Rarer dementias are associated with atypical symptoms and younger onset,which result in a higher burden of care.We provide a review of the global literature on longitudinal decline in activities of daily living(ADLs)i...Rarer dementias are associated with atypical symptoms and younger onset,which result in a higher burden of care.We provide a review of the global literature on longitudinal decline in activities of daily living(ADLs)in dementias that account for less than 10%of dementia diagnoses.Published studies were identified through searches conducted in Medical Literature Analysis and Retrieval System Online(MEDLINE),Excerpta Medica Database(Embase),Excerpta Medica Care(Emcare),PsycINFO,and Cumulative Index in Nursing and Allied Health Literature(CINAHL).The search criteria included terms related to‘rarer dementias’,‘activities of daily living’and‘longitudinal or cross-sectional studies’following a predefined protocol registered.Studies were screened,and those that met the criteria were citation searched.Quality assessments were performed,and relevant data were extracted.20 articles were selected,of which 19 focused on dementias within the frontotemporal dementia/primary progressive aphasia spectrum,while one addressed posterior cortical atrophy.Four studies were cross-sectional and 16 studies were longitudinal,with a median duration of 2.2 years.The Disability Assessment for Dementia was used to measure decline in 8 of the 20 studies.The varied sequences of ADL decline reported in the literature reflect variation in diagnostic specificity between studies and within-syndrome heterogeneity.Most studies used Alzheimer’s disease staging scales to measure decline,which cannot capture variant-specific symptoms.To enhance care provision in dementia,ADL scales could be deployed postdiagnosis to aid treatment and planning.This necessitates staging scales that are variant-specific and span the disease course from diagnosis to end of life.展开更多
This study explored psychological, biomedical, and social factors in childhood and adulthood associated with the occurrence of self-reported hearing problems in adulthood. In total, 4828 participants with complete dat...This study explored psychological, biomedical, and social factors in childhood and adulthood associated with the occurrence of self-reported hearing problems in adulthood. In total, 4828 participants with complete data on parental social class at birth, childhood hearing impairment measured at age 7 years and cognitive ability accessed at age 11 years, educational qualifications obtained at age 33 years, the Big-Five-Factor personality traits measured at age 50 years, current occupational levels and self-reported hearing problems at age 54 years were included in the study. Logistic regression analysis showed that among all the factors examined childhood hearing impairment and trait neuroticism as well as gender were the significant and independent predictors of hearing problems in adulthood.展开更多
Independent living and housing stability are core principles of the psychiatric recovery process.Only when basic needs such as safe,affordable and permanent housing are met can individuals with serious mental illnesse...Independent living and housing stability are core principles of the psychiatric recovery process.Only when basic needs such as safe,affordable and permanent housing are met can individuals with serious mental illnesses(SMI)reintegrate into their community,consistently engage with mental health services and begin(or restart)recovery.'Yet,post-discharged individuals with SMI and their psychiatric care providers often grapple with where to go after discharge from psychiatric hospitalisation.This question is particularly central in safety-net hospitals serving people affected by severe health disparities with myriad deficits in social determinants of health(SDoH).In this commentary,we aim to shed light on post-discharge challenges related to housing often encountered by safety-net psychiatric hospitals and propose ways to address them.展开更多
Context: This study set out to investigate the mental health literacy (MHL) about eight anxiety disorders (ADs), using vignette methodology. Methods: In all 317 British Adult participants completed a questionnaire wit...Context: This study set out to investigate the mental health literacy (MHL) about eight anxiety disorders (ADs), using vignette methodology. Methods: In all 317 British Adult participants completed a questionnaire with vignettes describing eight anxiety disorders including OCD, PTSD, Agoraphobia, Specific Phobias, Social Phobia, Separation Anxiety Disorder, GAD and Panic Disorder. Recognition, beliefs about treatments and perceived life adjustment (happiness, success at work) of specific people with these disorders were assessed. Results: Literacy levels varied across anxiety disorders, with high recognition of OCD (64.67%), but very poor for panic disorder (1.26%), GAD (2.84%) and separation anxiety disorder (5.99%). There were few significant effects of vignette gender on literacy levels. MHL for most anxiety disorders was relatively low;particularly panic disorder, GAD and separation anxiety disorder. Social Phobics were judged as least happy and adjusted and agoraphobics least successful at work and would benefit most from psychological help. Conclusions: Overall recognition of the anxiety disorders was poor. Beliefs about adjustment and treatment varied widely as a function of each disorder. Implications of the research for education of the public and limitations of this research are considered.展开更多
BACKGROUND There are rising numbers of patients who have heart failure with preserved ejection fraction(HFpEF).Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to...BACKGROUND There are rising numbers of patients who have heart failure with preserved ejection fraction(HFpEF).Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to a sparsity of studies,the management of HFpEF is challenging.AIM To determine the hospital readmission rate within 30 d of acute or acute on chronic heart failure with preserved ejection fraction and its effect on mortality and burden on health care in the United States.METHODS We performed a retrospective study using the Agency for Health-care Research and Quality Health-care Cost and Utilization Project,Nationwide Readmissions Database for the year 2017.We collected data on hospital readmissions of 60514 adults hospitalized for acute or acute on chronic HFpEF.The primary outcome was the rate of all-cause readmission within 30 d of discharge.Secondary outcomes were cause of readmission,mortality rate in readmitted and index patients,length of stay,total hospitalization costs and charges.Independent risk factors for readmission were identified using Cox regression analysis.RESULTS The thirty day readmission rate was 21%.Approximately 9.17%of readmissions were in the setting of acute on chronic diastolic heart failure.Hypertensive chronic kidney disease with heart failure(1245;9.7%)was the most common readmission diagnosis.Readmitted patients had higher in-hospital mortality(7.9%vs 2.9%,P=0.000).Our study showed that Medicaid insurance,higher Charlson co-morbidity score,patient admitted to a teaching hospital and longer hospital stay were significant variables associated with higher readmission rates.Lower readmission rate was found in residents of small metropolitan or micropolitan areas,older age,female gender,and private insurance or no insurance were associated with lower risk of readmission.CONCLUSION We found that patients hospitalized for acute or acute on chronic HFpEF,the thirty day readmission rate was 21%.Readmission cases had a higher mortality rate and increased healthcare resource utilization.The most common cause of readmission was cardio-renal syndrome.展开更多
BACKGROUND Acute carpal tunnel syndrome(ACTS)is commonly caused by repetitive strain,trauma,or inflammatory conditions.However,ACTS due to tophaceous gout is a clinical event that remains poorly understood and underre...BACKGROUND Acute carpal tunnel syndrome(ACTS)is commonly caused by repetitive strain,trauma,or inflammatory conditions.However,ACTS due to tophaceous gout is a clinical event that remains poorly understood and underreported.This rare manifestation necessitates prompt diagnosis and intervention to prevent irreversible complications.CASE SUMMARY A 51-year-old man who had poorly controlled hyperuricemia presented with ACTS secondary to tophaceous gout.Because of rapid symptom progression symptoms and severe median nerve compression within 3 mo,the patient underwent emergency decompression surgery for both wrists at different time points.Postoperatively,he exhibited complete recovery of sensory and motor functions,with no recurrence at long-term follow-up.Favorable outcomes were achieved through immediate decompression surgery,anti-inflammatory medications,postoperative active and passive range-of-motion exercises,and intermittent wrist splinting.Prompt diagnosis and surgical intervention,when necessary,are crucial for preventing long-term complications and obtaining favorable outcomes in patients with ACTS.An optimal gout management strategy involving pharmacologic therapy and lifestyle modifications may help minimize ACTS recurrence and improve clinical outcomes.CONCLUSION Prompt surgical intervention and optimal gout management are crucial for preventing irreversible nerve damage and ACTS recurrence.展开更多
BACKGROUND Behcet's disease(BD)is an inflammatory disorder known for various symptoms,including oral and genital ulcers and ocular inflammation.Panuveitis,a severe eye condition,is rare as the first sign of BD.CAS...BACKGROUND Behcet's disease(BD)is an inflammatory disorder known for various symptoms,including oral and genital ulcers and ocular inflammation.Panuveitis,a severe eye condition,is rare as the first sign of BD.CASE SUMMARY We present an unusual case of a 30-year-old man who developed panuveitis after receiving the mRNA-based coronavirus disease 2019(COVID-19)vaccine(Moderna).Laboratory tests ruled out infections,but he had a positive HLA-B51 result and a history of genital ulcer and oral ulcers,leading to a BD diagnosis.Treatment with corticosteroids improved his condition.Interestingly,he had another episode of panuveitis after the second mRNA vaccine dose,which also responded to corticosteroids.CONCLUSION This case highlights the rare onset of BD following mRNA COVID-19 vaccination,suggesting a potential link between these vaccines and BD's eye symptoms,emphasizing the importance of quick treatment in similar cases.展开更多
The distinction between natural and human-made disasters is ingrained in everyday language. Disaster scientists have long been critical of this dichotomy. Nonetheless,virtually no attention has been paid to how disast...The distinction between natural and human-made disasters is ingrained in everyday language. Disaster scientists have long been critical of this dichotomy. Nonetheless,virtually no attention has been paid to how disaster survivors conceptualize the causes of the disasters they experience. In this mixed-methods longitudinal study, 112 survivors of the2016–2017 Central Italy earthquakes completed questionnaires 3 and 16 months following the earthquakes, with the aim of assessing attributions of blame for the earthquake damage. In-depth interviews were also conducted with 52 participants at the 3-month mark to explore representations of causation for the earthquake damage. The distinction between disasters caused by nature and disasters caused by humans was not supported by survivors of the earthquake. In the longitudinal surveys, building firms and the State were assigned as much blame as nature for the earthquake damage, at both 3 months and 16 months after the earthquakes.Corroborating this complexity, in the interviews, the causes of the earthquake damage, rather than being understood as purely natural, were perceived as a complex mosaic composed of political, technological, natural, and moral factors.This empirical work shows that disaster survivors combine both nature-based and human-based explanations of disasters, rather than subscribing to one or the other. These findings have practical implications for disaster risk reduction and response.展开更多
基金supported by UKResearch and Innovation(MR/S03546X/1)National BrainAppeal,Economic and Social ResearchCouncil(ES/S010467/1)+4 种基金Wellcome Trust(221915/Z/20/Z),ESRC(ES/W006014/1)Royal National Institute for Deaf People-Dunhill Medical Trust Pauline Ashley(204841/Z/16/Z,PA23)London Hospitals Biomedical Research Centre(221915/Z/20/Z)Bloomsbury and East London Doctoral Training Partnership(ES/P000592/1)National Institute for Health Research.
文摘Rarer dementias are associated with atypical symptoms and younger onset,which result in a higher burden of care.We provide a review of the global literature on longitudinal decline in activities of daily living(ADLs)in dementias that account for less than 10%of dementia diagnoses.Published studies were identified through searches conducted in Medical Literature Analysis and Retrieval System Online(MEDLINE),Excerpta Medica Database(Embase),Excerpta Medica Care(Emcare),PsycINFO,and Cumulative Index in Nursing and Allied Health Literature(CINAHL).The search criteria included terms related to‘rarer dementias’,‘activities of daily living’and‘longitudinal or cross-sectional studies’following a predefined protocol registered.Studies were screened,and those that met the criteria were citation searched.Quality assessments were performed,and relevant data were extracted.20 articles were selected,of which 19 focused on dementias within the frontotemporal dementia/primary progressive aphasia spectrum,while one addressed posterior cortical atrophy.Four studies were cross-sectional and 16 studies were longitudinal,with a median duration of 2.2 years.The Disability Assessment for Dementia was used to measure decline in 8 of the 20 studies.The varied sequences of ADL decline reported in the literature reflect variation in diagnostic specificity between studies and within-syndrome heterogeneity.Most studies used Alzheimer’s disease staging scales to measure decline,which cannot capture variant-specific symptoms.To enhance care provision in dementia,ADL scales could be deployed postdiagnosis to aid treatment and planning.This necessitates staging scales that are variant-specific and span the disease course from diagnosis to end of life.
文摘This study explored psychological, biomedical, and social factors in childhood and adulthood associated with the occurrence of self-reported hearing problems in adulthood. In total, 4828 participants with complete data on parental social class at birth, childhood hearing impairment measured at age 7 years and cognitive ability accessed at age 11 years, educational qualifications obtained at age 33 years, the Big-Five-Factor personality traits measured at age 50 years, current occupational levels and self-reported hearing problems at age 54 years were included in the study. Logistic regression analysis showed that among all the factors examined childhood hearing impairment and trait neuroticism as well as gender were the significant and independent predictors of hearing problems in adulthood.
文摘Independent living and housing stability are core principles of the psychiatric recovery process.Only when basic needs such as safe,affordable and permanent housing are met can individuals with serious mental illnesses(SMI)reintegrate into their community,consistently engage with mental health services and begin(or restart)recovery.'Yet,post-discharged individuals with SMI and their psychiatric care providers often grapple with where to go after discharge from psychiatric hospitalisation.This question is particularly central in safety-net hospitals serving people affected by severe health disparities with myriad deficits in social determinants of health(SDoH).In this commentary,we aim to shed light on post-discharge challenges related to housing often encountered by safety-net psychiatric hospitals and propose ways to address them.
文摘Context: This study set out to investigate the mental health literacy (MHL) about eight anxiety disorders (ADs), using vignette methodology. Methods: In all 317 British Adult participants completed a questionnaire with vignettes describing eight anxiety disorders including OCD, PTSD, Agoraphobia, Specific Phobias, Social Phobia, Separation Anxiety Disorder, GAD and Panic Disorder. Recognition, beliefs about treatments and perceived life adjustment (happiness, success at work) of specific people with these disorders were assessed. Results: Literacy levels varied across anxiety disorders, with high recognition of OCD (64.67%), but very poor for panic disorder (1.26%), GAD (2.84%) and separation anxiety disorder (5.99%). There were few significant effects of vignette gender on literacy levels. MHL for most anxiety disorders was relatively low;particularly panic disorder, GAD and separation anxiety disorder. Social Phobics were judged as least happy and adjusted and agoraphobics least successful at work and would benefit most from psychological help. Conclusions: Overall recognition of the anxiety disorders was poor. Beliefs about adjustment and treatment varied widely as a function of each disorder. Implications of the research for education of the public and limitations of this research are considered.
文摘BACKGROUND There are rising numbers of patients who have heart failure with preserved ejection fraction(HFpEF).Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to a sparsity of studies,the management of HFpEF is challenging.AIM To determine the hospital readmission rate within 30 d of acute or acute on chronic heart failure with preserved ejection fraction and its effect on mortality and burden on health care in the United States.METHODS We performed a retrospective study using the Agency for Health-care Research and Quality Health-care Cost and Utilization Project,Nationwide Readmissions Database for the year 2017.We collected data on hospital readmissions of 60514 adults hospitalized for acute or acute on chronic HFpEF.The primary outcome was the rate of all-cause readmission within 30 d of discharge.Secondary outcomes were cause of readmission,mortality rate in readmitted and index patients,length of stay,total hospitalization costs and charges.Independent risk factors for readmission were identified using Cox regression analysis.RESULTS The thirty day readmission rate was 21%.Approximately 9.17%of readmissions were in the setting of acute on chronic diastolic heart failure.Hypertensive chronic kidney disease with heart failure(1245;9.7%)was the most common readmission diagnosis.Readmitted patients had higher in-hospital mortality(7.9%vs 2.9%,P=0.000).Our study showed that Medicaid insurance,higher Charlson co-morbidity score,patient admitted to a teaching hospital and longer hospital stay were significant variables associated with higher readmission rates.Lower readmission rate was found in residents of small metropolitan or micropolitan areas,older age,female gender,and private insurance or no insurance were associated with lower risk of readmission.CONCLUSION We found that patients hospitalized for acute or acute on chronic HFpEF,the thirty day readmission rate was 21%.Readmission cases had a higher mortality rate and increased healthcare resource utilization.The most common cause of readmission was cardio-renal syndrome.
文摘BACKGROUND Acute carpal tunnel syndrome(ACTS)is commonly caused by repetitive strain,trauma,or inflammatory conditions.However,ACTS due to tophaceous gout is a clinical event that remains poorly understood and underreported.This rare manifestation necessitates prompt diagnosis and intervention to prevent irreversible complications.CASE SUMMARY A 51-year-old man who had poorly controlled hyperuricemia presented with ACTS secondary to tophaceous gout.Because of rapid symptom progression symptoms and severe median nerve compression within 3 mo,the patient underwent emergency decompression surgery for both wrists at different time points.Postoperatively,he exhibited complete recovery of sensory and motor functions,with no recurrence at long-term follow-up.Favorable outcomes were achieved through immediate decompression surgery,anti-inflammatory medications,postoperative active and passive range-of-motion exercises,and intermittent wrist splinting.Prompt diagnosis and surgical intervention,when necessary,are crucial for preventing long-term complications and obtaining favorable outcomes in patients with ACTS.An optimal gout management strategy involving pharmacologic therapy and lifestyle modifications may help minimize ACTS recurrence and improve clinical outcomes.CONCLUSION Prompt surgical intervention and optimal gout management are crucial for preventing irreversible nerve damage and ACTS recurrence.
文摘BACKGROUND Behcet's disease(BD)is an inflammatory disorder known for various symptoms,including oral and genital ulcers and ocular inflammation.Panuveitis,a severe eye condition,is rare as the first sign of BD.CASE SUMMARY We present an unusual case of a 30-year-old man who developed panuveitis after receiving the mRNA-based coronavirus disease 2019(COVID-19)vaccine(Moderna).Laboratory tests ruled out infections,but he had a positive HLA-B51 result and a history of genital ulcer and oral ulcers,leading to a BD diagnosis.Treatment with corticosteroids improved his condition.Interestingly,he had another episode of panuveitis after the second mRNA vaccine dose,which also responded to corticosteroids.CONCLUSION This case highlights the rare onset of BD following mRNA COVID-19 vaccination,suggesting a potential link between these vaccines and BD's eye symptoms,emphasizing the importance of quick treatment in similar cases.
基金the municipality and health center of Amatrice,the psychiatric services of Rieti for their practical supportthe UK’s Economic and Social Research Council for their financial support
文摘The distinction between natural and human-made disasters is ingrained in everyday language. Disaster scientists have long been critical of this dichotomy. Nonetheless,virtually no attention has been paid to how disaster survivors conceptualize the causes of the disasters they experience. In this mixed-methods longitudinal study, 112 survivors of the2016–2017 Central Italy earthquakes completed questionnaires 3 and 16 months following the earthquakes, with the aim of assessing attributions of blame for the earthquake damage. In-depth interviews were also conducted with 52 participants at the 3-month mark to explore representations of causation for the earthquake damage. The distinction between disasters caused by nature and disasters caused by humans was not supported by survivors of the earthquake. In the longitudinal surveys, building firms and the State were assigned as much blame as nature for the earthquake damage, at both 3 months and 16 months after the earthquakes.Corroborating this complexity, in the interviews, the causes of the earthquake damage, rather than being understood as purely natural, were perceived as a complex mosaic composed of political, technological, natural, and moral factors.This empirical work shows that disaster survivors combine both nature-based and human-based explanations of disasters, rather than subscribing to one or the other. These findings have practical implications for disaster risk reduction and response.
