Physical Burden Research Articles

Feasibility characteristics of wrist-worn fitness trackers in health status monitoring for post-COVID patients in remote and rural areas.

Common, consumer-grade biosensors mounted on fitness trackers and smartwatches can measure an array of biometrics that have potential utility in post-discharge medical monitoring, especially in remote/rural communities. The feasibility characteristics for wrist-worn biosensors are poorly described for post-COVID conditions and rural populations. We prospectively recruited patients in rural communities who were enrolled in an at-home rehabilitation program for post-COVID conditions. They were asked to wear a FitBit Charge 2 device and biosensor parameters were analyzed [e.g. heart rate, sleep, and activity]. Electronic patient reported outcome measures [E-PROMS] for mental [bi-weekly] and physical [daily] symptoms were collected using SMS text or email [per patient preference]. Exit surveys and interviews evaluated the patient experience. Ten patients were observed for an average of 58 days and half [N = 5] were monitored for 8 weeks or more. Five patients [50%] had been hospitalized with COVID [mean stay = 41 days] and 4 [36%] had required mechanical ventilation. As baseline, patients had moderate to severe levels of anxiety, depression, and stress; fatigue and shortness of breath were the most prevalent physical symptoms. Four patients [40%] already owned a smartwatch. In total, 575 patient days of patient monitoring occurred across 10 patients. Biosensor data was usable for 91.3% of study hours and surveys were completed 82.1% and 78.7% of the time for physical and mental symptoms, respectively. Positive correlations were observed between stress and resting heart rate [r = 0.360, p<0.01], stress and daily steps [r = 0.335, p<0.01], and anxiety and daily steps [r = 0.289, p<0.01]. There was a trend toward negative correlation between sleep time and physical symptom burden [r = -0.211, p = 0.05]. Patients reported an overall positive experience and identified the potential for wearable devices to improve medical safety and access to care. Concerns around data privacy/security were infrequent. We report excellent feasibility characteristics for wrist-worn biosensors and e-PROMS as a possible substrate for multi-modal disease tracking in post-COVID conditions. Adapting consumer-grade wearables for medical use and scalable remote patient monitoring holds great potential.

The effectiveness of case management and nursing counselling among caregivers of patients with dementia: A pilot study.

According to the data released by the Taiwan Ministry of Health and Welfare in 2021, in 2019, 235,000 patients sought medical treatment for dementia-related diseases at the National-Health-Insurance-participating hospitals and clinics for more than three outpatient visits or had been hospitalised, and the number had increased by 15,000 from the previous year (Ministry of Health and Welfare, 2021). This implies that families are affected, causing tremendous physical, psychological, and economic pressures and burdens on the caregivers and families of the patient. The estimated social cost of caring for dementia families increased from $1.3 trillion in 2019 to $2.8 trillion in 2030 (World Health Organisation, 2021). Thus, long-term care for the dementia population has become a critical issue in medical care and social services in Taiwan and worldwide. In 2017, Taiwan Ministry of Health and Welfare has been starting Dementia care policy with 10 years long-term care plan through set up dementia care centre. The purpose of this study is to investigate the effectiveness of dementia care centre for reducing the burden and improving the quality of life for caregivers of dementia patients. This pilot study adopts a quasi-experimental research design and uses purposive sampling to select in house informal caregivers of dementia patients who are part of a dementia collaborative care programme at a medical centre in the northern region and were willing to participate in this study. Upon enrolment in the study, subjects were given a pre-test, followed by a one-hour face-to-face nursing consultation and assessment after 2weeks. Subsequently, a telephone nursing consultation was conducted once a month for 3months. Two weeks after completing all counselling sessions, a post-test was administered to measure the caregiver burden with The Chinese version of the Caregiver Burden Inventory and the quality of life for caregivers with The 'Chinese Health Questionnaire CHQ-12'. After providing case management and nursing counselling, the total caregiver burden score significantly decreased from an average of 40.1 (SD=21.6) at the pre-test to an average of 38.6 (SD=21.4) at the post-test, reaching statistical significance (p<0.01). The results of this study showed that providing dementia caregivers with case management and nursing consultation services helpsimprove the overall caregiver burden (particularly emotional burden and physical burden) as well as the health questionnaire scores. However, the social burden and time burden did not improve after receiving case management and counselling among caregivers; instead, post-test scores of these aspects were significantly higher.

Real-world use of spesolimab for the treatment of generalized pustular psoriasis: reports from four cases

Generalized pustular psoriasis (GPP) is a rare, chronic, autoinflammatory skin disease characterized by painful widespread pustular eruptions. Patients with GPP experience a substantial physical, social, and emotional burden, with significant impacts on their quality of life. Historically, treatment for GPP in the United States mainly involved off-label use of therapies approved to treat plaque psoriasis. Dysregulation of the interleukin-36 (IL-36) pathway appears to play a key role in the pathophysiology of GPP. Spesolimab is a first-in-class humanized monoclonal antibody that binds specifically to the IL-36 receptor and antagonizes IL-36 signaling. In September 2022, spesolimab was approved by the U.S. Food and Drug Administration for the treatment of GPP flares in adults and was subsequently approved for GPP flare treatment in other countries across the world. Here, we describe 4 cases from our respective clinical practices, in which individuals with GPP were treated successfully with spesolimab. These cases demonstrate the difficulties experienced by patients with GPP regarding the disease burden and its effect on patients’ lives. These cases also illustrate some of the challenges that health care professionals may face when seeking to initiate spesolimab treatment, as well as highlighting the need for wider awareness of both the impact and severity of GPP and of the efficacy of spesolimab in GPP treatment.

Impact of Social Needs and Identity Experiences on the Burden of Illness in Patients with Multiple Myeloma: A Mixed-Methods Study.

Multiple myeloma (MM) is a common hematologic malignancy, but due to its incurable nature, patients experience many relapses in their lifetime and hence face unique challenges. This mixed-methods study consisting of an online survey and subsequent focus groups aimed to understand how social and identity experiences affected the diagnostic, treatment, and care journey for patients with MM. Twenty-three adult patients with MM participated in this study. The survey participants identified common determinants negatively impacting their health, including mental health concerns (experienced by 90.5% of respondents), worries about food shortage (42.9%), and transportation concerns (28.6%). Focus group participants described high physical and mental health burdens associated with MM. Frequent monitoring, fear of a relapse, and unpredictable side effects contributed to high anxiety. Participants indicated that MM differed from other types of cancer and chronic health conditions in many ways, particularly how and where the diagnosis was made, disease progression and relapse, treatments and side effects, and financial concerns. Most participants (65.0%) reported ≥1 social need that negatively impacted health outcomes including lack of knowledge about MM, financial instability, and lack of insurance, transportation, and social support. The findings reveal that patients with MM continually experience patient-specific mental and physical health burdens indicating high unmet needs throughout the disease journey.

Special Issue on Robotics and Mechatronics Technology for Sports, Exercise, and Health Care (Part 1)

Robotics, mechatronics, and digital technologies are rapidly advancing in the fields of sports, exercise, and healthcare, and their applications are expanding daily. In part 1 of our special issue, we focus on the innovative contributions of cutting-edge technologies in various domains. Robotics technology is crucial in sports and exercise training as it monitors individual movements and forms, provides user feedback, and enables effective training. The development of robots to enhance the accuracy and reproducibility of sports techniques is a key element directly linked to performance improvements. Robotics and mechatronics provide new possibilities for treatment and rehabilitation in healthcare. Developing beneficial systems for medical professionals and patients contributes to increased precision in surgery and productive support in rehabilitation. Power assistance and motion augmentation are witnessing advancements that prolong individual capabilities and achieve better performance. These studies may reduce the physical burden of daily activities and specific tasks, thereby enhancing efficiency. Therefore, studies on haptics and sensory feedback are important. Efforts to improve user interfaces through virtual haptic experiences represent a promising new application of digital technology. The studies included in part 1 of this special issue present recent technological trends and practical examples of sports, exercise, and healthcare and aim to provide valuable information and inspire the readers. We hope that these studies will serve as significant steps toward future technological advancement and social implementation.

Experiences of the Older Adults After Being Abused: A Qualitative Meta-synthesis.

Elder abuse is a global public health problem with severe social costs. Research on elder abuse has gradually increased; however, less attention has been paid to older adults' perceptions and experiences of abuse. This review aimed to integrate older adults' perceptions and experiences of abuse to provide a theoretical basis for developing interventions that meet their authentic needs. Six electronic databases were searched to include qualitative studies examining perceptions and experiences of abuse among adults aged 60 years or older, and 22 studies were included. This study used the Joanna Briggs Institute meta-aggregation approach to integrate the qualitative findings, which identified four themes: (a) changes resulting from elder abuse, (b) causes of abuse, (c) barrier factors and facilitating factors to the disclosure of abusive behavior, and (d) adopting different response strategies. The findings revealed that older adults experience persistent physical and psychological burdens and financial stress following abuse. Multiple factors influence the emergence of abuse and older adults search for help from the outside world, especially social support and perceptions of abuse. Older adults can deal with abuse by accepting the status quo or taking steps to change it. These findings have important implications for helping older adults prevent and cope with abuse experiences.

Physical, emotional, and financial burdens of toileting assistance for family caregivers in home care settings and factors associated with each burden: A cross-sectional study.

Caregivers in home care settings may experience significant physical, emotional, and financial burdens in providing toileting assistance. However, few studies have evaluated these three aspects of caregiver burden. Therefore, this study aimed to clarify the physical, emotional, and financial burdens of toileting assistance and examine the factors associated with each burden. A self-administered postal questionnaire was distributed to 405 family caregivers of older adults receiving home care and subsidies for incontinence products in Japan in 2019. Family caregivers answered questions about toileting assistance, the perceived physical, emotional, and financial burdens of providing toileting assistance at home, and the urinary/fecal symptoms of older adults. Of the 242 family caregivers who reported each burden, 213 (88%) had experienced at least one physical, emotional, or financial burden. The prevalence of physical, emotional, and financial burdens was 77.3%, 78.1%, and 70.7%, respectively. Approximately 60% of respondents reported experiencing all three burdens. Physical burden was associated with spouses acting as primary caregivers, nocturia, fecal incontinence, and the odor of urine/feces from toileting assistance. Emotional burden was associated with nighttime assistance, urinary/fecal leakage from absorbent incontinence products, and the odor of urine/feces. Financial burden was associated with frequent assistance, disposal costs of absorbent incontinence products, and the degree of toileting assistance. The results revealed a high prevalence of the three burdens of toileting assistance among family caregivers, suggesting the need to assess these burdens. Furthermore, they suggested the importance of providing guidance to family members, which may help reduce these burdens.

The Effect of the Levonorgestrel-Releasing Intrauterine System on Myometrial Blood Flow in Patients With Heavy Menstrual Bleeding.

Background Abnormal uterine bleeding constitutes a vexing issue among female patients, substantially impacting their quality of life. Surgical interventions, particularly hysterectomy, contribute to the psychological, physical, and financial burden on families and, by extension, the healthcare system. Levonorgestrel-releasing intrauterine system (LNG-IUS) represents a conservative management approach and emerges as a beneficial option for affected patients. The present study aims to elucidate color Doppler changes in the uterine artery pre- and post-LNG-IUS insertion. Objective The primary objectives encompass an investigation into the variations in Doppler indices (resistance index (RI) and pulsatility index (PI)) within the arcuate and radial branches of the uterine artery, as well as the assessment of endometrial thickness before LNG-IUD insertion, at three months, and six months post-insertion. Secondary outcomes include evaluating changes in pictorial blood assessment chart (PBAC) scores before insertion, at three months, and at six months after LNG-IUS insertion. Methods A cross-sectional study was conducted at the Department of Obstetrics and Gynecology at All India Institute Of Medical Sciences (AIIMS), Nagpur. A cohort of 25 women underwent LNG-IUS insertion. The endometrial cavity, RI, and PI of both arcuate and radial arteries were assessed before LNG-IUS insertion and at three and six months after insertion. Results The PI of the arcuate artery exhibited minimal alteration over the six-month duration, with a p-value of 0.43. Conversely, the RI demonstrated a statistically significant increase over the same period (p = 0.03). Conversely, the radial artery exhibited no statistically significant changes in either PI or RI (p = 0.39 or 0.13, respectively). Conclusion Following six months of LNG-IUS utilization, a substantial reduction in endometrial thickness and menstrual flow was observed, concomitant with an improvement in hemoglobin levels. Notably, the PI of both the arcuate and radial arteries demonstrated no significant change. Although the RI of the arcuate artery increased, its clinical relevance may be limited. Consequently, the observed reduction in menstrual bleeding cannot conclusively be ascribed to diminished blood flow in uterine arteries.

Delirium care burden of intensive care nurses caring for patients undergoing open-heart surgery: A mixed-method research.

Delirium is an acute confusional state characterized by inattention, cognitive dysfunction and an altered level of consciousness. Delirium causes negative outcomes in patients, and patients with delirium increase the workload of nurses. Therefore, it is important to recognize the challenges and burdens experienced by nurses caring for patients with delirium. To determine the subjective burden experienced by intensive care nurses caring for patients who have undergone open-heart surgery. A mixed-method sequential explanatory design. A non-probability purposive sampling method was used for the quantitative stage. Using OpenEpi, we employed the method of sample calculation with an unknown universe. The sample size of the quantitive study comprised 130 nurses. Quantitative data were collected with Google survey. For gathering qualitative data, online video interviews were conducted with 10 nurses, an interpretive phenomenological approach was used and content analysis was performed. In the quantitative phase, we found that the subjective burden was high. In the qualitative phase, five main themes emerged: difficulty in recognizing delirium, physical burden, emotional burden, burden in care management of patients with delirium and the effect of patients with delirium on other patients. The nurses experienced physical and emotional burden in delirium management and felt lonely while caring for patients with delirium. Because nurses play a key role in the care of patients with delirium, reducing the burden nurses experience when caring for patients with delirium should be considered important in ensuring that this patient population receives adequate care. Delirium patients create a care burden for intensive care nurses. To reduce this burden of care, in-service training in patient management and bedside teaching support should be provided to nurses. Furthermore, the use of a valid scale to diagnose delirium should be integrated into health policies. Nurses should not be left alone in the management of delirium. Managing delirium patients with a team including physicians, nurses and professionals from other health disciplines will ensure that patients receive high-quality care, thereby reducing the care burden of nurses.

2272 Methodological challenges and strategies in understanding the lived experiences of childless Chinese older couples

Abstract Introduction With more cases of delayed marriage, voluntary childlessness and infertility among Chinese, childless older couples are anticipated to increase. Although evidence suggests that being childless in Western societies may benefit older couples, older Chinese couples without children are marginalised as no one is available to take care of their physical, psychosocial and financial burdens because children in the Chinese societies are often responsible for caring and supporting older individuals. This ongoing study explores the lived experiences of ageing among childless Chinese older couples. While the research methods are novel in the literature, this study highlights the methodological challenges encountered by the researchers. Method This qualitative study adopts the interpretive phenomenological approach with photovoice. Twenty childless older couples are recruited to participate in two face-to-face interviews and submit photos before the second interview. The photos convey contextual details that are challenging to express in words, thereby enhancing the richness of the interview data. Data are analysed using the van Manen’s thematic analysis and Oliffe’s photographic analysis. Results Some challenges experienced so far include difficulties in recruiting participants, as certain spouses refuse to participate while their partners choose to do so. Also, certain couples are reluctant to talk about dying as the last stage of their ageing or be interviewed simultaneously. Similarly, certain couples may not know how to take and submit photos. Strategies utilised include providing simple and clear explanations before the interview, allowing some couples to be interviewed separately, assuring confidentiality in data handling, and recruiting those competent in using smartphones. Conclusion The methodological challenges and related strategies surrounding recruiting older couples and using photovoice provide valuable implications for future researchers. Acknowledgement The work described in this paper was fully supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (UGC/FDS16/M09/23).

Symptom burden among men treated for castration-resistant prostate cancer: a longitudinal study

ObjectivesDespite rapid expansion of treatments for metastatic castration-resistant prostate cancer (mCRPC) and the importance of symptom management for enhancing quality of life, few studies have focused on men’s experiences of...

Psychological Factors Related to Treatment Outcomes in Head and Neck Cancer.

Patients with head and neck cancer (HNC) often demonstrate stress, distress, anxiety, depression, and are at risk forsuicide. These affect their quality of life (QoL) but less attention has been given to psychological variables that may impact response to treatment. This study aims to systematically review publications during 2013-2023 to collate evidence on the effects of psychological variables on HNC treatment outcomes. We searched Ovid Medline, PubMed, Scopus, and Web of Science for articles that examined psychological factors related to treatment outcomes in patients with HNC. There were 29 studies (5 before treatment, 2 during, 17 after, and 5 covering the whole management trajectory) including 362,766 patients. The psychological factors were either behavioral (adjustment and coping strategy, unrealistic ideas, self-blame), cognitive (elevated risk of psychiatric co-comorbidity), or emotional (distress, depression, anxiety, nervousness, and fear of disfigurement and complications). It was found that there was a relationship between depression and decreased survival in patients with HNC. Pretreatment pain was an independent predictor of decreased survival in a large sample of patients. The distress level was approximately 54%, emotional problems ranged between 10 and 44%, while financial difficulties wereidentified in 54% of the patients. Sixty-nine percent of patientswere reported to have used at least one cost-coping strategy within 6months after treatment initiation. During post-treatment period, depression increased from 15% at the baseline to 29%, while the fear of recurrence was found among at least 35% of patients. Several psychological factors predict QoL and survival among HNC survivors. Distress encompasses depression and anxiety, and physical burden from HNC diagnosis and treatment. Routine screening and early interventions that target distress could improve HNC survivors' QoL. A systematic and standardized measurement approach for QoL is warranted to homogenize these findings and to understand the underlying relationships.

Development and Evaluation of a Web-Based Platform for Personalized Educational and Professional Assistance for Dementia Caregivers: Proposal for a Mixed Methods Study.

Alzheimer disease (AD) and AD-related dementia are prevalent concerns for aging populations. With a growing older adult population living in the United States, the number of people living with dementia is expected to grow, posing significant challenges for informal caregivers. The mental and physical burdens associated with caregiving highlight the importance of developing novel and effective resources to support caregivers. However, technology solutions designed to address their needs often face low adoption rates due to usability issues and a lack of contextual relevance. This study focuses on developing a web-based platform providing financial and legal planning information and education for dementia caregivers and evaluating the platform's usability and adoptability. The goal of this project is to create a web-based platform that connects caregivers with personalized and easily accessible resources. This project involves industrial, academic, and community partners and focuses on two primary aims: (1) developing a digital platform using a Dementia Care Personalization Algorithm and assessing feasibility in a pilot group of caregivers, and (2) evaluating the acceptability and usability of the digital platform across different racial or ethnic populations. This work will aid in the development of technology-based interventions to reduce caregiver burden. The phase I study follows an iterative Design Thinking approach, involving at least 25 dementia caregivers as a user feedback panel to assess the platform's functionality, aesthetics, information, and overall quality using the adapted Mobile Application Rating Scale. Phase II is a usability study with 300 dementia caregivers in Texas (100 African American, 100 Hispanic or Latinx, and 100 non-Hispanic White). Participants will use the digital platform for about 4 weeks and evaluate its usefulness and ease of use through the Technology Acceptance Survey. The study received funding from the National Institute on Aging on September 3, 2021. Ethical approval for phase I was obtained from the Texas A&M University Institutional Review Board on December 8, 2021, with data collection starting on January 1, 2022, and concluding on May 31, 2022. Phase I results were published on September 5, 2023, and April 17, 2024, respectively. On June 21, 2023, ethical approval for human subjects for phase II was granted, and participant recruitment began on July 1, 2023. Upon completing these aims, we expect to deliver a widely accessible digital platform tailored to assist dementia caregivers with financial and legal challenges by connecting them to personalized, contextually relevant information and resources in Texas. If successful, we plan to work with caregiving organizations to scale and sustain the platform, addressing the needs of the growing population living with dementia. DERR1-10.2196/64127.

Psychological Burdens of Alzheimer’s Caregivers and Their Coping Mechanisms

Background and Objective: Alzheimer's disease is a progressive and irreversible disorder that not only affects patients but also has severe repercussions on the daily lives, social relationships, and mental health of caregivers. This qualitative study aimed to delve deeper into the daily challenges faced by caregivers, the coping mechanisms they employ, and the positive outcomes they may experience, focusing on caregivers in Richmond Hill, Ontario. Materials and Methods: A qualitative research approach was adopted, utilizing semi-structured interviews to collect data until theoretical saturation was achieved. A total of 26 participants were selected using purposive sampling method from Alzheimer Clinics of the Richmond Hill area, ensuring a representation of varied experiences. Data were analyzed using thematic analysis method and NVivo software was utilized to assist in the organization and analysis of the data. Results: Four main themes were identified: daily challenges, coping mechanisms, health impacts, and positive outcomes. Caregivers reported significant daily challenges, including time management difficulties, financial burdens, behavioral problems of the patients, and lack of social support. Coping strategies varied widely, encompassing both active and passive approaches, with some caregivers displaying significant psychological resilience and resourcefulness. Positive outcomes, such as personal growth and improved family relationships, were noted, despite the substantial burdens. Conclusion: Caregivers of Alzheimer’s patients endure considerable psychological and physical burdens. Nonetheless, the presence of effective coping strategies and social support significantly affected their ability to manage these challenges. Future interventions should focus on enhancing caregiver support systems and providing targeted education and resources to alleviate caregiver strain.

Experiences of parenting for autistic children in Australia and Italy: a qualitative cross-cultural comparison.

Parents vary in their gradual adaptation to the demands of caring for an autistic child. Their experiences can be positive, negative, or a combination of both, depending on the severity of the cases and various personal and social factors. Cross-cultural comparisons can aid in understanding how contextual factors, such as the availability of social and health services, and cultural factors, such as family relationships and the distribution of care burden, may influence the caregiving experience. However, there is a limited amount of cross-cultural research on this topic, which is almost exclusively quantitative. From an ecocultural perspective, our interview-based study aimed to explore the experiences of Australian (15) and Italian (11) parents of autistic children living in their respective countries. The analysis identified three main themes. Life through autism, autism through life: coexisting with an unexpected life partner, Parenting autistic children: reorganization of parents' subjectivity and familiar dynamics, and The unseen side of disability: autism communities between inclusion and segregation. Our comparative approach reveals both commonalities and differences between the two groups of participants. The similarities support features previously identified in the literature: the emotional and physical burden on parents and the positive impact on parental identity. The differences relate to the diagnostic process, interactions with health professionals, the impact of autism on family dynamics and parental perspectives, and the role assigned to siblings. Despite facing similar challenges, these differences reveal how Italian and Australian parents articulate different understandings linked to social and cultural differences.

CARING FOR THOSE WHO CARE: CHALLENGES AND STRATEGIES TO ALLEVIATE OVERBURDEN IN CAREGIVERS OF ONCOLOGY PATIENTS

Introduction: Cancer is a growing public health issue in Brazil, and it is clear that caregivers of cancer patients play a crucial role in supporting patients. However, they face a series of emotional, physical, and financial challenges that can exacerbate their burden. Therefore, the aim of this study is to analyze the various facets of the burden of caregivers of cancer patients, highlighting its origins, manifestations, and repercussions, with the purpose of devising effective relief strategies. Methodology: This literature review analyzed 15 articles published between 2021 and 2023, selected based on relevance and currency on the topic of caregiver burden in oncology. The following factors contributing to caregiver burden were identified: emotional burdens (negative emotions such as stress, anxiety, and depression), physical burdens (tasks such as mobility, hygiene, and medication administration), and financial burdens (significant treatment costs leading to financial difficulties). Results and Discussion: The research reveals that patient performance is the primary factor associated with caregiver burden. Other factors include the caregiver-patient relationship, such as degree of kinship, gender, age, emotional and financial burden, along with the social and family context, such as marital status, education, occupation, and employment status of the caregiver, as well as the hours dedicated to care. The results underscore the importance of identifying and addressing the factors contributing to caregiver burden. Conclusion: Caregiver burden is a serious issue that needs to be addressed. Developing effective strategies to mitigate it is essential to improve the quality of life for both caregivers and cancer patients.

Segmentation Guided Crossing Dual Decoding Generative Adversarial Network for Synthesizing Contrast-Enhanced Computed Tomography Images.

Although contrast-enhanced computed tomography (CE-CT) images significantly improve the accuracy of diagnosing focal liver lesions (FLLs), the administration of contrast agents imposes a considerable physical burden on patients. The utilization of generative models to synthesize CE-CT images from non-contrasted CT images offers a promising solution. However, existing image synthesis models tend to overlook the importance of critical regions, inevitably reducing their effectiveness in downstream tasks. To overcome this challenge, we propose an innovative CE-CT image synthesis model called Segmentation Guided Crossing Dual Decoding Generative Adversarial Network (SGCDD-GAN). Specifically, the SGCDD-GAN involves a crossing dual decoding generator including an attention decoder and an improved transformation decoder. The attention decoder is designed to highlight some critical regions within the abdominal cavity, while the improved transformation decoder is responsible for synthesizing CE-CT images. These two decoders are interconnected using a crossing technique to enhance each other's capabilities. Furthermore, we employ a multi-task learning strategy to guide the generator to focus more on the lesion area. To evaluate the performance of proposed SGCDD-GAN, we test it on an in-house CE-CT dataset. In both CE-CT image synthesis tasks-namely, synthesizing ART images and synthesizing PV images-the proposed SGCDD-GAN demonstrates superior performance metrics across the entire image and liver region, including SSIM, PSNR, MSE, and PCC scores. Furthermore, CE-CT images synthetized from our SGCDD-GAN achieve remarkable accuracy rates of 82.68%, 94.11%, and 94.11% in a deep learning-based FLLs classification task, along with a pilot assessment conducted by two radiologists.

The Hidden Costs of Psoriasis: A Population-Based Study Evaluating How Psoriasis Severity Impacts Work Absenteeism.

Psoriasis patients experience physical and emotional burdens, which may lead to work-related productivity loss. This loss carries professional and financial repercussions. It is unknown whether the extent of psoriasis affects work absenteeism. This study aims to compare work absenteeism between employed adults with mild versus moderate-to-severe psoriasis. A national, cross-sectional study using the 2009 to 2019 Medical Expenditure Panel Survey evaluated 5,209,956 (weighted) adults aged &ge; 22 years. Work absenteeism was compared between adults with mild (4,521,687 weighted) and moderate-to-severe psoriasis (688,269 weighted). Work absenteeism, as measured by the average number of episodes per year that someone was absent from work for at least a half day, was significantly higher in patients with moderate-to-severe psoriasis than in patients with mild disease (4.4 episodes vs 2.8 episodes, P=0.002). Multivariable logistic regression models showed moderate-to-severe patients were 2.68 times more likely (95% CI:1.72-4.21; P&lt;0.001) to take a half-day or more off from work than those with mild disease after adjusting for age, sex, race, ethnicity, poverty, cognitive limitations, insurance, education, and comorbidities. Disease severity directly impacts work absenteeism in psoriasis patients. Early diagnosis and treatment with appropriate therapies are needed to reduce disease severity and limit economic loss and professional ramifications associated with psoriasis. J Drugs Dermatol. 2024;23(8):640-644.&nbsp; doi:10.36849/JDD.7550.

Household cost of road traffic accident-related injuries: A case study of St. Joseph Hospital, Koforidua in Ghana

Road traffic accidents (RTAs) are a prominent contributor to both mortality and morbidity, particularly affecting individuals aged 5–29 years. Road traffic Injuries impose substantial physical and economic burden on individuals, households, and governments, particularly in African nations. Thus, our study focuses on assessing the economic cost of road traffic accidents within the context of St. Joseph Hospital, Koforidua.A cross-sectional survey was conducted at the Emergency Unit of the St. Joseph Hospital with a sample size of 291 patients. A patient perspective was used in costing the management of RTAs. Data was descriptively analyzed with Microsoft Excel with means and standard deviations estimated for direct, indirect, and intangible costs to the patient.Total direct and indirect cost of road traffic accidents were approximately GHS1,973,801.28 (US$164,483.44) and GHS520,309.46 (US$43,359.12) respectively which represents 79.1 % and 20.9 % of the total cost. The annual average economic cost for all cases was GHS8,570.83 (US$714.24). Intangible costs were also found to be high, with 54.2 % patients rating their RTA burden to be between mild to moderate, 10.8 % as moderate to severe and 1.4 % as severe.RTA cost burden is huge for all households. Uninsured patients bear significantly higher costs than insured patients. Intangible costs were also high, prompting the need to provide psychological care to RTA victims and their families. Concerted efforts should be directed at strict enforcement, training, improvement of road infrastructure and legislation to reduce or curb road traffic accidents in LMICs.

Physical Activity Engagement among Black Immigrants and African American Adults in the 2010 to 2018 NHIS Study.

High rates of physical inactivity persist in the United States, with higher rates among non-Hispanic Black adults than among their White peers. However, a comparison of physical activity engagement across nativity among Black adults in the United States has yet to be fully documented. The purpose of this cross-sectional study was to examine physical activity engagement rates among African immigrant and Afro-Caribbean immigrant adults compared with native-born African American adults using data from the 2010 to 2018 National Health Interview Survey. Using data from the 2010 to 2018 National Health Interview Survey, we used generalized linear models to compare levels of physical activity (meeting the moderate-to-vigorous physical activity [MVPA] recommendations) by ethnic subgroups of Black adults, sequentially adjusting for sociodemographic and health-related risk factors. Data from 38,037 adults (58.8% female, 21% college/graduate degree, and 41.4% with obesity) were included. Only 41.9% of all participants met the MVPA recommendations. In the fully adjusted models across the 9 years, higher levels of MVPA were seen among African Americans (42%) than among African immigrants (38%) and Afro-Caribbean immigrants (41%). Compared with African Americans, African immigrants were less likely to engage in physical activity that met the MVPA guidelines (prevalence ratio: 0.90; 95% confidence interval: 0.85, 0.96), whereas there were no differences in meeting the guidelines between Afro-Caribbean immigrants (prevalence ratio: 0.96; 95% confidence interval:0.90, 1.02) and African Americans. Culturally tailored interventions addressing socioenvironmental barriers and facilitators of physical activity may have important impacts on physical activity promotion and long-term disease burden among Black adults across nativity.