S Pirbay, MD, S Abou Kassm, MD, MPH, C Di-Maggio, MD
et al.
Objectives: Despite the benefits of geriatric telepsychiatry, the lack of support from the staff remains one of the major challenges it faces. We wanted to explore whether negative opinions towards telepsychiatry in nursing home (NH) stakeholders were affected by prior experience with this modality and by the level of geriatric psychiatric care provided in NH. Methods: We conducted an opinion survey towards telepsychiatry among NH stakeholders (executive managers and care providers) from 10 NH, divided into 5 groups of differing levels of geriatric psychiatric care: Group A used telepsychiatry, Group B had the smallest level of psychiatry care (i.e. without any mental health professional visit), Group C had visiting nurses of general psychiatry, Group D had visiting geriatric psychiatry nurses, Group E had mobile teams including nurses and geriatric psychiatrists. Results: 216 (78.5 %) questionnaires were returned We found significant differences among the groups (Mean Group A (meanA)=63.5, standard error of the mean Group A (SEMA)=1.6); meanB=67.9, SEMB=2.2; meanC=75.6, SEMC=1.6; meanD=69.6, SEMD=2.1; meanE=73.1, SEME=1.9; F(4208)=6.6333, p = 4.824 × 10–5). All groups except group B were significantly different from group A, even after adjusting for age, gender, professional category and knowledge of telepsychiatry. Discussion: Negative opinions towards telepsychiatry were negatively associated with telepsychiatry use in the NH and positively associated with a high level of geriatric psychiatric care, specifically the presence of mobile geriatric psychiatry teams. Conclusions: Our findings suggest that telepsychiatry and face-to-face geriatric psychiatry are in competition. Telepsychiatry acceptance program should aim at describing its complementarity to usual geriatric psychiatry care.
Context: Evidence shows that knowledge is important in tackling pandemics. By assessing awareness and knowledge about the coronavirus, more profound insights can be gained into existing public reception and practices, thereby helping to identify attributes that influence the adoption of healthy practices and responsive behavior. Assessing knowledge is important in identifying gaps and strengthening ongoing prevention efforts. Aims: The study aimed to investigate the geriatric population's knowledge, attitudes, and practices (KAP) toward coronavirus disease-2019 (COVID-19) during the pandemic spike. Settings and Design: The study was designed as a cross-sectional study; a questionnaire was developed regarding the World Health Organization training material for the detection, prevention, response, and control of COVID-19 and was validated by experts in geriatrics and public health. Materials and Methods: A prevalidated questionnaire consisting of four sections will be used. The first section consists of demographic data such as age and gender. The second, third, and fourth section will include prevalidated questions to gather information about the patient's KAP regarding general awareness of COVID-19 among geriatric patients in a tertiary care center in central Kerala. The inclusion criteria included patients of age 60 years and above, patients who are willing to participate in the study, and patients who are willing to give informed consent. The questionnaire was answered by over 199 participants anonymously from November 01, 2021, to February 08, 2022. Results: In our study, 199 participants were involved the mean knowledge score was 10.3 ± 1.224. The average attitude score regarding COVID-19 among the participants was 1.9 ± 1.1. The majority of the participants (67.8%) had a poor attitude toward COVID-19. There was a significant difference in average attitude scores according to socioeconomic status. According to the present study, the average correct answer score of the ten questions regarding COVID-19 practice was 6.3 ± 1.4. The majority of participants (75.4%) had moderate practice toward COVID-19. The average practice scores were significant difference among the socioeconomic status. Conclusions: The third wave of the pandemic demonstrated good knowledge, positive attitudes, and reasonable practice regarding COVID-19 during the outbreak. The results indicated the need for the health system to attempt to increase the public knowledge of the older people to improve their attitude and practice to deal with the crisis.
BackgroundDuring the COVID-19 pandemic, government-mandated social distancing prevented the spread of the disease but potentially exacerbated social isolation and loneliness for older people, especially those already vulnerable to isolation. Older adults may have been able to draw from their personal resources such as psychological resilience (PR) and technology use (TU) to combat such effects. Educational attainment (EA) or early-life EA may potentially shape later-life personal resources and their impact on the effects of the pandemic lockdown on outcomes such as loneliness. The developmental adaptation model allows for the supposition that social isolation, TU, and PR may be affected by early EA in older adults.
ObjectiveThis study examined the indirect impact of EA on pandemic-linked loneliness in a sample of older adults. The developmental adaptation model was used as the conceptual framework to view EA as a distal influence on loneliness, social isolation, PR, and TU. We hypothesized that EA would predict TU and PR and have a moderating impact on social isolation and loneliness. We also hypothesized that PR and TU would mediate the effect of EA on loneliness.
MethodsThis was a cross-sectional observational study, in which data were gathered from 92 older adults aged ≥65 years in the United Kingdom from March 2020 to June 2021, when the country was under various pandemic-linked social mobility restrictions. The data captured demographic information including age, gender, ethnicity, and the highest degree of education achieved. The University of California Los Angeles Loneliness Scale, Connor–Davidson Resilience Scale, Lubben Social Network Index, and Technology Experience Questionnaire were used as standardized measures. Pearson correlation, moderation, and mediation regression analyses were conducted to investigate the hypotheses.
ResultsWe found a higher prevalence of loneliness in older adults than in prepandemic norms. EA was correlated with greater TU and PR and moderated the impact of social isolation on loneliness. PR mediated and TU partially mediated the relationship between EA and loneliness.
ConclusionsEarly-life EA was confirmed as a distal resource for older adults and played an indirect role in affecting loneliness levels during the pandemic. It has an impact on present-day personal resources, such as PR and TU, which affect loneliness and also moderate the impact of social isolation on loneliness. Policymakers should be aware that older adults with low levels of EA may be more vulnerable to the harmful impacts of loneliness when isolated by choice.
Ivy Yan Zhao, Mu-Hsing Ho, Stefanos Tyrovolas
et al.
Abstract Background World Health Organization (WHO) has defined healthy ageing by highlighting five functional ability domains to (meet basic needs, make decisions, be mobile, build and maintain relationships, and contribute to society), which also emphasized the importance of addressing loneliness as priorities within United Nations Decade of Healthy Ageing initiative. However, the level and determinants of healthy ageing and its association with loneliness are rarely examined. This study aimed to construct a healthy ageing index to verify the WHO healthy ageing framework, measure five domains of functional ability of older adults and examine the relationship between functional ability domains and loneliness. Methods A total of 10,746 older adults from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were included. A healthy ageing index ranging from 0 to 17 was constructed using 17 components related to functional ability domains. Univariate and multivariate logistic regression analyses were utilized to determine the association between loneliness and healthy ageing. The STROBE guidelines with the RECORD statement for observational studies using routinely collected health data were observed. Results The factor analysis verified the five functional ability domains for healthy ageing. After adjusting for confounders, being mobile, building and maintaining relationships, and learning, growing and making decisions were significantly associated with lesser loneliness among participants. Conclusions The healthy ageing index of this study can be utilized and further modified with respect to large-scale research with relevant healthy ageing topics. Our findings will support healthcare professionals to provide patient-centered care when identifying their comprehensive abilities and needs.
Abstract Background A rapid increase in community transmission of COVID-19 across the country overwhelmed Uganda’s health care system. In response, the Ministry of Health adopted the home-based care strategy for COVID-19 patients with mild-to-moderate disease. We determined the characteristics, treatment outcomes and experiences of COVID-19 patients under home-based care during the second wave in Kapelebyong district, in eastern Uganda. Methods We conducted a sequential explanatory mixed-methods study. We first collected quantitative data using an interviewer-administered questionnaire to determine characteristics and treatment outcomes of COVID-19 patients under home-based care. Cured at home was coded as 1 (considered a good outcome) while being admitted to a health facility and/or dying were coded as 0 (considered poor outcomes). Thereafter, we conducted 11 in-depth interviews to explore the experiences of COVID-19 patients under home-based care. Multivariable logistic regression was used to assess factors associated with poor treatment outcomes using Stata v.15.0. Thematic content analysis was used to explore lived experiences of COVID-19 patients under home-based care using NVivo 12.0.0 Results A total of 303 study participants were included. The mean age ± standard deviation of participants was 32.2 years ± 19.9. Majority of the participants [96.0% (289/303)] cured at home, 3.3% (10/303) were admitted to a health facility and 0.7% (2/303) died. Patients above 60 years of age had 17.4 times the odds of having poor treatment outcomes compared to those below 60 years of age (adjusted odds ratio (AOR): 17.4; 95% CI: 2.2–137.6). Patients who spent more than one month under home-based care had 15.3 times the odds of having poor treatment outcomes compared to those that spent less than one month (AOR: 15.3; 95% CI: 1.6–145.7). From the qualitative interviews, participants identified stigma, fear, anxiety, rejection, not being followed up by health workers and economic loss as negative experiences encountered during home-based care. Positive lived experiences included closeness to friends and family, more freedom, and easy access to food. Conclusion Home-based care of COVID-19 was operational in eastern Uganda. Older age (> 60 years) and prolonged illness (> 1 months) were associated with poor treatment outcomes. Social support was an impetus for home-based care.
Hamidah Mahmud, Emma Landskroner, Abdou Amza
et al.
The World Health Organization (WHO) recommends continuing azithromycin mass drug administration (MDA) for trachoma until endemic regions drop below 5% prevalence of active trachoma in children aged 1-9 years. Azithromycin targets the ocular strains of Chlamydia trachomatis that cause trachoma. Regions with low prevalence of active trachoma may have little if any ocular chlamydia, and, thus, may not benefit from azithromycin treatment. Understanding what happens to active trachoma and ocular chlamydia prevalence after stopping azithromycin MDA may improve future treatment decisions. We systematically reviewed published evidence for community prevalence of both active trachoma and ocular chlamydia after cessation of azithromycin distribution. We searched electronic databases for all peer-reviewed studies published before May 2020 that included at least 2 post-MDA surveillance surveys of ocular chlamydia and/or the active trachoma marker, trachomatous inflammation-follicular (TF) prevalence. We assessed trends in the prevalence of both indicators over time after stopping azithromycin MDA. Of 140 identified studies, 21 met inclusion criteria and were used for qualitative synthesis. Post-MDA, we found a gradual increase in ocular chlamydia infection prevalence over time, while TF prevalence generally gradually declined. Ocular chlamydia infection may be a better measurement tool compared to TF for detecting trachoma recrudescence in communities after stopping azithromycin MDA. These findings may guide future trachoma treatment and surveillance efforts.
Arctic medicine. Tropical medicine, Public aspects of medicine
Cícero Alexandre de Freitas, José Martins de Alcântara Neto, Cinthya Cavalcante de Andrade
et al.
A preservação da função do enxerto é o principal foco do acompanhamento de pacientes transplantados renais. Estes pacientes estão sujeitos a doenças cardiovasculares, hipertensão arterial sistêmica, dislipidemia, diabetes mellitus, efeitos adversos da terapia imunossupressora, com alteração dos níveis de lipoproteínas, e outras disfunções metabólicas, que podem contribuir para perda do enxerto e maior morbimortalidade. A terapia hipolipemiante com estatinas oferece proteção ao endotélio do enxerto renal, com consequente diminuição das taxas de rejeição e melhora da qualidade de vida dos pacientes. Este trabalho propôs abordar o uso de estatinas como terapia hipolipemiante em pacientes transplantados renais, através de uma revisão narrativa da literatura. Foi realizada busca nas seguintes plataformas: Pubmed, Scielo, LILACS, Cochrane Library e MedRxiv, seguida de leitura explanatória. Foram incluídos 11 artigos científicos que contemplam os descritores: ‘Transplante de Rim’, ‘Inibidores de Hidroximetilglutaril-CoA Redutases’ e ‘Hipercolesterolemia’. Dos estudos, 45,6% (5) discutem os benefícios do uso de estatinas para controle de índices lipídicos, 36,4% (4) descrevem os riscos e benefícios do uso de estatinas para progressão de danos e 18% (2) relatam a efetividade das estatinas associadas com outras drogas. O uso de Inibidores de Hidroximetilglutaril-CoA Redutases (estatinas) apresenta relevância clínica em receptores de transplante renal, tendo como objetivo principal a diminuição das taxas lipídicas, fato que amplia a segurança no tratamento, promovendo benefícios para pacientes transplantados renais.
Specialties of internal medicine, Special situations and conditions
Aija Kotila, Jussi Tohka, Jukka-Pekka Kauppi
et al.
This video-based study examines the pragmatic non-verbal comprehension skills and corresponding neural-level findings in young Finnish autistic adults, and controls. Items from the Assessment Battery of Communication (ABaCo) were chosen to evaluate the comprehension of non-verbal communication. Inter-subject correlation (ISC) analysis of the functional magnetic resonance imaging data was used to reveal the synchrony of brain activation across participants during the viewing of pragmatically complex scenes of ABaCo videos. The results showed a significant difference between the ISC maps of the autistic and control groups in tasks involving the comprehension of non-verbal communication, thereby revealing several brain regions where correlation of brain activity was greater within the control group. The results suggest a possible weaker modulation of brain states in response to the pragmatic non-verbal communicative situations in autistic participants. Although there was no difference between the groups in behavioural responses to ABaCo items, there was more variability in the accuracy of the responses in the autistic group. Furthermore, mean answering and reaction times correlated with the severity of autistic traits. The results indicate that even if young autistic adults may have learned to use compensatory resources in their communicative-pragmatic comprehension, pragmatic processing in naturalistic situations still requires additional effort.
David Sadigursky, Juliana Almeida Braid, Diogo Neiva Lemos De Lira
et al.
Abstract Background Soccer is one of the most widely played sports in the world. However, soccer players have an increased risk of lower limb injury. These injuries may be caused by both modifiable and non-modifiable factors, justifying the adoption of an injury prevention program such as the Fédération Internationale de Football Association (FIFA) 11+. The purpose of this study was to evaluate the efficacy of the FIFA 11+ injury prevention program for soccer players. Methodology This meta-analysis was based on the PRISMA 2015 protocol. A search using the keywords “FIFA,” “injury prevention,” and “football” found 183 articles in the PubMed, MEDLINE, LILACS, SciELO, and ScienceDirect databases. Of these, 6 studies were selected, all of which were randomized clinical trials. Results The sample consisted of 6,344 players, comprising 3,307 (52%) in the intervention group and 3,037 (48%) in the control group. The FIFA 11+ program reduced injuries in soccer players by 30%, with an estimated relative risk of 0.70 (95% confidence interval, 0.52–0.93, p = 0.01). In the intervention group, 779 (24%) players had injuries, while in the control group, 1,219 (40%) players had injuries. However, this pattern was not homogeneous throughout the studies because of clinical and methodological differences in the samples. This study showed no publication bias. Conclusion The FIFA 11+ warm-up program reduced the risk of injury in soccer players by 30%.
Background/Aims: Postural instability in patients with normal pressure hydrocephalus (NPH) is a most crucial symptom leading to falls with secondary complications. The aim of the current study was to evaluate the therapeutic effect of spinal tap on postural stability in these patients. Methods: Seventeen patients with clinical symptoms of NPH were examined using gait scale, computerized dynamic posturography (CDP), and neuropsychological assessment. Examinations were done before and after spinal tap test. Results: The gait score showed a significant improvement 24 h after spinal tap test in all subtests and in the sum score (p Conclusion: Postural stability in NPH is predominantly affected by deficient vestibular functions, which did not improve after spinal tap test. Conditions which improved best were mainly independent from visual control and are based on proprioceptive functions.
Neurology. Diseases of the nervous system, Geriatrics
Lais Martins Moreira Anjos, Mariana Barros Marcondes, Mariana Ferreira Lima
et al.
Acute pharyngitis/tonsillitis, which is characterized by inflammation of the posterior pharynx and tonsils, is a common disease. Several viruses and bacteria can cause acute pharyngitis; however, Streptococcus pyogenes (also known as Lancefield group A β-hemolytic streptococci) is the only agent that requires an etiologic diagnosis and specific treatment. S. pyogenes is of major clinical importance because it can trigger post-infection systemic complications, acute rheumatic fever, and post-streptococcal glomerulonephritis. Symptom onset in streptococcal infection is usually abrupt and includes intense sore throat, fever, chills, malaise, headache, tender enlarged anterior cervical lymph nodes, and pharyngeal or tonsillar exudate. Cough, coryza, conjunctivitis, and diarrhea are uncommon, and their presence suggests a viral cause. A diagnosis of pharyngitis is supported by the patient's history and by the physical examination. Throat culture is the gold standard for diagnosing streptococcus pharyngitis. However, it has been underused in public health services because of its low availability and because of the 1- to 2-day delay in obtaining results. Rapid antigen detection tests have been used to detect S. pyogenes directly from throat swabs within minutes. Clinical scoring systems have been developed to predict the risk of S. pyogenes infection. The most commonly used scoring system is the modified Centor score. Acute S. pyogenes pharyngitis is often a self-limiting disease. Penicillins are the first-choice treatment. For patients with penicillin allergy, cephalosporins can be an acceptable alternative, although primary hypersensitivity to cephalosporins can occur. Another drug option is the macrolides. Future perspectives to prevent streptococcal pharyngitis and post-infection systemic complications include the development of an anti-Streptococcus pyogenes vaccine.
We introduce language-based games, a generalization of psychological games [6] that can also capture referencedependent preferences [7]. The idea is to extend the domain of the utility function to situations, maximal consistent sets in some language. The role of the underlying language in this framework is thus particularly critical. Of special interest are languages that can express only coarse beliefs [9]. Despite the expressive power of the approach, we show that it can describe games in a simple, natural way. Nash equilibrium and rationalizability are generalized to this setting; Nash equilibrium is shown not to exist in general, while the existence of rationalizable strategies is proved under mild conditions.
The study investigates the influence of climate conditions on radial increment of oak, with special concern to the situations when analysed trees formed conspicuously wider or narrower tree-rings. The research material was collected in four locations in central Poland within natural range of pedunculate and sessile oaks. The elaborated residual chronologies were correlated with CRUTS 2.1 climate data. The analyses included thermal and pluvial conditions spanning from April of the year prior to ring formation to September of the current growth year. Special interest was paid to simple water ability index that combined both temperature and precipitation during the vegetation season. Additionally, pointer year analysis was carried out to determine situations when conspicuously smaller or larger increment was formed.Investigated chronologies cover the period of 1927–1992 (Łochów), 1845–1992 (Płońsk), 1868–1992 (Pułtusk), and 1796–1992 (Sokołów). The analysed oaks from sites in central Poland exhibit growth patterns comparable with those known form previous studies concerning that species, where influence of precipitation (higher and positive) and temperature (negative) have been observed. Extreme growth reactions expressed by negative and positive pointer years turned to present high dependence of analysed oak’ growth on water availability during vegetation season.