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Western Journal of Nursing Research Jun 2024Social determinants of health affect health behaviors and outcomes. Youth experiencing homelessness suffer significant deprivation of resources such as inadequate...
BACKGROUND
Social determinants of health affect health behaviors and outcomes. Youth experiencing homelessness suffer significant deprivation of resources such as inadequate housing, reduced education, poor health care, and decreased economic stability. Inner resources, such as psychological capital, may also be related to health behaviors and health outcomes.
OBJECTIVE
In this study, we sought to describe and explore associations among selected determinants of health and self-reported scores on indicators of psychological capital among youth experiencing homelessness.
METHODS
This cross-sectional secondary analysis was conducted with a randomized subsample of 148 youth. We calculated chi-square frequencies to describe the data, classical item analyses to evaluate responses, and correlation tests to examine significance of associations.
RESULTS
Youth in this sample demonstrated that they possess inner resources associated with determinants of health. Education, health care, and social support were significantly associated with attributes of psychological capital (hope, efficacy, resilience, optimism). Sexual minority groups had high representation in this subsample (25.7%), indicating a need for more study and equitable services for this population.
CONCLUSION
More research should be conducted to better understand the associations between determinants of health, psychological capital, and health behaviors among disadvantaged youth to advance health equity initiatives.
PubMed: 38824395
DOI: 10.1177/01939459241253150 -
Resuscitation Jul 2024To develop a new scoring model for patients with cardiogenic out-of-hospital cardiac arrest (OHCA) to facilitate neurological prognosis prediction upon hospital arrival...
AIM
To develop a new scoring model for patients with cardiogenic out-of-hospital cardiac arrest (OHCA) to facilitate neurological prognosis prediction upon hospital arrival by using prehospital resuscitation features alone.
METHODS
Between 2005 and 2019, we enrolled 942,891 adult patients with OHCA of presumed cardiac aetiology from the All-Japan Utstein Registry. Scoring models applied prehospital resuscitation features a priori from the variables the American College of Cardiology algorithm including age, duration to return of spontaneous circulation (ROSC) or hospital arrival, no bystander cardiopulmonary resuscitation (CPR), unwitnessed arrest, and nonshockable rhythm (R-EDByUS score) to predict unfavorable neurological outcomes defined as Cerebral Performance Category 3, 4, or 5 at 1 month. We created nomograms as a "Regression-based model," and created a "Simplified model" in which points were assigned by category for predicting unfavorable neurological outcomes for both the prehospital ROSC cohort (67,064 patients) and the ongoing CPR cohort (875,827 patients). For internal validation, bootstrap optimism-corrected estimates of predictive performance were calculated.
RESULTS
A total of 46,971 (70.0%) and 870,991 (99.4%) patients in the prehospital ROSC and ongoing CPR cohorts, respectively, had unfavorable neurological outcomes. In the prehospital ROSC cohort, the C-statistics of the Regression-based and Simplified models were 0.851 and 0.842, and the bootstrap-validated C-statistics were 0.852 and 0.841, respectively. In the ongoing CPR cohort, the C-statistics of the Regression-based and Simplified models were 0.872 and 0.865, and the bootstrap-validated C-statistics were 0.852 and 0.841, respectively.
CONCLUSIONS
The R-EDByUS score accurately predicted the neurological prognosis of cardiogenic OHCA upon hospital arrival.
Topics: Humans; Out-of-Hospital Cardiac Arrest; Male; Female; Cardiopulmonary Resuscitation; Aged; Prognosis; Middle Aged; Japan; Emergency Medical Services; Registries; Return of Spontaneous Circulation; Nomograms; Aged, 80 and over
PubMed: 38823473
DOI: 10.1016/j.resuscitation.2024.110257 -
Scientific Reports May 2024Previous studies have shown that procrastinators tend to disregard the future. However, the "time view" of procrastinators, including their impressions of the future,...
Previous studies have shown that procrastinators tend to disregard the future. However, the "time view" of procrastinators, including their impressions of the future, has not been sufficiently examined. Therefore, we introduced new indices, "chronological stress view" and "chronological well-being view," which treat impressions of the past, present, and future (= time view) as time-series data via stress and well-being, respectively. The results showed that the group that believed that stress did not increase as they moved into the future had a lower percentage of severe procrastinators. No relationship was found between the chronological well-being view and procrastination. This result suggests that people who are relatively optimistic about the future based on the chronological stress view are less likely to be severe procrastinators. This may suggest the importance of having a hopeful prospect in the future to avoid procrastinating on actions that should yield greater rewards in the future.
Topics: Humans; Male; Procrastination; Female; Optimism; Adult; Stress, Psychological; Young Adult
PubMed: 38816408
DOI: 10.1038/s41598-024-61277-y -
PLoS Medicine May 2024Poor representation of pregnant and lactating women and people in clinical trials has marginalised their health concerns and denied the maternal-fetal/infant dyad...
BACKGROUND
Poor representation of pregnant and lactating women and people in clinical trials has marginalised their health concerns and denied the maternal-fetal/infant dyad benefits of innovation in therapeutic research and development. This mixed-methods systematic review synthesised factors affecting the participation of pregnant and lactating women in clinical trials, across all levels of the research ecosystem.
METHODS AND FINDINGS
We searched 8 databases from inception to 14 February 2024 to identify qualitative, quantitative, and mixed-methods studies that described factors affecting participation of pregnant and lactating women in vaccine and therapeutic clinical trials in any setting. We used thematic synthesis to analyse the qualitative literature and assessed confidence in each qualitative review finding using the GRADE-CERQual approach. We compared quantitative data against the thematic synthesis findings to assess areas of convergence or divergence. We mapped review findings to the Theoretical Domains Framework (TDF) and Capability, Opportunity, and Motivation Model of Behaviour (COM-B) to inform future development of behaviour change strategies. We included 60 papers from 27 countries. We grouped 24 review findings under 5 overarching themes: (a) interplay between perceived risks and benefits of participation in women's decision-making; (b) engagement between women and the medical and research ecosystems; (c) gender norms and decision-making autonomy; (d) factors affecting clinical trial recruitment; and (e) upstream factors in the research ecosystem. Women's willingness to participate in trials was affected by: perceived risk of the health condition weighed against an intervention's risks and benefits, therapeutic optimism, intervention acceptability, expectations of receiving higher quality care in a trial, altruistic motivations, intimate relationship dynamics, and power and trust in medicine and research. Health workers supported women's participation in trials when they perceived clinical equipoise, had hope for novel therapeutic applications, and were convinced an intervention was safe. For research staff, developing reciprocal relationships with health workers, having access to resources for trial implementation, ensuring the trial was visible to potential participants and health workers, implementing a woman-centred approach when communicating with potential participants, and emotional orientations towards the trial were factors perceived to affect recruitment. For study investigators and ethics committees, the complexities and subjectivities in risk assessments and trial design, and limited funding of such trials contributed to their reluctance in leading and approving such trials. All included studies focused on factors affecting participation of cisgender pregnant women in clinical trials; future research should consider other pregnancy-capable populations, including transgender and nonbinary people.
CONCLUSIONS
This systematic review highlights diverse factors across multiple levels and stakeholders affecting the participation of pregnant and lactating women in clinical trials. By linking identified factors to frameworks of behaviour change, we have developed theoretically informed strategies that can help optimise pregnant and lactating women's engagement, participation, and trust in such trials.
Topics: Humans; Female; Pregnancy; Lactation; Clinical Trials as Topic; Patient Participation; Pregnant Women; Decision Making; Motivation; Patient Selection
PubMed: 38814991
DOI: 10.1371/journal.pmed.1004405 -
Critical Care Explorations Jun 2024To develop and validate a prediction model for 1-year mortality in patients with a hematologic malignancy acutely admitted to the ICU.
OBJECTIVES
To develop and validate a prediction model for 1-year mortality in patients with a hematologic malignancy acutely admitted to the ICU.
DESIGN
A retrospective cohort study.
SETTING
Five university hospitals in the Netherlands between 2002 and 2015.
PATIENTS
A total of 1097 consecutive patients with a hematologic malignancy were acutely admitted to the ICU for at least 24 h.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
We created a 13-variable model from 22 potential predictors. Key predictors included active disease, age, previous hematopoietic stem cell transplantation, mechanical ventilation, lowest platelet count, acute kidney injury, maximum heart rate, and type of malignancy. A bootstrap procedure reduced overfitting and improved the model's generalizability. This involved estimating the optimism in the initial model and shrinking the regression coefficients accordingly in the final model. We assessed performance using internal-external cross-validation by center and compared it with the Acute Physiology and Chronic Health Evaluation II model. Additionally, we evaluated clinical usefulness through decision curve analysis. The overall 1-year mortality rate observed in the study was 62% (95% CI, 59-65). Our 13-variable prediction model demonstrated acceptable calibration and discrimination at internal-external validation across centers (-statistic 0.70; 95% CI, 0.63-0.77), outperforming the Acute Physiology and Chronic Health Evaluation II model (-statistic 0.61; 95% CI, 0.57-0.65). Decision curve analysis indicated overall net benefit within a clinically relevant threshold probability range of 60-100% predicted 1-year mortality.
CONCLUSIONS
Our newly developed 13-variable prediction model predicts 1-year mortality in hematologic malignancy patients admitted to the ICU more accurately than the Acute Physiology and Chronic Health Evaluation II model. This model may aid in shared decision-making regarding the continuation of ICU care and end-of-life considerations.
Topics: Humans; Hematologic Neoplasms; Intensive Care Units; Male; Retrospective Studies; Middle Aged; Female; Aged; Netherlands; Adult; APACHE; Cohort Studies
PubMed: 38813435
DOI: 10.1097/CCE.0000000000001093 -
World Journal of Psychiatry May 2024Epilepsy is a nervous system disease characterized by recurrent attacks, a long disease course, and an unfavorable prognosis. It is associated with an enduring...
BACKGROUND
Epilepsy is a nervous system disease characterized by recurrent attacks, a long disease course, and an unfavorable prognosis. It is associated with an enduring therapeutic process, and finding a cure has been difficult. Patients with epilepsy are predisposed to adverse moods, such as resistance, anxiety, nervousness, and anxiety, which compromise treatment compliance and overall efficacy.
AIM
To explored the influence of intensive psychological intervention on treatment compliance, psychological status, and quality of life (QOL) of patients with epilepsy.
METHODS
The clinical data of 105 patients with epilepsy admitted between December 2019 and July 2023 were retrospectively analyzed, including those of 50 patients who underwent routine intervention (control group) and 55 who underwent intensive psychological intervention (research group). Treatment compliance, psychological status based on the Self-Rating Anxiety Scale (SAS) and Depression Scale Self-Rating Depression Scale (SDS) scores, hope level assessed using the Herth Hope Scale (HHS), psychological resilience evaluated using the Psychological Resilience Scale, and QOL determined using the QOL in Epilepsy-31 Inventory (QOLIE-31) were comparatively analyzed.
RESULTS
Treatment compliance in the research group was 85.5%, which is significantly better than the 68.0% of the control group. No notable intergroup differences in preinterventional SAS and SDS scores were identified ( > 0.05); however, after the intervention, the SAS and SDS scores decreased significantly in the two groups, especially in the research group ( < 0.05). The two groups also exhibited no significant differences in preinterventional HHS, Connor-Davidson Resilience Scale (CD-RISC), and QOLIE-31 scores ( > 0.05). After 6 months of intervention, the research group showed evidently higher HHS, CD-RISC, tenacity, optimism, strength, and QOLIE-31 scores ( < 0.05).
CONCLUSION
Intensive psychological intervention enhances treatment compliance, psychological status, and QOL of patients with epilepsy.
PubMed: 38808083
DOI: 10.5498/wjp.v14.i5.670 -
BMC Medical Education May 2024Physician-scientists play a crucial role in advancing biomedical sciences. Proportionally fewer physicians are actively engaged in scientific pursuits, attributed to...
PURPOSE
Physician-scientists play a crucial role in advancing biomedical sciences. Proportionally fewer physicians are actively engaged in scientific pursuits, attributed to attrition in the training and retention pipeline. This national study evaluated the ongoing and longer-term impact of the COVID-19 pandemic on stress levels, research productivity, and optimism for physician-scientists at all levels of training.
METHODS
A multi-institutional cross-sectional survey of medical students, graduate students, and residents/fellows/junior faculty (RFJF) was conducted from April to August 2021 to assess the impact of COVID-19 on individual stress, productivity, and optimism. Multivariate regression analyses were performed to identify associated variables and unsupervised variable clustering techniques were employed to identify highly correlated responses.
RESULTS
A total 677 respondents completed the survey, representing different stages of physician-scientist training. Respondents report high levels of stress (medical students: 85%, graduate students: 63%, RFJF: 85%) attributed to impaired productivity concerns, concern about health of family and friends, impact on personal health and impairment in training or career development. Many cited impaired productivity (medical students: 65% graduate students: 79%, RFJF: 78%) associated with pandemic impacts on training, labs closures and loss of facility/resource access, and social isolation. Optimism levels were low (medical students: 37%, graduate students: 38% and RFJF: 39%) with females less likely to be optimistic and more likely to report concerns of long-term effects of COVID-19. Optimism about the future was correlated with not worrying about the long-term effects of COVID-19. Since the COVID-19 pandemic, all respondents reported increased prioritization of time with family/friends (67%) and personal health (62%) over career (25%) and research (24%).
CONCLUSIONS
This national survey highlights the significant and protracted impact of the COVID-19 pandemic on stress levels, productivity, and optimism among physician-scientists and trainees. These findings underscore the urgent need for tailored support, including mental health, academic, and career development assistance for this biomedical workforce.
Topics: Humans; COVID-19; Cross-Sectional Studies; Female; Male; Biomedical Research; Students, Medical; Adult; Pandemics; Faculty, Medical; Surveys and Questionnaires; Stress, Psychological; Research Personnel; SARS-CoV-2; Optimism; Physicians
PubMed: 38807106
DOI: 10.1186/s12909-024-05541-9 -
Cureus Apr 2024This literature review presents a bibliometric analysis of the randomized controlled trials conducted between 2014 and 2023 on the potential benefits of yoga as a... (Review)
Review
This literature review presents a bibliometric analysis of the randomized controlled trials conducted between 2014 and 2023 on the potential benefits of yoga as a complementary therapy for cancer patients. To conduct this analysis, we searched medical and scientific databases, such as Scopus, Cochrane, and PubMed, using relevant keywords. Our search yielded 58 clinical trials involving 4,762 patients, which indicates a growing trend in this field of research. The studies we reviewed mainly focused on breast cancer patients and demonstrated the adaptability and versatility of yoga, offering a ray of hope and optimism. Among the various styles of yoga, Hatha yoga was the most frequently practiced style in these clinical trials. The analysis we conducted reveals that yoga interventions have a promising role in cancer care and can be a valuable complementary therapy for cancer patients. However, significant gaps and limitations still need to be addressed in this area of research. For instance, more rigorous and diverse investigations are needed to further establish the potential benefits of yoga interventions for cancer patients. Additionally, the standardization of yoga interventions is crucial to optimize therapeutic benefits. By addressing these gaps and limitations, we can further enhance the potential of yoga as a complementary therapy for cancer patients.
PubMed: 38800314
DOI: 10.7759/cureus.58993 -
Frontiers in Psychiatry 2024To investigate societal perceptions of ketamine's use in depression therapy by analysing Twitter posts from January 1, 2010 to April 1, 2023.
OBJECTIVE
To investigate societal perceptions of ketamine's use in depression therapy by analysing Twitter posts from January 1, 2010 to April 1, 2023.
METHODS
Using Twitter as the social media platform of choice, and employing search terms based on (depression OR depressed OR depressive) AND (ketamine OR esketamine OR Spravato), we collected English-language tweets from January 1, 2010, to April 1, 2023. Using unsupervised machine learning and natural language processing (NLP) techniques, including Bidirectional Encoder Representations from Transformers (BERT) and BERTopic, the study identified prevalent topics surrounding public chatter around the use of ketamine in depression treatment. Manual thematic analyses further refined these topics into themes.
RESULTS
Out of an initial dataset of 99,405 tweets, after removing duplicate tweets, re-tweets and tweets posted by organizations over Twitter, 18,899 unique tweets from presumably individual users were analysed. Analysis of temporal trends revealed a shift in public attitudes, particularly after the United States Food and Drug Administration (FDA)'s 2019 approval of ketamine for depression. Three major themes emerged: a changing regulatory landscape, cautious optimism, and personal experiences with the drug. There was an initial spike in discussions post-FDA approval in 2019. Thereafter, cautious optimism (Theme 2) decreased among the general public, with more personal accounts (Theme 3) highlighting the potential benefits for some treatment-resistant patients. Limitations of the study include Twitter's inherent biases towards younger, English-speaking demographics.
CONCLUSION
In summary, the public's multifaceted perception leans towards a hopeful stance on ketamine's therapeutic potential for depression.
PubMed: 38800065
DOI: 10.3389/fpsyt.2024.1369727 -
Journal of Clinical Medicine May 2024To assess the association between pretreatment thrombocytosis, anemia, and leukocytosis and overall survival (OS) of advanced-stage EOC. Furthermore, to develop...
To assess the association between pretreatment thrombocytosis, anemia, and leukocytosis and overall survival (OS) of advanced-stage EOC. Furthermore, to develop nomograms using established prognostic factors and pretreatment hematologic parameters to predict the OS of advanced EOC patients. : Advanced-stage EOC patients treated between January 1996 and January 2010 in eastern Netherlands were included. Survival outcomes were compared between patients with and without pretreatment thrombocytosis (≥450,000 platelets/µL), anemia (hemoglobin level of <7.5 mmol/L), or leukocytosis (≥11.0 × 10 leukocytes/L). Three nomograms (for ≤3-, ≥5-, and ≥10-year OS) were developed. Candidate predictors were fitted into multivariable logistic regression models. Multiple imputation was conducted. Model performance was assessed on calibration, discrimination, and Brier scores. Bootstrap validation was used to correct for model optimism. : A total of 773 advanced-stage (i.e., FIGO stages IIB-IV) EOC patients were included. The median [interquartile range, IQR] OS was 2.3 [1.3-4.2] and 3.0 [1.4-7.0] years for patients with and without pretreatment thrombocytosis ( < 0.01). The median OS was not notably different for patients with and without pretreatment leukocytosis ( = 0.58) or patients with and without pretreatment anemia ( = 0.07). The final nomograms comprised established predictors with either pretreatment leukocyte or platelet count. The ≥5- and ≥10-year OS models demonstrated good calibration and adequate discrimination with optimism-corrected -indices [95%-CI] of 0.76 [0.72-0.80] and 0.78 [0.73-0.83], respectively. The ≤3-year OS model demonstrated suboptimal performance with an optimism-corrected c-index of 0.71 [0.66-0.75]. : Pretreatment thrombocytosis is associated with poorer EOC survival. Two well-performing models predictive of ≥5-year and ≥10-year OS in advanced-stage EOC were developed and internally validated.
PubMed: 38792332
DOI: 10.3390/jcm13102789