Search Results for: Lo stress può essere causa di infarto ed ictus

Nel 2024 6mila diagnosi in Italia, radioterapia strategia chiave

Nel 2024 6mila diagnosi in Italia, radioterapia strategia chiave

‘Polemica esagerata, lo può già fare quando commissaria regioni’

‘Polemica esagerata, lo può già fare quando commissaria regioni’

Introduction
Globally, studies have consistently demonstrated the harmful mental and physical health impacts of immigration detention, with high levels of distress documented among detained asylum seekers and refugees (ASR). However, the consequences of immigration detention over time on the psychological and physical health of ASR are unclear and poorly quantified.

Methods and analysis
This prospective, mixed-methods cohort study will recurrently assess and describe the health profiles of adult ASR with an experience of Australian Government-sponsored immigration detention greater than 28 days. ASR ≥18 years old released from immigration detention will be assessed at 0, 3, 6 and 12 months and annually thereafter for up to 10 years, contingent on resourcing. Five self-report scales and a structured psychiatric interview will assess the primary outcome of depression, anxiety, post-traumatic stress, pain intensity and severity, somatic symptoms, functional impairment, physical health conditions associated with detention and engagement in available treatment of this cohort. Additionally, pre-existing health records will be accessed to identify current and previous health status and assess changes in these health indices. Quantitative findings will be triangulated with a qualitative phenomenological thematic analysis of interviews to determine additional psychosocial factors associated with the outcomes.

Ethics and dissemination
The study protocol was approved by the Monash Health Human Research Ethics Committee (HREC/73614/MonH-2021-251322). Results will be reported at conferences, in peer-reviewed publications and to all relevant stakeholder groups.

Objectives
To investigate the prevalence and risk factors associated with burnout among residents and to explain their experiences with burnout.

Design
Mixed-methods convergent parallel study with an explanatory follow-up.

Settings
One tertiary hospital in Mirebalais and one community hospital in Saint-Marc.

Participants
Of the 127 registered residents in both settings, 26 were excluded because they were on leave. Therefore, 101 were asked to participate. We received responses from 98 residents (response rate 97.02%).

Interventions
Data collection took part in two stages: quantitative data collection was first made over a 2-week period in July 2023 using a questionnaire which included the Maslach Burnout Inventory. We simultaneously conducted a qualitative analysis based on three questions around which stress factors were related to work, personal fulfilment and social issues in the questionnaire. Second, following preliminary data results, one focus group was held with the seven chief residents to bring an in-depth understanding of the quantitative data analysis from the study questionnaire.

Primary and secondary outcomes
Sociodemographic and clinical factors linked to burnout for quantitative data. The themes explored for qualitative data were stress factors related to work, personal fulfilment and social issues. One focus group held with the chief residents explained, based on preliminary results, the main causes of burnout among medical residents, influencing factors, coping strategies and perspectives.

Results
Five major findings emerged from the quantitative data, including the following: (a) burnout prevalence was 79.59%; (b) 43% of the residents estimated working more than 80 hours/week; (c) the group with the highest burnout rates were the second-year postgraduate residents (p=0.01); (d) paediatrics and family medicine residents had the highest mean score of emotional exhaustion (p=0.01); (e) general surgery/orthopaedics and paediatrics had the highest mean score of depersonalisation (p

Introduction
The ARFID InitiativE Sweden (ARIES) investigates the genetic and environmental factors contributing to avoidant/restrictive food intake disorder (ARFID) in children and adolescents aged 6–14 years. ARIES will establish a national biobank and research registry. It aims to provide data for immediate research and track ARFID outcomes and clarify genetic links between ARFID and other conditions and analyse the gut microbiome to guide nutrition interventions.

Methods and analysis
The study will involve 1500 Swedish children and adolescents with ARFID and a control group of 500 Swedish children and adolescents without ARFID. Parents/guardians and their children will complete online questionnaires assessing ARFID and other eating disorder (ED) pathology, co-occurring conditions, quality of life and parental stress and ED pathology. All participants will provide a saliva sample for comprehensive genetic analyses. Additionally, a subset of participants will provide a stool sample to investigate the gut microbiome in ARFID.

Ethics and dissemination
ARIES was approved by the Swedish Ethical Review Authority (Dnr 2023-04638). All participants will give assent and their parents will complete informed consent. Data will be made available by the authors on reasonable request. Findings will be published in scientific journals and shared with the public and stakeholders in accessible ways, for example, via social media.

L’esperta: resta un test fondamentale ma l’abuso è causa del 5% dei casi

To the Editor I appreciated the recent comprehensive Review of the diagnostic approach, risk stratification, and treatment options for PV. The authors highlighted the use of exogenous androgens and erythropoietin as causes of secondary erythrocytosis. However, there was no mention of the use of SGLT2 inhibitors (canagliflozin, empagliflozin, dapagliflozin, ertugliflozin, and sotagliflozin) as a cause of drug-induced secondary polycythemia. Current guidelines strongly recommend an SGLT2 inhibitor in patients with type 2 diabetes and cardiovascular disease or for those at high risk of cardiovascular disease. Due to their multiple health benefits, SGLT2 inhibitors are increasingly used not only for patients with diabetes but also for those with heart failure and chronic kidney disease. However, SGLT2 inhibitors are associated with erythrocytosis and increased hematocrit. The potential mechanisms behind erythrocytosis involve increased erythropoietin production through activation of hypoxia-inducible factor 2α and regulation of iron metabolism via hepcidin. A 2021 meta-analysis of 40 randomized clinical trials with 21 050 participants demonstrated that SGLT2 inhibitors significantly increased hematocrit levels, especially at higher doses. In a Mayo Clinic analysis of 100 consecutive patients without JAK2 gene variants characteristic of PV who were treated with an SGLT2 inhibitor, the median increase of baseline hemoglobin and hematocrit was 2.5 g/dL (range, 0.4-7.3 g/dL) and 7.5% (range, 1.8%-21.1%), respectively. Understanding that these increases are a known pharmacological response to SGLT2 inhibitors, rather than an indication of a pathological condition, is important to avoid unnecessary and expensive diagnostic tests. By informing clinicians and patients about this effect, we can prevent unnecessary stress for patients and their families and avoid unnecessary testing, allowing for more efficient use of health care resources and improving patient care and outcomes.

DiagnostiCare, prestazioni con donazioni a favore di chi non può

La composizione del microbiota può influenzare la fertilità di uomini e donne

Introduction
Caregivers of patients undergoing haematopoietic stem cell transplantation (HSCT) experience tremendous psychological distress before, during and after HSCT. However, few interventions are tailored to the protracted needs of these caregivers while considering scalability and accessibility. We previously developed an evidence-based intervention for caregivers of patients undergoing HSCT that improved quality of life (QOL), caregiving burden and mood. We have since adapted this clinician-delivered intervention into a self-administered, digital health application (BMT-CARE app) and are currently evaluating the effect of this intervention on QOL in caregivers of patients receiving HSCT.

Methods and analysis
The study design is a non-blinded randomised controlled trial of a digital health intervention for caregivers of patients undergoing HSCT at the Massachusetts General Hospital Cancer Center. We are enrolling and randomising 125 caregivers to receive the BMT-CARE app or usual care in a 1:1 assignment, stratifying by transplant type (autologous vs allogeneic). Caregivers assigned to the BMT-CARE app complete five self-guided modules designed to improve coping and stress management prior to and up to 60 days post-HSCT. The modules include interactive, gamified features and video vignettes to optimise engagement. Participants complete questionnaires at baseline and days 10, 60 and 100 post-HSCT. The primary outcome is comparison of QOL at day 60 post-HSCT. Secondary outcomes include caregiver burden, anxiety and depression symptoms, as well as post-traumatic stress symptoms. We are also exploring the usability of the BMT-CARE app to inform refinements prior to future testing.

Ethics and dissemination
The study is funded by the Leukemia and Lymphoma Society and approved by the Dana-Farber/Harvard Cancer Center Institutional Review Board (Protocol #22–634 v.1.5). The results of this study will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials. Results will be disseminated at scientific meetings and in peer-reviewed journals.

Trial registration number
NCT05709912; Pre-results.

Transcription-replication conflicts (TRCs) are a key source of replication stress in cancer, with pancreatic ductal adenocarcinoma (PDAC) showing uniquely high levels. This study investigates the mechanism, oncogene dependency, subtype specificity, and preclinical activity of the TRC-targeting molecule AOH1996 in PDAC models. Initial clinical evidence of AOH1996 activity in PDAC patients is also provided.