Risultati per: Demenze: trattamento farmacologico e non farmacologico e gestione dello stress del caregiver

Stroke, Volume 56, Issue Suppl_1, Page ATP156-ATP156, February 1, 2025. Introduction:Early recognition of acute stroke and activation of emergency medical services (EMS) is a critical first step in the stroke care continuum. Failure to call 9-1-1 and other delays in seeking care contribute to prolonged prehospital delays, often limiting access to time-sensitive treatment. To identify challenges in early initiation of EMS, we sought to understand stroke survivor and caregiver perspectives on seeking acute stroke care.Methods:We conducted individual, semi-structured interviews with a convenience sample of adult stroke survivors and caregivers for patients with acute stroke that occurred in central North Carolina. In virtual interviews, participants were asked about stroke signs and symptoms experienced, their response, and care received from EMS and in the ED and hospital. Interviews were recorded, transcribed, and analyzed by two individual coders. Deductive coding and rapid thematic analysis focused on care-seeking behaviors and perspectives.Results:Of 16 interviews conducted thus far, 10 were with stroke survivors and 6 were with accompanying caregivers (14 Non-Hispanic White; 13 used EMS). Stroke onset was promptly recognized when the patient/caregiver had prior experience with stroke, exposure to stroke education, or access to healthcare professionals among their personal circles. Early stroke recognition prompted over half of the caregivers or other bystanders (spouses, adult children, or neighbors) to call 9-1-1 right away. Symptoms perceived by the patient/caregiver as a non-stroke issue (e.g., migraine, seizure) or not severe enough led a third of the participants/caregivers to delay or fail to call 9-1-1. Some participants reported being aware of EMS costs; however, none reported delaying care-seeking due to these concerns. Other concerns with calling 9-1-1 included general apprehension of medical professionals and fear of being perceived as “the boy who cried wolf.”Conclusion:Stroke survivors’ and caregivers’ perspectives highlighted accurate and early stroke recognition as a facilitator of prompt EMS initiation. Conversely, symptoms associated with other neurologic conditions or perceived as mild created delays in seeking care. Further recruitment is in progress until reaching at least 30 participants, focusing on racial and ethnic minority groups and underserved rural populations. Study findings will be used to develop effective solutions to challenges in seeking acute stroke care.

Stroke, Volume 56, Issue Suppl_1, Page ATP378-ATP378, February 1, 2025. Introduction:The molecular and metabolic changes that occur after acute ischemic stroke (AIS) are not fully understood. One mechanism known to trigger systemic inflammatory responses and neuronal death during ischemic stroke cascades the rapid increase in Reactive Oxygen Species (ROS). Accumulation of oxidative stress has been shown to trigger the initiation and progression of cognitive deficits, including mild cognitive impairment (MCI) and Alzheimer’s Dementia (AD). One emerging biomarker able to reliably measure oxidative stress is Malondialdehyde (MDA), a reactive carbonyl compound originating from polyunsaturated fatty acid oxidation and lipid peroxidation. Due to its composition, MDA readily reacts with lipid membranes, making it a sensitive oxidative stress biomarker. This study assessed MDA levels in the plasma of AIS patients to evaluate its ability to predict cognitive impairment and long-term functional outcomes.Hypothesis:We hypothesized that oxidative stress correlates with long-term functional outcomes in AIS patients and varies based on non-modifiable risk factors such as sex and race.Methods:In this study, we used peripheral blood plasma from healthy volunteers (HV, N=24), and from ischemic stroke patients (N=27) at 3d and 7d post-stroke to capture the temporal profile of MDA after injury. Cognitive impairment was assessed during hospitalization with the Brief Neurocognitive Screening Test (BNST), with a score of 8 or below denoting cognitive impairment.Results:AIS patients had an increase in MDA levels compared to the control group, as seen in prior literature. There was a significant correlation with increase age of stroke patients and higher levels of MDA (p

Stroke, Volume 56, Issue Suppl_1, Page AWP54-AWP54, February 1, 2025. Introduction:Post-stroke fatigue is prevalent and significantly impacts quality of life chronically after stroke. Its underlying biological mechanisms remain largely unknown. Here we set out to understand the persistence of post-stroke fatigue and to use plasma proteomics to identify candidate mechanisms.Methods:We acquired neurocognitive assessments and blood draws from 250 stroke survivors from two sites at baseline (median 8 mo after stroke, range 5-120 mo), and 131 participants one year later. The Functional Assessment of Chronic Illness-Fatigue (FACIT) scale was used to assess fatigue, with no fatigue defined as FACIT >41, any fatigue as FACIT≤41, and severe fatigue as FACIT

Stroke, Volume 56, Issue Suppl_1, Page AWP69-AWP69, February 1, 2025. Objective:Stroke patients with tube feeding have a high probability of feeding problems when they had regained oral intake ability. Assisting patients with eating is a major task for caregivers and they require better training. We developed an intervention to engage caregiver in feeding patients prior to feeding tube removal and examined the impact on oral feeding resumption in rehabilitation among stroke survivor.Methods:A total of 61 stroke patients with dysphagia recovery were enrolled in rehabilitation hospital from Jan. 2021 to Jul. 2024. They all recovered from tube feeding to complete oral feeding before discharge. Inclusion criteria included 1) Stroke patients with feeding tube. 2) Impaired oral intake which was defined as viscosity of pudding ≥5 ml and sum of three viscosities ≤15 ml based on the modified Volume-viscosity Swallow Test (V-VST). An intervention for caregivers, which engaged them on feeding practices was introduced from Jan 2023 to Jul 2024. The intervention program for feeding practices was primarily carried out by ward nurses. It consisted of thickener preparation and feeding patients skills training. Outcomes were compared between an intervention group of 28 patients and a historical control group of 33 patients recruited between Jan 2021 to Jul 2022. We compared the baseline characteristics and the length of oral feeding resumption between the groups. Volume change of three viscosities was represented by bar graphs.Results:The length of patients who could remove the tube feeding and completed oral feeding resumption was significantly shorter in the intervention group compared with the control group (24.57±11.04 days vs 31.09±12.61 days, P=0.038). 22/28 (78.6%) patients in the intervention group had their feeding tubes removed within one week. The volume growth of three different viscosities was demonstrated following the intervention. Swallowing function of stroke patients in the intervention group improved more quickly comparedConclusion:Our data indicated that effective caregiver engagement is necessary. Successful caregiver engagement has the potential to reduce costs and enhance patient outcomes.

Stroke, Volume 56, Issue Suppl_1, Page AWP126-AWP126, February 1, 2025. Introduction:Posttraumatic stress disorder (PTSD) has emerged as a mental health barrier that can be experienced by survivors of stroke. PTSD triggered by thoughts of stroke impacts a patient’s ability to optimize their health outcome and maintain compliance with secondary prevention. A young adult stroke clinic treating survivors aged 18-50 in an urban setting in Maryland implemented a standardized practice to screen all patients for PTSD. A retrospective data analysis was performed to determine prevalence of PTSD in the young stroke population and identify predictive characteristics.Methods:Clinic patients were eligible for screening if they were survivors of ischemic or hemorrhagic stroke. The PCL-5 was utilized as the validated PTSD screening tool. Patients were asked to think about their stroke as the stressful event when answering the questions on the tool. A score on the PCL-5 of ≥ 31 was considered positive for PTSD and < 31 was negative. Only the initial screening for each patient was included in the analysis. Additional data collected included demographics, medical history, mental health history, substance use at time of stroke, and mRS at the time of visit. Data collection began in September 2023. Univariate analysis was done to identify which characteristics are associated with developing symptoms of PTSD after stroke.Results:A total of 106 young stroke survivors were screened. Mean age of first stroke was 39.5 years (range 5-50), 57.5% were female (61/106), and 57.5% were black (61/106). PTSD was prevalent in young adult stroke survivors at a rate of 17% (18/106). Compared to patients without the following characteristics, there was a significant increase in the rate of developing PTSD after stroke for patients with a history of anxiety (OR 5.1, 95% [1.2-21.5]) or active smoking (OR 3.8, 95% [1.18-12.4]). The remaining characteristics did not have statistically significant associations with PTSD.Conclusion:PTSD prevalence in this age group of stroke survivors is consistent with what is reported in the literature for all stroke survivors. Preliminary analysis shows there may be predictive characteristics of young stroke survivors who develop PTSD, which can impact their recovery and secondary prevention. The first months are the most impactful in stroke recovery. Further data collection and analysis should be done in this population to look for additional characteristics associated with PTSD to identify at-risk patients early.

Stroke, Volume 56, Issue Suppl_1, Page ADP27-ADP27, February 1, 2025. Introduction:Air pollution derived from diesel exhaust has been linked with cognitive decline and cerebrovascular diseases. In previous studies, subacute diesel exhaust exposure has been shown to increase neurotoxicity and white matter damage; however, few studies have modeled the effects of air quality improvement. Our previous data from the same cohort showed persistent microglial activation (Iba-1) after an 8-week recovery period. The objective of this study was to further investigate the extent of recovery after neurotoxic diesel exhaust particulate (DEP) exposure.Methods:Female and male 8-week-old C57BL/6 mice were exposed to inhaled Filtered Air (FA) and DEP (NIST SRM 2975) at concentration of 100μg/m3. There were three arms in this study: 1) 8 weeks of FA or DEP exposure (n=16/group); 2) 8 weeks of FA or DEP exposure followed by 8 weeks of recovery (n=16/group); and 3) 16 weeks of FA or DEP exposure (n=16/group). Mice were humanely euthanized and brain hemispheres sectioned at 5 µm. Corpus callosum levels of C5 complement protein, C5a anaphylatoxin, 4-hydroxynonenal (4-HNE), 8-Oxo-2′-deoxyguanosine (8-OHDG), and degraded myelin basic protein (dMBP) were assayed via immunofluorescence.Results:The 8-week DEP group demonstrated increases in C5 (+39%), C5a (+45%), 4-HNE (+107%), 8-OHDG (+26%), and dMBP (+118%) in comparison to the 8-week FA group. The 8-week DEP recovery group demonstrated no significant elevation in C5, C5a, 4-HNE, and 8-OHDG in comparison to the 8-week FA recovery group. However, dMBP remained elevated (+87%) after in the 8-week DEP recovery group compared to the 8-week FA recovery group. The 16-week DEP group demonstrated increases in C5 (+44%), C5a (+58%), 4-HNE (+106%), 8-OHDG (+57%), and dMBP (+94%) in comparison to the 16-week FA group (p-values in Figure 1).Conclusions:DEP exposure results in increased oxidative stress, neuroinflammation, and myelin breakdown at 8 weeks and 16 weeks. Unlike neuroinflammation and oxidative stress that recovered, white matter damage showed a persistent effect after an 8-week washout period. Combined with our previous data on persistent microglia activation, this suggests that prolonged neuroimmune response may contribute to the white matter injury that persists several months after DEP exposure termination.

Stroke, Volume 56, Issue Suppl_1, Page ATP7-ATP7, February 1, 2025. Introduction:Venous thromboembolism (VTE)manifesting as deep vein thrombosis (DVT) and pulmonary embolus (PE) and arterial thromboembolism (ATE) manifesting as acute ischemic stroke (AIS) result in ~1 million US deaths annually. Increased levels of circulating inflammatory markers, particularly von Willebrand factor (VWF), may indicate poor outcomes in ATE, but previous studies limit this response to high shear stress milieu. We compared VTE and AIS thrombi inflammatory markers at time of intervention.Methods:Clots were harvested from 20 PE, 9 DVT, and 74 AIS patients and immunofluorescent staining completed in duplicate with VWF, plasminogen activator inhibitor 1 (PAI-1), glycophorin A (RBCs), CD42b (platelets), fibrinogen, and neutrophil endothelial trap constituents (NETs). NETs were defined as citrullinated histones (CitH3), neutrophil elastase (NE) and myeloperoxidase (MPO). Clot sections were analyzed with Image J.Results:VWFlevels were lower in AIS clots (21.02 +/- 12.02%) compared to DVT (24.87 +/- 12.98%, p=0.0212) and higher in PE (12.21 +/- 5.96%, p=0.0001).PAI-1levels were higher in AIS clots (42.80 +/- 16.28%) compared to DVT (27.43 +/- 15.61%, p=0.0001) and lower in PE (51.23 +/- 10.89%, p=0.0016). AlthoughRBCswere not significantly different in AIS (35.34 +/- 15.32%) compared to DVT, they were more prevalent in PE (52.93 +/- 8.31%, p=0.0001). Surprisingly, althoughplateletswere lower in DVT thrombi (15.30 +/- 12.33%, p=0.0105) compared to AIS (23.06 +/- 13.71%), they were increased in PE (32.70 +/- 8.46%, p=0.0001. Lastly, although there was no difference in DVT thrombi compared to AIS clots,fibrinogen(21.307 +/- 8.75%) was lower in PE clots (14.85 +/- 7.56%, p=0.0001), as wasCitH3(8.42 +/- 10.42% vs 7.03 +/- 4.18%, p=0.0001, andNE(31.10 +/- 18.31% vs 37.18 +/- 14.31% in PE, p=0.0025).MPOwas unremarkable.Conclusion:Inflammatory marker levels in AIS vs VTE have a complexity beyond shear stress and offer insights into targeting thrombolytics.

Stroke, Volume 56, Issue Suppl_1, Page AWP402-AWP402, February 1, 2025. Background:Patients with hypertension (HTN) are almost 3 times more likely to have a stroke than non-hypertensive individuals. HTN is associated with oxidative stress (OS), exacerbated inflammation, and vascular remodeling. In experimental models, normotensive Sprague-Dawley (SD) and Spontaneously Hypertensive Rats (SHR) show different susceptibilities and outcomes to ischemic stroke. We propose that better understanding of the modulation in gene expression profile in HTN brains may provide critical insight into this complex process.Methods:We focused on transcriptomic characterization of OS, inflammatory, and apoptosis pathway specific genes in SD and SHR brains before and after ischemic stroke. Middle Cerebral Artery Occlusion was used to induce focal ischemia/reperfusion injury (I/R). Using pathway specific arrays containing 84 selected genes, we performed a transcriptome analysis in the brain cortical regions. Fold-changes in gene expression were determined using the 2−ΔΔCtmethod.Results:In no-stroke SHR brain, HTN was associated with increased levels of pro-inflammatory genes including chemokine ligand (CCL)5 (3.0-fold), IL-6 (3.3-fold), and TNF superfamily member 7 (14-fold) as compared to normotensive SD rats without stroke. On the other hand, Mitogen-activated protein kinase 13, involved in tissue remodeling and cell proliferation was significantly decreased in SHR brains. However, following I/R, expression of redox signaling genes including aldehydeoxidase1 (3.4 fold), dual oxidase 1 (2.5-fold), and lactoperoxidase (3.3-fold) were upregulated in SHR brains as compared to SD rat brains. This was linked to a dysregulation in inflammatory response genes including SELE (2.8-fold), IL-1β (2-fold), and CCL21 (3.2-fold). The downstream effects of OS and inflammation on apoptotic process was supported by an upregulated expression of pro-apoptotic genes, including caspases-3,6,12 (2.1,1.7, 3.4-fold), CIDEA (1.7-fold), FAS (1.7-fold), and PYCARD (2-fold). These data indicate that OS and inflammatory pathways are further over-activated in hypertensive rat brains.Conclusion:Our data show that the expression of genes involved in OS and inflammation are coordinately upregulated as a function of HTN, which may worsen the outcome of ischemic stroke by likely regulating vascular remodeling, neuronal apoptosis, and blood brain barrier functions. Further studies focusing on these key genes may open up new ways to mitigate HTN-linked post-stroke brain damage.

Stroke, Volume 56, Issue Suppl_1, Page ATP63-ATP63, February 1, 2025. Background and Issues:A neurovascular intensive care unit (ICU) had a large volume of employee turnover associated with burnout and moral distress. Literature suggested nurses caring for stroke patients experienced significant moral distress and secondary traumatic stress injuries. ICU leadership implemented a combined approach of Schwartz Center Rounds (SCR) Stress First Aid (SFA) and American Association of Critical-Care Nurses (AACN) 4-As methodology to support and improve staff resiliency.Purpose:Would employees experience decreased moral distress, improved sense of resiliency, decreased burnout, and decreased turnover through a combined implementation of the SCR SFA and AACN 4-A’s process?Methods:SFA and 4-As models were selected because they both aligned with project goals. They guided support for and educated on how to support one another. Models were launched one month apart via computerized learning modules. All employees were educated, but the measures focused on nursing. Techniques used for ongoing educational support included:-Monthly newsletters-Self-care and stress reduction tactics-Awareness of hospital resources, including crisis resources-Quarterly Mobile Town Hall: Unit rounding with therapy dogs, education, snacks, senior directors, chaplaincy, and employee assistance program directorResults:The annual employee engagement survey used a numeric rating scale of 0-5. The statement specific to this project was “This facility helps me deal with stress and burnout”. In fiscal year (FY)2021, the ICU scored 2.43. In FY2022, the score improved to 2.53. Unfortunately, the survey question changed in 2023 to “The amount of job stress I feel is reasonable”, so an equal comparison could not be made. The score for FY2023 was 3.06.Turnover rates decreased from a high of 32.76% to a low of 26.87% one year following implementation.Conclusions:Implementation of SFA and 4-As skills improved resiliency and the unit benefited in decreased turnover. Lessons learned included implementing both programs during the onboarding process and leadership role-modeling to support enculturation.Initially, staff felt awkward approaching one another. Use of case studies would have improved confidence and comfort in approaching peers about their stress level.A comprehensive list of hospital resources was essential.Senior Directors played a valuable role in modeling new behaviors, increasing frontline visibility, budgeting, and supporting efforts.

Stroke, Volume 56, Issue Suppl_1, Page ATP56-ATP56, February 1, 2025. Background and Purpose:Stroke is the main cause of disability in the adult population. Only 25% of stroke survivors fully recover their prior level of functioning; 75% survive with some form of impairment, and half of them lose their capacity for self-sufficiency, which has a significantly negative impact on their quality of life. The purpose of this study was to to evaluate the impact of customized training interventions on the experience of the caregiver-stroke survivor dyad during the complex transitional care period.Methods:A critical interpretative meta-synthesis approach was adopted. Sample selection was guided by the SPIDER framework, while identification of eligible studies was informed by the PRISMA criteria. A comprehensive search was conducted across Scopus, PubMed and CINAHL up to October 2023 to identify all studies examining lived experiences and perceptions of caregivers and stroke survivors regarding the suitability of training supports provided during the pivotal transitional care period. The methodological quality and risk of bias were critically evaluated using the authoritative Joanna Briggs Institute Checklist for Quality Assessment and Review Instrument.Results:Out of the 394 articles initially found, only 10 met eligibility criteria and were included. Text analysis revealed two themes that encapsulate the lived experience of caregivers and stroke survivors as related to transitional care supports: 1) acknowledging that life will never be the same and 2) growing recognition of the so-called new normal. The first theme incorporated six significant subthemes. These included the need for information and training, uncertainty about the future, participation, realistic assessments of evolving training needs, coordinated discharge planning; as well as psychological distress. The second one consisted of three interrelated subthemes: variation in perceived roles and responsibility after a stroke, availability and perceived adequacy of post-discharge support, and adapting processes to change.Conclusions:The meta-synthesis provided evidence that a lack of tailored and targeted training support negatively affected both members of the dyad. Unaddressed information and training increased experiences of anxiety, uncertainty, and stress during transitional care. The ability to adapt to post-stroke and achieve a satisfactory quality of life is strongly associated with the informational and training support given during the transitional care period.

Stroke, Volume 56, Issue Suppl_1, Page AWP271-AWP271, February 1, 2025. Introduction:Patients with single subcortical infarction (SSI) have relatively favorable prognosis, but they often experience early neurological deterioration (END) in a clinical course. Endothelial shear stress (ESS) applied to the vascular wall may also be one of the causes.Hypothesis:We would like to analyze the association between ESS and occurrence of END in SSI patients.Methods:We included consecutive patients with SSI within 72 hours of symptom onset between 2010 and 2020. END was defined as an increase of ≥ 2 in the total NIHSS score or ≥ 1 in the motor NIHSS score within the first 72 hours of admission. As a parameter for ESS, the signal intensity gradient (SIG) value was obtained at the vessel boundary in time-of-flight image in initial brain magnetic resonance angiography. The maximum, minimum, mean, and standard deviation of SIG were obtained from all intracranial vessels. Among them, the SIG value of the relevant vessel that caused SSI was taken as the main independent variable.Results:A total of 495 patients with SSI were evaluated (median age: 67 years, END prevalence: 17.2%). In multivariable analysis, the mean SIG value of relevant vessels was significantly associated with END (adjusted odds ratio = 0.81, 95% confidence interval: 0.68-0.97). However, maximum, minimum, or standard deviation SIG value of relevant vessel was not associated with END. Additionally, the mean SIG value of the whole intracranial vessel also showed no correlation with the occurrence of END. The statistical correlation between the average SIG value of relative vessels and END was clearly evident in distal SSI, but the correlation was lost in proximal SSI. Age or proximal type SSI also showed an association with END regardless of SIG value.Conclusions:In patients with acute SSI, the mean SIG value of relevant vessels showed a negative association with the occurrence of END. In other words, if the ESS applied to the relevant vessel where the index stroke occurred is weak, END may occur relatively easily. This tendency was more evident in patients with distal SSI lesions.

Introduction
The aim of this scoping review is to connect theoretical research related to stress with practical applications to supervision experiences within allied health professions. Understanding the implications of stress between clinical supervisors and allied health students will allow for better insights to improve supervisory methods within clinical training, stronger mentorship and lead to better quality patient care.

Methods and analysis
This review is conducted according to Joanna Briggs Institute (JBI) methodology for scoping reviews, which includes defining the research question, developing inclusion criteria and searching for, selecting, extracting and analysing the evidence. A literature search will be conducted in MEDLINE (PubMed), CINAHL (EBSCO), ERIC (EBSCO), PsycINFO (EBSCO) and Embase (Elsevier), as well as various grey literature resources. Studies will be included if they focus on undergraduate or graduate allied health students in a clinical setting and allied health clinical educators, and report on outcomes related to stress dynamics between these two populations. Results will pass through title/abstract and full-text screening before data are extracted using a tool developed by the reviewers. Data will be analysed and summarised descriptively and presented in both tabular and narrative formats.

Ethics and dissemination
Ethical approval is not required for this scoping review. Results will be disseminated in peer-reviewed publications and professional conferences.

Trial registration number
The protocol was registered with Open Science Framework on 2 October 2024 (https://doi.org/10.17605/OSF.IO/REK7Z).

Introduction
The incidence of post-traumatic stress disorder (PTSD) in emergency trauma surgery patients is 24%, emphasising the urgent need for effective early interventions and treatments. Transauricular vagus nerve stimulation (ta-VNS) modulates the autonomic nervous system by stimulating the nucleus tractus solitarius while affecting PTSD-related neural networks, including the prefrontal cortex, hippocampus and amygdala, potentially offering new options for PTSD prevention and treatment. This study aims to evaluate the efficacy and safety of ta-VNS in preventing PTSD in emergency trauma surgery patients.

Methods and analysis
This multicentre, double-blind, randomised controlled study aims to evaluate the incidence of PTSD in emergency trauma surgery patients receiving either ta-VNS or sham stimulation. A total of 350 participants will be randomly assigned to receive either active or sham stimulation. The active group will undergo electrical stimulation of the left cymba conchae at 30 Hz with a pulse width of 250 µs, using a 30 s on/30 s off cycle. The intensity will start at 0.4 V, increasing in 0.4 V increments until a tingling sensation is detected, and will be adjusted to the highest tolerable level without causing pain. The initial intervention will begin once informed consent is obtained and randomisation is completed in the preoperative preparation room, continuing until the surgery is finished. For the four postoperative days, the intervention will be administered two times per day in 2-h sessions each morning and evening. The sham stimulation group will follow a similar procedure without actual stimulation. The primary outcome is the incidence of PTSD evaluated on postoperative day 30, with secondary outcomes including recovery quality, sleep quality, and adverse events.

Ethics and dissemination
The protocol received approval from Sir Run Run Shaw Hospital, affiliated with Zhejiang University School of Medicine, on 15 October 2024 (approval number: 20240562). The study will adhere to the Declaration of Helsinki guidelines, and written informed consent will be obtained from all participants. Results will be submitted to a peer-reviewed journal for publication.

Trial registration number
China Clinical Trial Registration Center (ChiCTR2400080342). Trial details: https://www.chictr.org.cn/showproj.html?proj=217809

Background
Many countries have addressed the global issue of nursing shortage by recruiting overseas nurses who are also qualified in the host country. Nevertheless, such nurses may encounter various obstacles in their personal and professional lives in the host country, leading to apprehensions about their perceptions of workplace safety in healthcare organisations.

Objective
This study investigated the current state of immigration-specific stress among overseas qualified nurses (OQNs) working in Japan and its impact on safety attitudes.

Settings
Invitation letters with a Quick Response (QR) code for a survey were sent to 119 hospitals across Japan that accepted OQNs as per the Ministry of Health, Labour and Welfare. Additionally, the survey QR code was shared with OQN-specific social media groups.

Participants
The inclusion criteria were being born and having received basic nursing education outside Japan, passing the Japanese national nursing examination, and current employment in the Japanese healthcare organisations. Valid responses were received from 214 OQNs.

Methods
Data were collected via an online survey, including the Demands of Immigration Scale and Safety Attitudes Questionnaire-Short Form (SAQ-SF) to measure stress and safety attitudes evaluation, respectively. Spearman’s correlation analysis and a generalised linear model were used to analyse the relationship between immigration-specific stress and safety attitudes as perceived by OQNs.

Results
The findings showed that various safety attitude dimensions were significantly impacted by stressors such as ‘Not at home’, ‘Occupation’ and ‘Discrimination’. Notably, ‘Occupation’ disadvantages perceived by OQNs significantly affected all the safety attitude dimensions, such as ‘Teamwork climate’ (B=–5.69, [–7.78, –3.60], p

Introduction
Yeast beta-glucan (YBG) are recognised for enhancing the immune system by activating macrophages, a key defence mechanism. Given the global prevalence and impact of upper respiratory tract infections (URTIs) on productivity and healthcare costs, YBG has shown promise as a potential therapeutic and preventive strategy for recurrent respiratory tract infections. However, little is known regarding the efficacy of YBG at lower dosages in relation to URTI, fatigue, immune response and uncertainties of how they affect the gut microbiota composition.

Methods and analysis
This 12-week randomised, double-blinded, placebo control, parallel-group clinical trial aims to evaluate the efficacy of YBG 1,3/1,6 on respiratory tract infection, fatigue, immune markers and gut health among adults with moderate stress. The study involves 198 adults aged 18–59 years with moderate stress levels as assessed using Perceived Stress Scale 10 (score 14–26) and Patient Health Questionnaire 9 (score ≥9); and had symptoms of common colds for the past 6 months as assessed using Jackson Cold Scale. These participants will be randomised into three groups, receiving YBG 1,3/1,6 at either 120 mg, 204 mg or a placebo. The outcomes measures include respiratory infection symptoms, fatigue, mood state and quality of life assessed using Wisconsin Upper Respiratory Symptoms Scale, Multidimensional Fatigue Inventory, Profile of Mood State and Short Form 36 Health Survey Questionnaire, respectively. In addition, full blood analysis and assessment of immune, inflammatory and oxidative stress biomarkers will be taken. Secondary outcome includes gut microbiota analysis using stool samples via 16S rRNA sequencing.

Ethics and dissemination
The research protocol of the study was reviewed and approved by the Research Ethics Committee of Universiti Kebangsaan Malaysia (UKM/PPI/111/8/JEP-2023–211). The findings will be disseminated to participants, healthcare professionals and researchers via conference presentations and peer-reviewed publications.

Trial registration number
ISRCTN48336189