Normal Self Research Articles

Parent - Young Adult Relationship with Self-esteem among Undergraduate Students

Worldwide, there are over 1.8 billion young people living today and 90 % of who live in developing countries1. Parent–child relationships are central to psychological development and several studies have shown that suboptimal parenting is an important risk factor for psychological disorder in clinical and representative community samples.2 This study is an insight to know the Parent - Young Adult Relationship in the current generation of young adult and its impact on Self - esteem. Research results carried out on this topic suggest & promote Parents and Young Adult to have a better relationship. The aim of the study was to correlate relationship between Parent - Young Adult with Self-esteem among undergraduate students in selected college at Puducherry. Methods: A Quantitative Descriptive Research Design was used to assess the correlation between Parent - Young Adult Relationship with Self-esteem among undergraduate students in selected college at Puducherry. After taking a written consent, both male and female (117) undergraduate students (18 - 21 years) were selected using Simple Random Sampling Technique. The Parent - Young Adult Relationship among undergraduate students was assessed by Parent Adult Child Relationship Questionnaire (PACQ) and level of Self esteem was assessed by Rosenberg's Self - esteem Scale. The data was analyzed by using frequency, percentage, mean and Standard Deviation. Correlate the relationship between Parent - Young Adult Relationship and Self – esteem was analyzed by using Pearson’s correlation coefficient test. The association between the demographic variables between Parent - Young Adult Relationship and Self – esteem was analyzed by using Fisher’s exact test Result: The results show the correlation between Parent - Young Adult Relationship with Self-esteem among 117 undergraduate students. The mean self esteem score was 19.26 ± 3.791 and it ranged from 6 to 29. The level of self - esteem among nursing college students was normal, high and low, for 88.0%, 5.1% and 6.9%, respectively. There was a weak negative correlation observed between Parent - Young Adult relationship (Father) with Self - esteem in control aspect which implies greater the control by father lower the Self - esteem of the students. There was no statistically significant correlation was observed between Parent-Young Adult Relationship (Mother) with self -esteem at the significance level of p>0.05. Statistically significant association was found between Parent-Young Adult Relationship (Father - Regard) with gender, (Father -control) with Occupation, (Father - Responsibility) with feels more attached. Statistically significant association was noted between Parent-Young Adult Relationship (Mother - Responsibility) with year of studying implying B.Sc (N) - II Year and with area of residence, (Mother - Regard) with time spent every day (1-2 hours). Borderline statistically significant association was found in (Father - Control) with feels more attached & area of residence and (Mother - Responsibility) with Occupation. Conclusion: The findings of the study reflect that the Undergraduate relationship with both of their parents and majority Undergraduate students had normal self - esteem. The way parents raise their children influences the development of their self-esteem. Stronger relationship with parents boosts the self-esteem level in an individual. The study participants get benefited by participating in the study. Conducting this research in another society and with a greater sample size and in different setting may generate different results.

2036 “I didn’t personally think it would change my life, but it has”: The experience following emergency laparotomy for older people

Abstract Introduction Older people living with frailty are at high risk of adverse clinical outcomes following emergency laparotomy, including early death, hospital readmission and functional decline. Despite this, there is a paucity of literature exploring patient experience of surgery in this group, particularly following hospital discharge. As a result, there is limited information to guide the development of service delivery models that support optimal post-operative recovery and improve overall experience. Methods Twenty older people, aged ≥65 years, with a Clinical Frailty Scale score of ≥ 4 and who had undergone emergency laparotomy were recruited from eight participating hospital sites. Participants were interviewed at 3 weeks following their surgery, or the earliest convenient date. Semi-structured interviews were undertaken either face to face or via telephone and explored the peri-operative and early recovery experience. Data were analysed using reflexive thematic analysis. Results Participants described physical, psychological, and social implications following emergency laparotomy which extended further than hospital discharge. Recovery was perceived to be an ongoing and slow process of returning to ‘normal self’ however participants displayed resilience towards achieving this by ‘knuckling down’ and ‘pushing forward’. The experience of hospital care was generally positive, but lack of access to discharge advice and community follow up left some participants feeling ‘abandoned’ and uncertain once they returned home. Many were reliant on family support during this period. Conclusions Older people living with frailty experience multifaceted consequences of emergency laparotomy that result in a prolonged recovery period. Multi-disciplinary post-operative care pathways are essential in addressing the holistic care needs of this group following surgery. The provision of robust discharge information and enhanced access to support in the community could improve patient experience and facilitate ongoing recovery at home.

Tales of resilience: voices from detention and imprisonment in Russia.

As the exposure to state violence could have long-term negative consequences on the survivors, we analyzed which optics and measures could be used regardless of the vulnerabilities of the individual, their social status and institutional context. We examine the ways in which law enforcement system challenges individuals and measures used to practice resilience.We use the concept of resilience within torturing environment to achieve our goal. Various actors of Russian law enforcement and penitentiary systems - detainees and pris-oners, their family members, human rights activists, state agents etc. - participated in semi-structured in-depth interviews, which we coded basing on grounded theory.Measures employed by survivors to exer-cise resilience involve regaining bodily control (both by exercise and self-harm), having pro-jections for future (by threats of legal prose-cution or publicity), exploiting bureaucracy to one's advantage, controlling information flow (by bluffing), controlling material evidence, employing allies and preserving the meaning of "normal self ".We believe that our findings can have prac-tical applications, e.g. for preventing some of the negative consequences of torture by train-ing vulnerable individuals to employ resilient strategies. Describing the way to interpret the power imbalances inherent to the torture en-vironment might also be helpful for appre-ciating even the smallest acts, including the choice not to act.

“I didn’t personally think it would change my life, but it has”: The experience following emergency laparotomy for older people living with frailty

Abstract Introduction Older people living with frailty are at high risk of adverse clinical outcomes following emergency laparotomy, including early death, hospital readmission and functional decline. Despite this, there is a paucity of literature exploring patient experience of surgery in this group, particularly following hospital discharge. There is therefore limited information to guide the development of service delivery models that support optimal post-operative recovery and improve overall experience. Methods Twenty older people, aged ≥65 years, with a Clinical Frailty Scale score of ≥ 4 and who had undergone emergency laparotomy were recruited from eight hospital sites. Participants were interviewed 3 weeks following their surgery, or the earliest convenient date. Interviews were undertaken either face to face or via telephone and explored the peri-operative and early recovery experience. Data were analysed using reflexive thematic analysis. Results Participants described physical, psychological, and social implications following emergency laparotomy which extended further than hospital discharge. Recovery was perceived to be an ongoing and slow process of returning to ‘normal self’. Although generally satisfied with in-hospital care, a lack of access to discharge advice and community follow up left some participants feeling ‘abandoned’ and uncertain once they returned home, hindering recovery. Conclusions Older people living with frailty experience multifaceted consequences of emergency laparotomy that result in a prolonged recovery phase and care needs. Multi-disciplinary post-operative pathways are imperative in addressing these holistic care needs. Better access to information and enhanced community support could improve patient experience and facilitate ongoing recovery.

Flexural Behavior of Normal and High Strength Self-Curing Self- Compacted Concrete Beams of Local Materials

In some construction industries, there are difficulties in achieving the required concrete compaction, Self-compaction is an alternative option. Working with self-compaction self-curing concrete requires a unique approach. This study aims to examine the possibility of producing self-compacting concrete with normal and high self-cure rates. This research observed how both the self-curing and self-compacting concrete behaved under normal and high-strength conditions. Two stages were prepared for this investigation. The first stage of this research studied the effect of a curing agent on the fundamental characteristics of both normal-strength and high-strength self-compacting concrete, with the aim of achieving self-curing self-compacting concrete. The primary variables of this study include the grade of concrete, the type of curing agent, the reinforcing bars, and the dosage of these variables. In the second stage, reinforced concrete beams were cast with one of the two proposed concrete types, and their behavior was studied. The findings were analyzed in terms of the beginning cracking loads, the ultimate loads, and the crack patterns of the testing beams. According to the results, both the normal-strength and the high-strength varieties of self-curing self-compacting concrete are effective in providing structural features, which are absent from the processes of curing and compacting. Curing chemicals are utilized to mitigate the process of water evaporation in self-compacting concrete, hence enhancing the water retention capabilities of self-compacting concretes that possess enough hardened concrete characteristics.

Cis mutagenesis in vivo reveals extensive noncanonical functions of Dscam1 isoforms in neuronal wiring.

Drosophila Down syndrome cell adhesion molecule 1 (Dscam1) encodes tens of thousands of cell recognition molecules via alternative splicing, which are required for neural function. A canonical self-avoidance model seems to provide a central mechanistic basis for Dscam1 functions in neuronal wiring. Here, we reveal extensive noncanonical functions of Dscam1 isoforms in neuronal wiring. We generated a series of allelic cis mutations in Dscam1, encoding a normal number of isoforms, but with an altered isoform composition. Despite normal dendritic self-avoidance and self-/nonself-discrimination in dendritic arborization (da) neurons, which is consistent with the canonical self-avoidance model, these mutants exhibited strikingly distinct spectra of phenotypic defects in the three types of neurons: up to ∼60% defects in mushroom bodies, a significant increase in branching and growth in da neurons, and mild axonal branching defects in mechanosensory neurons. Remarkably, the altered isoform composition resulted in increased dendrite growth yet inhibited axon growth. Moreover, reducing Dscam1 dosage exacerbated axonal defects in mushroom bodies and mechanosensory neurons but reverted dendritic branching and growth defects in da neurons. This splicing-tuned regulation strategy suggests that axon and dendrite growth in diverse neurons cell-autonomously require Dscam1 isoform composition. These findings provide important insights into the functions of Dscam1 isoforms in neuronal wiring.

Dissociative Identity Disorder: a case of three Selfs

IntroductionThe DSM-5 defines dissociation as “disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior”. The disorders in this group include depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder, the last being a controversial entity.Dissociative disorders are associated with elevated levels of disability, impaired quality of life, high economic cost, and a significantly increased risk of suicide attempts.ObjectivesIn this work we present the case of a 21-year-old man that was assisted in the Emergency Room with dissociative symptoms. We intend to do a non-systematic review on the subject of dissociation symptoms, the psychiatric disorders in which they are present, identified risk factors, how to access the psychopathology features and the recommended treatment to best address them.MethodsFor a comprehensive approach of this subject we proceeded to a non-systematic review in PubMed using the following keywords “dissociation”, “dissociative identity disorder” and “dissociative disorders”.ResultsIn this work we present the case of a 21-year-old man assisted in the Emergency Room describing dissociative symptoms that were suggestive of Dissociative identity disorder. He referred out-of-body experiences and a sense that he was not controlling his actions while self-injuring himself and being aggressive towards his family. He described “three Selfs”: the “Normal Self”, the “Suicidal Self” and the “Bad Self”.Symptoms of dissociation are present in a variety of mental disorders namely depression, anxiety disorders, posttraumatic stress disorder, borderline personality disorder and eating disorders.Dissociative disorders appear to be linked to trauma, interpersonal stress, and strongly associated with a history of chronic child abuse. An association with alexithymia, depression and suicidality were also found. Some studies found structural and functional abnormalities, particularly a reduction in grey matter volume in limbic system structures, a dysregulation of prefrontal–limbic circuitry and dysfunction of the hypothalamic–pituitary-adrenal axis.Psychotherapy appears to be the cornerstone of treatment for dissociative disorders, namely Cognitive-Behavior therapy and Eye-movement desensitization and reprocessing.ConclusionsSymptoms of dissociation are not only present in dissociative disorders, but they may be present in almost all mental disorders. The evaluation of possible dissociative symptoms should be a part of every psychopathological assessment. There is a need for further studies to better understand this diagnostic entity and improve the therapeutic intervention.Disclosure of InterestNone Declared

Abstract P4-10-22: Patient reported symptoms and functional status in breast cancer

Abstract Background: To improve symptom management in cancer patients, the province of Ontario (Canada) implemented the collection of the Edmonton Symptom Assessment System (ESAS) and Patient-Reported Functional Status (PRFS) tool at cancer centre outpatient visits. ESAS measures 9 symptoms on a scale from 0 (no symptoms) to 10 (worst possible symptom); scores > 4 (moderate to severe) require intervention. The PRFS tool is a version of the Eastern Cooperative Oncology Group performance status tool designed to be completed by the patient; scores range from 0 (“normal with no limitation”) to 4 (“pretty much bedridden, rarely out of bed”). Our main objective was to describe the symptom burden and functional status of breast cancer (BC) patients.Methods: This cross-sectional study included women with stage I-IV BC who completed the ESAS and the PRFS tool during outpatient clinic visits at 2 Toronto academic centres. ESAS and PRFS scores were described for 3 participant groups: women diagnosed with early-stage BC (ESBC= stages I-III) in the year prior to enrolment; women with ESBC diagnosed > 1 year prior to enrolment; and women with metastatic BC. Multivariable logistic regression models were used to identify factors associated with ESAS scores > 4 for each ESAS symptom. Covariates included age, comorbidity, BC subtype, disease group, previous surgery, and current systemic therapy. Results: Of 381 women, 107 (28%) were diagnosed with ESBC ≤ 1 year prior to enrolment; 171 (45%) were diagnosed with ESBC > 1 year prior to enrolment; 103 (27%) had metastatic BC. Mean age was 57 (SD17) years. For ESBC, tiredness had the highest incidence of moderate to severe scores, followed by impaired well-being and anxiety (Table 1). For metastatic BC, impaired well-being had the highest incidence of moderate to severe symptoms, followed by tiredness and anxiety. More than 20% of metastatic BC patients had scores > 4 for pain, drowsiness, shortness of breath and depression. Most reported PRFS scores of 0 (“Normal with no limitations”) or 1 (“Not my normal self, but able to be up and about with fairly normal activities”), but 17% of metastatic BC patients reported a PRFS of 2 (“Not feeling up to most things, but in bed or chair less than half the day”). A comorbidity score ≥1 was associated with moderate to severe depression (OR 2.0; 95%CI 1.1-3.7), lack of appetite (OR 3.1; 95%CI 1.4-6.6), shortness of breath (OR 2.6; 95%CI 1.3-5.2), tiredness (OR 2.0; 95%CI 1.2-3.3) and impaired well-being (OR 2.0; 95%CI 1.2-3.4). Metastatic BC was associated with moderate to severe scores for anxiety (OR 2.3; 95%CI 1.2-4.5), pain (OR 3.0; 95%CI 1.4-6.4) and impaired well-being (OR 2.1; 95%CI 1.1-4.0). Conclusion: A high prevalence of symptom scores > 4 was found both in ESBC and metastatic BC, highlighting the need of symptom screening for all BC patients. Particular attention should be paid to patients with comorbidity scores ≥ 1, who have increased odds of presenting higher symptom scores. Table 1.- Prevalence of ESAS scores ≥ 4 and PRFS scores for each disease group.ESAS SymptomsPercent with ESAS scores ≥ 4 (moderate to severe)Early-Stage Breast Cancer – 1st year (N=107)Early-Stage Breast Cancer – > 1st year (N=171)Metastatic Breast Cancer (N=103)Total (N=381)Pain12.1%14.7%30.1%18.2%Tiredness25.2%30.1%39.8%31.3%Drowsiness1.8%12.9%25.2%16.6%Nausea9.4%3.5%7.8%4.2%Lack of Appetite10.3%7.1%13.6%9.5%Shortness of Breath14%7.6%22.3%12.4%Depression17.7%14.6%22.6%16.5%Anxiety24.3%17.2%35.3%21.3%Well-being1.8%25.7%44.1%30.3%PRFS scoresPercent with PRFS ScoreNormal with no limitations (0)30.8%49.7%28.2%38.6%Not my normal self, but able to be up and about with fairly normal activities (1)52.3%42.1%50.5%47.2%Not feeling up to most things, but in bed or chair less than half the day (2)12.2%4.7%16.5%10%Able to do little activity and spend most of the day in bed or chair (3)3.7%2.3%4.9%3.4%Pretty much bedridden, rarely out of bed (4)---- Citation Format: Sofia Torres, Ahmed Bayoumi, Geoffrey Liu, Ana Beatriz Kinupe Abrahao, Nicholas Mitsakakis, Murray Krahn, Maureen Trudeau. Patient reported symptoms and functional status in breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-22.

Moral dilemma: To operate or not to operate

Moral dilemma: To operate or not to operate

Immune discrimination of the environmental spectrum through C-type lectin receptors.

Our bodies are continuously assaulted by infection and tissue damage; most of these injurious insults are primarily sensed by immune receptors to maintain tissue homeostasis. Although immune recognition of proteins or nucleic acids has been well characterized, the molecular mechanisms by which immune receptors discriminate lipids to elicit suitable immune responses remain elusive. Recent studies have demonstrated that the C-type lectin receptor family functions as immune sensors for adjuvant lipids derived from pathogens and damaged tissues, thereby promoting innate/acquired immunity. In this review, we will discuss how these receptors recognize lipid components to initiate appropriate, but sometimes deleterious, immune responses against environmental stimuli. We will also discuss an aspect of inhibitory C-type lectin receptors; their ligands might reflect normal self which silences the immune response regarded as "silence"-associated molecular patterns or may be associated with escape strategies of pathogens as "evasion"-associated molecular patterns.

Posthospitalization Follow-up: Always Needed or As Needed?

A 4-year-old child is being discharged after a 3-day hospitalization for pneumonia that included treatment with supplemental oxygen and antibiotic therapy. The hospitalist instructs the child’s mother to schedule a follow-up appointment with the child’s primary care provider (PCP) within the coming week. The mother makes an appointment and calls her manager at work to ask if she can miss part of work that day for the appointment. Her manager mentions that she has already missed several days of work recently (related to the child’s medical care) but ultimately grants her the additional time away. Within 2 days of hospital discharge, the mother notes that the child seems to have recovered from her illness and is back to her normal self. Nevertheless, she takes the child to her follow-up appointment because that was the recommendation provided by the hospitalist. The child’s PCP concurs with the mother’s assessment that the child appears to have completely recovered from the illness. The mother appreciates the reassurance from the child’s PCP but also wonders if the visit, the co-pay, and the time away from work were really necessary. Most hospitalized children are prescribed automatic posthospitalization follow-up, that is, they are routinely instructed to visit their PCP shortly after hospital discharge, regardless of symptom improvement. For example, one multicenter study of 198 children hospitalized for bronchiolitis revealed that 84% of parents were given instructions for automatic follow-up.1 The high rate of automatic follow-up recommendations is perhaps unsurprising given that automatic follow-up is considered the standard of care2 and has been proposed (and implemented by at least 1 hospital3) as a quality metric.4 The intuitive appeal of automatic …

Self-harm behaviour, psychopathological distress and suicidal ideation in normal and deliberate self-harm outpatient's adults.

To identify the association among suicidal ideation, deliberate self-harm, and psychopathological distress in normal and deliberate self-harm adults. The cross-sectional study was conducted at the Department of Psychiatry, Military Hospital, Rawalpindi, Pakistan, from January to July 2017, and comprised deliberate self harm and normal adults aged 18-25 years. Psychiatric evaluation involved a semi-structured interview based on mental status examination. The self-harm tendency was assessed on the basis of self-harm inventory of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Beck scale for suicide ideation and he depression anxiety and stress scale were also used for data collection. Data was analysed using SPSS 22. There were 200 subjects with a mean age of 20.89±9.06 years; 100(50%) each in deliberate self-harm and normal groups. Deliberate self-harm was significantly positively associated with suicidal ideation and mental health problems, including depression, anxiety and stress (p<0.05). Deliberate self-harm tendency was also positively associated with mental health problems in normal adults (p<0.05). Normal adults had higher level of mental health problems, such as depression and stress, compared to deliberate self harm adults (p<0.05). Adults having self-harm behaviour were more inclined to have suicidal ideation compared to normal adults behaviour (p<0.05). Deliberate self-harm was found to be strongly related to suicidal behaviour and mental health issues in both normal and deliberate self-harm adults.

Transitioning from hurting to healing: self-management after distal radius fracture

Purpose Chronic pain and disability after musculoskeletal trauma support the need for non-biomedical perspectives to frame experiences of recovery. Self-management is a specific holistic lens with implications for improving health outcomes. This qualitative study explored how adults made meaning of self-management after distal radius fracture (DRF). Methods Thirty-one individuals aged 45–72 with a unilateral DRF participated in a semi-structured interview 2–4 weeks after discontinuing full-time wrist immobilization. Interviews were audio-recorded and transcribed, and constructivist grounded theory techniques were used to analyze the data. Results Participants made meaning of self-management as a process of “transitioning from hurting to healing,” which occurred via three underlying processes. “Learning because of my injury” included gaining information for empowerment and understanding by physically living through the experience. “Working and hoping toward healing” involved taking active steps to recovery in the face of uncertainty. “Getting back to my normal self” comprised reconnecting to one’s body and identity after injury. Conclusions Participants’ lived experiences overlapped with those of self-managing chronic conditions, highlighting the need to consider how individuals actively engage in their recovery after DRF. Findings suggest using supportive interventions to facilitate patients’ understanding, activation, and engagement in meaningful activity after DRF. Implication for rehabilitation To maximize health outcomes after distal radius fracture, clinicians should move beyond impairment remediation to supporting multiple dimensions of recovery, including emotional distress and functional limitations. Clinicians should routinely provide early and ongoing information, such as expected symptoms and recovery time frames, to minimize loss of control related to uncertainty. Clinicians should emphasize active interventions, such as collaborative goal setting and functional tasks, that engage patients in their own healing. Clinicians should support patients’ early return to meaningful activity to maintain or restore connection to the body and identity.

Treatment pathways traversed by polycystic ovary syndrome (PCOS) patients: A mixed-method study.

This study was undertaken to explore the treatment-seeking pathways traversed by women with PCOS and elicit their behavior, experiences and perspectives regarding it. This concurrent mixed-method study was conducted on 18-40 years old women diagnosed with PCOS at the Gynecology outpatient department, PGIMER, Chandigarh, India. Of the 275 women, who were administered a questionnaire to elicit their treatment-seeking behavior, 62 willing participants were subjected to in-depth interviews. Quantitative responses were descriptively analyzed and presented as count, proportion, mean or median. Framework analysis was performed for the qualitative data. The findings of both types of data were triangulated to construct the pathways to treatment traversed by PCOS patients. Many (~45%) respondents had no information regarding PCOS. Only 9.1% received some information from their doctors. Though the internet was the primary source of information for 37.5% of respondents, they expressed dissatisfaction with the quality of information. Multiple health care agencies were consulted by most (85.8%) of the respondents. Allopathy was the preferred choice of treatment. The average delay in initiating the treatment was 3 months. The major reasons for this were ignorance, the concept of 'normality' and 'endurance'. Deviations from the normal self (like irregular-menstruation, obesity, hirsutism, infertility) were the concern that led them to consult a doctor. They were also dissatisfied with the treatment due to a late diagnosis, lack of relief, taboo, side-effects, expenses involved and the need for repeated laboratory tests. Participants' course of treatment was influenced by the interplay of individual, distress, health-system, and social-economic factors. Women with PCOS were dissatisfied with the quality of the information and treatment received. There were treatment delays. The patients consulted multiple health agencies, including indigenous therapies, in the hope of relief. The findings provide an empirical basis on points to focus on for building better coping strategies for managing the condition.

IMPACT OF THE COVID-19 PANDEMIC ON PSYCHOLOGICAL HEALTH STATUS DURING LOCKDOWN PERIOD: A CROSS-SECTIONAL STUDY

Objective. The aim of this research was access the effect of lockdown on the psychological health status of people. Methods. This was an online questionnaire survey developed and circulated among people using snow-ball sampling techniques from April to mid of June 2020. The online survey collected information on demographic data and psychosocial health elements. Results. This study included 604 peoples (59.1% were female and 40.8% were females) of Haryana. Of the total respondents, 57.6% were in age group of 18-30 years, 40.8% were in 31-45 years and 1.5% was in 45-60 years group. 90% of people have normal self- reported BMI, 6.5% were overweight, 3% were underweight and 0.5% people have obesity. 74% respondents were graduate, 11.5% postgraduate, 3.2% were PhD, and 9.2% were 12th pass. 31.8% were unemployed, 35.9% were student, 15.8% regular government employee, 4.7% were self- employed and 2.5% were adhoc/contract employee. 79.5% people reside in urban community and 16% in rural community and 4.5% in semi-urban area. Most of the respondents have agree with the statement that lockdown induced constant sense of insecurity (72.9%); anxiety (58.7%),psychological stress (66.4%); work &amp; financial stress (52.4%), phobia of infection (50.9%); stigma towards symptomatic people, which might be because of simple flu (55.2%); stress from watching &amp; listening COVID-19 news (38.6%); stress from practice of prevention measure (31.9%). Most of people also agree with that behavior-change modification (follow preventive regulations) can improve mental stress (53.2%). Conclusion. Majority of people has realized the lockdown have significant impact on psychological health status of people.

Impact of Activity Therapy on Improving the Self Esteem among Women with Mental Illness

Self-esteem is an important component of psychological health. Much previous research indicates that lowered self-esteem frequently accompanies psychiatric disorders. It has been suggested that low self-esteem is an etiological factor in many psychiatric conditions as well as in suicidal individuals. Self-esteem also plays some role in quality of life for psychiatric patients.&#x0D; The objective of the study is to evaluate the effectiveness of activity therapy in improving the self-esteem of mentally ill women.&#x0D; A quantitative, single-group pretest posttest design is adopted and Non- probability convenient sampling technique is used to select the 60 women with mental illness at psychiatric rehabilitation centre, Jaipur, Rajasthan, India. Samples were divided in to four groups. In pre test the level of self esteem was assessed by Rosenberg Self Esteem Scale (RSES). Each group should to select in each week and gave the activity intervention. After the intervention the post was conducted.&#x0D; Demographic variables were analyzed with descriptive (mean, median and standard deviation) and clinical variables were inferential statistics (Chi- square and paired “t” Test).&#x0D; In this study 70.0% of the women have low self esteem score. After activity therapy intervention 76.7% of them are having normal self esteem score, 23.3% of the women are having low Self-esteem score. Women are gained 26.3% of self esteem.&#x0D; These study findings concluded that nurse’s role in managing and improving the self esteem is obligatory. Through activity therapy, women with mental illness self-esteem had got improved 26.3% that indicate the effectiveness of activity therapy in improving the self-esteem of the women with mental illness.

A Severe Case of Hypothyroidism: Immunotherapy Induced

Background: Immune check point inhibitors are playing a crucial role in the treatment of many cancers. Their primary role is to reactivate anti tumor cytotoxic T cells. Programmed cell death 1(PD 1) is a transmembrane protein expressed on T cells, B cells and Natural killer cells. PD 1 ligand is expressed in many tumor cells along with hematopoietic cells and their interaction directly inhibits apoptosis of the tumor cell. Pembrolizumab binds PD1. FDA approved pembrolizumab initially for nonsquamous cell lung cancer and metastatic melanoma that express PD1 ligand which showed improved survival compared to standard therapy. Additionally it has been used in several others tumors with more than 50% PD L1 expression. Although well tolerated, these agents can cause immune related adverse events. Thyroid dysfunction is reported to range between 3.2-10.1% patients receiving pembrolizumab. Clinical Case: 86 year old Caucasian female with past medical history of hypertension and osteoarthritis was diagnosed with stage III metastatic colon cancer in the hepatic flexure and underwent hemicolectomy. Pathology showed 6.5cm mass and 2/30 lymph nodes positive. Due to fear of side effects from chemotherapy, patient refused further treatment. Her follow up labs showed elevation of carcinoembyronic antigen (CEA). Her oncologist suggested Pembrolizumab, immunotherapy. She was started on 5 cycles every 3 weeks. She had fatigue and fell twice after first cycle, but her CEA levels were improving, so it was decided to continue treatment. Soon after fifth cycle she became extremely weak, lethargic, and unable to do any ADLS and was exhausted all the time. Her labs showed TSH 137, free T4 0.4. At that point decision was made to stop pembrolizumab. She was started on levothyroxine 25mcg by her oncologist and referred to me few months later. She complained of tiredness, low energy. On exam Pulse 78, Blood pressure 152/77. Her labs showed TSH 106 and Free T4 0.45. Her levothyroxine dose was increased to 75mcg and followed her 6 weeks later. Her energy levels improved significantly and she is back to her normal self. Her thyroid function was normal. At this point patient has decided not to undergo any treatments for colon cancer. Conclusion: Immune related thyroid events are increasingly noticed with wide use of pembrolizumab. There is insufficient evidence to suggest the cause of these events. Reversible destructive thyroiditis and overt hypothyroidism are the common clinical presentations. It is important to recognize patients at high risk for these adverse events so these highly efficacious agents can be safely used in patients. Thyroid has been a frequent target for anti PD 1 treatments, further research can be of benefit to use against thyroid cancers.

COVID-19 survivor experiencing long-term symptoms

COVID-19 survivor experiencing long-term symptoms

\u2018I wanted to talk about it, but I couldn\u2019t\u2019, an H70 focus group study about experiencing depression in early late life

BackgroundKnowledge about experiences of depression among younger-old adults from the general population is limited. The aim was to explore experiences of depression in early late life.MethodsSixteen participants in the population-based Gothenburg H70 Birth Cohort Studies (12 women and 4 men) who had reported a history of depression between ages 60–70 took part in focus group discussions (n = 4). Data were analyzed using focus group methodology.ResultsThe analysis resulted in the overall theme ‘I wanted to talk about it, but I couldn’t’. The participants expressed unmet needs of communication about depression with family, friends, and healthcare staff. Participants wanted to know more about the causes and effects of depression, available treatment options and how to avoid recurrence. Lack of knowledge was a source of frustration; trust in health care providers was diminished. Being retired meant that opportunities for communication with co-workers were no longer available, and this made it harder to break negative thought and behavioral patterns. Being depressed meant losing one’s normal self, and participants were grieving this. Thoughts of death and suicide were experienced in solitude; knowing that there was an escape could generate a feeling of comfort and control.ConclusionsYounger-old adults have expressed a need to talk about their experiences of depression. They would like to know more about available treatments, potential side effects, and how to avoid recurrence. Care providers also need to be aware there is a need for an existential dialogue about death.

Strengthening and Repair of Self Compacting Concrete Beams( Dept.C )

While there is abundant research information on ordinary concrete beams strengthening or repairing with FRP, relatively little data on the behavior of self-consolidating concrete (SCC) is available. Carbon Fiber Reinforced Polymers laminates (CFRP) was investigated for strengthening and repairing SCC and high strength self compacting concrete (HSSCC) beams subjected to one midpoint load in in order to compared to beams made of normal concrete (NC) and normal high strength self compacting concrete (NHSSCC) at the same conditions respectively. To demonstrate the concept, this paper presents results of a laboratory investigation of 24 beams (150x200x1600 mm) on the behavior of self compacting concrete strengthening and repairing with one layer of CFRP laminate and subjected to one midpoint load, including the effect of using 8 different mixes to study the effect of mix proportions on rapped CFRP beams behavior. Test results showed that the addition of CFRP laminate to the tension surface of the beams demonstrated significantly improvement in stiffness and ultimate load capacity of beams. The response of control and strengthened beams were compared and evaluated by experimental and theoretical calculations. It was observed that ductility indexes of SCC and HSSCC beams were more efficient than NC and NHSC respectively. Load carrying capacity of control, strengthening and repairing self compacting concrete beams was closed to traditional concrete beams (about 90-95%). The paper also highlighted the crack pattern of all cases of beams which indicated more distribution and smaller crack amplitude for strengthened beams with respected to the control beams.