Mental Burden Research Articles

Mental Health and Quality of Life in Pulmonary Embolism: A Literature Review

Pulmonary embolismis an acute disease with chronic complications and, although it is not considered a chronic disease, it requires close follow-up. The scope of the present literature review is to decode the existing data concerning quality of life and the mental health impact of PE during the acute and long-term phases of the disease. The majority of studies reported impaired quality of life in patients with PE when compared to population norms, both in the acute phase and >3 months after PE. Quality of life improves over time, irrespectively of the measurement used. Fear of recurrences, elderly, stroke, obesity, cancer and cardiovascular comorbidities are independently associated with worse QoL at follow-up. Although disease specific instruments exist (e.g., the Pulmonary Embolism Quality of Life questionnaire), further research is required in order to develop questionnaires that may fulfil international guideline requirements. The fear of recurrences and the development of chronic symptoms, such as dyspnea or functional limitations, may further impair the mental health burden of PE patients. Mental health may be implicated by post-traumatic stress disorder, anxiety and depressive symptoms present following the acute event. Anxiety may persist for 2 years following diagnosis and may be exaggerated by persistent dyspnea and functional limitations. Younger patients are at higher risk of anxiety and trauma symptoms while elderly patients and patients with previous cardiopulmonary disease, cancer, obesity or persistent symptoms exhibit more frequently impaired QoL. The optimal strategy for the assessment of mental health in this patient pool is not well defined in the literature. Despite mental burden being common following a PE event, current guidelines have not incorporated the assessment or management of mental health issues. Further studies are warranted to longitudinally assess the psychological burden and elucidate the optimal follow-up approach.

Treatment of intermediate-risk prostate cancer with active surveillance in the routine care-Long-term outcomes of a prospective noninterventional study (HAROW).

We report here the long-term outcomes of patients with intermediate-risk prostate cancer (PCa) treated with active surveillance (AS) in a daily routine setting. HAROW (2008-2013) was a noninterventional, health service research study investigating the management of localized PCa in a community setting. A substantial proportion of the study centers were office-based urologists. A follow-up examination of all intermediate-risk patients with AS was conducted. Overall, cancer-specific, metastasis-free, and treatment-free survival rates, as well as reasons for discontinuation, were determined and discussed. Of the 2957 patients enrolled, 52 with intermediate-risk PCa were managed with AS and were available for evaluation. The median follow-up was 6.8 years (interquartile range, 3.4-8.6 years). Seven patients (13.5%) died of causes unrelated to PCa, of whom 4 were under AS or under watchful waiting. Two patients (3.8%) developed metastasis. The estimated 8-year overall, cancer-specific, metastasis-free, and treatment-free survival rates were 85% (95% confidence interval [CI], 72%-96%), 100%, 93% (95% CI, 82%-100%), and 31% (95% CI, 17%-45%), respectively. On multivariable analysis, prostate-specific antigen density of ≥0.2 ng/mL2 was significantly predictive of receiving invasive treatment (hazard ratio, 3.29; p = 0.006). Reasons for discontinuation were more often due to patient's or physician's concerns (36%) than due to observed clinical progression. Although survival outcome data for intermediate-risk patients managed with AS in real-life health care conditions were promising, rates of discontinuation were high, and discontinuation was often a patient's decision, even when the signs of disease progression were absent. This might be an indication of higher levels of mental burden and anxiety in this specific subgroup of patients, which should be considered when making treatment decisions. From a psychological perspective, not all intermediate-risk patients are optimal candidates for AS.

Effect of steering reaction torque of ultra-compact electric vehicle on steering burden for active steering wheel system

An ultra-compact electric mobility vehicle cannot be equipped with power steering, and the physical burden is large. Therefore, we are continuously researching steering support for an ultra-compact electric mobility vehicle equipped with a steer-by-wire system (SBWS). The SBWS has not been widely diffused because the steering and front wheels are connected only to electric signals and do not have a high redundancy level. However, the advantage of an SBWS is that the steering reaction torque felt through the steering wheel can be controlled freely. We investigated an active steering wheel system (ASWS) that can control an appropriate steering feeling for each driver by being equipped with SBWS and evaluating the steering burden of each driver. So far, research on the SBWS has been considered to improve operability by transmitting road information and feeding back vehicle motion, however few research on an SBWS considers the physical and mental burden on the driver. In this study, we conducted a fundamental analysis of the effect of the steering reaction torque on the steering burden, focusing on the operating direction of the steering wheel.

The impact of COVID-19 pandemic on mental burden and quality of life in physicians: Results of an online survey.

In previous pan-/epidemics such as the SARS epidemic of 2002/2003, negative effects on the wellbeing and an increase in symptoms of depression and anxiety were observed in doctors due to social isolation and the threat they experienced. Therefore, it is feared that the COVID-19 pandemic will also have a negative impact on the mental health and quality of life of doctors. The impact of the COVID-19 pandemic on the mental health of physicians. In particular, on the subjective anxiety and burden, depression and quality of life for the total sample and subsamples (work in COVID-19 units vs. no work in COVID-19 units). In an online survey, 107 physicians (23-42 years) were asked about their mental health during the COVID-19 pandemic. In addition to socio-demographic data, pandemic- and work-related data were also included. For example, infection control measures, deployment on COVID-19 wards and the subjective perceived threat posed by the pandemic. The physicians were asked to rate their perceived anxiety and stress, retrospectively, at 7 different points in time during the pandemic. The Hospital Anxiety and Depression Scale (HADS) was used to retrospectively assess symptoms of anxiety and depression before and after the onset of the pandemic. The quality of life of the participants after 2 years of the pandemic was assessed using the WHO Quality of Life (WHOQOL-BREF). Both subjective anxiety and burden showed wave-like patterns with higher scores in autumn, winter and spring. We observed significant differences between the seven measurement time points for anxiety [Chi2(6) = 197.05, p < 0.001] as well as for burden [Chi2(6) = 106.33, p < 0.001]. Symptoms of depression and anxiety increased significantly during the COVID-19 pandemic (M = 14.16, SD = 7.83) compared to the pre-pandemic time [M = 7.31, SD = 5.14, t (106) = -10.67, p < 0.001]. Physicians who worked at COVID-19 units showed higher scores in quality of life related to social relationships (M = 70.39, SD = 17.69) than physicians not working at COVID-19 units [M = 61.44, SD = 24.55, t (90.14) = -2.145, p = 0.035]. The multi-factorial ANOVA showed that previous psychiatric illness (p < 0.001), greater difference in depression scores (p = 0.014), higher anxiety scores (p = 0.048) and less work experience (p = 0.032) led to lower quality of life. Hospitals should offer specific support, such as supervision, to prevent the development of longer-term psychiatric sequelae likely to lead to sick leave and high costs for the healthcare system. The study has been registered at the German Clinical Trials Registry (DRKS-ID: DRKS00028984).

Evaluation of Heating Inserts in Active Protective Clothing for Mountain Rescuers—Preliminary Tests

Rescue operations in mountain areas, lasting many hours, pose a mental and physical burden on the rescuer’s body. In addition, they cause thermal discomfort associated with variable energy expenditures and the high variability of weather conditions. One of the solutions for improving the comfort of the work of mountain rescuers is clothing with an active heating function. This paper discusses the technology of manufacturing flexible heating inserts with steel thread as a heating element. In order to assess the durability and safety of the applied heating inserts, they were subjected to simulated conditions of use. Multiple washing (25 cycles) and bending (9000 cycles) as well as exposure to artificial acidic sweat did not cause a significant change in the electrical power and resistance of the heating inserts. In order to assess the effectiveness of the inserts, they were tested within a system of clothing fabrics on an “artificial skin model”. Supplying the heating insert with a voltage of 4 V increased the thermal resistance of the fabric system, incorporating the insert by approx. 40%. Due to their high flexibility, durability, and heating efficiency, the developed heating inserts are a major step towards the development of electrical heated clothing.

Exploring the experience of family caregivers of children with medical complexity during COVID-19: a qualitative study

Background and objectivesChildren with medical complexity have been disproportionately impacted by the COVID-19 pandemic and the associated changes in healthcare delivery. The primary objective of this study was to gain a thorough understanding of the lived experiences of family caregivers of children with medical complexity during the pandemic.MethodsWe conducted semi-structured interviews with family caregivers of children with medical complexity from a tertiary pediatric hospital. Interview questions focused on the aspects of caregiving for children with medical complexity, impact on caregiver mental and physical well-being, changes to daily life secondary to the pandemic, and experiences receiving care in the healthcare system. Interviews were conducted until thematic saturation was achieved. Interviews were audio recorded, deidentified, transcribed verbatim, coded and analyzed using content analysis.ResultsTwelve semi-structured interviews were conducted. The interviews revealed three major themes and several associated subthemes: (1) experiences with the healthcare system amid the pandemic (lack of access to healthcare services and increased hospital restrictions, negative clinical interactions and communication breakdowns, virtual care use); (2) common challenges during the pandemic (financial strain, balancing multiple roles, inadequate homecare nursing); and (3) the pandemic’s impact on family caregiver well-being (mental toll, physical toll).ConclusionsFamily caregivers of children with medical complexity experienced mental and physical burden due to the intense nature of their caregiving responsibilities that were exacerbated during the pandemic. Our results highlight key priorities for the development of effective interventions to support family caregivers and their children.

LBA01-15 PROSPECTIVE RANDOMIZED DOUBLE BLIND CLINICAL TRIAL TO COMPARE HOLMIUM LASER LITHOTRIPSY WITH AND WITHOUT MOSES 2.0 TECHNOLOGY FOR THE URETEROSCOPIC TREATMENT OF NEPHROLITHIASIS

You have accessJournal of UrologyCME1 Apr 2023LBA01-15 PROSPECTIVE RANDOMIZED DOUBLE BLIND CLINICAL TRIAL TO COMPARE HOLMIUM LASER LITHOTRIPSY WITH AND WITHOUT MOSES 2.0 TECHNOLOGY FOR THE URETEROSCOPIC TREATMENT OF NEPHROLITHIASIS Nicole Miller, Naren Nimmagadda, Amy Reed, Ryan Hsi, Seth Bechis, Mitchell Humphreys, Michael Lipkin, Manoj Monga, Ojas Shah, Karen Stern, Roger Sur, and Sriharan Sivalingam Nicole MillerNicole Miller More articles by this author , Naren NimmagaddaNaren Nimmagadda More articles by this author , Amy ReedAmy Reed More articles by this author , Ryan HsiRyan Hsi More articles by this author , Seth BechisSeth Bechis More articles by this author , Mitchell HumphreysMitchell Humphreys More articles by this author , Michael LipkinMichael Lipkin More articles by this author , Manoj MongaManoj Monga More articles by this author , Ojas ShahOjas Shah More articles by this author , Karen SternKaren Stern More articles by this author , Roger SurRoger Sur More articles by this author , and Sriharan SivalingamSriharan Sivalingam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The clinical impact of Moses pulse modulation remains debated. We sought to evaluate the potential of Moses 2.0 to reduce operative time for ureteroscopic treatment of nephrolithiasis. METHODS: In this multi-institutional, randomized, double-blind clinical trial, 150 patients were randomized to Moses or non-Moses and underwent unilateral ureteroscopy for stones 8-20mm. Stones were treated by attending endourologists with standardized dusting settings. A validated survey (NASA Task Load Index) was completed afterwards. Stents were maintained for 4-10 days, and CT imaging was obtained 6 weeks postoperatively. The primary outcome was to compare total operative times. Secondary outcomes included blinded measures of stone retropulsion, stone-free rate, and surgeon workload. RESULTS: 143 patients were included in the analysis. Demographics and stone characteristics were similar between groups. Moses setting led to shorter ureteroscopy time overall on average, but difference was not statistically significant. (29.5min v 30.7min, p=0.61). When stratified for stone size, total stone burden between 8-12mm demonstrated shorter operative times (-3.5 min, p=0.41) compared to longer operative times for stone burden 12-16mm (+1.0min, p=0.83), and 16-20mm (+9.5min, p=0.13). Amongst 112 patients reaching 6 week follow-up, no difference in stone-free status was seen with and without the Moses setting (42.3% v 38.9%). Surgeons correctly perceived the Moses setting in 57.7% of cases compared to 48.6% of cases without Moses. After using Moses, surgeons experienced less mental burden, physical burden, temporal demand, frustration, and less required effort. Perception of operative performance was higher when using the Moses setting. These findings remained significant on multivariable analysis. CONCLUSIONS: No significant differences were seen in total operative time, ureteroscopy time nor stone-free rate. However, use of Moses settings remained a significant predictor across NASA task load domains after controlling for factors that increase surgeon workload during ureteroscopy. Source of Funding: This study was funded by a grant from the Endourology Disease Group for Excellence © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1182 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicole Miller More articles by this author Naren Nimmagadda More articles by this author Amy Reed More articles by this author Ryan Hsi More articles by this author Seth Bechis More articles by this author Mitchell Humphreys More articles by this author Michael Lipkin More articles by this author Manoj Monga More articles by this author Ojas Shah More articles by this author Karen Stern More articles by this author Roger Sur More articles by this author Sriharan Sivalingam More articles by this author Expand All Advertisement PDF downloadLoading ...

Management of palmoplantar psoriasis and its comorbidities using yoga and naturopathic lifestyle interventions: A case report

Palmoplantar psoriasis is an autoimmune disorder that contributes to significant functional disability. Apart from the chronic inflammatory reactions in the skin, psoriasis patients are more likely to develop chronic systemic disorders, which impose significant physical, mental, and economic burdens. This warrants a holistic, patient-centered approach that can address the prevailing multimorbidity in psoriasis patients. Yoga and Naturopathy-based Lifestyle Interventions (YNBL) are known for their whole-person approach and are reported to be beneficial in the management of autoimmune disorders. We report a case of a 63-year-old male treated with YNBL for palmoplantar psoriasis along with diabetes mellitus, coronary artery disease, low back pain, and insomnia. The patient underwent YNBL in an inpatient setting for 10 days each with a gap of 7 months, along with follow-up advises. The prognosis was measured through the Psoriasis Area and Severity Index, along with other biochemical markers like fasting blood sugar, random blood sugar, vitamins D and B12, and subjective visual analog scores for vitality and other symptoms. He achieved complete remission of psoriasis by the end of 8 months, and the results were sustained even during the follow-up. The results are encouraging for using the YNBL protocol in the management of palmoplantar psoriasis; however, these findings need to be validated using clinical trial designs.

Usability and Acceptability of Electronic Immunization Registry Data Entry Workflows From the Health Care Worker Perspective in Siaya, Kenya (Part 3): Pre-Post Study.

Digital health tools such as electronic immunization registries (EIRs) have the potential to improve patient care and alleviate the challenges that arise from the use of paper-based clinic records for reporting. To address some of these challenges, the Kenya Ministry of Health and the International Training and Education Center for Health Kenya implemented an EIR system in 161 immunizing clinics in Siaya County between 2018 and 2019. The successful implementation of digital health tools depends on many factors, one of which is alignment between the technology and the context in which it is used. One important aspect of that implementation context is the perceptions of the health care workers (HCWs) using the EIR. This study aimed to evaluate HCWs' perceptions of the usability and acceptability of multiple clinic workflows using the new EIR. We performed a mixed methods pre-post study using semistructured interviews with HCWs at 6 facilities in Siaya County, Kenya. We interviewed HCWs at each facility 4 times: at baseline and once after the implementation of 3 different workflow modifications (n=24 interviews). The baseline state was dual data entry with paper records and the EIR. We then implemented 3 workflow modifications for 1 full day each: fully paperless data entry, preparation of an appointment diary before patient visits for the day, and a combination of the 2 workflows. We compared ratings and themes across interviews after each of the 4 workflows to understand the changes in the usability and acceptability of the EIR. HCWs considered the EIR clinic workflows to be usable and acceptable. Of the modified workflows, HCWs perceived the fully paperless workflow most favorably. In all workflows, HCWs' perceived benefits included ease of clinical decision-making using the EIR, reduced mental burden of data entry when using the EIR, and ease of identification of errors. Perceived barriers to the workflow included contextual challenges such as staffing shortages and lack of network connectivity, EIR platform challenges such as errors in saving records and missing fields, and workflow challenges such as the dual data entry burden of using paper and digital tools simultaneously. Fully paperless EIR implementation shows great promise from a workflow acceptability standpoint, contingent upon the presence of supporting contextual clinic factors and the resolution of system performance and design challenges. Rather than trying to identify a singular best workflow, future efforts should provide adequate flexibility for HCWs to implement the new system in their unique clinic context. Future EIR implementation stands to benefit from continued monitoring of EIR adoption acceptability during implementation, both for Siaya's program and for other efforts around the globe, as digital health interventions become more widely used.

A qualitative crossroads of rhythm and race: Black patients' experiences living with atrial fibrillation

ImportanceRace-based disparities in atrial fibrillation (AF) outcomes are well-documented, but few studies have investigated individuals' experiences of living with the condition, particularly among Black individuals. ObjectiveWe aimed to identify common themes and challenges experienced by individuals of Black race with AF. DesignA tailored, qualitative script was developed to assess the perspectives of participants in focus groups. SettingVirtual focus groups. ParticipantsThree focus groups of 4–6 participants (16 participants total) were recruited from the racial/ethnic minority participants in the Mobile Relational Agent to Enhance Atrial Fibrillation Self-care Trial. Main outcomes and measuresFocus group transcripts were inductively coded to identify common themes. ResultsNearly all participants self-identified as Black race (n = 15, 93.8 %). Participants were mostly male (62.5 %) with mean age of 67 (range 40–78) years. Three themes were identified. First, participants described physical and mental burdens associated with having AF. Second, participants described AF as being a condition that is difficult to manage. Lastly, participants identified key tenets to support self-management of AF (self-education, community support, and patient-provider relationships). Conclusions and relevanceParticipants reported AF is unpredictable and challenging to manage, and that social and community supports are essential. The social and behavioral themes identified in this qualitative research highlight the need for tailored clinical strategies for AF self-management which incorporate individuals' social contexts. Trial registrationNational Clinical Trial number 04075994.

Ayurvedic Management of Polypoidal Choroidal Vasculopathy (PCV) -A Case Report

Polypoidal Choroidal Vasculopathy (PCV), a subtype of neovascular Age-related Macular Degenerationn (AMD) is a disease characterized by persistent, recurrent serous leakage and hemorrhage in the macular area, mostly seen in the elderly population. While contemporary science offers anti Vasculo Endothelial Growth Factor (VEG-F) monotherapy and combination with Photodynamic Therapy (PDT), the outcomes of these remain doubtful. Repeated anti-VEG-F injections not only cause a financial and mental burden on the patients with no or very little visual outcome. Chronicity paves the way to complete loss of vision due to exudative retinal detachment. Symptoms like Raktavatdristi (to visualize things as if through a column of blood), Pashyatiaasyamanaasikam (unable to recognize the faces of people around) and aaviladarshanam (blurred vision) were suggestive of Raktaja Timira (an eye disease caused by Raktadosa) associated with Kaphadushti), according to Ayurveda. A 77-year-old male patient diagnosed with PCV sought Ayurvedic treatment after being advised to undergo anti-VEG-F therapy for the 3rd time in a row. His treatment comprised internal medicines consisting of Mahatiktakakashaya, Guduchyadikashaya, Chandraprabhavati and Avipathichurna; external treatments like Pratimarshanasya with Anu tailam and Gandusha with Triphalakashaya; Kriyakalpa (eye treatments) like Seka, Vidalaka, Aschotana and Anjana karma. At the end of 3 months of Ayurvedic treatment, his visual acuity in the right eye improved to 6/6, Optical Coherence Tomography (OCT) affirmed complete normalcy of the macula and Fundus examination confirmed the absence of neovascularization. Ayurvedic treatment is effective in reversing the process of neovascularization, thereby bringing about the marked visual outcome in PCV. Such patients should be encouraged to adopt Ayurvedic treatment instead of expensive and invasive treatment procedures like intra-vitreal injections even when the absolute effects of these remain doubtful.

Biomimetic Enzyme Cascade Structural Color Hydrogel Microparticles for Diabetic Wound Healing Management

Hard-healing diabetic wound brings burgeoning physical and mental burdens to patients. Current treatment strategies tend to achieve multistage promotion and real-time reporting to facilitate wound management. Herein, a biomimetic enzyme cascade inverse opal microparticles system for wound healing, which is intergated with glucose oxidase (GOD) and copper peroxide (CP). Such microparticles are composed of biofriendly hyaluronic acid methacryloyl (HAMA) and pH-responsive acrylic acid (AA), which provided abundant binding sites and spaces for chemical immobilizing and physical doping of enzymes and metal bioinorganics. When the cascade catalytic system is applied on wound sites, hyperglycemia environment would serve as a hydrogen peroxide (H2 O2 ) generator through GOD catalysis, while acidic environment triggers the decomposition of CP, further catalyzing H2 O2 to generate reactive oxygen species (ROS). Additionally, the distinctive structural color of the microparticles can visually reflect the wound pH and intelligently estimate the healing state. It is demonstrated that such microparticle systems exhibit excellent broad-spectrum antibacterial and angiogenesis-promoting properties, as well as significant real-time reporting ability for wound healing. These features indicate that enzyme cascade structural color microparticles possess valuable potential in wound healing and related field.

Two Functional Wheel Mechanism Capable of Step Ascending for Personal Mobility Aids

Obstacles such as ramps, steps, and irregular floor surfaces are commonly encountered in homes, offices, and other public spaces. These obstacles frequently limit the daily activities of people who use mobility aids. For this purpose, this study solves a slope minimization problem for personal mobility aids. As a solution approach, a gradient-reduction scheme is proposed, which allows existing mobility aids to reduce the required horizontal forces and vibrations when ascending steps while maintaining their wheel sizes. Practically, an axle-transitional wheel mechanism realizing the gradient-reduction computation model is established, and its step-ascending wheel prototype is developed. Specifically, since the proposed wheel enables integration into existing personal mobility-assisting devices, two functional roles, such as rolling and step ascending, can be used. The developed step-climbing wheel can help the users of mobility aids mitigate the aforementioned limitations. The physical and mental burdens of caregivers and medical staff can also be reduced by making the users of the gradient-reduction scheme more self-sufficient. This study provides details on the axle-transitional wheel mechanism and its step-ascending wheel prototype. The findings are analyzed mathematically, and their functionality is verified through extensive experiments using a prototype.

Less-Invasive Approach to Early-Onset Scoliosis—Surgical Technique for Magnetically Controlled Growing Rod (MCGR) Based on Treatment of 2-Year-Old Child with Severe Scoliosis

Spinal deformities in children can be caused by various etiologies, such as congenital, syndromic, neuromuscular, or idiopathic. Early-onset scoliosis (EOS) is diagnosed before the age of ten years, and when the curvature continues to progress and exceeds a Cobb angle of 60-65 degrees, surgical treatment should be considered. Initial minimally invasive surgery and the implantation of magnetically controlled growing rods (MCGRs) allows for the noninvasive distraction of the spine, growing, and avoids multiple operations associated with the classic distractions of standard growing rods. A 2-year-old girl was admitted to our clinic with rapidly progressive thoracic scoliosis. The major curve of the thoracic spine Cobb angle was 122° at 30 months. No congenital deformities were detected. The surgical technique was the less-invasive percutaneous and subfascial implantation of MCGRs, without long incisions on the back and the non-invasive ambulatory lengthening of her spine over the next 4 years. MCGR is a safe procedure for EOS patients. It is extremely effective at correcting spinal deformity; controlling the growth and curvature of the spine as the child develops during growth; reducing the number of hospitalizations and anesthesia; and minimizing the physical and mental burden of young patients, parents, and their families.

COVID-19 Pandemic: Brief Overview of the Consequences on Family Informal Caregiving

Background and aim of the work: The COVID-19 pandemic has deeply affected the quality of people’s social life, strongly impacting family dynamics, too, not only in the harshest periods of the pandemic but also afterwards. Pandemic-related measures led to a ‘stay-at-home’ approach that increased the mental and physical burdens of family caregivers, irrespective of whether they were living together with the person they were caring for or not. In this paper, we provide an overview of the impact that the COVID-19 pandemic had on family relationships and dynamics, as well as on family caregivers’ mental burden, and outline how this developed. Methods: We collected relevant info by searching the PubMed/Medline database with appropriate keywords. The search was performed up to 28 February 2023. This paper is reported in line with PRISMA guidance. Results: Given the recent onset of the issue, the number of relevant papers was limited. However, the additional burden that the pandemic has caused worldwide to informal caregivers clearly emerges. Conclusions: The worldwide impact of the pandemic on informal caregiving is assessed, and recommendations on how the issue can be handled are briefly sketched, too.

Nurses' Burnout in the Emergency Department and the Intensive Care Unit During COVID-19: A Literature Review

The COVID-19 pandemic is a clinical threat to healthcare workers and the general population. Nurses maintain closer contact with patients than other members of the country. Therefore, nurses are at increased risk of infection, and their physical and mental burden has doubled. A comprehensive review is needed to examine nurses’ burnout during the COVID-19 pandemic. Our research follows the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We conducted article searching through international databases such as PubMed and ProQuest from January to November 2020. Of the total 820 articles detected, five articles were reviewed. The results of data extraction and analysis found that the burnout feelings felt by nurses included emotional exhaustion, depersonalization, and lack of personal accomplishment. We concluded that nurses experienced high levels of burnout during the COVID-19 pandemic.&#x0D; Keywords: burnout, COVID-19, pandemic, nurses

The unbreakable journey: using photovoice to raise awareness and fight leprosy stigma in Papua, Indonesia.

In preparation of an ongoing trial to improve the treatment of leprosy (MetLep, clinicaltrials.gov: NCT05243654), we conducted a photovoice project among persons affected by leprosy in eastern Indonesia. Photovoice is a participatory visual method in which photographic images are used to explore community health and social issues among disadvantaged populations. This project generated opportunities to visualize stigma and misunderstandings people with leprosy face, and the social and mental burden that this puts on them and those around them.

Text-mining of children's answers to national web-survey questions on parental status during COVID-19

Objectives Behavior at school has been restricted due to infection control during the COVID-19 pandemic. This study aimed to clarify children's opinions by examining the structure of their text responses to open-ended web survey questions, as well as how they differed to the psychological and socio-economic status of their parents.Method From September to October 2020, approximately six months after the temporary closure of schools in Japan due to COVID-19, 2,111 respondents (elementary, junior high, and high school students) answered a questionnaire on "The third wave of CORONA-CODOMO project" website. The text data of 1,140 students who provided free-text answers to open-ended questions such as, "what are you concerned about and what do you want to say?" (comments) and "how should I get them to understand?" (proposals) were analyzed. Results were stratified by parental demographics such as age, employment status, the Kessler Psychological Distress Scale (K6), and financial status. The text mining assessed the frequency of word appearances, analyzed characteristic words, and showed a term network (word-relationship diagram).Results The total number of lines (number of respondents) of comments and proposal texts were 531 and 1,017, respectively, and the average line length (number of characters) was 21.5 and 31.5, respectively. In the dependency relations frequency analysis, the actions of proposals and comments such as "speaking-listening", "event-disappearing", and "mask-removing" appeared. In the word network, words such as "moving" and "speaking" formed a strong co-occurrence network to "I", which had the largest node in proposals, while "COVID-19" in the comments strongly co-occurred with "end+?" (predicate attribute: question) and "I+want to disappear" (predicate attribute: aspirations). According to the parent attributes, in the proposals, the characteristic words (complementary similarity measure) were "talk" (35.9) in the employed group, "talk" (26.6) in the K6 lower score group, and "understand+not" (23.5/17.3, predicate attribute: negation) in the K6 higher score group/bad economic status. In the comments, it was "COVID-19" (28.1, 27.5) in the employed group and the high mental health group.Conclusions While children displayed discomfort and fear of COVID-19 when asked about proposals, the children were willing to talk directly, also, they wanted someone to listen to them. The characteristics of the proposals in their answers were "I don't know" in both the high mental burden group and the bad economic status group of the parents.

Unruptured Intracranial Aneurysm:Indications and Outcomes

Since most unruptured intracranial aneurysms(UIA)are asymptomatic, it is important to determine treatment indications. The purpose of UIA treatment is to prevent rupture and relieve the patient's mental burden. Therefore, building a good relationship between doctors and patients is a major premise for one of the indications for surgical treatments. In addition, long-term follow-up of patients is necessary because endovascular treatment has the possibility of recurrence and retreatment. Since endovascular treatment is "possible" and "suitable" is different, it is necessary to determine the treatment policy from a radical point of view.

Efficacy and safety of laparoscopic vaginoplasty using the peritoneal flap and cervicoplasty in patients with congenital cervical and complete vaginal atresia: a pilot study.

Hysterectomy places a huge physical and mental burden on young female patients with congenital cervical and complete vaginal atresia. Thus, it is necessary to develop a method to detach the obstruction and simultaneously preserve the vagina and uterus in these patients. This study sought to evaluate the efficacy and safety of laparoscopic vaginoplasty using the peritoneal flap and cervicoplasty in patients with congenital cervical and complete vaginal atresia. Between April 2013 and June 2022, 9 patients with congenital cervical and complete vaginal atresia at Henan Provincial People's Hospital were enrolled in this prospective study. All the patients were treated with laparoscopic vaginoplasty using the peritoneal flap and cervicoplasty. Baseline clinical features (such as age, uterus size, etc.) were collected. The surgical success rate and adverse events were assessed. The 9 enrolled patients had a median [interquartile range (IQR)] age of 15.0 (14.0-18.0) years, and 5/9 patients presented with pelvic adhesions. The surgeries were successful in all (9/9) patients, who preserved their vagina and uterus with a normal menstrual cycle. After a median follow-up duration of 48 months, the neovagina had a median length of 7.5 cm. Post-surgical complications occurred in 3/9 patients, which were cured by an appropriate treatment. The 5/9 married patients reported being satisfied with their sexual life. Even though the current study preliminary exhibits the efficiency of laparoscopic vaginoplasty using the peritoneal flap and cervicoplasty in patients with congenital cervical and complete vaginal atresia, due to the small sample size, lack of a control group, and relatively high incidence of the adverse events, further studies are still needed to verify the current findings. The current study put forward a further direction for preserving the vagina and uterus simultaneously for those patients with congenital cervical and complete vaginal atresia.