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International Journal of Environmental... Jun 2024Rheumatoid arthritis (RA) patients often encounter psychological challenges due to chronic pain, fatigue, side effects of medications, and disability. This study...
BACKGROUND
Rheumatoid arthritis (RA) patients often encounter psychological challenges due to chronic pain, fatigue, side effects of medications, and disability. This study examines the relationship between autobiographical narratives and recollection patterns in RA patients. We investigated how different recall strategies for positive life events affect the emotional processing of negative episodes. We hypothesized that vividly recalling positive life events provides psychological resources that support a more intense emotional elaboration of stressful memories, allowing individuals to delve deeper into negative life experiences. Additionally, we explored the impact of these perspectives on self-reported well-being and physical health, proposing that re-living positive events improves overall well-being.
METHODS
We collected and analyzed high-point and low-point life-story episodes from 60 RA patients (85% female; age mean 61 ± 11 years; range 37-79) using episodic narrative interviews and the Narrative Categorical Content Analysis algorithm (NarrCat). Participants were categorized into 2 clusters based on their temporal perspective during high-point episodes: 25 used a Retrospective viewpoint, while 35 employed a Re-experiencing strategy. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS), and functioning was measured using the Health Assessment Questionnaire (HAQ).
RESULTS
The Re-experiencing group, which was more likely to articulate their high-point episode in vivid and real-time narrative, used more psychological perspectives (U(58) = 223, < 0.01) and showed heightened emotional frequency (U(58) = 280, < 0.05; positive: U(58) = 328, < 0.05; negative: U(58) = 278, < 0.05) in low-point episodes. No significant difference emerged between the two groups regarding psychological state (anxiety, depressive symptoms) and physical impairment.
CONCLUSIONS
Vividly recalling positive events may facilitate a deeper exploration of negative memories. The Re-experiencing group showed increased positive emotions during low points, suggesting better emotion regulation. However, no significant association was found between recalling strategies, psychological state, and physical impairment. This indicates that further research is needed to determine whether re-experiencing positive life events is adaptive or maladaptive.
Topics: Humans; Arthritis, Rheumatoid; Female; Middle Aged; Male; Aged; Adult; Mental Recall; Emotions; Life Change Events; Depression; Anxiety
PubMed: 38929005
DOI: 10.3390/ijerph21060759 -
International Journal of Environmental... May 2024The National Disability Insurance Scheme (NDIS) ushered in a transformative era in disability services in Australia, requiring new workforce models to meet evolving... (Review)
Review
The National Disability Insurance Scheme (NDIS) ushered in a transformative era in disability services in Australia, requiring new workforce models to meet evolving participant needs. Therapy Assistants are utilised to increase the capacity of therapy services in areas of workforce shortage. The governance arrangements required to support this emergent workforce have received limited attention in the literature. This review examined the key components and contextual factors of governance in rural settings, specifically focusing on therapy support workers under the guidance of allied health professionals in rural and remote areas. Guided by the social model of disability and the International Classification of Functioning, Disability and Health, a realist perspective was used to analyse 26 papers (after deduplication), mostly Australian and qualitative, with an emphasis on staff capabilities, training, and credentialling. Success measures were often vaguely defined, with most papers focusing on staff improvement and few focusing on client or organisational improvement. Consistent staffing, role clarity, community collaboration, and supportive leadership were identified as enabling contexts for successful governance of disability therapy support workers in rural areas. Investment in capability (soft skills) development, tailored training, competency assessment, credentialling, and supervision were identified as key activities that, when coupled with the identified enabling contexts, were likely to influence staff, client and organisational outcomes. Further research is warranted to explore long-term impacts of governance arrangements, educational program accountability, and activities targeted at enhancing staff capabilities.
Topics: Humans; Disabled Persons; Australia; Rural Health Services; Rural Population; Allied Health Personnel
PubMed: 38928939
DOI: 10.3390/ijerph21060693 -
International Journal of Environmental... May 2024While the literature has highlighted the immense challenges in caring for family members, it is still unclear what the needs of family carers of persons with...
Qualitative Protocol of Chinese Parents and Siblings Experiences of Managing Challenging Behaviours of Adult Persons with Intellectual Disability in Hong Kong and Northern China.
BACKGROUND
While the literature has highlighted the immense challenges in caring for family members, it is still unclear what the needs of family carers of persons with intellectual disability and challenging behaviours are and what has worked for them. This study aims to examine 60 parents' and siblings' experiences in managing the challenging behaviours of their adult family member with intellectual disability whilst living at home.
METHODS
A qualitative grounded theory approach using semi-structured interviews will be adopted. Purposive sampling will be used to recruit family carers who live with adult persons with intellectual disability and use one community service in Hong Kong. Three special schools for persons with intellectual disability from northern China will be approached.
RESULTS
This study will aim to provide an in-depth understanding of the experiences of family carers and compare the different circumstances they face when managing the challenging behaviours of their adult relatives with intellectual disability in their family home.
CONCLUSIONS
Although this study targets adults with intellectual disability, the findings will provide a point of reference for adolescents and younger persons who exhibit demanding and challenging behaviours and live with their families. Recommendations can guide the development of appropriate strategies to strengthen services for family carers.
Topics: Humans; Intellectual Disability; Hong Kong; China; Adult; Parents; Siblings; Caregivers; Qualitative Research; Male; Female; Problem Behavior; East Asian People
PubMed: 38928920
DOI: 10.3390/ijerph21060673 -
International Journal of Environmental... May 2024The purpose of this study is to summarize the ICF foci, looking beyond body structures and function, and to analyze who has been assessed in research about adolescents... (Review)
Review
PURPOSE
The purpose of this study is to summarize the ICF foci, looking beyond body structures and function, and to analyze who has been assessed in research about adolescents and young adults (AYAs) with CP in the phase of transition to adulthood.
METHOD
Medline, EMBASE, PsycINFO, and CINAHL databases were searched using terms related to cerebral palsy, adolescents/young adults, health development, participation, and independence. Studies including youth with CP (13-30 years old) published in English from 2014 to 2021 were considered. The methods of assessment reported in the included studies were used to identify the ICF foci and who was assessed.
RESULTS
In this study, 86 studies were reviewed. The main ICF foci are activity and participation (51% of the studies), personal factors (23%), ICF not covered (14%), ICF not defined (9%), with environmental factors being the least focused ICF component (3%). Most studies assessed AYAs directly (49% of studies).
CONCLUSIONS
Activity- and participation-related constructs are the leading research focus of studies, and more attention is needed concerning environmental factors. AYAs are the main source of information, and the perspectives of other key figures are also being valued. To bridge the gap between child and adult health care, a broader view of health development and approaches to explore AYA developmental issues must be taken.
Topics: Cerebral Palsy; Humans; Adolescent; Young Adult; Adult; Disability Evaluation; International Classification of Functioning, Disability and Health; Disabled Persons
PubMed: 38928917
DOI: 10.3390/ijerph21060670 -
International Journal of Environmental... May 2024Air pollution is recognized as a critical global health risk, yet there has been no comprehensive assessment of its impact on public health in Libya until now. This...
Air pollution is recognized as a critical global health risk, yet there has been no comprehensive assessment of its impact on public health in Libya until now. This study evaluates the burden of disease associated with ambient particulate matter (PM) in Libya, drawing on data from the Global Burden of Disease Study 2019. By integrating satellite-based estimates, chemical transport models, and ground-level measurements, PM exposure and its effects on mortality and disability-adjusted life years (DALYs) across the different sexes and all age groups from 1990 to 2019 are estimated. Our findings reveal that the annual population-weighted mean PM concentration in Libya was 38.6 μg/m in 2019, marking a 3% increase since 1990. In the same year, PM was responsible for approximately 3368 deaths, accounting for 11% of all annual deaths in the country. Moreover, a total of 107,207 DALYs were attributable to PM, with ischemic heart disease being the leading cause, representing 46% of these DALYs. The analysis also highlights a significant burden of years of life lost (YLLs) at 89,113 and years lived with disability (YLDs) at 18,094, due to PM. Given the substantial health risks associated with air pollution, particularly from ambient particulate matter, Libyan authorities must implement effective policies aimed at reducing air pollution to enhance healthcare outcomes and preventive services.
Topics: Particulate Matter; Humans; Libya; Global Burden of Disease; Female; Male; Adult; Adolescent; Middle Aged; Child; Young Adult; Public Health; Air Pollution; Child, Preschool; Aged; Infant; Air Pollutants; Disability-Adjusted Life Years; Environmental Exposure; Infant, Newborn; Aged, 80 and over
PubMed: 38928913
DOI: 10.3390/ijerph21060667 -
International Journal of Environmental... May 2024Rheumatoid arthritis (RA) can lead to severe joint impairment and chronic disability. Primary care (PC), provided by general practitioners (GPs), is the first level of... (Review)
Review
Rheumatoid arthritis (RA) can lead to severe joint impairment and chronic disability. Primary care (PC), provided by general practitioners (GPs), is the first level of contact for the population with the healthcare system. The aim of this scoping review was to analyze the approach to RA in the PC setting. PubMed, Scopus, and Web of Science were searched using the MESH terms "rheumatoid arthritis" and "primary care" from 2013 to 2023. The search strategy followed the PRISMA-ScR guidelines. The 61 articles selected were analyzed qualitatively in a table and discussed in two sections, namely criticisms and strategies for the management of RA in PC. The main critical issues in the management of RA in PC are the following: difficulty and delay in diagnosis, in accessing rheumatological care, and in using DMARDs by GPs; ineffective communication between GPs and specialists; poor patient education; lack of cardiovascular prevention; and increase in healthcare costs. To overcome these criticisms, several management strategies have been identified, namely early diagnosis of RA, quick access to rheumatology care, effective communication between GPs and specialists, active patient involvement, screening for risk factors and comorbidities, clinical audit, interdisciplinary patient management, digital health, and cost analysis. PC appears to be the ideal healthcare setting to reduce the morbidity and mortality of chronic disease, including RA, if a widespread change in GPs' approach to the disease and patients is mandatory.
Topics: Arthritis, Rheumatoid; Primary Health Care; Humans; Antirheumatic Agents
PubMed: 38928909
DOI: 10.3390/ijerph21060662 -
International Journal of Environmental... May 2024Preschoolers with disabilities and their caregivers have been neglected in health and social service provision in most low-income countries and arguably also in... (Review)
Review
Preschoolers with disabilities and their caregivers have been neglected in health and social service provision in most low-income countries and arguably also in low-resourced areas of more affluent nations. Yet as this rapid review of the published literature identifies, there are low-cost, evidence-based strategies to address their needs that can be implemented in communities by local people. Five key features of the necessary supports are examined. First, the leadership functions required to create and implement the support services. Second, the family-centred, home-based support provided to caregivers and the personnel undertaking this form of support. Third, providing opportunities for peer support to flourish and encouraging the formation of advocacy groups across families. Fourth, mobilizing the support of significant groups within the community: notably, traditional healers and leaders, health services and poverty alleviation initiatives. Fifth, devising ways in which preschool educational opportunities can be offered to children as a prelude to their inclusion in primary schools. The review serves a further purpose. It provides an example of how public health researchers and academics could achieve more rapid implementation of evidence-based knowledge into existing and new support services through dissemination to community practitioners.
Topics: Humans; Child, Preschool; Developmental Disabilities; Developing Countries; Social Support; Caregivers
PubMed: 38928898
DOI: 10.3390/ijerph21060651 -
Diagnostics (Basel, Switzerland) Jun 2024Ischemic stroke is a leading cause of mortality and disability. The relationships of heart rate variability (HRV) and stroke-related factors with mortality and...
Exploring Relationships of Heart Rate Variability, Neurological Function, and Clinical Factors with Mortality and Behavioral Functional Outcome in Patients with Ischemic Stroke.
Ischemic stroke is a leading cause of mortality and disability. The relationships of heart rate variability (HRV) and stroke-related factors with mortality and functional outcome are complex and not fully understood. Understanding these relationships is crucial for providing better insights regarding ischemic stroke prognosis. The objective of this study is to examine the relationship between HRV, neurological function, and clinical factors with mortality and 3-month behavioral functional outcome in ischemic stroke. We prospectively collected the HRV data and monitored the behavioral functional outcome of patients with ischemic stroke. The behavioral functional outcome was represented by a modified Rankin Scale (mRS) score. This study population consisted of 58 ischemic stroke patients (56.9% male; mean age 70) with favorable (mRS score ≤ 2) and unfavorable (mRS score ≥ 3) outcome. The analysis indicated that the median of the mean RR interval (RR mean) showed no statistical difference between mortality groups. Conversely, the median of the RR mean had significant association with unfavorable outcome (OR = 0.989, = 0.007). Lower hemoglobin levels had significant association with unfavorable outcome (OR = 0.411, = 0.010). Higher National Institute of Health Stroke Scale (NIHSS) score at admission had significant association with unfavorable outcome (OR = 1.396, = 0.002). In contrast, age, stroke history, NIHSS score at admission, and hemoglobin showed no significant association with mortality in ischemic stroke. These results imply that HRV, as indicated by the median of RR mean, alongside specific clinical factors and neurological function at admission (measured by NIHSS score), may serve as potential prognostic indicators for 3-month behavioral functional outcome in ischemic stroke.
PubMed: 38928719
DOI: 10.3390/diagnostics14121304 -
Diagnostics (Basel, Switzerland) Jun 2024The Expanded Disability Status Scale (EDSS) is the most popular method to assess disease progression and treatment effectiveness in patients with multiple sclerosis...
The Expanded Disability Status Scale (EDSS) is the most popular method to assess disease progression and treatment effectiveness in patients with multiple sclerosis (PwMS). One of the main problems with the EDSS method is that different results can be determined by different physicians for the same patient. In this case, it is necessary to produce autonomous solutions that will increase the reliability of the EDSS, which has a decision-making role. This study proposes a machine learning approach to predict EDSS scores using aerobic capacity data from PwMS. The primary goal is to reduce potential complications resulting from incorrect scoring procedures. Cardiovascular and aerobic capacity parameters of individuals, including aerobic capacity, ventilation, respiratory frequency, heart rate, average oxygen density, load, and energy expenditure, were evaluated. These parameters were given as input to CatBoost, gradient boosting (GBM), extreme gradient boosting (XGBoost), and decision tree (DT) machine learning methods. The most significant EDSS results were determined with the XGBoost algorithm. Mean absolute error, root mean square error, mean square error, mean absolute percent error, and R square values were obtained as 0.26, 0.4, 0.26, 16, and 0.68, respectively. The XGBoost based machine learning technique was shown to be effective in predicting EDSS based on aerobic capacity and cardiovascular data in PwMS.
PubMed: 38928664
DOI: 10.3390/diagnostics14121249 -
Diagnostics (Basel, Switzerland) Jun 2024Traumatic brain injury (TBI) is a severe neurological condition characterized by inflammation in the central nervous system. SERPINA3 has garnered attention as a...
Traumatic brain injury (TBI) is a severe neurological condition characterized by inflammation in the central nervous system. SERPINA3 has garnered attention as a potential biomarker for assessing this inflammation. Our study aimed to explore the predictive value of postoperative serum SERPINA3 levels in identifying the risk of cerebral edema and its prognostic implications in TBI. This study is a prospective observational study, including 37 patients with TBI who finally met our criteria. The Glasgow Outcome Scale (GOS), Levels of Cognitive Functioning (LCF), Disability Rating Scale (DRS), and Early Rehabilitation Barthel Index (ERBI) scores at six months after trauma were defined as the main study endpoint. We further calculated the ventricle-to-intracranial-volume ratio (VBR) at 6 months from CT scans. The study included patients with Glasgow Coma Scale (GCS) scores ranging from 3 to 8, who were subsequently categorized into two groups: the critical TBI group (GCS 3-5 points) and the severe TBI group (GCS 6-8 points). Within the critical TBI group, SERPINA3 levels were notably lower. However, among patients with elevated SERPINA3 levels, both the peak intracranial pressure (ICP) and average mannitol consumption were significantly reduced compared with those of patients with lower SERPINA3 levels. In terms of the 6-month outcomes measured via the GOS, LCF, DRS, and ERBI, lower levels of SERPINA3 were indicative of poorer prognosis. Furthermore, we found a negative correlation between serum SERPINA3 levels and the VBR. The receiver operating characteristic (ROC) curve and decision curve analysis (DCA) demonstrated the predictive performance of SERPINA3. In conclusion, incorporating the novel biomarker SERPINA3 alongside traditional assessment tools offers neurosurgeons an effective and easily accessible means, which is readily accessible early on, to predict the risk of intracranial pressure elevation and long-term prognosis in TBI patients.
PubMed: 38928660
DOI: 10.3390/diagnostics14121245