RESUMEN
OBJECTIVES: Little is known about oral hygiene habits of patients suffering from chronic diseases. This study aims to describe oral hygiene behavior (OHB) in terms of tooth brushing and professional scaling frequency among patients with chronic diseases. Secondarily, it aims to assess the association between OHB and periodontitis, tooth loss, and oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: This is a cross-sectional analysis of data of adult participants in the ComPaRe e-cohort. Participants were classified into having good, moderate, and poor OHB according to self-reported frequency of toothbrushing and professional tooth scaling. Periodontitis was assessed using the PEriodontal Screening Score (PESS). Weighted binary regression models were used to estimate the association between OHB and the following outcomes: (i) periodontitis; (ii) number of missing teeth; and (iii) OHRQoL based on the Oral Health Impact Profile-14. RESULTS: Overall, 8553 patients were included in the analyses (52.9% females, mean age of 56.3 ± 17 years). Of these, 2907 (34%), 3953 (46%) and 1693 (20%) were considered as having good, moderate, and poor OHB, respectively. Over half (54.1%) of the patients had a PESS ≥ 5 suggestive for severe periodontitis. Moderate OHB was associated with lower odds of PESS ≥ 5 compared to poor OHB (Adjusted Odds Ratio, OR = 0.81 [95%CI: 0.70-0.92]). Good and moderate OHB were significantly associated with lower odds of ≥ 10 missing teeth (OR = 0.26 [95%CI: 0.21-0.33] and OR = 0.47 [95%CI: 0.4-0.56], respectively) and better OHRQoL than poor OHB. CONCLUSIONS: Although, most of patients with chronic diseases reported to have good or moderate OHB, severe periodontitis is highly prevalent among this patient population in France. CLINICAL RELEVANCE: This study describes OHB in a representative sample of patients suffering from one or more chronic diseases and provides an estimate of the prevalence of self-reported severe periodontitis, missing teeth, and OHRQoL.
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Higiene Bucal , Periodontitis , Calidad de Vida , Pérdida de Diente , Humanos , Estudios Transversales , Femenino , Masculino , Persona de Mediana Edad , Periodontitis/epidemiología , Pérdida de Diente/epidemiología , Enfermedad Crónica , Salud Bucal , Encuestas y CuestionariosAsunto(s)
Artralgia , Humanos , Anciano , Artralgia/etiología , Diagnóstico Diferencial , Masculino , Enfermedad CrónicaRESUMEN
Vocational rehabilitation plays a key role in the overall improvement of the quality of life for patients with chronic illness or after injury. Physicians have an important role in identifying suitable patients and recommending vocational rehabilitation as part of a comprehensive rehabilitation treatment. This article provides an overview of the use of vocational rehabilitation in the treatment of various patients with different types of illnesses and suggests criteria for selecting appropriate patients for involvement in vocational rehabilitation. The review presents the current state of vocational rehabilitation, its possibilities, limitations, and challenges for further development. One of the main challenges is the potential use of vocational rehabilitation for patients on temporary disability leave. Although employment law has allowed this possibility for 20 years, in practice, the tool of vocational rehabilitation has not yet been used for this group of individuals. The article also brings new findings revealed by research conducted within an experimental project that pilot tested the concept of so-called "vocational rehabilitation centers." The research showed, among other things, that the early involvement of individuals with disabilities in vocational rehabilitation, combined with a multidisciplinary approach, more than triples their chances of obtaining or retaining employment.
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Rehabilitación Vocacional , Humanos , Rehabilitación Vocacional/métodos , Enfermedad Crónica/rehabilitación , Personas con Discapacidad/rehabilitación , Heridas y Lesiones/rehabilitaciónRESUMEN
Self-stigma beliefs are common among people with visible chronic skin diseases and can negatively affect their quality of life and psychosocial wellbeing. Hence, evidence-based interventions are urgently needed. The objective for this systematic review was to summarize research on available interventions and evaluate their benefits and limitations. Following PRISMA guidelines, we conducted an electronic database search of four databases (EMBASE, PsycINFO, PubMed, Web of Science). Studies were eligible if they (a) investigated interventions to reduce self-stigma in adults with chronic skin disease, (b) were original empirical articles, and (c) were written in English or German. Two independent reviewers conducted the abstract and full text screening as well as data extraction. The quality of the included studies was evaluated using the Critical Appraisal Skills Programme checklists. The initial search yielded 5811 abstracts; of which, 23 records were eligible. Studies addressed a broad range of skin conditions, and interventions ranged from social skills training, counselling and self-help to psychosocial and behavioural interventions. Overall, interventions had mostly positive effects on self-stigma and related constructs. However, the study quality was heterogeneous, and further efforts to develop, thoroughly evaluate and implement interventions tackling self-stigma in multiple skin conditions and languages are warranted.
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Calidad de Vida , Autoimagen , Enfermedades de la Piel , Estigma Social , Humanos , Enfermedades de la Piel/psicología , Enfermedades de la Piel/terapia , Conocimientos, Actitudes y Práctica en Salud , Enfermedad CrónicaRESUMEN
BACKGROUND: One of the promising methods of influencing the wound process is photobiomodulation (PBM) therapy. The optimal parameters of PBM therapy have not yet been found because the molecular mechanisms of light interaction with tissue are not fully understood. OBJECTIVE: Studying the influence of PBM of various parameters on the regulation of reparative process- es of chronic wounds using the example of indicators of aggregation activity of platelets, platelet-derived growth factor (PDGF), interleukin-8 (IL-8), and amino-terminal propeptide of type III procollagen (PIIINP) at the remodeling stage. And also the study of the structural and functional features of chronic wound heal- ing in an experiment under various parameters of PBM therapy. METHODS: Experiments were carried out on Wistar rats. Chronic wounds were simulated. Experimental animals were exposed to PBM at a wavelength of 660 nm and an energy density of 1 J/cm2. In serum, PDGF, IL-8, and PIIINP levels were measured by enzyme-linked immunosorbent assay. The functional activity of platelets was measured using the turbidimetric method. Histological analysis was performed. RESULTS: The work noted the dose-dependent effect of PBM using the example of platelet aggregation at the remodeling stage during the healing of chronic wounds. The use of PBM therapy resulted in increased serum PDGF levels. Histological examination data indicate a positive effect of PBM therapy on the wound healing process. CONCLUSIONS: The effectiveness of the use of PBM therapy for the healing of chronic wounds to regulate reparative processes has been proven.
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Terapia por Luz de Baja Intensidad , Factor de Crecimiento Derivado de Plaquetas , Ratas Wistar , Cicatrización de Heridas , Cicatrización de Heridas/efectos de la radiación , Cicatrización de Heridas/fisiología , Animales , Ratas , Terapia por Luz de Baja Intensidad/métodos , Factor de Crecimiento Derivado de Plaquetas/metabolismo , Enfermedad Crónica , Interleucina-8/metabolismo , Interleucina-8/sangre , Modelos Animales de EnfermedadRESUMEN
The antithrombotic management of chronic coronary syndrome (CCS) involves a 6-month course of dual antiplatelet therapy (DAPT), followed by chronic aspirin therapy. In patients with a baseline indication for anticoagulation, a variable duration of triple antithrombotic therapy is administered, followed by dual antithrombotic therapy until the sixth month post-percutaneous coronary intervention (PCI), and ultimately a transition to chronic anticoagulation. However, advancements in stent technology reducing the risk of stent thrombosis and a growing focus on the impact of bleeding on prognosis have prompted the development of new therapeutic strategies. These strategies aim to enhance protection against ischemic events in the initial stages after PCI while mitigating the risk of bleeding in the long term. This article delineates the therapeutic strategies outlined in European and American guidelines for CCS management, with special attention to investigational strategies.
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Fibrinolíticos , Intervención Coronaria Percutánea , Humanos , Intervención Coronaria Percutánea/métodos , Fibrinolíticos/uso terapéutico , Fibrinolíticos/administración & dosificación , Inhibidores de Agregación Plaquetaria/uso terapéutico , Inhibidores de Agregación Plaquetaria/administración & dosificación , Enfermedad Crónica , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Terapia Antiplaquetaria Doble/métodosRESUMEN
The relationship between structural changes in the cerebral gray matter and diminished balance control performance in patients with chronic ankle instability (CAI) has remained unclear. This paper aimed to assess the difference in gray matter volume (GMV) between participants with CAI and healthy controls (HC) and to characterize the role of GMV in the relationship between disease duration and balance performance in CAI. 42 participants with CAI and 33 HC completed the structural brain MRI scans, one-legged standing test, and Y-balance test. Regional GMV was measured by applying voxel-based morphometry methods. The result showed that, compared with HC, participants with CAI exhibited lower GMV in multiple brain regions (familywise error [FWE] corrected p < 0.021). Within CAI only, but not in HC, lower GMV in the thalamus (ß = -0.53, p = 0.003) and hippocampus (ß = -0.57, p = 0.001) was associated with faster sway velocity of the center of pressure (CoP) in eyes closed condition (i.e., worse balance control performance). The GMV in the thalamus (percentage mediated [PM] = 32.02%; indirect effect ß = 0.119, 95% CI = 0.003 to 0.282) and hippocampus (PM = 33.71%; indirect effect ß = 0.122, 95% CI = 0.005 to 0.278) significantly mediated the association between the disease duration and balance performance. These findings suggest that the structural characteristics of the supraspinal elements is critical to the maintenance of balance control performance in individuals suffering from CAI, which deserve careful consideration in the management and rehabilitation programs in this population.
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Articulación del Tobillo , Sustancia Gris , Inestabilidad de la Articulación , Imagen por Resonancia Magnética , Equilibrio Postural , Humanos , Equilibrio Postural/fisiología , Masculino , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/diagnóstico por imagen , Femenino , Adulto Joven , Sustancia Gris/diagnóstico por imagen , Sustancia Gris/patología , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/fisiopatología , Articulación del Tobillo/patología , Estudios de Casos y Controles , Adulto , Enfermedad Crónica , Tálamo/diagnóstico por imagen , Tálamo/patología , Tálamo/fisiopatología , Hipocampo/diagnóstico por imagen , Hipocampo/patología , Factores de TiempoRESUMEN
BACKGROUND: In Sub-Saharan Africa (SSA), there is a noticeable shift from infectious diseases to chronic non-communicable diseases (CNCDs) based on recent studies. However, other studies suggest that social support can significantly improve self-care, increase knowledge of disease symptoms, and ultimately increase overall well-being in patients with CNCDs. In this study, we investigated the influence of perceived social support on treatment adherence among adults living with CNCDs in the Ho Municipality. METHODS: This was a health facility-based cross-sectional study among 432 adults living with cancer, diabetes, chronic kidney disease (CKD), stroke, and hypertension in the Ho Municipality of the Volta Region, Ghana. We adopted the Multi-dimensional Scale of Perceived Social Support (MSPSS), Medication Adherence Rating Scale and independent items to collect data. Logistic regression models were used to analyze the data with STATA v17.0 at 95% Confidence Intervals with statistical significance set at p<0.05. RESULTS: Majority of the participants (62%) reported high levels of perceived social support. While friends were the main source of support (69.4%), significant others provided the least support (45.4%). Among the dimensions of treatment adherence, participants demonstrated the highest adherence to reviews/check-ups (98.8%), while medication adherence had the highest level of non-adherence (38%). We did not find a significant association between perceived social support and overall treatment adherence, except for individuals with low perceived social support from friends (aOR = 8.58, 95% CI = 4.21,17.52), who were more likely to exhibit high adherence to behavioural and lifestyle recommendations. CONCLUSION: While the majority of respondents reported high perceived social support, there was no significant link between social support and overall treatment adherence. However, individuals with low support from friends showed a notably increased adherence to behavioural and lifestyle recommendations. This underscores the nuanced impact of social support on specific aspects of adherence, highlighting the need for targeted interventions tailored to individual support networks.
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Enfermedades no Transmisibles , Apoyo Social , Humanos , Ghana , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Adulto , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/terapia , Enfermedades no Transmisibles/psicología , Enfermedad Crónica/psicología , Anciano , Cumplimiento y Adherencia al Tratamiento/psicología , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Cumplimiento de la Medicación/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Instituciones de SaludRESUMEN
Ferroptosis is an important pathological mechanism of chronic heart failure (CHF). This study aimed to investigate the protective mechanism of Astragaloside IV (AS-IV) on CHF rats by integrating bioinformatics and ferroptosis. CHF-related targets and ferroptosis-related targets were collected. After the intersection, the common targets were obtained. The PPI network of the common targets was constructed, and topological analysis of the network was carried out. The target with the highest topological parameter values was selected as the key target. The key target p53 was obtained through bioinformatics analysis, and its molecular docking model with AS-IV was obtained, as well as molecular dynamics simulation analysis. The rat models of CHF after myocardial infarction were established by ligation of left coronary artery and treated with AS-IV for 4 weeks. AS-IV treatment significantly improved cardiac function in CHF rats, improved cardiomyocyte morphology and myocardial fibrosis, reduced mitochondrial damage, decreased myocardial MDA and Fe2+ content, increased GSH content, inhibited the expression of p53 and p-p53, and up-regulated the expression of SLC7A11 and GPX4. In conclusion, AS-IV improved cardiac function in CHF rats, presumably by regulating p53/SLC7A11/GPX4 signaling pathway and inhibiting myocardial ferroptosis.
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Biología Computacional , Ferroptosis , Insuficiencia Cardíaca , Saponinas , Triterpenos , Animales , Ferroptosis/efectos de los fármacos , Triterpenos/farmacología , Saponinas/farmacología , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/metabolismo , Ratas , Biología Computacional/métodos , Masculino , Fosfolípido Hidroperóxido Glutatión Peroxidasa/metabolismo , Proteína p53 Supresora de Tumor/metabolismo , Simulación del Acoplamiento Molecular , Enfermedad Crónica , Modelos Animales de Enfermedad , Ratas Sprague-Dawley , Transducción de Señal/efectos de los fármacos , Miocitos Cardíacos/metabolismo , Miocitos Cardíacos/efectos de los fármacos , Miocitos Cardíacos/patología , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/metabolismo , Infarto del Miocardio/patología , Simulación de Dinámica Molecular , Miocardio/metabolismo , Miocardio/patologíaRESUMEN
BACKGROUND & AIMS: Chronic migraine poses a global health burden, particularly affecting young women, and has substantial societal implications. This study aimed to assess the efficacy of Greater Occipital Nerve Block (GONB) in individuals with chronic migraine, focusing on the impact of local anesthetics compared with placebo. METHODS: A meta-analysis and systematic review were conducted following the PRISMA principles and Cochrane Collaboration methods. Eligible studies included case-control, cohort, and randomized control trials in adults with chronic migraine, adhering to the International Classification of Headache Disorders, third edition (ICHD3). Primary efficacy outcomes included headache frequency, duration, and intensity along with safety assessments. RESULTS: Literature searches across multiple databases yielded eight studies for qualitative analysis, with five included in the final quantitative analysis. A remarkable reduction in headache intensity and frequency during the first and second months of treatment with GONB using local anesthetics compared to placebo has been reported. The incidence of adverse events did not differ significantly between the intervention and placebo groups. CONCLUSION: The analysis emphasized the safety and efficacy of GONB, albeit with a cautious interpretation due to the limited number of studies and relatively small sample size. This study advocates for further research exploring various drugs, frequencies, and treatment plans to enhance the robustness and applicability of GONB for chronic migraine management.
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Trastornos Migrañosos , Bloqueo Nervioso , Humanos , Bloqueo Nervioso/métodos , Enfermedad Crónica , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: Chronic cough, a cough lasting >8 weeks, includes refractory chronic cough (RCC) and unexplained chronic cough (UCC). Patient-reported outcome (PRO) measures are needed to better understand chronic cough impacts that matter most to patients. The 19-item Leicester Cough Questionnaire (LCQ), an existing PRO measure of chronic cough, assesses impacts of cough across physical, psychological, and social domains. However, the content validity of the LCQ evaluating these concepts in patients with RCC/UCC had not been established. OBJECTIVES: To evaluate the content validity of the LCQ in patients with RCC/UCC. DESIGN: A cross-sectional, qualitative interview study. METHODS: First, previously completed qualitative interview results in adults with RCC/UCC (N = 30) were evaluated and mapped to LCQ concepts. Next, a clinical cough expert reviewed each LCQ item and assessed the salience of its concepts for patients with RCC/UCC. Finally, semistructured interviews-including both concept elicitation and cognitive debriefing-were conducted in adults with RCC/UCC (N = 20) to elicit a comprehensive set of participant experiences and to assess the appropriateness of using the LCQ in this population. RESULTS: Concepts reported in the past and present qualitative interviews were included across all LCQ items, and most impacts reported to be the "most bothersome" were assessed in the LCQ. In the current study, all participants indicated that reduced cough frequency would be an important treatment target. During cognitive debriefing, each LCQ item was endorsed by ⩾70% of participants. Additionally, participants were generally able to understand, recall, and select a response for each LCQ item. All participants and the clinical expert indicated that the LCQ was appropriate and assessed the impacts most relevant to patients with RCC/UCC. CONCLUSION: Our findings support the content validity of the LCQ and demonstrate that this measure is fit-for-purpose and includes important cough impacts in adults with RCC/UCC.
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Tos , Entrevistas como Asunto , Medición de Resultados Informados por el Paciente , Humanos , Tos/diagnóstico , Tos/fisiopatología , Tos/psicología , Masculino , Femenino , Persona de Mediana Edad , Enfermedad Crónica , Estudios Transversales , Adulto , Anciano , Reproducibilidad de los Resultados , Investigación Cualitativa , Encuestas y Cuestionarios , Calidad de Vida , Valor Predictivo de las Pruebas , Tos CrónicaRESUMEN
AIMS: Fear of physical activity (PA) is discussed as a barrier to regular exercise in patients with heart failure (HF), but HF-specific theoretical concepts are lacking. This study examined associations of fear of PA, heart-focused anxiety and trait anxiety with clinical characteristics and self-reported PA in outpatients with chronic HF. It was also investigated whether personality-related coping styles for dealing with health threats impact fear of PA via symptom perception. METHODS AND RESULTS: This cross-sectional study enrolled 185 HF outpatients from five hospitals (mean age 62 ± 11 years, mean ejection fraction 36.0 ± 12%, 24% women). Avoidance of PA, sports/exercise participation (yes/no) and the psychological characteristics were assessed by self-reports. Fear of PA was assessed by the Fear of Activity in Situations-Heart Failure (FActS-HF15) questionnaire. In multivariable regression analyses higher NYHA class (b = 0.26, p = 0.036) and a higher number of HF drugs including antidepressants (b = 0.25, p = 0.017) were independently associated with higher fear of PA, but not with heart-focused fear and trait anxiety. Of the three anxiety scores only increased fear of PA was independently associated with more avoidance behavior regarding PA (b = 0.45, SE = 0.06, p < 0.001) and with increased odds of no sports/exercise participation (OR = 1.34, 95% CI 1.03-1.74, p = 0.028). Attention towards cardiac symptoms and symptom distress were positively associated with fear of PA (p < 0.001), which explained higher fear of PA in patients with a vigilant (directing attention towards health threats) coping style (p = 0.004). CONCLUSIONS: Fear of PA assessed by the FActS-HF15 is a specific type of anxiety in patients with HF. Attention towards and being distressed by HF symptoms appear to play a central role in fear of PA, particularly in vigilant patients who are used to direct their attention towards health threats. These findings provide approaches for tailored interventions to reduce fear of PA and to increase PA in patients with HF. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02898246.
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Adaptación Psicológica , Ejercicio Físico , Miedo , Insuficiencia Cardíaca , Autoinforme , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ansiedad/psicología , Enfermedad Crónica , Estudios Transversales , Ejercicio Físico/psicología , Miedo/psicología , Insuficiencia Cardíaca/psicología , Insuficiencia Cardíaca/fisiopatología , Encuestas y CuestionariosRESUMEN
Liver fibrosis is often undetected whereas it is the determinant of liver-related mortality. We evaluate a pathway based on the systematic calculation of FIB-4 to screen for advanced hepatic fibrosis. Systematic calculation of FIB-4 was implemented in the centralized laboratory of a French University Hospital in 4 pilot departments. If ≥ 2.67, the FIB-4 result was returned to the prescribers, for patients between 18 and 70 years of age, with an incentive to measure liver stiffness by vibration controlled transient elastography. During a 2-years period, a FIB-4 was calculated in 2963 patients and 135 were ≥ 2.67 (4.6%). After exclusion of patients with a known cause of elevated FIB-4, 47 patients (34.8%) were eligible for elastography. Forty patients underwent elastography, but only 15% (7/47) at the spontaneous request of the referring physician. Fifteen patients were identified with significant fibrosis, among which 8 attended the scheduled specialist consultation, all with a confirmed diagnosis of cirrhosis. A sequential pathway based on the systematic calculation of FIB-4 enables the identification of patients with significant unknown liver fibrosis, allowing to refer them to specialized care. Raising awareness is essential to improve the care pathway.
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Diagnóstico por Imagen de Elasticidad , Cirrosis Hepática , Humanos , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/patología , Persona de Mediana Edad , Masculino , Femenino , Adulto , Anciano , Diagnóstico por Imagen de Elasticidad/métodos , Diagnóstico Precoz , Adolescente , Adulto Joven , Enfermedad Crónica , Tamizaje Masivo/métodosRESUMEN
Chronic diseases and pain exacerbate depressive symptom in Syria. Limited research on hospital-induced depressive symptom among Syrian patients with chronic diseases warrants further study. A cross-sectional study in four Damascus hospitals revealed high rates of pain and depressive symptom. This study aims to investigate the prevalence and severity of chronic pain and hospital-induced depressive symptom in Syrian patients, as well as the relationship between pain, depressive symptom, and medication behavior. This study analyzes the impact of pain, hospitalization, and medication on patients with chronic diseases. The four Damascus hospitals included 453 patients from various departments. Data were collected through structured interviews and internationally recognized scales such as the PSEQ, HADS, and MMAS. These findings offer insights into pain management and psychological well-being, with implications for patient care and support strategies. The study involved 453 patients with chronic diseases, with gender distribution showing 46.6% females and 53.4% males. The age range was from 7 to 87 years, with an average of 46.87 years. Chi-square tests revealed a significant connection between gender and HADS-A scores, where 48.3% of females had abnormalities (χ2 (1, N = 453) = 7.125, p = 0.028). Marital status was significantly associated with anxiety and depressive symptom levels, particularly among widowed and divorced patients. Employment status, education, and comorbidity were linked to abnormal HADS-A scores, while education level showed a positive correlation with HADS-D scores. ANOVA tests showed significant differences in MMAS scores across income groups (F (3, 449) = 3.167, p = 0.024), with a notable difference between low-income and lower-middle-income groups (mean difference = 0.389, p = 0.031. Chronic pain and HID are prevalent among Syrian patients with chronic diseases and influenced by socio-demographic factors. Personalized interventions are needed to address psychological symptoms and medication behavior.
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Depresión , Hospitalización , Humanos , Masculino , Femenino , Persona de Mediana Edad , Siria/epidemiología , Adulto , Depresión/epidemiología , Anciano , Estudios Transversales , Adolescente , Enfermedad Crónica , Adulto Joven , Anciano de 80 o más Años , Dolor Crónico/tratamiento farmacológico , Dolor Crónico/epidemiología , Dolor Crónico/psicología , Niño , PrevalenciaRESUMEN
BACKGROUND: Malnutrition is common in older patients with chronic heart failure (HF) and often accompanies a deterioration of their condition. The Controlling Nutritional Status (CONUT) score is used as an objective indicator to evaluate nutritional status, but relevant research in this area is limited. This study aimed to report the prevalence, clinical correlates, and outcomes of malnutrition in elder patients hospitalized with chronic HF. METHODS: A retrospective analysis was conducted on 165 eligible patients admitted to the Department of Cardiology at Huadong Hospital from January 2021 to December 2022. Patients were categorized based on their CONUT score into three groups: normal nutrition status, mild risk of malnutrition, and moderate to severe risk of malnutrition. The study examined the nutritional status of this population and its relationship with clinical outcomes. RESULTS: Findings revealed that malnutrition affected 82% of the older patients, with 28% experiencing moderate to severe risk. Poor nutritional scores were significantly associated with prolonged hospital stay, increased in-hospital mortality and all-cause mortality during readmissions within one year (P < 0.05). The multivariable analysis indicated that moderate to severe malnutrition (CONUT score of 5-12) was significantly associated with a heightened risk of prolonged hospitalization (aOR: 9.17, 95%CI: 2.02-41.7). CONCLUSIONS: Malnutrition, as determined by the CONUT score, is a common issue among HF patients. Utilizing the CONUT score upon admission can effectively predict the potential for prolonged hospital stays.
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Insuficiencia Cardíaca , Desnutrición , Estado Nutricional , Humanos , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/diagnóstico , Masculino , Femenino , Anciano , Estudios Retrospectivos , Desnutrición/epidemiología , Desnutrición/diagnóstico , Pronóstico , Anciano de 80 o más Años , Enfermedad Crónica , Evaluación Nutricional , Mortalidad Hospitalaria/tendencias , Hospitalización/tendencias , Tiempo de Internación/tendencias , PrevalenciaRESUMEN
INTRODUCTION: This study investigated the effects of falls on self-rated health and anxiety symptoms and the moderating role of psychological resilience in Chinese older persons with chronic multimorbidity. METHODS: Data were taken from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used a linear regression model to evaluate the associations among falls and self-rated health and anxiety symptoms, the moderating role of psychological resilience was verified by moderation analysis, and we also used a replacement model to test robustness. Finally, the results of the study were further verified via heterogeneity analysis through subgroup regression. RESULTS: A total of 2933 people aged 60 years or older with chronic multimorbidity were included in our study. The linear regression results revealed that falls were significantly negatively correlated with the self-rated health symptoms of older Chinese people with chronic multimorbidity (ß = -0.1703, p < 0.01) and significantly positively correlated with anxiety symptoms (ß = 0.5590, p < 0.01). Among the moderating effects, we found that psychological resilience played a moderating role between falls and anxiety symptoms (ß = - 0.151 [-0.217, -0.084], p < 0.01). Finally, we found heterogeneity in the study results by sex, residence and number of chronic diseases. CONCLUSION: Falls are associated with poorer self-rated health and higher anxiety levels among older persons with chronic multimorbidity in China. High levels of psychological resilience have a moderating effect on the development of anxiety symptoms.
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Accidentes por Caídas , Ansiedad , Multimorbilidad , Resiliencia Psicológica , Humanos , Masculino , Femenino , Anciano , China/epidemiología , Ansiedad/psicología , Ansiedad/epidemiología , Persona de Mediana Edad , Anciano de 80 o más Años , Enfermedad Crónica/psicología , Enfermedad Crónica/epidemiología , Estudios Longitudinales , Autoinforme , Estado de Salud , Autoevaluación Diagnóstica , Pueblos del Este de AsiaRESUMEN
OBJECTIVES: Chronic rejection remains the leading cause of progressive decline in graft function. Accumulating evidence indicates that macrophages participate in chronic rejection dependent on CD40-CD40L. The FOS family members are critical in inflammatory and immune responses. However, the mechanisms underlying the role of FOS family members in chronic rejection remain unclear. In this study, we aimed to elucidate the role and underlying mechanisms of FOS-positive macrophages regulated by CD40 that mediate chronic allograft rejection. MATERIALS AND METHODS: We downloaded publicly accessible chronic rejection kidney transplant single-cell sequencing datasets from the gene expression omnibus database. Differentially expressed genes between the CD40hi and CD40low macrophage chronic rejection groups were analyzed. We established a chronic rejection mouse model by using CTLA-4-Ig. We treated bone marrow-derived macrophages with an anti-CD40 antibody. We assessed expression of the FOS family by flow cytometry, real-time quantitative polymerase chain reaction, Western blotting, and immunofluorescence. We identified altered signaling pathways by using RNA sequencing analysis. We detected DNA specifically bound to transcription factors by using ChIP-sequencing, with detection of the degree of graft fibrosis and survival. RESULTS: FOS was highly expressed on CD40hi macrophages in patients with chronic transplantrejection. Mechanistically, we showed that CD40 activated NF-κB2 translocation into the nucleus to upregulate c-Fos and FosB expression, thus promoting chronic rejection of cardiac transplant.We showed thatNF-κB2 regulated c-Fos and FosB expression by binding to the c-fos and fosb promoter regions. Inhibition of c-Fos/activator protein-1 decreased graft fibrosis and prolonged graft survival. CONCLUSIONS: CD40 may activate transcription factor NF-κB2 translocation into the nucleus of macrophages to upregulate c-Fos and FosB expression, thus promoting chronic rejection of cardiac transplant. Inhibition of c-Fos/activator protein-1 decreased grafts fibrosis and prolonged graft survival.