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CMAJ : Canadian Medical Association... Jun 2024The response of Canada's research community to the COVID-19 pandemic provides a unique opportunity to examine the country's clinical health research ecosystem. We sought...
BACKGROUND
The response of Canada's research community to the COVID-19 pandemic provides a unique opportunity to examine the country's clinical health research ecosystem. We sought to describe patterns of enrolment across Canadian Institutes of Health Research (CIHR)-funded studies on COVID-19.
METHODS
We identified COVID-19 studies funded by the CIHR and that enrolled participants from Canadian acute care hospitals between January 2020 and April 2023. We collected information on study-and site-level variables from study leads, site investigators, and public domain sources. We described and evaluated factors associated with cumulative enrolment.
RESULTS
We obtained information for 23 out of 26 (88%) eligible CIHR-funded studies (16 randomized controlled trials [RCTs] and 7 cohort studies). The 23 studies were managed by 12 Canadian and 3 international coordinating centres. Of 419 Canadian hospitals, 97 (23%) enrolled a total of 28 973 participants - 3876 in RCTs across 78 hospitals (median cumulative enrolment per hospital 30, interquartile range [IQR] 10-61), and 25 097 in cohort studies across 62 hospitals (median cumulative enrolment per hospital 158, IQR 6-348). Of 78 hospitals recruiting participants in RCTs, 13 (17%) enrolled 50% of all RCT participants, whereas 6 of 62 hospitals (9.7%) recruited 54% of participants in cohort studies.
INTERPRETATION
A minority of Canadian hospitals enrolled the majority of participants in CIHR-funded studies on COVID-19. This analysis sheds light on the Canadian health research ecosystem and provides information for multiple key partners to consider ways to realize the full research potential of Canada's health systems.
Topics: Humans; Canada; COVID-19; Biomedical Research; SARS-CoV-2; Pandemics; Randomized Controlled Trials as Topic
PubMed: 38885975
DOI: 10.1503/cmaj.230760 -
JMIR MHealth and UHealth Jun 2024Despite the increasing need for digital services to support geriatric mental health, the development and implementation of digital mental health care systems for older...
Digital Phenotyping of Geriatric Depression Using a Community-Based Digital Mental Health Monitoring Platform for Socially Vulnerable Older Adults and Their Community Caregivers: 6-Week Living Lab Single-Arm Pilot Study.
BACKGROUND
Despite the increasing need for digital services to support geriatric mental health, the development and implementation of digital mental health care systems for older adults have been hindered by a lack of studies involving socially vulnerable older adult users and their caregivers in natural living environments.
OBJECTIVE
This study aims to determine whether digital sensing data on heart rate variability, sleep quality, and physical activity can predict same-day or next-day depressive symptoms among socially vulnerable older adults in their everyday living environments. In addition, this study tested the feasibility of a digital mental health monitoring platform designed to inform older adult users and their community caregivers about day-to-day changes in the health status of older adults.
METHODS
A single-arm, nonrandomized living lab pilot study was conducted with socially vulnerable older adults (n=25), their community caregivers (n=16), and a managerial social worker over a 6-week period during and after the COVID-19 pandemic. Depressive symptoms were assessed daily using the 9-item Patient Health Questionnaire via scripted verbal conversations with a mobile chatbot. Digital biomarkers for depression, including heart rate variability, sleep, and physical activity, were measured using a wearable sensor (Fitbit Sense) that was worn continuously, except during charging times. Daily individualized feedback, using traffic signal signs, on the health status of older adult users regarding stress, sleep, physical activity, and health emergency status was displayed on a mobile app for the users and on a web application for their community caregivers. Multilevel modeling was used to examine whether the digital biomarkers predicted same-day or next-day depressive symptoms. Study staff conducted pre- and postsurveys in person at the homes of older adult users to monitor changes in depressive symptoms, sleep quality, and system usability.
RESULTS
Among the 31 older adult participants, 25 provided data for the living lab and 24 provided data for the pre-post test analysis. The multilevel modeling results showed that increases in daily sleep fragmentation (P=.003) and sleep efficiency (P=.001) compared with one's average were associated with an increased risk of daily depressive symptoms in older adults. The pre-post test results indicated improvements in depressive symptoms (P=.048) and sleep quality (P=.02), but not in the system usability (P=.18).
CONCLUSIONS
The findings suggest that wearable sensors assessing sleep quality may be utilized to predict daily fluctuations in depressive symptoms among socially vulnerable older adults. The results also imply that receiving individualized health feedback and sharing it with community caregivers may help improve the mental health of older adults. However, additional in-person training may be necessary to enhance usability.
TRIAL REGISTRATION
ClinicalTrials.gov NCT06270121; https://clinicaltrials.gov/study/NCT06270121.
Topics: Humans; Pilot Projects; Aged; Male; Female; Depression; Caregivers; COVID-19; Aged, 80 and over; Middle Aged; Vulnerable Populations; Heart Rate; Telemedicine
PubMed: 38885033
DOI: 10.2196/55842 -
Journal of Medical Internet Research Jun 2024The emergence of the COVID-19 pandemic rapidly accelerated the need and implementation of digital innovations, especially in medicine.
BACKGROUND
The emergence of the COVID-19 pandemic rapidly accelerated the need and implementation of digital innovations, especially in medicine.
OBJECTIVE
To gain a better understanding of the stress associated with digital transformation in physicians, this study aims to identify working conditions that are stress relevant for physicians and differ in dependence on digital transformation. In addition, we examined the potential role of individual characteristics (ie, age, gender, and actual implementation of a digital innovation within the last 3 years) in digitalization-associated differences in these working conditions.
METHODS
Cross-sectional web-based questionnaire data of 268 physicians (mean age 40.9, SD 12.3 y; n=150, 56% women) in Germany were analyzed. Physicians rated their chronic stress level and 11 relevant working conditions (ie, work stressors such as time pressure and work resources such as influence on sequence) both before and after either a fictional or real implementation of a relevant digital transformation at their workplace. In addition, a subsample of individuals (60; n=33, 55% women) submitted self-collected hair samples for cortisol analysis.
RESULTS
The stress relevance of the selected working conditions was confirmed by significant correlations with self-rated chronic stress and hair cortisol levels (hair F) within the sample, all of them in the expected direction (P values between .01 and <.001). Multilevel modeling revealed significant differences associated with digital transformation in the rating of 8 (73%) out of 11 working conditions. More precisely, digital transformation was associated with potentially stress-enhancing effects in 6 working conditions (ie, influence on procedures and complexity of tasks) and stress-reducing effects in 2 other working conditions (ie, perceived workload and time pressure). Younger individuals, women, and individuals whose workplaces have implemented digital innovations tended to perceive digitalization-related differences in working conditions as rather stress-reducing.
CONCLUSIONS
Our study lays the foundation for future hypothesis-based longitudinal research by identifying those working conditions that are stress relevant for physicians and prone to differ as a function of digital transformation and individual characteristics.
Topics: Humans; Cross-Sectional Studies; Female; Adult; Male; Physicians; COVID-19; Occupational Stress; Middle Aged; Germany; Surveys and Questionnaires; SARS-CoV-2; Hydrocortisone; Workplace; Hair; Stress, Psychological; Pandemics; Workload
PubMed: 38885014
DOI: 10.2196/49581 -
Health Care Expenses and Financial Hardship Among Medicare Beneficiaries With Functional Disability.JAMA Network Open Jun 2024Medicare beneficiaries with functional disabilities often require more medical care, leading to substantial financial hardship. However, the precise magnitude and...
IMPORTANCE
Medicare beneficiaries with functional disabilities often require more medical care, leading to substantial financial hardship. However, the precise magnitude and sources of this hardship remain unknown.
OBJECTIVES
To quantify the financial burden from health care expenses by functional disability levels among Medicare beneficiaries.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study used data, including demographic and socioeconomic characteristics, health status, and health care use, from a nationally representative sample of Medicare beneficiaries from the 2013 to 2021 Medical Expenditure Panel Survey. Functional disability was measured using 6 questions and categorized into 3 levels: none (no difficulties), moderate (1-2 difficulties), and severe (≥3 difficulties). Data were analyzed from December 2023 to March 2024.
MAIN OUTCOMES AND MEASURES
Financial hardship from health care expenses was assessed using objective measures (annual out-of-pocket spending, high financial burden [out-of-pocket spending exceeding 20% of income], and catastrophic financial burden [out-of-pocket spending exceeding 40% of income]) and subjective measures (difficulty paying medical bills and paying medical bills over time). We applied weights to produce results representative of national estimates.
RESULTS
The sample included 31 952 Medicare beneficiaries (mean [SD] age, 71.1 [9.7] years; 54.6% female). In weighted analyses, severe functional disability was associated with a significantly higher financial burden from health care expenses, with out-of-pocket spending reaching $2137 (95% CI, $1943-$2330) annually. This exceeded out-of-pocket spending for those without functional disability by nearly $700 per year ($1468 [95% CI, $1311-$1625]) and for those with moderate functional disability by almost $500 per year ($1673 [95% CI, $1620-$1725]). The primary factors that played a role in this difference were home health care ($399 [95% CI, $145-$651]) and equipment and supplies ($304 [95% CI, $278-$330]). Beneficiaries with severe functional disability experienced significantly higher rates of both high and catastrophic financial burden than those without disability and those with moderate disability (13.2% [12.2%-14.1%] vs 9.1% [95% CI, 8.6%-9.5%] and 9.4% [95% CI, 9.1%-9.7%] for high financial burden, respectively, and 8.9% [95% CI, 7.8%-10.1%] vs 6.4% [95% CI, 6.1%-6.8%] and 6.0% [95% CI, 5.6%-6.4%] for catastrophic financial burden, respectively). Similar associations were observed in subjective financial hardship. For example, 11.8% (95% CI, 10.3%-13.3%) of those with severe functional disability experienced problems paying medical bills, compared with 7.7% (95% CI, 7.6%-7.9%) and 9.3% (95% CI, 9.0%-9.6%) of those without functional disability and those with moderate functional disability, respectively. Notably, there were no significant differences in financial hardship among those with Medicaid based on functional disability levels.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study of Medicare beneficiaries, those with severe functional disability levels experienced a disproportionate burden from health care costs. However, Medicaid played a pivotal role in reducing the financial strain. Policymakers should explore interventions that effectively relieve the financial burden of health care in this vulnerable population.
Topics: Humans; United States; Medicare; Female; Male; Cross-Sectional Studies; Aged; Disabled Persons; Health Expenditures; Financial Stress; Aged, 80 and over; Cost of Illness
PubMed: 38884997
DOI: 10.1001/jamanetworkopen.2024.17300 -
Neuropsychiatric Disease and Treatment 2024A combination of antiepileptic drugs and antioxidants may be an effective treatment by restoring the disrupted redox balance and reducing oxidative stress exposure to...
PURPOSE
A combination of antiepileptic drugs and antioxidants may be an effective treatment by restoring the disrupted redox balance and reducing oxidative stress exposure to neurons. This study aims to evaluate the effects of valproate and vitamin B12 on oxidative stress in an experimental epilepsy model induced by penicillin when administered alone or in combination.
PATIENTS AND METHODS
35 male Wistar rats were used in this study. The rats were divided into five groups, which were saline group, 1 mg/kg, 2 mg/kg Vit B12 groups and Sodium valproate group Sodium valproate + Vit B12 group. The epileptic activity was induced by 500 IU of penicillin injection. Sodium valproate and Vitamin B12 were administered 30 min after penicillin administration. Electrocorticogram recordings were taken for 2 hours post-treatment and serum parameters were assessed for oxidative stress markers using spectrophotometric method.
RESULTS
There is statistically significant difference between the groups in total antioxidant status, total oxidant status, and oxidative stress index value (p=0.013; p˂0.001; p˂0.001, respectively). The valproate+vitamin B12 group showed elevated total thiol and native thiol levels, along with reduced disulphide levels, resulting in the lowest OSI value.
CONCLUSION
These findings suggest the combined treatment effectively reduces oxidative stress. This study provides valuable insights into the antioxidant properties of valproate and vitamin B12, positioning them as potential agents for managing epilepsy. Understanding the efficacy and reliability of antioxidant strategies in epilepsy management could contribute significantly to advancements in epilepsy therapeutics.
PubMed: 38883417
DOI: 10.2147/NDT.S459870 -
Frontiers in Neurology 2024Ataxia-telangiectasia (A-T) is an autosomal recessive primary immunodeficiency disorder (PID) caused by biallelic mutations occurring in the serine/threonine protein...
Ataxia-telangiectasia (A-T) is an autosomal recessive primary immunodeficiency disorder (PID) caused by biallelic mutations occurring in the serine/threonine protein kinase () gene. The major role of nuclear is the coordination of cell signaling pathways in response to DNA double-strand breaks, oxidative stress, and cell cycle checkpoints. Defects in ATM functions lead to A-T syndrome with phenotypic heterogeneity. Our study reports the case of a Tunisian girl with A-T syndrome carrying a compound heterozygous mutation , with a splice acceptor variant in the gene that was identified by next-generation sequencing (NGS). Further genetic analysis of the family showed that the mother carried the c.[5763-2A>C] splice acceptor variant, while the father harbored the c.[3894dupT] variant in the heterozygous state. Molecular analysis provides the opportunity for accurate diagnosis and timely management in A-T patients with chronic progressive disease, especially infections and the risk of malignancies. This study characterizes for the first time the identification of compound heterozygous ATM pathogenic variants by NGS in a Tunisian A-T patient. Our study outlines the importance of molecular genetic testing for A-T patients, which is required for earlier detection and reducing the burden of disease in the future, using the patients' families.
PubMed: 38882696
DOI: 10.3389/fneur.2024.1344018 -
Frontiers in Plant Science 2024Plantations located outside the species distribution area represent natural experiments to assess tree tolerance to climate variability. Climate change amplifies...
INTRODUCTION
Plantations located outside the species distribution area represent natural experiments to assess tree tolerance to climate variability. Climate change amplifies warming-related drought stress but also leads to more climate extremes.
METHODS
We studied plantations of the European larch (Larix decidua), a conifer native to central and eastern Europe, in northern Spain. We used climate, drought and tree-ring data from four larch plantations including wet (Valgañón, site V; Santurde, site S), intermediate (Ribavellosa, site R) and dry (Santa Marina, site M) sites. We aimed to benchmark the larch tolerance to climate and drought stress by analysing the relationships between radial growth increment (hereafter growth), climate data (temperature, precipitation, radiation) and a drought index.
RESULTS
Basal area increment (BAI) was the lowest in the driest site M (5.2 cm2 yr-1; period 1988-2022), followed by site R (7.5 cm2 yr-1), with the youngest and oldest and trees being planted in M (35 years) and R (150 years) sites. BAI peaked in the wettest sites (V; 10.4 cm2 yr-1; S, 10.8 cm2 yr-1). We detected a sharp BAI reduction (30% of the regional mean) in 2001 when springto-summer conditions were very dry. In the wettest V and S sites, larch growth positively responded to current March and June-July radiation, but negatively to March precipitation. In the R site, high April precipitation enhanced growth. In the driest M site, warm conditions in the late prior winter and current spring improved growth, but warm-sunny conditions in July and dry-sunny conditions in August reduced it. Larch growth positively responded to spring-summer wet conditions considering short (1-6 months) and long (9-24 months) time scales in dry (site M) and wet-intermediate (sites S and R) sites, respectively.
DISCUSSION
Larch growth is vulnerable to drought stress in dry slow-growing plantations, but also to extreme spring wet-cloudy events followed by dry-hot conditions in wet fast-growing plantations.
PubMed: 38882570
DOI: 10.3389/fpls.2024.1404347 -
International Journal of Public Health 2024While psychological safety is recognized as valuable in healthcare, its relationship to resource constraints is not well understood. We investigate whether psychological...
OBJECTIVES
While psychological safety is recognized as valuable in healthcare, its relationship to resource constraints is not well understood. We investigate whether psychological safety mitigates the negative impact of resource constraints on employees.
METHODS
Leveraging longitudinal survey data collected from healthcare workers before and during the COVID-19 crisis ( = 27,240), we examine how baseline psychological safety relates to employee burnout and intent to stay over time, and then investigate this relationship relative to resource constraints (i.e., the inadequacy of staffing and tools).
RESULTS
Using hierarchical linear models, we find that psychological safety has enduring protective benefits for healthcare workers during periods of stress, and that these benefits mitigate the negative consequences of resource constraints for burnout and turnover intent over time.
CONCLUSION
These findings extend the empirical basis for psychological safety and suggest that investments in building psychological safety can foster employee resilience and organizational commitment, even when resources are strained.
Topics: Humans; COVID-19; Burnout, Professional; Male; Female; Longitudinal Studies; Health Personnel; Adult; SARS-CoV-2; Middle Aged; Personnel Turnover; Surveys and Questionnaires; Resilience, Psychological; Psychological Safety
PubMed: 38882559
DOI: 10.3389/ijph.2024.1607332 -
Psychology Research and Behavior... 2024In the post-epidemic era, the problem of short-video app addiction among older adults has become increasingly prominent, and people have begun to pay attention to the...
BACKGROUND
In the post-epidemic era, the problem of short-video app addiction among older adults has become increasingly prominent, and people have begun to pay attention to the negative emotional and psychological consequences of Perceived Overload of short-video apps. Given the growing mental health concerns of older adults, it is critical to understand the potential relationship between the Perceived Overload of short video apps for older adults and older adults' mental health.
METHODS
This study applied the stress-strain-outcome (SSO) framework to explore the relationship between perceived overload of a short-video application and loneliness, mental health, and Confucianism tenets in 1300 Chinese older adults. The relationship between perceived overload and loneliness, mental health, and Confucianism tenet moderated mediation models of perceived overload and mental health were created using SPSS 26.0 and PROCESS 4.1 for SPSS.
RESULTS
The perceived overload of a short video application for older adults directly predicted loneliness and mental health in older adults, and the Confucianism tenet moderated the mediation process between perceived overload and mental health. Perceived overload affects mental health through loneliness in older adults.
DISCUSSION
The results of this study are of practical significance for understanding the current problem of short-video addiction among older adults. Understanding the effects of perceived overload on older adults' loneliness and mental health can help prevent loneliness and mental health problems caused by short-video addiction among older adults on the one hand, and on the other hand, it can also help to develop targeted coping strategies and create psychological intervention programs based on the Confucianism tenet of intervention ethics to improve mental health in a changing technological stress environment.
PubMed: 38882234
DOI: 10.2147/PRBM.S459426 -
Frontiers in Aging 2024Family caregivers are family members or friends of care recipients who assist with activities of daily living, medication management, transportation, and help with...
BACKGROUND
Family caregivers are family members or friends of care recipients who assist with activities of daily living, medication management, transportation, and help with finances among other activities. As a result of their caregiving, family caregivers are often considered a population at risk of experiencing increased stress, isolation, and loneliness. During the COVID-19 pandemic in the US, social isolation and decrease in social activities were a top concern among older adults and their family caregivers. Using secondary analysis of survey data as part of a multi-site implementation trial of a caregiver skills training program, we describe differences in caregiver experiences of loneliness before and during the COVID-19 pandemic.
METHODS
Health and wellbeing surveys of family caregivers were collected on 422 family caregivers of veterans before and during COVID-19. Logistic regression modeling examined whether the loneliness differed between caregiver groups pre vs during COVID-19, using the UCLA 3-item loneliness measure. Rapid directed qualitative content analysis of open-ended survey questions was used to explore the context of how survey responses were affected by the COVID-19 pandemic.
RESULTS
There were no significant differences in loneliness between caregivers pre vs during COVID-19. In open-ended responses regarding effects of COVID-19, caregivers described experiencing loneliness and social isolation; why they were unaffected by the pandemic; and how caregiving equipped them with coping strategies to manage negative pandemic-related effects.
CONCLUSION
Loneliness did not differ significantly between pre vs during COVID-19 caregivers. Future research could assess what specific characteristics are associated with caregivers who have resiliency, and identify caregivers who are more susceptible to experiencing loneliness. Understanding caregiver loneliness could assist other healthcare systems in developing and implementing caregiver support interventions.
PubMed: 38881826
DOI: 10.3389/fragi.2024.1376103