Search Results (5,724)

Background: Chronic obstructive pulmonary disease (COPD) is marked by severe physical symptoms, impaired quality of life, and high psychological distress. Despite its impact, the identification of not only physical but also psychosocial and existential issues in the clinic lags behind that of other patient groups. Methods: This study aimed to assess physical, psychosocial, and existential issues among patients with COPD using a patient-reported outcome measure for general palliative care (the ‘PRO-Pall’) in a Danish outpatient clinic. We included 115 adults with COPD who completed the PRO-Pall either electronically or in the clinic. Sociodemographic and illness-related data were retrieved from their electronic health records. Results: We found that shortness of breath, tiredness, and difficulty walking were predominant physical issues. Worry about change in social roles was the most frequently reported psychosocial issue, while existential issues were reported by approximately one in ten patients. Most patients (44.5%) felt able to share their feelings with family or friends, and a majority (62.2%) felt their illness-related issues were addressed satisfactorily. Females expressed a greater need for rest and males more frequently reported intimacy issues. Higher COPD-impact on life measured by the COPD Assessment Test was associated with lower ratings on the quality-of-life item of the PRO-Pall independent of age, gender, lung function, and smoking status. Conclusions: Patients reported issues in physical, psychosocial, and existential dimensions of the PRO-Pall. The PRO-Pall shows potential as a broader alternative to measures that focus mainly on physical issues. Full article

Low-grade endotoxemia by lipopolysaccharide (LPS) has been detected in COVID-19 and could favor thrombosis via eliciting a pro-inflammatory and pro-coagulant state. The aim of this study was to analyze the mechanism accounting for low-grade endotoxemia and its relationship with oxidative stress and clotting activation thrombosis in COVID-19. We measured serum levels of sNOX2-dp, zonulin, LPS, D-dimer, and albumin in 175 patients with COVID-19, classified as having or not acute respiratory distress syndrome (ARDS), and 50 healthy subjects. Baseline levels of sNOX2-dp, LPS, zonulin, D-dimer, albumin, and hs-CRP were significantly higher in COVID-19 compared to controls. In COVID-19 patients with ARDS, sNOX2-dp, LPS, zonulin, D-dimer, and hs-CRP were significantly higher compared to COVID-19 patients without ARDS. Conversely, concentration of albumin was lower in patients with ARDS compared with those without ARDS and inversely associated with LPS. In the COVID-19 cohort, the number of patients with ARDS progressively increased according to sNOX2-dp and LPS quartiles; a significant correlation between LPS and sNOX2-dp and LPS and D-dimer was detected in COVID-19. In a multivariable logistic regression model, LPS/albumin levels and D-dimer predicted thrombotic events. In COVID-19 patients, LPS is significantly associated with a hypercoagulation state and disease severity. In vitro, LPS can increase endothelial oxidative stress and coagulation biomarkers that were reduced by the treatment with albumin. In conclusion, impaired gut barrier permeability, increased NOX2 activation, and low serum albumin may account for low-grade endotoxemia and may be implicated in thrombotic events in COVID-19. Full article

Cancer prehabilitation is the process between the time of cancer diagnosis and the beginning of the active acute treatment; prehabilitation consists of various need-based interventions, e.g., physical activity, a nutritional program, and psychological support. It can be delivered as unimodal or multimodal interventions. Physical activity, including resistant exercise and aerobic activities, has to be tailored according to the patient’s characteristics; nutritional support is aimed at preventing malnutrition and sarcopenia; while psychological intervention intercepts the patient’s distress and supports specific intervention to address it. In addition, multimodal prehabilitation could have a potential impact on the immune system, globally reducing the inflammatory processes and, as a consequence, influencing cancer progression. However, many challenges are still to be addressed, foremost among them the feasibility of prehabilitation programs, the lack of adequate facilities for these programs’ implementation, and the fact that not all prehabilitation interventions are reimbursed by the national health system. Full article

Background: The Second Victim Phenomenon (SVP) significantly impacts the well-being of healthcare professionals and patient safety. While the SVP has been explored in various healthcare settings, there are limited data on its prevalence and associated factors among nurses in Austria. This study investigates the prevalence, symptomatology, and preferred support measures for SVP among Austrian nurses. Methods: A nationwide, cross-sectional, anonymous online survey was conducted September to December 2023 using the SeViD questionnaire (Second Victims in German-speaking Countries), which includes the Big Five Inventory-10 (BFI-10). Statistical analyses included binary logistic regression and multiple linear regression using the bias-corrected and accelerated (BCa) bootstrapping method based on 5000 bootstrap samples. Results: A total of 928 participants responded to the questionnaire with a response rate of 15.47%. The participants were on average 42.42 years old and were mainly women (79.63%). Among the respondents, 81.58% (744/912) identified as Second Victims (SVs). The primary cause of becoming an SV was aggressive behavior from patients or relatives. Females reported a higher symptom load than males, and higher agreeableness was linked to increased symptom severity. Notably, 92.47% of SVs who sought help preferred support from colleagues, and the most pronounced desire among participants was to process the event for better understanding. Conclusions: The prevalence of SVP among Austrian nurses is alarmingly high, with aggressive behavior identified as a significant trigger. The findings emphasize the necessity for tailored support strategies, including peer support and systematic organizational interventions to mitigate the impact of SVP on nurses and to improve overall patient care. Further research should focus on developing and implementing effective prevention and intervention programs for healthcare professionals in similar settings. Full article

Background: Burnout is a well-recognized problem among resident physicians. The COVID-19 pandemic impacted the dynamics of the patient/resident relationship and introduced new stressors for medical trainees, such as new restrictions in the hospital, increased patient death, and uncertainty around safety. There is limited research on the implementation of group therapy for residents to address issues of wellbeing and burnout during the pandemic. Method: In response to perceived burnout amongst internal medicine residents, a university-based internal medicine residency program in the Northeast United States implemented process groups, a form of group therapy, in the curriculum. These sessions were held hourly once every five weeks for each cohort of twelve residents during the academic year. We sought to measure resident burnout and identify themes that impacted wellbeing to facilitate the intervention of process groups during the pandemic. In 2021 and 2022, internal medicine residents were invited to complete the Maslach Burnout Inventory (MBI) and answer two open-ended questions about the factors that most negatively and positively influenced their wellness. Results: Of the 134 participants, 82% had high emotional exhaustion or depersonalization. The most prevalent themes hindering wellness were negative personal interactions at work, most notably rude behavior by patients, unsupportive attendings, residency program expectations, and work intensity. Findings unique to the pandemic include social isolation from family, distress from poor outcomes, and fear of contracting or spreading the virus. The most prevalent themes for supporting wellness were personal life, camaraderie, professional satisfaction, and program structured support. Conclusions: Our findings suggest that programs can tailor structured support to improve wellness, despite the presence of significant stressors. Full article

Therapeutic communities face high drop-out rates and general distrust of their effectiveness among substance users. Actively involving users early in treatment promotes greater compliance with the treatment and is predictive of better outcomes. However, users often occupy a passive and subordinate role, exacerbated by the lack of research that explores their perspectives, beliefs, and experiences. This study examined the discourses of 57 consumers who were part of a community for less than 15 days, investigating the meanings attributed to service entry and treatment. A protocol of four written open-ended questions was employed and analysed through discourse analysis and positioning theory. The results indicate that participants configure the community as a place symbolically and spatially distinct from the rest of the world, where they isolate themselves to seek support during times of extreme difficulty. However, what they are seeking is a solution to acute distress caused by substance use, intertwined with social, economic, and relational issues. The concept of treatment is built on the image of the substance user as an individual making a weak request for help, attributing the problem solely to drugs and exhibiting reduced agency in addressing their issues. The collected texts provide a better understanding of the experiences of new users, highlighting the importance of co-constructing personalised projects that empower consumers to feel actively involved in their own change, exploring their theories and definitions of self to structure pathways based strictly on their needs. Full article

People with disabilities experience inequitable exposure to social determinants of health (SDOH) that contribute to disparate health outcomes, including psychological distress. There is little research examining which SDOH have the strongest effect on psychological distress among people with disabilities. This leaves healthcare providers and policy makers with insufficient information to make well-informed treatment decisions or allocate resources effectively. We explored the association between SDOH and disability and which factors may moderate the association between disability and psychological distress. Using data from the US Census Bureau’s Household Pulse Survey (Phase 3.5), we examined SDOH among people with and without disability (n = 26,354). Among people with disability, the odds of severe psychological distress were highest among those who had low incomes (OR = 4.41, 95% CI: 3.51–5.60), were food insecure (OR = 3.75, 95% CI: 3.43–4.10), housing insecure (OR = 3.17, 95% CI: 2.82–3.58), or were unable to work (OR = 1.98, 95% CI: 1.80–2.18). Only difficulty paying for household expenses moderated the association between disability and severe psychological distress (OR = 9.81, 95% CI: 7.11–13.64). These findings suggest that supporting employment and economic opportunities and improving access to safe and affordable housing and food may improve psychological well-being among people with disabilities. Full article

Background/Objectives: Laryngeal cancer significantly impacts patients’ psychological well-being and quality of life (QoL). This study aims to evaluate the psychological impact and QoL in patients with laryngeal cancer, focusing on differences based on tumor stage and treatment. Methods: This longitudinal study included 75 patients diagnosed with laryngeal cancer. Participants were assessed at diagnosis and 3 months post-treatment using validated tools such as the Hospital Anxiety and Depression Scale (HADS) and the EORTC QLQ-H&N35 questionnaire. This study analyzed the impact of tumor stage, treatment type, and demographic factors on psychological well-being and QoL. Results: Patients with early-stage tumors (Stage I) reported significantly better psychological well-being and QoL compared to those with more advanced tumors (Stages III and IV) both before and after treatment. The non-significant p-values in advanced stages suggest a uniformity of severe distress and poor QoL among these patients. Treatment led to significant reductions in anxiety and depression in early-stage patients, while those with advanced-stage disease showed less improvement. Conclusions: The findings highlight the critical need for early psychological intervention, particularly in advanced-stage laryngeal cancer patients who continue to experience substantial psychological distress and poor QoL despite treatment. Integrating comprehensive psychological support into standard care is essential to improve overall outcomes for these patients. Full article

The present study aimed to identify in patients with severe COVID-19 and acute respiratory distress syndrome (ARDS) the association between rs3804099 and rs3804100 (TLR2) and evaluate the expression of TLR-2 on the cell surface of innate and adaptive cells of patients’ carriers of C allele in at least one genetic variant. We genotyped 1018 patients with COVID-19 and ARDS. According to genotype, a subgroup of 12 patients was selected to stimulate peripheral blood mononuclear cells (PBMCs) with spike and LPS + spike. We evaluated soluble molecules in cell culture supernatants. The C allele in TLR2 (rs3804099, rs3804100) is not associated with a risk of severe COVID-19; however, the presence of the C allele (rs3804099 or rs3804100) affects the TLR-2 ability to respond to a spike of SARS-CoV-2 correctly. The reference group (genotype TT) downregulated the frequency of non-switched TLR-2+ B cells in response to spike stimulus; however, the allele’s C carriers group is unable to induce this regulation, but they produce high levels of IL-10, IL-6, and TNF-α by an independent pathway of TLR-2. Findings showed that TT genotypes (rs3804099 and rs3804100) affect the non-switched TLR-2+ B cell distribution. Genotype TT (rs3804099 and rs3804100) affects the TLR-2’s ability to respond to a spike of SARS-CoV-2. However, the C allele had increased IL-10, IL-6, and TNF-α by stimulation with spike and LPS. Full article

Rutting is a significant form of pavement distress that arises from irreversible strains accumulating along wheel paths, directly impacting pavement safety. This research investigates the effectiveness of nanocarbon-coated micronized calcium carbonate powder as a modified filler to mitigate rutting, utilizing numerical methods via finite element software. The study specifically examines the addition of 5% by weight of this modified filler to the asphalt mix. To validate the numerical results, laboratory wheel-tracking tests were conducted on samples incorporating both conventional and modified fillers. The findings reveal that the modified calcium carbonate filler enhances the asphalt’s resistance to rutting, with the 5% inclusion demonstrating a marked improvement in durability and performance. The study also underscores the necessity of characterizing the elastic and visco-plastic properties of materials through rigorous testing methods, such as elastic modulus and dynamic creep tests, to better understand their behavior under load. Numerical analysis based on linear elastic conditions was prioritized over viscous conditions to effectively compare the results of these specialized materials. The strong correlation between the numerical simulations and laboratory results reinforces the effectiveness of finite element methods in predicting pavement behavior and optimizing asphalt mixtures. Full article

Climate change significantly impacts transportation infrastructure, particularly asphalt pavements. Similarly, the heat absorption of paved surfaces, especially conventional black pavements, significantly intensifies the urban microclimate. Paved surfaces, including asphalt pavements, account for over 30% of the covered surfaces and are vulnerable to rising temperatures, which cause not only pavement distress, such as rutting and cracking, but also urban heat islands (UHI). Sustainable pavement solutions, specifically colored pavements, have been investigated for their potential to mitigate these effects. This review presents an extensive overview of current pavement technologies, emphasizing conventional asphalt’s economic, environmental, and functional characteristics. A discussion of the benefits and challenges of colored pavements is also provided, including their ability to reduce UHI, enhance safety, and contribute to sustainable urban growth. This paper discusses advancements in pavement material science, the use of recycled materials, and the application of reflective coatings, providing insights into sustainable infrastructure development. Transitioning from conventional black pavements to sustainable colored alternatives is not merely a matter of material choice but a strategic transition toward resilient urban planning. Increasing demand for environmentally friendly infrastructure could prompt the construction industry to adopt colored pavements as a tool to promote environmental stewardship. Full article

In the early Buddhist discourses, distressing experiences like fear and disgust are evaluated in contradictory modes. These upsetting emotions are considered both a detriment and an advantage for those seeking liberation from suffering. This ambivalence is reflective of the classical Buddhist conception of distress. The earliest scholastic Buddhist texts (i.e., Abhidharma sources) have sought to resolve the ambivalence surrounding this conception. The Abhidharma texts thus explain precisely how, when, where and for whom distress can prove favorable. By tracing this intellectual endeavor, I examine in this article the systematic and philosophical treatments of distress (saṃvega) in early Buddhist scholasticism. I outline the reasons for considering the experience of distress to be beneficial, unveiling the religious framework within which distress is rendered positive and even essential. My central claim is that early Abhidharma sources conceive of distress as a potential source of energy that facilitates one’s progress on the religious path and determines how rapidly one can understand the truth. Full article

Intimate partner violence (IPV) against women is a major global public health and human rights issue, with significant consequences for women’s health and well-being. This study aimed to determine the relevance of IPV on women’s mental distress, post-traumatic stress symptoms and life satisfaction, and to examine whether age, education, socioeconomic status, social support and self-esteem are associated with mental health and well-being. The sample consisted of 255 women aged 18 to 71 living in Colombia who were assessed using six self-reported questionnaires. Hierarchical multiple regression analyses showed that more IPV was associated with women’s increased mental distress, post-traumatic stress symptoms and decreased life satisfaction. Although self-esteem and, to a lesser extent, social support were important predictors of women’s mental distress and well-being, psychological IPV was the main predictor of women’s post-traumatic stress symptoms, followed by lower self-esteem and younger age. The most important predictor of women’s mental distress was lower self-esteem, followed by more psychological IPV and lower social support. The main predictor of women’s life satisfaction was high self-esteem, followed by high social support, less psychological IPV and higher age and education. It is concluded that IPV, especially psychological IPV, is a serious threat to women’s mental health and well-being, while high self-esteem and, to a lesser extent, high social support are associated with better mental health and well-being. Full article

(1) Background: Clinical aspects like sex, age, Karnofsky Performance Scale (KPS) and psychosocial distress can affect the health-related quality of life (HR-QoL) and treatment satisfaction of patients with malignant isocitrate dehydrogenase wild-type (IDHwt) gliomas and caregivers. (2) Methods: We prospectively investigated the HR-QoL and patient/caregiver treatment satisfaction in a cross-sectional study with univariable and multiple regression analyses. Questionnaires were applied to investigate the HR-QoL (EORTC QLQ-C30, QLQ-BN20) and treatment satisfaction (EORTC PATSAT-C33). (3) Results: A cohort of 61 patients was investigated. A higher KPS was significantly associated with a better HR-QoL regarding the functional scales of the EORTC QLQ-C30 (p < 0.004) and a lower symptom burden regarding the EORTC QLQ-BN20 (p < 0.001). The patient treatment satisfaction was significantly poorer in the patients older than 60 years in the domain of family involvement (p = 0.010). None of the investigated aspects showed a significant impact on the treatment satisfaction of caregivers. (4) Conclusions: We demonstrated that in patients with IDHwt gliomas, the KPS was the most important predictor for a better HR-QoL in functional domains. Data on the HR-QoL and treatment satisfaction in patients with IDHwt gliomas and their caregivers are rare; therefore, further efforts should be made to improve supportive care in this highly distressed cohort. Full article

(1) Background: The observational retrospective study aimed to investigate the prevalence of personality disorders (PDs) and their association with psychopathological symptoms in a group of patients with cocaine addiction. (2) Methods: Ninety-five medical records of the Pathological Addictions Service of the National Health Service of Lecce (Italy) were analyzed. PDs were diagnosed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) and psychopathological symptoms were investigated through the Symptom Checklist 90-Revised (SCL-90-R). (3) Results: Ninety-two out of ninety-five patients met the criteria for at least one PD (96.8%), almost 35% had two Cluster B PDs, and over 25% had three Cluster B PDs. Nine out of ninety-five people met the criteria for all Cluster B PDs. Among the Cluster B PDs, it emerged that the most frequent diagnosis was that of narcissistic–borderline–antisocial (over 20% of the total sample). The analysis highlighted that mental suffering is prevalent in those with multiple comorbid Cluster B PDs. Specifically, depression and psychoticism exceed the clinical cut-off (T score > 63) in all patient groups. At the same time, anxiety and obsessions–compulsions are complained of only by those with more than two PDs as well as the level of general distress. Furthermore, anxiety, hostility, and paranoid ideation are significantly higher in the group of patients with more than three PDs. (4) Conclusions: Further studies should better investigate the relationship between the two aspects and describe the causal effects of PDs on psychopathological symptoms or, on the contrary, the effects of the substance on mental health and the worsening of personality alterations. Full article