Search Results for: Come stress e attacchi di cuore sono collegati

Stima l’età del cuore e il rischio di infarto e ictus usando ECG

Ampio studio sul New England, protegge il cuore anche in pillola

Objective
Measuring the effectiveness of mass casualty incident (MCI) scenario training is challenging due to simultaneously assessing individual skills, team dynamics, decision-making under pressure and adaptability. Existing instruments often focus too narrowly on individual skills, overlooking the comprehensive range of skills needed for effective prehospital disaster response. This study aims to develop and validate a comprehensive self-assessment tool for prehospital disaster response skills during initial MCI scenario training.

Design
The instrument was developed and validated using a comprehensive methodology. This included literature reviews to identify the construct, ensuring content validity through expert evaluation and conducting field trials in MCI scenario training to evaluate the instrument under simulated conditions that approximated real-life incidents. The instrument’s psychometric properties were assessed using exploratory factor analysis (EFA) and Horn’s parallel analysis, as well as Cronbach’s α and item–total correlation analysis.

Setting
Two field trials conducted with participants in Sweden during 2023 and 2024.

Participants
75 students from a bachelor’s programme at a Swedish university were recruited to participate in the field trials. The programme featured one semester of comprehensive theoretical and practical training in disaster medicine, including MCI response and management. 88 instruments were collected during the field trials.

Results
Overall Cronbach’s α score was 0.86, indicating high internal consistency for the instrument. EFA and Horn’s parallel analysis revealed a five-factor model accounting for 52.3% of the total variance: incident control and management; systematic examination procedures; risk assessment and management; stress response and impact; and triage procedures. Cronbach’s α for all factors indicated good internal consistency (range: 0.74–0.85).

Conclusions
The instrument addresses a critical gap by offering a comprehensive self-evaluation tool for disaster response skills. The robust psychometric properties indicate its potential for practical implication. Future studies should explore its application in diverse training settings and populations to enhance its utility and generalisability.
A comprehensive development and validation methodology ensured the high content validity of the instrument.

Objective
Measuring the effectiveness of mass casualty incident (MCI) scenario training is challenging due to simultaneously assessing individual skills, team dynamics, decision-making under pressure and adaptability. Existing instruments often focus too narrowly on individual skills, overlooking the comprehensive range of skills needed for effective prehospital disaster response. This study aims to develop and validate a comprehensive self-assessment tool for prehospital disaster response skills during initial MCI scenario training.

Design
The instrument was developed and validated using a comprehensive methodology. This included literature reviews to identify the construct, ensuring content validity through expert evaluation and conducting field trials in MCI scenario training to evaluate the instrument under simulated conditions that approximated real-life incidents. The instrument’s psychometric properties were assessed using exploratory factor analysis (EFA) and Horn’s parallel analysis, as well as Cronbach’s α and item–total correlation analysis.

Setting
Two field trials conducted with participants in Sweden during 2023 and 2024.

Participants
75 students from a bachelor’s programme at a Swedish university were recruited to participate in the field trials. The programme featured one semester of comprehensive theoretical and practical training in disaster medicine, including MCI response and management. 88 instruments were collected during the field trials.

Results
Overall Cronbach’s α score was 0.86, indicating high internal consistency for the instrument. EFA and Horn’s parallel analysis revealed a five-factor model accounting for 52.3% of the total variance: incident control and management; systematic examination procedures; risk assessment and management; stress response and impact; and triage procedures. Cronbach’s α for all factors indicated good internal consistency (range: 0.74–0.85).

Conclusions
The instrument addresses a critical gap by offering a comprehensive self-evaluation tool for disaster response skills. The robust psychometric properties indicate its potential for practical implication. Future studies should explore its application in diverse training settings and populations to enhance its utility and generalisability.
A comprehensive development and validation methodology ensured the high content validity of the instrument.

Introduction
Recent guidelines suggest behavioural weight loss (BWL) and pelvic floor muscle training (PFMT) as first-line treatment approaches for women with both obesity and stress urinary incontinence (SUI). However, the optimal therapeutic and management strategies for these populations remain uncertain.

Methods and analysis
This assessor-blinded parallel-group randomised controlled trial aims to compare the efficacy of BWL alone, BWL plus conventional PFMT and BWL plus PFMT with a biofeedback device for women who are overweight or obese experiencing SUI or SUI-predominant mixed urinary incontinence. A total of 120 eligible women will be randomly assigned at a 1:1:1 ratio. All the three groups will be subjected to a 3-month self-supervision intervention after randomisation and will be assessed at baseline, after the 3-month intervention, 6 months after the intervention and 12 months after the intervention. The primary outcome measure is the self-reported severity of urinary incontinence assessed by the International Consultation on Incontinence Questionnaire-Urinary Incontinence short form. The secondary outcomes include weight loss effectiveness, pelvic muscle strength, pelvic floor ultrasound, three-dimensional body posture, adherence to the intervention and questionnaires for symptoms of pelvic organ prolapse, quality of life and sexual function.

Ethics and dissemination
This study has been approved by the Peking Union Medical College Hospital ethics committee (K5504). All results from the study will be submitted to international journals and international conferences.

Trial registration number
This trial has been registered with the Chinese Clinical Trial Registry (ChiCTR2400084015).

Introduction
Recent guidelines suggest behavioural weight loss (BWL) and pelvic floor muscle training (PFMT) as first-line treatment approaches for women with both obesity and stress urinary incontinence (SUI). However, the optimal therapeutic and management strategies for these populations remain uncertain.

Methods and analysis
This assessor-blinded parallel-group randomised controlled trial aims to compare the efficacy of BWL alone, BWL plus conventional PFMT and BWL plus PFMT with a biofeedback device for women who are overweight or obese experiencing SUI or SUI-predominant mixed urinary incontinence. A total of 120 eligible women will be randomly assigned at a 1:1:1 ratio. All the three groups will be subjected to a 3-month self-supervision intervention after randomisation and will be assessed at baseline, after the 3-month intervention, 6 months after the intervention and 12 months after the intervention. The primary outcome measure is the self-reported severity of urinary incontinence assessed by the International Consultation on Incontinence Questionnaire-Urinary Incontinence short form. The secondary outcomes include weight loss effectiveness, pelvic muscle strength, pelvic floor ultrasound, three-dimensional body posture, adherence to the intervention and questionnaires for symptoms of pelvic organ prolapse, quality of life and sexual function.

Ethics and dissemination
This study has been approved by the Peking Union Medical College Hospital ethics committee (K5504). All results from the study will be submitted to international journals and international conferences.

Trial registration number
This trial has been registered with the Chinese Clinical Trial Registry (ChiCTR2400084015).

Stroke, Ahead of Print. Stroke remains a predominant cause of death and long-term disability among adults worldwide. Emerging evidence suggests that proteinopathies, characterized by the aggregation and accumulation of misfolded proteins, may play a significant role in the aftermath of stroke and the progression of neurodegenerative disorders. In this review, we explore preclinical and clinical research on key proteinopathies associated with stroke, including tau, Aβ (amyloid-β), TDP-43 (TAR DNA-binding protein 43), α-synuclein, and UCH-L1 (ubiquitin C-terminal hydrolase-L1). We focus on their potential as biomarkers for recovery management and as novel treatment targets that may enhance neuronal repair and mitigate secondary neurodegeneration. The involvement of these proteinopathies in various aspects of stroke, including neuroinflammation, oxidative stress, neuronal damage, and vascular dysfunction, underscores their potential. However, further investigations are essential to validate the clinical utility of these biomarkers, elucidate the mechanisms connecting proteinopathies to poststroke neurodegeneration, and develop targeted interventions. Identifying specific protein signatures associated with stroke outcomes could facilitate the advancement of precision medicine tailored to individual patient needs, significantly enhancing the quality of life for stroke survivors.

Circulation, Ahead of Print. BACKGROUND:Morbidity and mortality of heart failure with preserved ejection fraction (HFpEF) is increased in metabolic disorders. However, options for preventing and treating these prevalent outcomes are limited. Intramyocardial lipotoxicity contributes to cardiac dysfunction. Here, we investigate the mechanisms underlying endoplasmic reticulum degradation enhancing EDEM2 (endoplasmic reticulum degradation–enhancing alpha-mannosidase–like protein 2) regulation of cardiac lipid homeostasis and assess strategies that inhibit the incidence and progression of HFpEF.METHODS:Metabolic stress was induced in C57BL/6 male mice using a high-fat diet and Nω-nitro-l-arginine methyl ester. The recombinant adeno-associated virus 9 delivery system was used for loss- and gain-of-function studies. Palmitic acid and oleic acid stimulation of rat cardiomyocytes and human induced pluripotent stem cell–derived cardiomyocytes imitated a condition of high lipids in vitro. Molecular mechanisms were investigated via RNA sequencing, mass spectrometry proteomics, lipidomic analyses, transmission electron microscopy, histology, and luciferase reporter assays.RESULTS:In the human heart, we first detected lipid overload accompanied by a reduction of XBP1 (X-box binding protein 1) under metabolic stress. Thereafter, a decrease in EDEM2 was confirmed in human and mouse HFpEF hearts. Given that the spliced form of XBP1 (XBP1s) is a transcription factor, EDEM2 was identified as its new target in cardiomyocytes. EDEM2 knockdown mice manifested lipid droplet accumulation and higher levels of triglycerides and diglycerides in the myocardium, aggravating oxidative stress, hypertrophy, and the onset and progression of HFpEF under metabolic stress. XBP1s ablation mice displayed a similar myocardial lipid disturbance and cardiac phenotypes, which were reversed by EDEM2 overexpression. Mechanistically, the findings obtained from rat cardiomyocytes and human induced pluripotent stem cell–derived cardiomyocytes demonstrated that, in the presence of EDEM2, SEC23A mediated intracellular translocation of ATGL (adipose triglyceride lipase) under fatty acid stimulation, inhibiting ATGL degradation and excessive intracellular lipid droplets. Furthermore, the functional studies supported that EDEM2 prevention of lipid overload occurred in an ATGL-dependent manner. Therapeutically, cardiac XBP1s or EDEM2 restoration mitigated lipid deposition and preserved lipid profiles in the myocardium, thus preventing the development of HFpEF.CONCLUSIONS:We demonstrate a cardioprotective mechanism regulating myocardial lipid homeostasis. The findings provide a promising therapeutic target to prevent and treat HfpEF, a condition with limited treatment options.

Objectives
This study aimed at better understanding the challenges imposed by Sudan 2023 military conflict on medical education through surveying students about their view of the current faced challenges and their future and academic plans. It as well investigated the effect of the war on their mental health status in terms of anxiety, depression and post-traumatic stress disorder (PTSD) and their associated factors.

Design
A multicentric observational cross-sectional design was adopted.

Setting and participants
Medical students of all Khartoum state governmental medical universities were invited to participate in an online survey.

Primary and secondary outcomes measures
Primary: prevalence of anxiety, depression and post-traumatic stress disorders (PTSDs) among medical students. Secondary: the associated factors that could impact these disorders, current status of medical education and students’ future career intentions.

Results
Of the 612 included students, 64.38% were females and 96.90% were single, with a median age of 21 years. Approximately 68% reported their schools had plans to continue education. The prevalence rates of 58.3%, 51.5% and 27.1% were found for depression, anxiety and PTSD, respectively. Increase in increased age (β=0.18, 95% CI: 0.04 to 0.32) and female gender (β=–2.3, 95% CI: –2.9 to –1.6) were linked to higher anxiety risk. Weekly conflict news checks (β=–0.89, 95% CI: –1.7 to –0.09) and religious habits (β=–1.3, 95% CI: –1.9 to –0.63) reduced anxiety. Age was associated with higher depression risk (β=0.14, 95% CI: 0.02 to 0.27), while internet stability (β=–1.3, 95% CI: –2.2 to –0.37), religious habits (β=–1.2, 95% CI: –1.8 to –0.53) and online education or reading (β=–1.0, 95% CI: –1.7 to –0.36) reduced it. Male gender lowered PTSD risk (β=–4.5, 95% CI: –7.2 to –1.7). Above-average pre-conflict financial status (β=3.3, 95% CI: 0.04 to 6.6), financial damage (β=3.6, 95% CI: 0.93 to 6.2), physical abuse (β=8.5, 95% CI: 3.1 to 14) and family member death (β=6.2, 95% CI: 0.38 to 12) were associated with higher PTSD risk.

Conclusion
Medical education is currently disrupted in Sudan due to war, with most of the universities having no clear plan to ease the situation. Medical students suffer from depression and anxiety, among other psychological stresses, with many of them considering transferring or dropping out from medical schools; the majority intend to leave Sudan after graduation.

Background
The transition to higher education represents a demanding adaptation process with several socioeconomic factors involved. Mental health problems among university students have been worsening since the beginning of the COVID-19 pandemic. Our objective is to create scientific evidence about the models of mental health-promoting interventions among higher education students applied in academic environments, as well as their effectiveness. We aim to synthesise the scientific evidence on the models of an intervention promoting mental health among university students applied in academic environments as well as their results.

Methods and analysis
A systematic review of the literature will be conducted. The research will be carried out using the EBSCO databases (CINAHL Complete, MEDLINE Complete, Psychology and Behavioral Sciences Collection), PubMed and Scopus. The research strategy includes the following MeSH or similar terms: Universities [Mesh], Students [Mesh], Education [Mesh], Undergraduate, “Higher Education”, Universit*, College, Student*; “Psychosocial intervention” [Mesh], “Non-pharmacological”, “Intervention model*”, “Mental health promotion program*”, Intervention*; “Randomized Controlled Trial”, RCT; “Mental health” [Mesh], Depression [Mesh], Anxiety [Mesh], “Stress, psychological” [Mesh], “Quality of life” [Mesh], and “Psychological well-being” [Mesh]. All experimental studies with mental health-promoting interventions for university students that were published between January 2017 and November 2024 in English will be eligible. Two independent reviewers will apply the inclusion and exclusion criteria, analyse the quality of the data and extract it for synthesis. Disagreements will be resolved by a third reviewer. All randomised controlled trial studies with interventions in university students and their efficacy (with means and SD) will be included in the systematic review of the literature. The standardised mean difference will be used as the effect size to standardise individual results. Sensitivity analysis, subgroup analysis and meta-regression will be conducted to explore the causes of heterogeneity and the robustness of the results.

Ethics and dissemination
Ethical approval is not required for this study as it is based on the review of previously published data. The results will be disseminated through publication in peer-reviewed journals and presentations at academic conferences, as well as in events organised by student associations.

PROSPERO registration number
CRD42022359608.

Background
Medication preferences and associated challenges remain unexplored in Saudi patients with rheumatoid arthritis (RA).

Objectives
To explore the perceptions, beliefs and experiences of patients with RA regarding the disease and its treatment in Saudi Arabia.

Design
Three focus groups were created in Riyadh, Saudi Arabia through purposeful sampling. Discussions were recorded and transcribed. Subsequently, thematic analysis was performed.

Participants
The groups included women, aged 35–50 years (n=6), men (n=4) and women above 50 years (n=5).

Results
The identified themes included stress and losing a loved one as the primary factors inducing RA, delay in diagnosis and beliefs about certain foods that triggered RA flare-ups. The most common adverse effects were weight gain, nausea and fungal infections. The participants were open to starting new medications. Stiffness was the main unmet need among the participants. Adverse effects, pain management and fertility problems were key factors affecting treatment transitions. Younger participants expressed concerns about prices and availability of medications. Physical exercise and therapy were identified as important complementary therapies for improving the quality of life. The lockdown during the pandemic may have positively impacted patients’ symptoms. Younger women highlighted challenges related to the transition of treatment before and after contraception, losing their jobs, meeting their children’s and family’s needs and pursuing their dreams. Men expressed concerns about fertility and a fear of needles. Psychological and social challenges were the main theme among older participants.

Conclusion
This study identified patient preferences and needs that could guide future educational initiatives for physicians and communities.

Objectives
Music listening for pain relief is well studied in diverse healthcare settings, but its implementation remains challenging. While healthcare providers generally have a positive attitude, there is a lack of knowledge about healthcare recipients’ perceptions and attitudes. Therefore, the aim of this study is to explore healthcare recipients’ perceptions of listening to music for pain management, focusing on their general attitudes, implementation strategies and subjective experiences of how music helps (or does not help).

Design
A multi-method study comprising a quantitative survey and qualitative interviews. It is a follow-up conducted 6 months after a randomised experimental study, which assessed the influence of different music genres on pain tolerance. At the end of the original experiment, participants received advice on listening to music in painful situations.

Setting
Rotterdam, The Netherlands.

Participants
The survey involved 169 participants (age mean 30.6, SD 9.8; 61.9% female) who participated in the initial trial. Following this, 20 in-depth interviews were conducted.

Outcome measures
Perceptions of music for pain management were investigated, revealing general trends in the quantitative survey data. Data-led thematic analysis of the qualitative interviews focused on individual perceptions.

Results
Participants showed a high willingness to use music for pain relief, particularly for so-called emotional pain (eg, anxiety, stress and heartbreak). Individual attitudes varied regarding different situations, types of music and types of pain. Barriers such as not considering the option and social sensitivity within healthcare contexts were discussed. A proactive approach by healthcare professionals and autonomy of healthcare recipients were suggested to overcome these barriers. Interestingly, the ‘wrong’ type of music or the ‘wrong’ situation were mentioned as non-beneficial or even harmful.

Conclusions
Awareness of individual needs and potential negative effects is crucial for the use of music for pain relief. A proactive and personalised approach is needed to effectively implement music in healthcare.

Introduction
Cancer affects not only patients but also their families, increasing the risk of stress-related illnesses among family members. Despite the development of various support interventions, family members continue to report unmet support needs, largely due to the limited implementation of these interventions into routine care or their lack of relevance to family needs. Co-design approaches, which involve stakeholders in the development process, are recommended to enhance both implementation and relevance. This scoping review aims to map the available evidence on co-design approaches in family interventions within oncology, examining key themes, methodologies and outcomes of interventions.

Methods and analysis
This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews checklist and the Joanna Briggs Institute framework. The review will follow five stages: identifying the research questions, retrieving relevant studies, selecting studies, charting data and collating, summarising and reporting the results. The research will focus on co-design approaches in family interventions in oncology, exploring activities involved, barriers encountered and their impact on outcomes. A comprehensive search was conducted in EMBASE, MEDLINE, Scopus, CINAHL and PsycINFO databases in August 2024, with no date restrictions, and articles will be selected based on predefined inclusion criteria. Study selection will be performed independently by two reviewers, with disagreements resolved by a third. All reviewers will carry out the data extraction. Data will be analysed using descriptive content analysis and presented through narrative summaries, tables and diagrams to highlight study characteristics and research aims. The findings will inform future research and practice, offering insights into co-design strategies in family interventions in oncology.

Ethics and dissemination
Ethical approval is not needed as this scoping review does not involve collecting data from human participants. The results produced from this review will be submitted to a scientific peer-reviewed journal for publication and will be presented at scientific meetings.

Trial registration details
https://doi.org/10.17605/OSF.IO/2RWB9.

Introduction
Despite having more family physicians (FPs) and nurse practitioners (NPs) per capita than ever before in Canada, there is a clear gap between population primary care needs and system capacity. Primary care needs may be shaped by population ageing, increasing clinical and social complexity and growing service intensity. System capacity may be shaped by falling practice volumes, increasing administrative workload, changing clinician demographics and new health system roles (eg, hospitalist and focused practices). These changing factors could contribute to reduced patient access to primary care, worsened health inequities and stress and overwork among primary care clinicians. Workforce planning tools used in most countries do not adequately consider these factors. Our study will identify and explore factors shaping population service use and system capacity over time and develop planning tools to estimate future primary care needs and capacity.

Methods and analysis
We will interview FPs and NPs about factors shaping workload, including patient characteristics, practice expectations and system context. This will inform analysis of administrative data to describe factors shaping primary care need (patient demographics, clinical and social complexity, service intensity) and capacity (provider supply, demographics, service volume, roles) over a 20-year period from 2004/2005 to 2023/2024. Qualitative and quantitative findings will inform analytical models that project and compare need and capacity under stakeholder-informed scenarios. The study includes the Canadian provinces of British Columbia, Manitoba, New Brunswick and Nova Scotia, provinces with varied policy and population contexts and complementary administrative health data.

Ethics and dissemination
Research ethics board (REB) approval for the qualitative study has been provided by Research Ethics BC, with subsequent approvals from Horizon Health Network, Nova Scotia Health, University of Manitoba and University of Ottawa. REB approval for analysis of linked administrative data was obtained from the Nova Scotia Health REB, Research Ethics BC, University of Manitoba and University of New Brunswick. Our findings will support primary care capacity planning to equitably meet the needs of a growing and ageing population.