Risk Of Distress Research Articles

Canine pulmonary clearance during feto-neonatal transition according to the type of delivery

The success of immediate adaptation to extrauterine life depends on appropriate lung function, however, elective cesarean section can increase the risk of respiratory distress as a result of reduced pulmonary fluid absorption. This study aimed to evaluate the influence of birth mode on pulmonary clearance and respiratory performance of canine neonates in the transition period. For this purpose, 37 neonates were selected according to the obstetric condition: Vaginal Eutocia (n = 17) and Elective C-section (n = 20). Neonates were evaluated for neonatal vitality score, as well as evaluation of heart and respiratory rates, body temperature and body weight, venous hemogasometric evaluation, blood lactate and glucose, pulse oximetry and radiographic evaluation during the first 24 h of life. Additionally, amniotic fluid electrolyte composition of each puppy was evaluated. There was no influence of the type of delivery on electrolyte composition of canine amniotic fluid and neonatal pulmonary liquid content, analyzed by thoracic X-Rays. On the other hand, elective cesarean section delayed pulmonary adaptation, resulting in hypoxemia and less efficient compensatory response to acid-base imbalance and thermoregulation. In conclusion, elective c-section does not delay pulmonary clearance, whilst alters pulmonary adaptation by less efficient gas exchange and lower oxygenation, hindering the compensatory response to acid-base imbalance during the fetal-neonatal transition in dogs.

Trends in Health-Risk Behaviors and Psychological Distress among Australian First-Year University Students.

University students are recognized as a high-risk population group who experience greater rates of poor health outcomes and mental ill-health. Commencing university is recognized as a major life transition, where students experience new financial, academic, environmental, and social pressures that can cause changes in their normal behaviors. This study explored trends in health-risk behaviors and psychological distress in commencing university students over four survey years. First-year undergraduate students, aged 17-24, from an Australian university were included. A secondary analysis was performed on data collected via cross-sectional surveys on four occasions (2016, 2017, 2019, 2020). Crude logistic regression models were utilized to investigate the association between meeting guidelines and survey year. Odds ratios for the pairwise comparison between each year are reported. In this analysis, 1300 (2016), 484 (2017), 456 (2019), and 571 (2020) students were included. Analyses showed two clear trends: students' probability of being at high/very high risk of psychological distress (35-55%) and consuming breakfast daily (44-55%) consistently worsened over the four survey years. These findings suggest that the odds of psychological distress and daily breakfast consumption worsened over time, whilst the proportion of students engaging in some health-risk behaviors was high, highlighting the importance of early intervention during the transition to university.

ESG performance and financial distress prediction of energy enterprises

In the current drive to cut global carbon emissions, energy companies are facing intensifying policy pressures. This study investigates the impact of ESG (Environmental, Social, Governance) performance on the risk of corporate financial distress in the energy sector. Using a tripartite methodology of sentiment, topic, and word frequency analysis, we measure the characteristics of texts of ESG reports. These ESG-related textual variables, combined with company carbon performance and other variables, are integrated into the CatBoost algorithm to predict financial distress. The empirical findings indicate that text words, topics and sentiments derived from ESG reports prove to be effective in forecasting financial distress in energy companies. Additionally, the CatBoost used in this study surpasses other models such as logistic regression and decision trees in predictive capability. This study demonstrates how incorporating textual analysis of ESG reports enhances the predictive accuracy for financial distress in energy companies, highlighting the important role of comprehensive ESG evaluation in financial risk assessment.

Dignity-related distress and recall among alert, non-delirious critically ill patients.

Critical illness is associated with multiple undesired impacts, including residual psychological distress, frequently associated with recollections of critical illness. Dignity-related distress is highly prevalent among the one-fifth of critically ill patients who are alert. The distress may be associated with unpleasant recollections of care. We examined whether patients at risk for dignity-related distress had recall of their reported distress approximately 1 week after assessment and whether this recall differed from another high-risk group, specifically patients undergoing dialysis for end-stage renal disease. The prospective cohort study included patients with critical illness and patients with end-stage renal disease enrolled from intensive care units (ICUs) and dialysis units at 1 academic center. Distress was assessed using the Patient Dignity Inventory (PDI). Participants received in-patient or telephonic follow-up 7-10 days after the initial interaction. Follow-up encounters focused on recollection of key aspects of the interpersonal interaction as well as the content of the PDI. A total of 32 critically ill patients participated in initial assessment and follow-up. In total, 26 dialysis patients participated in both phases. The groups' demographics differed. Fifty percent (n = 16) of critically ill patients and 58% (n = 15) of dialysis patients reported a mean score per item of >1.6, corresponding with severe distress on the PDI. Among the ICU patients, the 95% upper 2-sided confidence interval for the median level of recall was commensurate with the participant having had no recall of the initial interview beyond remembering that there was an interview. The end-stage renal disease group did not demonstrate significantly better recall. Dignity-related distress is high in both critically ill patients and those with end-stage renal disease; however, recollection of assessment is poor in both groups. Any intervention designed to mitigate dignity-related distress will need either to be immediately deployable or not to be reliant upon recollection for impact.

A Systematic Literature Review of Working Capital Management in Business Organizations

Working capital management is a crucial aspect of financial management that focuses on the effective management of a company's current assets and liabilities to ensure the smooth operation of day-to-day activities. A literature review on working capital management reveals a plethora of research studies highlighting the significance of optimizing working capital to enhance a firm's profitability, liquidity, and overall financial performance. Several studies have emphasized the importance of maintaining an optimal level of working capital to strike a balance between liquidity and profitability. By efficiently managing components such as cash, inventory, accounts receivable, and accounts payable, companies can minimize the risk of financial distress and improve their operational efficiency. Researchers have proposed various models and techniques to assess and improve working capital management practices, such as the cash conversion cycle, the operating cycle, the current ratio, and the quick ratio. Moreover, studies have also explored the impact of working capital management on firm value and performance. It has been widely documented that effective working capital management positively influences a company's profitability and shareholder value. By reducing the cash conversion cycle and operating cycle, firms can release trapped capital and reinvest it in value-creating activities. Conversely, inadequate working capital management can lead to financial constraints, increased costs, and reduced profitability. Furthermore, researchers have investigated the determinants and challenges of working capital management across different industries and regions. Factors such as industry characteristics, firm size, profitability, growth rate, and macroeconomic conditions have been identified as key determinants of working capital management practices. Cultural, regulatory, and technological factors also play a significant role in shaping companies' approaches to working capital management. In conclusion, the literature review on working capital management underscores the importance of adopting efficient strategies to manage current assets and liabilities effectively. By optimizing working capital levels, companies can improve their financial performance, enhance liquidity, and create long-term value for stakeholders.

Exploring the unmet needs and experiences of informal caregivers of patients with end-stage kidney disease (ESKD) receiving haemodialysis - a qualitative study.

Patients with end stage kidney disease (ESKD) receiving haemodialysis experience multiple symptoms, which can present physical and emotional challenges for both patients and their informal caregivers. Caregivers can experience anxiety, depression, and social isolation negatively impacting their overall wellbeing and resulting in caregiver burden. The needs of this group of caregivers have been largely neglected, with little emphasis placed on supportive interventions that might assist and support them in their caring role. The aim of this study Is to explore the unmet needs and experiences of caregivers of patients with ESKD receiving haemodialysis, and to determine the components of a supportive intervention. A qualitative study using semi-structured interviews (n = 24) with informal caregivers. An interpretive qualitative framework was employed to generate a rich understanding of the unmet needs and experiences of caregivers. Data was analysed using thematic analysis. Interviews were transcribed verbatim and data management was assisted through NVIVO version 11. Twenty-four informal caregivers were purposively recruited from two haemodialysis settings within Northern Ireland. Three themes were identified: (1) The negative impact of distress, anxiety, and isolation on caregivers due to their caregiving responsibilities (2) Inadequate information and knowledge about the complexities of renal care (3) The benefits of spiritual beliefs, stress management and peer support in relieving the caregiving burden. Caregivers of patients with ESKD receiving haemodialysis are at increased risk of physical and psychological distress and burden arising from their caregiving role. The unpredictable nature of ESKD and haemodialysis treatment negatively impacts the caregiver experience and adds to the challenges of the role. The information needs of caregivers are not always adequately met and they subsequently lack appropriate knowledge, skills, and guidance to assist them in their caregiving role. Supportive interventions are essential for caregivers to enhance their capability to deliver effective care and improve their quality of life.

Maternal distress during the COVID-19 outbreak: A socio-ecological perspective.

Mothers faced an increased risk of adverse mental health outcomes during the COVID-19 pandemic compared to other populations. However, there is little data on the factors that placed mothers at increased risk of distress. The present study explored a range of individual, familial, and environmental factors associated with psychological distress in mothers during the COVID-19 pandemic. This repeated cross-sectional study was composed of a convenience sample of mothers who completed an online survey that included a demographic questionnaire, an emotion regulation questionnaire, and the Depression, Anxiety, and Stress scale. The survey was administered during the second and third lockdowns in Israel in 2020-2021. The study included 575 mothers (M age = 39). The findings of a hierarchical regression indicated that individual-level factors, composed of age and emotion regulation tendencies predicted psychological distress. The family-level factors of household income and number of children in the family also predicted distress. In terms of environmental-level factors, COVID-19-related media consumption and school status (open or closed) were also significant predictors of psychological distress. Importantly, the results showed that the most important predictors of psychological distress in mothers during the COVID-19 outbreak were school closures, household income, and the use of adaptive and maladaptive emotion regulation strategies. The findings highlight the intersection of individual, familial, and environmental factors in mothers' mental health during crises.

Associations between Illicit ADHD Medication Use and Aspects of Mental Distress Among College Students

The illicit use of Attention-Deficit Hyperactivity Disorder (ADHD) medication has become a prevalent issue on college campuses. Illicit ADHD medications are used without a medical prescription. The concern is that these medications are psychostimulants that may alter brain chemistry and affect the quality of brain maturity in individuals who do not need them medically, which potentially can affect mental health. An alarmingly high percent of reported illicit ADHD medication users are college aged students between the age of 18 and 22 years. Little is known about the effect of illicit ADHD medication use on mental well-being among college students. Thus, the purpose of the study was to assess the impact of illicit ADHD medication use on different aspects of mental distress among college students. The study collected 702 responses from undergraduate students at several US colleges and included self-reported data on illicit Adderall use, age and symptoms of mental distress. The anonymous survey was created in Google Forms. Mental distress was evaluated through The Kessler Psychological Distress Scale (K10). The data were analyzed in SPSS, Version 28.0, using Pearson’s Correlation Coeffcient. Of the 72.5% of the participants who reported using ADHD medication without a prescription, 71.4% reported academic reasons as their motivation for use. There is a positive correlation between feelings of worthlessness and illicit ADHD medication use (p<0.05). Age was negatively correlated with feelings nervous (p<0.01) and restless or fidgety (p<0.01). Additionally, a negative correlation was found between age and being able to do only half or less of what you would normally have been able to do (p<0.01). On the other hand, illicit ADHD medication use was negatively correlated with feeling that everything was an effort (p<0.05), as well feeling unable to work or carry out normal activities (p<0.01). Our results suggest that students who use ADHD medication illicitly are more likely to experience symptoms of mental distress. Interestingly, our findings propose that the younger the age of use, the higher the risk of mental distress. We received no support or financial grants. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

2024 Alzheimer's disease facts and figures.

This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, includingthe absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.

Meaning-focused coping as a cultural process: A mixed quantitative and PhotoVoice study of adolescents with Arab backgrounds overcoming stigma and harassment

Poor mental health among U.S. adolescents has reach epidemic proportions, with those from the Middle East and North African region exhibiting increased risk for distress and suicide ideation. This mixed-methods study analyzes quantitative data from first- and second-generation Arab adolescents (n = 171) and qualitative data from a participatory study conducted with 11 adolescents of the same population to understand the role of cultural resources in coping. Drawing on the Intersectional Theory of Cultural Repertoires in Health, we show that: 1) cultural resources underlie meaning-making throughout coping; 2) coping strategies are inseparable from the influence of peer and familial relationships, as dictated through the social norms and other cultural resources; 3) collectively held repertoires of coping can promote belonging, affirm identity, and protect against discrimination; and 4) the outcomes of coping strategies, and the culturally informed meaning individuals make of these outcomes, influence their future coping behaviors.

The impact of childhood trauma on emotional distress and the moderating role of sense of coherence among college students in China

Childhood trauma is strongly linked to emotional distress. However, few studies have explored the impact of sense of coherence (SOC) on the relationship between childhood trauma and emotional distress in college students. This study aimed to explore its impact on the relationship between childhood trauma and emotional distress. Analyzing data from 2307 Chinese college students, we found that SOC moderated the association between childhood trauma and anxiety/depression levels. Females showed higher SOC and lower anxiety/depression despite experiencing more childhood trauma. Multiple linear regression revealed that anxiety was negatively associated with SOC(P < 0.001) and grade(P = 0.027), and positively with childhood trauma(P < 0.001) and male gender(P = 0.004). Similarly, the depression exhibited similar associations. SOC moderated negatively the relationship between CTQ and anxiety, as well as between CTQ and depression. Childhood trauma is associated with increased emotional distress risk among college students, but a strong SOC can reduce this risk.

Psychosocial distress and health status as risk factors for ten-year major adverse cardiac events and mortality in patients with non-obstructive coronary artery disease

BackgroundWe examined the risk of psychosocial distress, including Type D personality, depressive symptoms, anxiety, positive mood, hostility, and health status fatigue and disease specific and generic quality of life for MACE in patients with non-obstructive coronary artery disease (NOCAD). MethodsIn the Tweesteden mild stenosis (TWIST) study, 546 patients with NOCAD were followed for 10 years to examine the occurrence of cardiac mortality, a major cardiac event, or non-cardiac mortality in the absence of a cardiac event. Cox proportional hazard models were used to examine the impact of psychosocial distress and health status on the occurrence of MACE while adjusting for age, sex, disease severity, and lifestyle covariates. ResultsIn total 19% of the patients (mean age baseline = 61, SD 9 years; 52% women) experienced MACE, with a lower risk for women compared to men. Positive mood (HR 0.97, 95%CI 0.95–1.00), fatigue (HR 1.03, 95%CI 1.00–1.06), and physical limitation (HR 0.99, 95%CI 0.98–1.00) were associated with MACE in adjusted models. No significant interactions between sex and psychosocial factors were present. Depressive symptoms were predictive of MACE, but no longer after adjustment. ConclusionsIn patients with NOCAD fatigue, low positive mood, and a lower physical limitation score were associated with MACE, without marked sex differences. Type D personality, psychosocial factors, and health status were not predictive of adverse outcomes. Reducing psychosocial distress is a valid intervention goal by itself, though it is less likely to affect MACE in patients with NOCAD.

A Model for Providing Psychological Support to Healthcare Leaders and Teams in Times of Crisis.

Pre-pandemic, the healthcare workforce was already at risk for higher burnout than the general population and, in some roles (e.g., physicians, nurses), at higher risk for clinical distress and suicide. Studies of healthcare workforce well-being during and after past pandemics reflect that distress can persist after a pandemic subsides, if adequate support within the workplace is not forthcoming and accessible. The current report presents the rationale for and development of a wellness consult service to provide support to leaders and teams in an academic medical center during the COVID-19 pandemic and now as teams work to recover and rebuild after years of significant pandemic and other stressors. Healthcare workers who participated in supportive Listening Sessions or Interactive Workshops facilitated by the wellness consult service were invited to complete an anonymous post-session survey. Between March 2020 and November 2022, 185 leaders and teams participated in 342 supportive Listening Sessions and Interactive Workshops. Of the respondents to the post-session survey (N = 701), 89% rated the intervention as "good to excellent" and 84% were likely or very likely to recommend this service. Leaders rated the experience more highly than non-leaders (F (1,307) = 13.99, p < 0.001) and were more likely to report feeling emotionally supported (F (1,304) = 19.836, p < 0.001). Supporting leader and team well-being may be critical to post-pandemic recovery of the healthcare workforce. The current report presents a feasible, theory-driven model for doing so, which was rated as highly satisfactory by participants.

Stress responses to bacterial and viral mimetics in polycystic ovary syndrome model rats

Polycystic ovary syndrome (PCOS) is associated with an increased risk of psychological distress as well as enhanced responses to psychosocial stress. Recently, it was hypothesized that PCOS patients may be at high risk of novel COVID-19 infections and worse clinical presentations during such infections. Here, we evaluated the effects of PCOS on stress responses to bacterial and viral mimetics using dihydrotestosterone-induced PCOS model rats. Lipopolysaccharide (LPS; a bacterial mimetic) or polyinosinic-polycytidylic acid (Poly-IC; a viral mimetic) was injected into PCOS model rats (PCOS) and non-PCOS rats (control), and the rats' stress responses were evaluated. In the PCOS group, the rats’ anorectic and febrile responses to LPS injection were enhanced, whereas their anorectic and febrile responses to Poly-IC injection were unaltered. The PCOS group also exhibited greater changes in peripheral cytokine levels in response to LPS, but not Poly-IC. On the contrary, after the injection of Poly-IC depressed locomotor activity was more evident in the PCOS group, whereas no such changes were observed after LPS injection. These findings indicate that although the stress responses of PCOS model rats to infection may be enhanced, the patterns of change in stress responses and their underlying mechanisms may differ between bacterial and viral infections.

The effect of improving psychosocial stressors on psychological distress: a quasi-experiment of Finnish health and social care workers.

To examine how a positive change in one to three psychosocial stressors (job demands, job rewards, and workplace social capital) influenced psychological distress. The analysis included 3605 Finnish health and social services workers who completed surveys in 2019, 2020 and 2021. A logistic regression model was used to estimate the propensity score of experiencing a positive change in one to three psychosocial stressors between 2019 and 2020. We balanced the baseline characteristics with propensity scoring. A generalised linear model with a binomial distribution and a log link function was used to compare the quasi-intervention and quasi-control groups for the risk of psychological distress in 2021. Among the total sample, neither improving a single stressor nor two or three stressors affected psychological distress. However, among employees younger than 50 years, improving two or three psychosocial stressors in 2019-2020 decreased the risk of moderate to severe psychological distress in 2021 by 41% (risk ratio 0.59, 95% confidence interval 0.36-0.96). Among employees aged 50 years or older, improving job rewards lowered the risk of mild to severe psychological distress by 23% (risk ratio 0.77, 95% confidence interval 0.62-0.96). The results of this quasi-experiment suggest that the positive effect of improving psychosocial stressors is stronger among younger than older workers. Future interventions should be customised for different ages and aim to improve accumulated work stressors and individual stress-coping skills.

Limit to Arbitrage and Distress Risk Puzzle in Vietnam: Does Corporate Bankruptcy Regulation Matter?

This study is the first to examine how limit-to-arbitrage factors impact the distress risk puzzle in Vietnam before and after implementing bankruptcy regulations. Our research utilizes asset pricing models, portfolio sorting methodologies, and the Fama and French four-factor model to analyze an unbalanced panel with 35,255 firm-month observations from non-financial firms in the Vietnam stock market from 2008 to 2021. We find a persistent negative correlation between distress risk and corporate profitability, even after accounting for limit-to-arbitrage factors. Notably, this trend is more pronounced among larger firms. Intriguingly, the distress risk puzzle disappears after the introduction of bankruptcy regulations. Additionally, we observe that limit-to-arbitrage factors suppress stock returns due to mispricing issues, supporting liquidity risk theory. Our study provides valuable insights into the distress risk puzzle, especially in emerging markets. JEL Classification: G11, G12, G14.

Gaining consensus on emotional wellbeing themes and preferences for digital intervention type and content to support the mental health of young people with long-term health conditions: A Delphi study.

Young people (YP) with long-term conditions (LTCs) are at greater risk of psychological distress than those without LTCs. Despite this, there is a scarcity of quality digital interventions designed to help improve mental wellbeing in this population. The aim of this study was to determine what YP, parents and health professionals preferred for future interventions. Twenty-six YP with asthma, diabetes and/or epilepsy (the three most common LTCs in YP), 23 parents of YP with LTCs and 10 health professionals mainly in paediatric specialisms (total n = 59) took part in an online Delphi study to gain consensus (set at 75% agreement) on four questions across three rounds. Participants ordered psychological themes that may be experienced by YP with LTCs by importance and ranked digital intervention types and delivery modes by importance or usefulness. The most common results were reported if no consensus was reached by round 3. Participants preferred a mobile phone app (73% agreement) and a mixture of one-on-one and group support for an intervention (75% agreement). The two highest ranked psychological themes were anxiety (44%) and wanting to appear 'normal' (38%), and the top intervention type was 'general counselling' (54% agreement). There was a clear desire for an app to help with the psychological aspects of living with LTCs and for a combination of one-to-one and group intervention elements. Anxiety and wanting to appear 'normal' might be two closely linked psychological challenges that could be addressed by a single intervention. The results will be important to consider for a future intervention, although further consultation will be needed for app development. Two YP with a LTC provided feedback on the study protocol including the aims and procedures of the project. Another six YP with LTCs were consulted on an early draft of the study questionnaire (the four questions), which was subsequently revised. Once the project began, a patient and public involvement group consisting of two YP with LTCs and one parent of a YP with an LTC gave feedback on the research process, lay report of the results and dissemination plan.

Fetal Outcome among Women with Postdate Pregnancy

OBJECTIVE: The study aimed to determine the mode of delivery and fetal outcome among women with postdated pregnancies. METHODOLOGY: This cross-sectional study was conducted from July to December 2020 in the Department of Gynecology, Hayatabad Medical Complex, Peshawar. A total of 287 women with postdated pregnancies (beyond 41 weeks) were selected through a convenient sampling technique for the study and followed to detect expected fetal outcomes. All women of age 20-45 with no signs of labor onset and cepahlic presentation of singleton pregnancy were included, while women with retained placenta detected by ultrasound, women with a medical disorder like coagulopathies (Haemophilia, Von Willebrand disease, Thrombocytopenia, DIC, Protein S deficiency, Protein C deficiency) detected by the specific investigation were excluded from the study. Data was analyzed using SPSS version 20. RESULTS: The mean age of the sample was 30.5 years, with a standard deviation of 6.1 years. The mean parity of the sample was 2.1±1.5. The mean BMI of the sample was 26.1±3.8kg/m2. On follow-up, fetal distress in 16%, macrosomia in 18.5%, birth asphyxia in 18.1%, meconium aspiration in 8.4% and NICU admission in 9.1%. None of the neonates died in this study. CONCLUSION: Postdated pregnancy carries a high risk of fetal distress, macrosomia and birth asphyxia. We recommend more large-scale surveys as well as trials to determine the efficacy of induction before pregnancy enters the postdate period and reduce the morbidity and mortality due to postdate pregnancies. KEYWORDS: Postdate Pregnancy, Meconium Aspiration, Birth Asphyxia, Fetal Distress, Intrauterine Growth Restriction, Macrosomia

‘In the shower crying…but we came back in the following day and did it all again’. Distress and resilience in care home staff during the COVID-19 pandemic– A qualitative interview study

BackgroundCare homes (long-term care facilities) were profoundly impacted early in the COVID-19 pandemic, both in terms of resident mortality and restrictions for infection control. This study investigated the impact on the emotional well-being of care home staff of challenges faced at this time, and the strategies used to manage them.MethodsSemi-structured interviews conducted October 2020-June 2021 with care home staff and health service staff working with them explored the impact of the early waves of the COVID-19 pandemic (March 2020-June 2021). Interview data were analysed using reflexive thematic analysis.ResultsInterview participants were 16 care home staff and 10 health service staff. Analysis generated four key themes: 1)Anxiety and distress, 2)Overwhelming workload, 3)Pulling through; and 4)Resilience in a time of crisis. Care home staff experienced Anxiety and distress due to uncertainty of what to expect; witnessing illness and deaths of residents; concerns regarding their own health, and sometimes feeling their work was under-recognised. They also experienced an Overwhelming workload due to infection control measures, caring for sick residents and reduction in external healthcare support. Our theme of Pulling through reflects the peer support and problem-solving strategies with which care home staff managed the impact of the pandemic, along with a sense of responsibility and meaning towards their work. An overarching theme of Resilience in a time of crisis drew on the other three themes and describes how many staff managed, maintained, and often increased their work despite the challenges of the pandemic. Participants also described increasing emotional fatigue as the pandemic continued.ConclusionsThis paper builds on literature on the emotional impact of the pandemic on care home staff, also exploring ways that staff responded to this impact. These findings can help inform planning for future crises including disease outbreaks, and raise important questions for further work to develop pandemic preparedness in care homes and beyond. They also raise wider questions about the current cultural status of care work, which may have exposed care home staff to greater risk of distress, and which contrasts with the professionalism and responsibility shown by staff in response to pandemic challenges.

Triglyceride-glucose index in early pregnancy predicts the risk of gestational diabetes: a prospective cohort study

ObjectiveThis study aimed to investigate the association between the triglyceride-glucose (TyG) index in early pregnancy and the development of gestational diabetes mellitus (GDM) in the second trimester. The primary objectives were to evaluate the predictive potential of the TyG index for GDM, determine the optimal threshold value of the TyG index for GDM assessment, and compare the predictive performance of the TyG index alone versus its combination with maternal age and pre-pregnancy body mass index on GDM. Moreover, the study explored the association between the TyG index in early pregnancy and the risk of other pregnancy-related complications (PRCs), such as placental abruption and gestational hypertension.Patients and methodsThis prospective cohort study recruited 1,624 pregnant women who underwent early pregnancy antenatal counseling and comprehensive assessments with continuous monitoring until delivery. To calculate the TyG index, health indicators, including maternal triglycerides and fasting plasma glucose, were measured in early pregnancy (< 14 weeks of gestation). The predictive power of the TyG index for evaluating GDM in Chinese pregnant women was determined using multifactorial logistic regression to derive the odds ratios and 95% confidence interval (CI). Subgroup analyses were conducted, and the efficacy of the TyG index in predicting PRCs was assessed via receiver operating characteristic (ROC) curve analysis and restricted cubic spline, with the optimal cutoff value calculated.ResultsLogistic regression analyses revealed a 2.10-fold increase in the GDM risk for every 1-unit increase in the TyG index, after adjusting for covariates. The highest GDM risk was observed in the group with the highest TyG index compared with the lowest quintile group (odds ratios: 3.25; 95% CI: 2.23–4.75). Subgroup analyses indicated that exceeding the recommended range of gestational weight gain and an increased GDM risk were significantly associated (P = 0.001). Regarding predictive performance, the TyG index exhibited the highest area under the curve (AUC) value in the ROC curve for GDM (AUC: 0.641, 95% CI: 0.61–0.671). The optimal cutoff value was 8.890, with both sensitivity and specificity of 0.617.The combination of the TyG index, maternal age, and pre-pregnancy body mass index proved to be a superior predictor of GDM than the TyG index alone (AUC: 0.672 vs. 0.641, P < 0.01). After adjusting for multiple factors, the analyses indicated that the TyG index was associated with an increased risk of gestational hypertension. However, no significant association was noted between the TyG index and the risk of preeclampsia, placental abruption, intrauterine distress, or premature rupture of membranes.ConclusionThe TyG index can effectively identify the occurrence of GDM in the second trimester, aligning with previous research. Incorporating the TyG index into routine clinical assessments of maternal health holds significant practical implications. Early identification of high-risk groups enables healthcare providers to implement timely interventions, such as increased monitoring frequency for high-risk pregnant women and personalized nutritional counseling and health education. These measures can help prevent or alleviate potential maternal and infant complications, thereby enhancing the overall health outcomes for both mothers and babies.