Impaired Health Research Articles

Does sedentary time and physical activity predict chronic back pain and morphological brain changes? A UK biobank cohort study in 33,402 participants

BackgroundThe relationship between sedentary time, physical activity, and chronic back pain remains unclear. The study aims to investigate whether sedentary time and physical activity predict chronic back pain and morphological brain changes.MethodsThis cohort study recruited adults aged 37–73 years enrolled between 2006 and 2010, with follow-up until 2014. The total cohort comprised 33,402 participants (mean age: 54.53). Data were collected on daily sedentary time, physical activity, lifestyle factors, and health outcomes.ResultsAfter nearly 8-year follow-up, 3,006 individuals (9.00%) reported chronic back pain in total. Individuals with daily sedentary time exceeding 6 h had a 33% higher risk of chronic back pain compared to those with sedentary time of 2 h or less (RR, 1.33, 95%CI, 1.17–1.52). Sedentary time was also associated with decreased grey matter volume in several brain regions, including bilateral primary somatosensory cortex (S1), secondary somatosensory cortex, putamen, primary motor cortex (M1), insula, hippocampus, amygdala, as well as right supplementary motor area, left medial frontal cortex, and right anterior cingulate cortex (FDR-corrected p-value < 0.05). Compared to individuals who sat for more than 6 h with light physical activity, those engaging in moderate physical activity with sedentary time of 2 h or less (RR, 0.71, 95%CI, 0.52–0.99) exhibited a significant decrease in chronic back pain risk. In addition, replacing sedentary time with equivalent amount of physical activity also demonstrated a reduction in the risk of chronic back pain (RR, 0.87, 95%CI, 0.77–0.99) and increased the reginal grey matter volumes including the amygdala, insula, M1, putamen and S1.ConclusionsProlonged sedentary time is associated with heightened risks of chronic back pain and deterioration in brain health.

Alcohol use disorders among healthcare professionals: a call for action.

Alcohol consumption and harmful and hazardous drinking are significant contributors to the global burden of disease, accounting for about 3 million deaths each year globally. Owing to their stressful work environment, healthcare professionals are at a high risk of experiencing physical and mental health problems, particularly alcohol use disorders. Alcohol use disorder among healthcare professionals is of concern as it is associated with decreased work productivity and performance and associated ill health and cognitive impairment. This review, therefore, aimed to gather evidence on the prevalence and associated factors for alcohol use disorders among healthcare professionals. The findings revealed a high prevalence of alcohol use disorders among healthcare professionals, which were worsened during the COVID-19 pandemic. Additionally, there was a glaring dearth of studies conducted in low- and middle-income countries. Urgent interventions and support systems are therefore needed to address these issues. A comprehensive approach, considering individual and organizational factors, alongside evidence-based interventions, training and support programs, can promote workforce well-being and improve the quality of patient care. It is imperative to integrate alcohol use screening, preventive and treatment interventions with primary healthcare and psychiatry services.This will help ensureearly diagnosis and timelyinitiation of preventive and therapeutic measures, reducing the risk of missed opportunities. Furthermore, offering effective human resource management support services to healthcare professionals would significantly enhance their well-being and help prevent alcohol use disorders.

Using augmented intelligence to improve long term outcomes.

For augmented intelligence (AI) tools to realize their potential, critical care clinicians must ensure they are designed to improve long-term outcomes. This overview is intended to align professionals with the state-of-the art of AI. Many AI tools are undergoing preliminary assessment of their ability to support the care of survivors and their caregivers at multiple time points after intensive care unit (ICU) discharge. The domains being studied include early identification of deterioration (physiological, mental), management of impaired physical functioning, pain, sleep and sexual dysfunction, improving nutrition and communication, and screening and treatment of cognitive impairment and mental health disorders.Several technologies are already being marketed and many more are in various stages of development. These technologies mostly still require clinical trials outcome testing. However, lacking a formal regulatory approval process, some are already in use. Plans for long-term management of ICU survivors must account for the development of a holistic follow-up system that incorporates AI across multiple platforms. A tiered post-ICU screening program may be established wherein AI tools managed by ICU follow-up clinics provide appropriate assistance without human intervention in cases with less pathology and refer severe cases to expert treatment.

Vitamin D supplementation for cardiometabolic risk markers in pregnant women based on the gestational diabetes mellitus or obesity status : a randomized clinical trial.

Women with gestational diabetes mellitus (GDM) or obesity are vulnerable to impaired gestational cardiovascular health (CVH) and cardiovascular disease (CVD) in the future. It is unclear if prenatal vitamin D supplementation improves gestational CVH, especially in women at high risk for developing CVD. Our goal was to find out if vitamin D supplementation could protect against gestational CVH, including the women with GDM or obesity. We randomly assigned women with a serum 25(OH)D concentration < 75 nmol/L to receive 1600 IU/d (intervention group) or 400 IU/d (control group) of vitamin D3 for two months at 24-28 weeks' gestation. The primary outcome was gestational CVH marks (lipids, inflammatory cytokines, endothelial function). There were 1537 participants divided into the intervention (N = 766) and control groups (N = 771). No baseline differences existed among study groups in CVH markers. At the two-month visit, the intervention group's HDL-C levels (2.01 ± 0.39 VS 1.96 ± 0.39 mmol/L) were significantly higher than those of the control group, while the hs-CRP levels were significantly lower (3.28 ± 2.02 VS 3.64 ± 2.42mg/L). Subgroup analysis found that HDL-C, TC, hs-CRP, E-Selectin, and SBP were improved in the intervention group among women with GDM or overweight/obesity, and the improvement was not found in women without GDM or overweight/obesity. Vitamin D supplementation significantly decreased the mean triglyceride-glucose index at the two-month visit in women with GDM. Vitamin D supplementation at mid-gestation might optimize the gestational CVH status for pregnant women, particularly the women with GDM or obesity, which is advantageous for later-life primary prevention of CVD. The Chinese Clinical Trial Registry (ChiCTR2100051914, 10/9/2021, Prospective registered, https://www.chictr.org.cn/showproj.aspx?proj=134700 ).

Experiences of Family Caregivers of Older Adults With Dementia in Korea During the COVID-19 Pandemic: A Qualitative Analysis.

To explore the experiences of family caregivers of older adults with dementia in Korea during the coronavirus disease 2019 pandemic. In-depth interviews were conducted with eight family caregivers of older adults with dementia from September to October 2021. Collected data were analyzed using Giorgi's phenomenological methodology. Four themes were derived: A Rough Journey With Worry, A Desolate Life in a Disconnected World, Frustration Due to Health Deterioration, and Looking Toward the Future Despite Heavy Responsibility. This study is meaningful as it increases our understanding of the experiences and needs of individuals with dementia and their family caregivers, and results can assist in finding ways to help them cope with their difficulties during future pandemic situations. [Journal of Gerontological Nursing, 50(10), 42-48.].

Resection of colorectal liver metastases with second-line aflibercept plus FOLFIRI: Results from the RESECTION prospective French cohort

AimTo evaluate R0/R1 resection rate in patients with colorectal liver metastases (CLM) treated with aflibercept plus FOLFIRI after failure of a prior oxaliplatin-based regimen in daily clinical practice. MethodsThis French, multicentre, prospective, observational cohort (NCT05178745) included patients with CLM (alone or predominant; up to 5 lung nodules <2 cm allowed) initiating aflibercept/FOLFIRI every 2 weeks per physician choice. Primary endpoint was R0/R1 resection rate. Secondary endpoints included overall survival (OS), progression-free survival (PFS), radiological and pathological responses, and safety. ResultsA total of 137 patients (median age 65 years, RAS/BRAF mutant 57%/9%) were enrolled at 22 French sites. CLM (median 4) were synchronous in 82%, bilobar in 71% and located in liver only in 54%. Overall, 17% of patients had R0/R1 resection (21% for patients with liver-only disease). A major pathological response per Blazer score was observed in 55% of resected patients, along with significantly longer OS (median 34.8 vs 9.1 months, p<0.0001) and PFS (median 11.4 vs 4.9 months, p<0.0001) compared to non-resected patients. Post-operative complications occurred in 17% of patients (all Dindo-Clavien grade I-II) with no post-operative deaths. Overall, 34% had grade ≥3 adverse events, mainly general health deterioration and diarrhea. ConclusionsResults suggest that aflibercept plus FOLFIRI, after failure of a prior oxaliplatin-based regimen, allows R0/R1 resection of CLM in almost 20% of patients with a major pathological response in most cases and a median OS prolonged by more than 3-fold versus non-resected patients.

Bone health in childhood cancer survivors, is there really a problem? Pitfalls of assessment, calculating risk and suggested surveillance and management for osteonecrosis and low and very low bone mineral density.

Childhood cancer survivors are at increased risk of developing (long-term) skeletal adverse effects, such as osteonecrosis, impaired bone mineral density, and fractures. This paper provides an overview of the current understanding of bone health in these survivors, examining whether it represents a significant concern. It focuses on the challenges of assessing and managing bone health in childhood cancer survivors, highlighting diagnostic pitfalls, methods for accurately identifying those at high risk, and suggested strategies for surveillance and management of osteonecrosis and impaired bone mineral density. The need for improved surveillance strategies, particularly for high-risk survivors, alongside potential prevention and management options, including pharmacological and lifestyle interventions, is emphasised. Given the lack of consensus on optimal prevention and treatment strategies, the paper emphasises the need for further research to optimise care and improve long-term outcomes for childhood cancer survivors with bone health impairments.

Dual burden of sarcopenia and impaired oral status on activities of daily living, cognition and swallowing outcomes in post-stroke patients

Background and aimsSarcopenia and poor oral health are common in older patients and are associated with negative outcomes. However, evidence of their combined impact on post-stroke rehabilitation outcomes is limited. This study aimed to investigate the combined impact of sarcopenia and impaired oral health on activities of daily living (ADL), cognition, and swallowing outcomes in post-stroke patients. MethodsA retrospective cohort study was conducted using 1,012 post-stroke patients (median age 75.6 years; 54.1 % men). Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. Poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating impaired oral status. Functional outcomes were measured using the Functional Independence Measure (FIM) for ADL and cognition, and the Food Intake Level Scale (FILS) for swallowing status. ResultsThe prevalence of sarcopenia was 45.6 % (492/1,080), impaired oral health was 27.5 % (297/1,080), and the coexistence of both conditions was 12.0 % (130/1,080). The coexistence of sarcopenia and impaired oral health was associated with poorer outcomes compared to either condition alone. After adjusting for confounders, the combination of sarcopenia and impaired oral status showed the strongest negative impact on FIM-motor (B=-8.666, 95 % CI -11.484 to -5.847), FIM-cognition (B=-1.122, 95 % CI -1.987 to -0.256), and FILS (B=-0.785, 95 % CI -1.055 to -0.514) scores at discharge. ConclusionThe dual burden of sarcopenia and impaired oral health significantly impacts functional recovery in post-stroke patients. Comprehensive assessments and interventions targeting both conditions may optimize rehabilitation outcomes in this population.

Association of sedentary behavior and physical activity with occurrence of signs and symptoms in participants of a cardiac rehabilitation program

Sedentary behavior (SB) is associated with health impairments, while physical activity (PA) has been a protective factor. It is unclear whether SB and PA are associated with occurrence of signs and/or symptoms (SS) during cardiac rehabilitation program (CRP) exercise sessions. The objective was to evaluate the association between SB and PA with occurrence of SS. Was included 48 patients from a CRP program (64.7 ± 10.4 years-old). Daily time and % of time of SB and weekly time in moderate-to-vigorous-intensity [MVPA], % of MVPA time, steps/day, and steps/minute were accelerometer-measured. Patients were followed-up during 24 CRP sessions, for accompaniment of SS. Age, sex, and comorbidities (hypertension, diabetes, dyslipidemia, obesity) were covariates. Log-transformed values of SB, MVPA and steps/day were also analyzed. As results, 43.7% (n = 21) of participants presented occurrence of signs, 62.5% (n = 30) presented occurrence of symptoms, and 81.2% (n = 39) present occurrence of SS. In fully adjusted model, % of time in MVPA (β: −0.449,p = 0.045) and steps/minute (β: −0.244,p = 0.026) were inversely associated with occurrence of symptoms. No association was observed between SB and PA and occurrence of signs. The occurrence of symptoms and SS among CRP participants was directly associated with SB and inversely associated with variables of PA.

Sex differences in upper and lower strength and their association with body composition among university students

[Purpose] Sex strongly influences physical performance throughout adolescence, and excess fat mass is associated with several health and performance impairments. This study aimed to evaluate whether variations in strength between men and women dependent on lean mass and body fat content.[Methods] This cross-sectional, quasi-experimental, non-probabilistic study involved 44 university students (22 men and 22 women, aged 19–29). Handgrip strength (HGS) was measured using an adjustable handgrip dynamometer, body composition was assessed using bioimpedance, and countermovement jumps (CMJ) were measured using a force platform. Data were analyzed using ANOVA to compare HGS and CMJ based on body mass, and the Pearson correlation coefficient was applied to examine the relationships between grip strength, body composition, and jump test performance.[Results] Strength is significantly higher in men compared to women, as is countermovement jump. The strength of women corresponded to over 50% of that of men, whereas the quantity of lean mass in women corresponded to 55% of that of men. We found a significant relationship between strength and lean mass.[Conclusion] This study supports the idea that both upper- and lower-body strengths are strongly influenced by lean mass, thereby contributing to sex differences. The primary factor in body composition that explains the disparities in HGS and CMJ between sexes is the proportion of fat mass to lean mass. Finally, the sex disparities observed between body composition and strength depend on lean mass content.

IMPACT OF HABITUAL SMOKING ON THE ORGANISM OF ADOLESCENTS LIVING IN THE NORTH OF RUSSIA

The aim of the work is to analyze the impact of habitual smoking on the physiological systems of adolescents living in the north of Russia (65º N). Materials and Methods. Using generally accepted methods, morphofunctional, physiometric, physiological and psychological parameters were determined in 34 boys aged 14–15 years (11 smokers for at least 2–3 years and 23 non-smokers). The level of physical health was assessed according to Apanasenko method. Results. Compared with non-smokers, smoking adolescents have statistically significantly higher body weight, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean blood pressure (MBP) during exercise, heart rate (HR) during exercise and its increase while working, HR recovery after exercise (Martine-Kushelevsky test), rate pressure product (RPP), and scores of activity (WAM questionnaire). At the same time, they demonstrated lower strength index (SI), maximum expiratory pressure (MEP), vital capacity (VC), vital index (VI), Skibinskaya index (SI), level of physical health (LPH), and WAM parameters. Smokers, compared to 11 non-smokers of the same weight, have statistically significantly lower height, strength and SI, Genchi test time, MEP, VC, VI, SI, LPH, and scores of well-being and mood (WAM parameters). However, they have higher HR during exercise, its increase while working, and HR recovery. Excess body weight in smokers leads to hypertension, while long-term smoking in teenagers living in the north of Russia causes physiological decline and physical health deterioration. In some cases, our results (decrease in strength, Genchi test time, VC, VI, increased HR, hypertensive reactions, and health deterioration in smokers) correlate with the data obtained both in our country and abroad.

Artificial Intelligence-Powered Technologies For Independent Living Among Older Adults: A Review

Abstract Background The ageing populations in Ireland and around the world has led to an increased focus on technologies that support independent living for older adults. Artificial intelligence (AI) has emerged as a promising solution, with various AI-powered technologies being proposed to assist their daily lives. This review aims to synthesize the findings of studies exploring AI-powered technologies for independent living among older adults. Methods A systematic literature search was conducted using relevant databases, including PubMed, IEEE Xplore, and Google Scholar. The search terms included “artificial intelligence” and “independent living”. Studies published between 2009 and 2023 that investigated AI-powered technologies for independent living among older adults were included in the analysis. Results The included studies investigated various AI-powered technologies including tablets, wearable devices like smartwatches, web portals for carers, Internet of Things (IoT) solutions, user-centered design considerations, the integration of AI with sociology and healthcare, smart home technology, and ambient information systems. The pooled results indicated that AI-powered technologies can improve independent living outcomes for older adults. Benefits included real-time monitoring and health deterioration recognition, fall detection, personalised care, cognitive assistance and reduced isolation. User-centered design approaches and the integration of AI with sociology and healthcare were also found to be essential factors in the successful implementation of these technologies. Conclusion This analysis provides evidence supporting the effectiveness of AI-powered technologies in promoting independent living among older adults. IoT solutions and smart home technology appear to be particularly promising. However, the successful implementation of these technologies requires a multidisciplinary approach, incorporating user-centered design and the integration of AI with sociology and healthcare. Further research is needed to explore the long-term impact of AI-powered technologies on the well-being and autonomy of older adults.

Perceptions of Academic Performance, Impairment, and Mental Health in University Students With and Without ADHD.

This study aims to investigate the impact of positive illusory bias (PIB) on the relationship between ADHD symptoms and functioning in college students, with a focus on gender differences. The sample consisted of 195 college students, including 148 with ADHD and 47 without ADHD. Measures of ADHD symptomatology, life satisfaction, affect, gender identity, and impairment were collected, along with cumulative grade point average. ADHD symptomatology was inversely linked to subjective well-being, with PIB acting as a significant moderator. Functional impairment was predicted by ADHD symptoms and subjective well-being, while social impairment and academic functioning were predicted by PIB and well-being. Significant gender differences were found, particularly in the interaction between PIB and ADHD symptoms for non-binary individuals. This study suggests that PIB is relevant for emerging adults with ADHD enrolled in higher education. Subjective well-being and PIB act as buffers against the detrimental functional and social effects of ADHD symptoms in emerging adult college students. The study highlights the importance of considering gender-specific approaches in understanding and supporting the mental health of this population.

Mood, Anxiety, and Cognitive Alterations in Cancer Patients.

To analyze the cytokine profile in cerebrospinal fluid (CSF), as well as mood, anxiety, and cognition profiles in patients with CC. One hundred and nine individuals were evaluated, 37 controls, 18 CWC, and 54 CC patients. Assessments included BDI, HADS, Digit Span, FAS-verbal, Animals/WMS-R, Matrix Reasoning and Vocabulary (WASI), and QLQ-C30. The CC group exhibited 62.96% depression and probable anxiety/depression, with 75.92% showing attention deficits. The CC and CWC groups demonstrated significant cognitive impairment on the WASI-Vocabulary test (CWC: 13.4 ± 2.2; CC: 15.9 ± 1.1) compared to the control group (Ct: 22.8 ± 1.6; p = 0.0002). In the QLQ-C30 scores, the CC group reported a greater perceived loss of quality of life and health deterioration (score of 17.5 ± 2.6) and lower scores on the Functional Scale (49.8 ± 4.5). The CC group had 18.52% illiteracy, 18.52% incomplete higher education, and 22.22% complete elementary education. The CC group also had lower weight (Ct: 67.8 ± 1.4; CWC: 61.7 ± 3.1; CC: 59.6 ± 1.7; p = 0.0023) and BMI (CC: 21.5 [18.3; 24.8]; Ct: 24.9 [23; 25.8]; p = 0.0021) compared to controls. Cytokines detected in the CSF were MCP-1, VEGF, IL-8, IP-10, and MIP-1β. Higher concentrations of MCP-1 were found in cancer patients (CSC: 571.2 ± 105.8; CC: 399.5 ± 65.9; Ct: 1477 ± 0.1; p < 0.0001), along with lower levels of MIP-1β (CC: 4345 [3060; 7353]) and VEGF (CC: 48.3 ± 2.0; CWC: 49.8 ± 3.8; Ct: 64.8 ± 3.2; p < 0.0001). The level of mental impairment (mood, anxiety, and cognitive deficits) correlated with cancer-associated and cachexia-associated inflammation, weight loss, low BMI, elevated C-reactive protein (CRP), leukocytosis, lymphopenia, anemia, hypoalbuminemia, and low scores on the QLQ-C30 questionnaire (Global Health Status, Functional Scale, Symptom Scale). The CC group exhibited a higher prevalence of depression/anxiety, a stronger correlation between depression and inflammation, and greater cognitive impairment in attention, reasoning, and language, alongside lower average educational attainment. The low concentration of certain cytokines in the CSF combined with elevated systemic CRP in cancer and cachexia, associated with mental disorders, presents a paradox that requires further investigation. Higher concentrations of the cytokine MCP-1 in cancer patient groups indicated a positive correlation with the preservation of language abilities in these patients.

One element of the emergency department nurse burnout epidemic – who can help? Based on a qualitative exploratory case study

ABSTRACT Background Nurses are responsible for a substantial portion of the care patients receive in emergency departments and must be well-equipped to deal with the associated environmental challenges, including managing patients in crises, boarding, and overcrowding. These challenges lead to adverse impacts, like burnout. This study identified training as a resource to reduce the prevalence of nurse burnout. Methods This qualitative case study employed the Job Demands-Resources model to explore the experiences of one hundred and eleven nurses regarding their preparedness to manage patients undergoing mental health crises and associated boarding and overcrowding. Data were collected from July to August 2023 using anonymous surveys, a burnout inventory, semi-structured interviews, and focus groups. Results 75% reported experiencing burnout, with over half expressing feelings of inadequacy due to insufficient training. Those not reporting burnout indicated a strong support system at work and felt adequately trained. The imbalance between job demands and resources influenced motivational and health impairments. Conclusion The study aimed to bridge literature gaps by examining the link between training and burnout, offer empirical evidence and recommendations to academic and healthcare leaders to promote the well-being of nursing staff, and highlight the critical need for supportive training and resources to diminish burnout.

Rethinking culture: a narrative review on the evolving role of museum and art gallery-based heritage activities and programmes on wellbeing.

The prevalence of chronic mental and physical diseases is increasing globally. In addition, the changing demographics towards an ageing population pose a challenge to healthcare systems, as ageing is associated with a decrease in physical and mental capacity and an increased risk of developing disease. The review aims to explore primary studies that investigated the effect of museum and art gallery-based heritage activities and programmes on the wellbeing of (1) individuals recovering from drug addiction or patients with dementia and (2) younger and older adults. We conducted a search using specific keywords, and inclusion and exclusion criteria, in databases for the period 2013-2023. Following a detailed examination of numerous articles, 15 original studies were included in this review. 15 original studies investigated the effects of museum and art gallery-based heritage activities or programmes on (1) patients with chronic diagnoses associated with mental health and/or physical impairment, such as drug addiction and dementia and (2) the wellbeing of younger and older populations. The interactive environment of museums had positive health outcomes for patients with chronic mental (addiction recovery, dementia) and physical diseases (cancer) as well as hospitalized patients. In addition, it improved the physical and mental wellbeing of younger and older individuals. Museum art-based interventions may be integrated as part of the non-pharmacological management of patients experiencing mental disorders as well as for improving the wellbeing of younger and older populations.

An approach to the prevention of global warming impact on human health

Global climate warming leads to an increase in eye, somatic and mental diseases, but the trigger of these processes is unknown, so treatment is ineffective. The author's hypothesis is that the trigger of health deterioration in global warming may be excessively constricted pupils, which trigger pathological biochemical processes in the body through the optic-vegetative system. It is proposed to moderately dilate the pupils of people who are sensitive to suboptimal temperatures in the course of a weather forecast of heat or cold, which will mitigate the course of their diseases and reduce mortality.

Prevalence of anxio-depressive disorders, insomnia and self-esteem in a Moroccan population addicted to cannabis and/or alcohol: a cross-sectional study

ABSTRACT Background Addiction to cannabis and alcohol is a global public health concern, linked to significant mental health impairments such as anxiety, depression, insomnia, and low self-esteem. This study, conducted in Marrakech’s addiction treatment centers, aims to assess the prevalence of mental health disorders, insomnia, and self-esteem among individuals seeking treatment for alcohol and/or cannabis addiction. Methods This cross-sectional study was conducted from January 1 2023 to January 1 2024. Depression, anxiety, insomnia, and self-esteem were assessed using the HADS, ISI, and Rosenberg scale. Results Anxiety prevalence for cannabis, alcohol, and both substances was 57.9%, 55.2%, and 59.2%, respectively. Depression prevalence was 71.7% (cannabis), 73.1% (alcohol), and 75% (both substances). Sub-clinical insomnia (mild) prevalence for the three groups was 65.4%, 71.6%, and 77.6%. Low self-esteem was observed at 59.1%, 64.2%, and 60.5% for cannabis, alcohol, and both substances, respectively. No significant association has been found between the type of product consumed (cannabis, alcohol, cannabis and alcohol) and anxiety, depression, insomnia and self-esteem. Conclusions These findings highlight prevalent mental health disorders in cannabis and alcohol addiction, underscoring the need for comprehensive, multidisciplinary treatments, including regular mental health screenings, quarterly follow-ups, and family involvement in group therapies at Moroccan addiction centers.

Clinical and immunological characteristics of post-covid patients with infectious immunopathology syndrome

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has caused global morbidity and high mortality worldwide. Today it is known that, despite recovery from COVID-19, confirmed by both laboratory and instrumental diagnostic methods, many patients, regardless of the severity of the disease, suffer from a significant deterioration in health and increased exacerbations of chronic diseases. During examinations by attending physicians, they note fatigue, an increase in cases of acute respiratory viral infections per year, an increase in relapses of skin diseases such as furunculosis, pyoderma, exacerbation of pulmonary pathologies, pathologies of the urinary tract of inflammatory origin, as well as chronic infectious diseases such as herpesvirus and human papillomavirus infections, which occur for the first time or are characterized by frequent relapses no less than six months after recovery from acute COVID-19. Such persistent post-infectious consequences are known as post-COVID syndrome. SARS-CoV-2 infection is accompanied by damage to both the acquired and innate immune systems. In previous work, we determined the role of B cells, cytotoxic T lymphocytes, natural killer cells and the regulatory properties of CD46, as well as its involvement in the processes of viral entry into the cell. In this study, we studied the relationship of immune disorders of these factors of innate and acquired immunity with the clinical manifestations of post-COVID infectious syndrome in this category of patients and the severity of lung damage in these patients during the acute period of COVID-19. The results of the study showed that in some patients more than six months after suffering from COVID-19, the following was revealed: in patients who had a coronavirus infection without lung damage, no violations of the innate and acquired parts of the immune system were detected. In addition, significant differences were identified between clinical manifestations of diseases with increasing cases of relapses or newly identified after clinical recovery from an acute COVID-19 infection, depending on the phenotype of immune status disorders.

Regional differences, repeated use, and costs of emergency medical services in Germany.

Little is known about regional differences regarding the utilization and costs of emergency medical services (EMS) in Germany. Evidence on characteristics of repeated use of EMS is also scarce. To compare German federal states regarding the utilization and costs of EMS and to analyze characteristics of repeated EMS use. We used BARMER health insurance data on more than 1.4million German EMS cases in 2022. We estimated EMS use rates (per 1000 inhabitants) and median reimbursements and costs by EMS type (ground transport with/without emergency physician (EP); helicopter emergency medical services), hospitalization status, and federal state. We applied Poisson regression to estimate incidence rate ratios (IRRs) with 95% confidence intervals (95% CI), capturing relationships between repeated use of EMS and individual characteristics, including care degree and income level. Ground transport EMS use rates varied between federal states by more than 2.6-fold without EP (Bavaria: 84.6; Berlin: 223.2) and 2.1-fold with EP (Bremen: 19.1; Saxony: 41.3). Median reimbursement of ground transport with EP was 132% higher in Schleswig-Holstein (€ 1530) compared with Berlin (€ 660). Approximately one-third of all persons used EMS more than once and accounted for two-thirds of all EMS cases. Repeated EMS use was strongly related to care degree (IRR of care degree5: 3084; 95% CI 3.012-3.158) and low income (IRR: 1.174; 95% CI 1.161-1.189). The substantial regional heterogeneity in terms of utilization and costs of EMS calls for anationwide, consistent regulation of EMS in Germany. Additionally, (outpatient) primary nursing care of persons with severe health impairments and health literacy should be strengthened.