial lifestyle modification that improves metabolic health in these conditions, but the optimal exercise intensity remains debated. This study investigates the effects of different exercise intensities on metabolic health in patients with NAFLD and T2DM to provide insights for tailored exercise prescriptions. Materials and Methods: This randomized controlled trial involved 100 participants with NAFLD and T2DM, divided into two groups: MICT and HIIT, over 12 weeks. Participants were adults aged 30-65 years with confirmed NAFLD and T2DM, and a sedentary lifestyle. Exclusion criteria included other liver diseases, uncontrolled hypertension, severe diabetic complications, recent participation in a structured exercise program, and contraindications to exercise. Participants were randomly assigned to MICT or HIIT, with exercise sessions supervised by certified physiologists. Primary outcomes were liver fat content and insulin sensitivity, while secondary outcomes included lipid profiles, inflammatory markers, feasibility, and safety. Results: A total of 100 participants (50 per group) completed the study with comparable baseline characteristics. Both groups showed significant reductions in liver fat content and improvements in insulin sensitivity, with HIIT showing greater reductions (p=0.01 for liver fat, p=0.02 for insulin sensitivity). HIIT also led to more significant improvements in triglycerides, LDL, HDL, and inflammatory markers compared to MICT. Adherence rates were high in both groups, although slightly lower in the HIIT group, and dropout rates were comparable. Conclusion: Both MICT and HIIT significantly improve metabolic health in patients with NAFLD and T2DM, with HIIT yielding superior outcomes in reducing liver fat, improving insulin sensitivity, enhancing lipid profiles, and decreasing inflammatory markers. These findings support incorporating HIIT into exercise regimens for this population, highlighting its potential for greater metabolic health benefits. Future research should explore the long-term sustainability and broader applicability of HIIT and strategies to enhance adherence and safety.

Evaluation of the Level of Alkaline Phosphatase, Calcium, and Vitamin D3 in Patients with Celiac Disease

Background: Celiac disease, sometimes called wheat allergy, is multiple names for one disease. It is a long-term acquired autoimmune disease that primarily affects the small intestine, as individuals develop intolerance to gluten, which is found in foods such as wheat, rye, and barley. Aim of the study: Our study aims to monitor biochemical parameters such as alkaline phosphatase, calcium, and vitamin D3 as an indicator to monitor the progress of bone health in the blood serum of patients with celiac disease in Wasit Governorate/Iraq. Materials and methods: In this research, studied 80 samples, including 50 samples from patients with celiac disease of both sexes, 19 men and 31 women With 30 control samples for both sexes equally. used an Enzyme-linked immunosorbent assay (ELISA) kit to measure the concentrations of vitamin D3 and alkaline phosphatase, while a Cobas c111 device was used for calcium. Results: The results showed that the level of alkaline phosphatase increased more in patients with celiac disease than in the control group at p≤(0.05), while the concentrations of calcium and vitamin D3 decreased more than in the control group at p≤(0.05). Conclusion: The studied criteria contribute as indicators of developing health risks to the body and bone health in patients with celiac disease.

Changes in patient-reported outcomes during admission to a South African psychiatric facility.

Patient-reported outcome measures (PROMs) are used as part of clinical practice to determine the impact of the condition and treatment interventions on a patient's health and quality of life. The Patient Health Questionnaire-9 (PHQ-9) is a self-administered diagnostic tool that has been widely adopted for the detection and monitoring of depression. This analysis reports the change in PHQ-9 scores from admission to discharge in patients admitted for depression to a South African acute psychiatric facility and aims to quantify the treatment effect of the admission using the PHQ-9 as the measurement tool. South African acute psychiatric facility. This was a retrospective observational study of all patients admitted to Netcare Akeso acute psychiatric facilities from 01 January 2018 to 31 October 2022. Patients were included if they were ≥ 18 years of age, admitted with a primary International Classification of Disease (ICD)-10 code for depression (i.e. F32-F33) and fully completed both an admission and discharge PHQ-9 questionnaire. We excluded facilities focusing only on the treatment of patients with specialised conditions such as addiction or eating disorders. This analysis included 13 308 patients admitted for depression at 10 different facilities. The median PHQ-9 score on admission was 19 (interquartile range [IQR] 14-23) and 5 (IQR 2-11) on discharge, with a median change of -12 (IQR -5 to -18). A minimal clinically important difference was seen in 87.6% patients (n = 10 091/11 515); a treatment effect was seen in 74.5% of patients and a clinically significant improvement was seen in 72.1% of patients. With the average patient reporting a four-fold reduction in the severity of their depression scores, PROMs provide a critical patient-centred window into the benefit that an inpatient admission has on those suffering with depression. These changes are consistent with those seen internationally and provide a baseline for understanding the treatment efficacy of an inpatient admission for the treatment of depression.

A Development of an IoT-Based Healthcare System Using Distributed Blockchain Technology

Modern healthcare systems have two main sections: electronic health records (EHRs) and remote patient monitoring (RPM). With these sections, several issues have arisen related to comprehensiveness, which these sections lack in covering all the data information about the patient’s state, and other issues in privacy and security. Many types of research have been presented to solve these issues or mitigate their effects. One of these ideas is to use blockchain technology. However, some research may not utilize this technique properly, where data comprehensiveness problems remain and the preservation of individual nodes' data may be compromised. This paper introduces a new system called Patient Health Record (PHR), which will provide comprehensive patient health data and IoT device reading. PHR data is protected using a multi-peer, distributed, and decentralized system based on blockchain. A smart contract has been created for the system through which the PHR data will be cached in the blockchain. It is deployed on the Proof of Authority network to increase the speed of transaction processing, which is important in processing data for IoT devices. The proposed system is evaluated according to a range of metrics (cost, immutability, data storage, and estimated time) to validate the system.

SURVEY ON CAREGIVERS' BURDEN OF CARE PATIENTS WITH CHRONIC STROKE AND CONSIDERATIONS ON THE ROLE OF THEPHYSIOTHERAPIST

Background: Therole of caregivers in the rehabilitation process is crucial, yet the impact of caregiving on their well-beingis not fully understood.This study aims to analyze the psycho-physical load on caregivers of chronic stroke patients, evaluate the variables affecting their health, and assess the significance of physiotherapists in improving patient rehabilitation outcomes. Materials: A sample of 30 chronic strokepatients and their caregivers involving home-based rehabilitation services was examined over eight weeks. The study utilized various scales such as the Short Form Health Survey 36 (SF-36), Barthel Index, Stroke Impact Scale 3.0, Modified Rankin Scale, and Caregiver Burden Inventory to assess the health status of patients and the burden on caregivers before and after the intervention. Results: The study found significant improvements in patient health metrics (SF-36, Barthel Index, Stroke Impact Scale, Modified Rankin Scale) post-rehabilitation. Similarly, a notable reduction in caregiver burden was observed, highlighting the effectiveness of targeted physiotherapy interventions in alleviating the psycho-physical stress on caregivers.

Impact of Digital Health Interventions on Birth Equity: A Review.

The rise in smartphone utilization and technology uptake has popularized digital health interventions as a means of supporting healthy pregnancies and optimizing maternal and child health. Digital health interventions include several modalities, such as telemedicine, remote patient monitoring, smartphone applications, web-based interventions, wearables, and health information technology. However, the impact of these interventions on improving maternal and infant health outcomes by race and socioeconomic status to achieve birth equity is unknown. This review summarizes current literature on the impact of digital health interventions on the outcomes of communities of color and lower socioeconomic status in the United States. We demonstrate there is emerging evidence of the impact of digital health interventions on maternal health outcomes, particularly for telemedicine, but evidence specifically focused on assessing outcomes by race and ethnicity and for other modalities, like mHealth apps or wearables, is limited. Digital health interventions may play a part in birth equity initiatives, but should not be considered a standalone solution, and instead should be integrated into other existing efforts to achieve birth equity, like diversifying the clinician workforce, expanding access to high-quality prenatal and postpartum care, or delivering respectful maternity care.

Proposed Nutrition Competencies for Medical Students and Physician Trainees: A Consensus Statement.

In 2022, the US House of Representatives passed a bipartisan resolution (House of Representatives Resolution 1118 at the 117th Congress [2021-2022]) calling for meaningful nutrition education for medical trainees. This was prompted by increasing health care spending attributed to the growing prevalence of nutrition-related diseases and the substantial federal funding via Medicare that supports graduate medical education. In March 2023, medical education professional organizations agreed to identify nutrition competencies for medical education. To recommend nutrition competencies for inclusion in medical education to improve patient and population health. The research team conducted a rapid literature review to identify existing nutrition-related competencies published between July 2013 and July 2023. Additional competencies were identified from learning objectives in selected nutrition, culinary medicine, and teaching kitchen curricula; dietetic core competencies; and research team-generated de novo competencies. An expert panel of 22 nutrition subject matter experts and 15 residency program directors participated in a modified Delphi process and completed 4 rounds of voting to reach consensus on recommended nutrition competencies, the level of medical education at which they should be included, and recommendations for monitoring implementation and evaluation of these competencies. A total of 15 articles met inclusion criteria for competency extraction and yielded 187 competencies. Through review of gray literature and other sources, researchers identified 167 additional competencies for a total of 354 competencies. These competencies were compiled and refined prior to voting. After 4 rounds of voting, 36 competencies were identified for recommendation: 30 at both undergraduate and graduate levels, 2 at the undergraduate level only, and 4 at the graduate level only. Competencies fell into the following nutrition-related themes: foundational nutrition knowledge, assessment and diagnosis, communication skills, public health, collaborative support and treatment for specific conditions, and indications for referral. A total of 36 panelists (97%) recommended nutrition competencies be assessed as part of licensing and board certification examinations. These competencies represent a US-based effort to use a modified Delphi process to establish consensus on nutrition competencies for medical students and physician trainees. These competencies will require an iterative process of institutional prioritization, refinement, and inclusion in current and future educational curricula as well as licensure and certification examinations.

"If They Help Us, We Can Help Them": First Nations Peoples Identify Intercultural Health Communication Problems and Solutions in Hospital in Northern Australia.

Effective intercultural communication between First Nations peoples and healthcare providers in colonised countries is required to deliver equitable healthcare and improve patient experiences and health outcomes. This paper presents First Nations peoples' perspectives and proposed solutions to problematic communication experiences at Royal Darwin Hospital in northern Australia. The study's methodological foundations comprise decolonising principles rooted in Critical Race Theory, Freirean pedagogy, and cultural safety. Eleven individuals from diverse First Nations backgrounds receiving treatment at the largest hospital in the Northern Territory, participated in in-depth interviews conducted in their preferred languages. Data were inductively analysed, adapted from a constructivist grounded theory approach and guided by First Nations knowledges. First Nations patients at Royal Darwin Hospital described a culturally unsafe hospital due to ineffective intercultural communication. Patient "counterstories" recounted instances of confusion, aggression, healthcare provider resistance to shared decision-making opportunities, pressure to abandon cultural protocols, and institutional neglect. Poor communication incited anger among staff and patients, and contributed to experiences of racism, missed appointments, clinical mistakes, patients prematurely discharging before completing treatment, and patients experiencing financial troubles and homelessness. In a spirit of generosity, patients proposed solutions focused on relationship building and mutual understanding so that new decolonised systems, which draw on First Nations and Western knowledges, can be codesigned. This study serves as a call to action for policymakers, administrators, and healthcare providers to prioritise improving intercultural communication by addressing the behaviour of staff and changing systemically racist policies in the pursuit of health equity and cultural safety for First Nations peoples.

The Power of Thought: The Role of Psychological Attentiveness and Emotional Support in Patient Trajectories.

In modern healthcare, the influence of a patient's mindset on health outcomes is an often neglected yet vital component of holistic care. This review explores the significant impact of positive and negative mindsets on disease progression and recovery, emphasizing the need to integrate mental wellness practices into conventional medical care. Drawing from a wide array of studies, it demonstrates how fostering a positive mindset can enhance patient trajectories across various medical specialties. The article advocates for training healthcare providers to adopt a more empathetic and patient-centered approach, bridging the gap between mind and body. By presenting compelling evidence on the correlation between patient mindset and health outcomes, this review highlights the potential benefits of incorporating psychological support and holistic strategies into standard care protocols. Practical strategies for implementing mindset-focused interventions are also proposed, including training programs for healthcare professionals and the development of interdisciplinary treatment plans. Ultimately, this article underscores the need for a paradigm shift in medical practice, advocating for a comprehensive approach that recognizes the power of thought in promoting patient wellness.

Prevalence and management of depressive symptoms in coronary heart disease patients and relationship with cardiovascular prognosis: a prospective cohort study

AimsDepressive symptoms are comorbid with coronary heart disease (CHD). There is a controversial debate about whether screening and intervention for depressive symptoms could improve cardiovascular prognosis. This study characterizes the prevalence, characteristics, cardiovascular prognosis and management need of depressive symptoms among CHD patients.MethodsCHD patients were recruited between November 18, 2020 and November 26, 2021. Depressive symptoms were evaluated with the Patient Health Questionnaire (PHQ-9). During the 12-month follow-up, cardiovascular disease (CVD) was the endpoint. Time-to-event data were estimated by Kaplan-Meier curves and Cox models.ResultsOf 582 patients (25% women), 21.0% had mild depressive symptoms, and 7.5% had moderate-to-severe depressive symptoms during hospitalization. Mild and moderate-to-severe depressive symptoms were risk factor-adjusted predictors of the primary composite endpoints (adjusted HR = 2.20; 95%CI 1.19–4.03, and adjusted HR = 2.70; 95%CI 1.23–5.59, respectively). Platelet count and low-density lipoprotein were higher in mild depressive symptoms compared to no depressive symptoms.ConclusionDepressive symptoms are prevalent in CHD patients. Mild and moderate-to-severe depressive symptoms are associated with higher risk of further CVD in CHD patients. Platelet function and behavioral mechanisms may contribute to this association.Trial registrationThis research was registered at https://www.chictr.org.cn. Full data of first registration is 11/09/2020. The registration number is ChiCTR2000038139.

Influence of Depression and Subjective Health Status on COVID-19 Vaccine Acceptance: Based on the 2021 Community Health Survey

Background: Coronavirus Disease 2019 (COVID-19) is a novel coronavirus identified in 2019 that exhibited an exceptionally rapid spread. Although the development and administration of COVID-19 vaccines progressed quickly, concerns about side effects and safety persisted. This study utilized data from the 2021 Community Health Survey to analyze the relationship between COVID-19 vaccination and psychosocial factors, including depression and subjective health status.Methods: Analysis included 203,449 individuals, excluding those who had not received or were ineligible for the COVID-19 vaccine, based on the 2021 Community Health Survey. The chi-square tests assessed sociodemographic and health status differences related to vaccination status. Subjective health status was categorized based on survey responses as ‘good’ or ‘poor,’ and depression was assessed using the self-reported Patient Health Questionnaire-9. The association between depression, subjective health status, and vaccination status was examined using chi-square tests, followed by multiple logistic regression to determine independent effects.Results: Vaccination rates were higher among the elderly, those with lower education, higher income, healthcare workers, and individuals with lower depression, higher subjective health, and chronic conditions like hypertension or diabetes. Significantly lower vaccination rates were observed in those with lower subjective health and Patient Health Questionnaire-9 scores ≥5 or ≥10. Among individuals with chronic illnesses, those with good subjective health had the lowest odds for non-vaccination (odds ratio=0.42; 95% confidence interval, 0.39-0.45), while those without chronic illnesses and poor subjective health had the highest odds (odds ratio=1.89; 95% confidence interval, 1.76-2.02).Conclusions: This study found significantly higher odds ratios for vaccine non-receipt among individuals with lower levels of depression and subjective health status. Incorporating psychosocial factors such as depression and subjective health status may be crucial in developing strategies to enhance vaccination rates during future outbreaks of novel infectious diseases.

Australian medical regulations and strengthened continuing professional development (CPD): A policy implementation gap analysis with the specialist medical colleges

Introduction: Starting from 2023, Australian medical practitioners must meet new mandatory continuing professional development (CPD) requirements for registration renewal. In particular, each year they must complete 12.5 hours of educational activities and 25 hours of CPD activities related to reviewing performance and measuring outcomes, with a minimum of 5 hours each for reviewing performance and measuring outcomes activities, and they are encouraged to use patient health data and large eHealth datasets for better insights. Despite concerns regarding data accessibility and outcome measurement, specialist medical colleges are implementing these requirements. This study aims to explore factors influencing colleges’ efforts and provide recommendations for future research and action to enable data-driven CPD practices. Methods: A policy implementation gap analysis employing semi-structured interviews as a standalone method was conducted with participating colleges. Four colleges agreed to participate, with a total of 18 participants recruited from either the colleges’ staff who are responsible for interpreting and implementing CPD regulatory policies or the colleges’ CPD committees. Interviews were analysed using inductive and deductive thematic analysis. Data collection, data analysis and final results were reported using the COREQ checklist. Results: Three themes were identified from the interview analysis: (1) colleges' organisational structure and their roles and responsibilities within the Australasian CPD ecosystem, (2) challenges and enablers for policy implementation and (3) organisational needs and future actions at college level and necessary pre-conditions at ecosystemic level for strengthened CPD. Conclusions: Internal and external organisational factors are hindering colleges’ efforts to implement policy. More research, a reassessment of colleges’ roles, responsibilities and structure, and collaboration among colleges and data holders are necessary to enable full policy implementation and strengthened CPD practices.