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The article discusses the effectiveness of high-intensity interval training for improving walking capacity in chronic stroke patients.

The article presents the summary of the critically appraised paper "Additional rehabilitation following botulinum toxin-does not improve goal attainment and upper limb activity in chronic stroke survivors" which was published within the issue.

The author comments on the critically appraised paper entitled "Additional rehabilitation following botulinum toxin-A does not improve goal attainment and upper limb activity in chronic stroke survivors" which was published within the issue.

The article focuses on implicit motor learning is not superior to explicit motor learning for improving gait speed in chronic stroke.

The article offers information on people with chronic obstructive pulmonary disease, initiation of nocturnal non-invasive ventilation at home is non-inferior to initiation during a hospital admission.

Objectives: Existing electronic data capture options are often financially unfeasible in resource-poor settings or difficult to support technically in the field. To help facilitate large-scale multicenter studies in sub-Saharan Africa, the African Partnership for Chronic Disease Research (APCDR) has developed an open-source electronic questionnaire (EQ). Study Design and Setting: To assess its relative validity, we compared the EQ against traditional pen-and-paper methods using 200 randomized interviews conducted in an ongoing type 2 diabetes case-control study in South Africa. Results: During its 3-month validation, the EQ had a lower frequency of errors (EQ, 0.17 errors per 100 questions; paper, 0.73 errors per 100 questions; P-value ≤ 0.001), and a lower monetary cost per correctly entered question, compared with the pen-and-paper method. We found no marked difference in the average duration of the interview between methods (EQ, 5.4 minutes; paper, 5.6 minutes). Conclusion: This validation study suggests that the EQ may offer increased accuracy, similar interview duration, and increased cost-effectiveness compared with paper-based data collection methods. The APCDR EQ software is freely available [ABSTRACT FROM AUTHOR]

The article presents a commentary on how group-format dual-task training reduces dual-task interference in mobility tasks in people with chronic stroke. Topics discussed include potential advantages in terms of increasing social interactions, improving adherence, and reducing costs; simultaneous performance practice of walking and concurrent tasks across numerous participants; and reductions in dual-task interference effects were observed only in the group receiving dual-task training.

In this paper, we present a review of several selected talks presented at the CTTACC conference (Cellular Therapies in Trauma and Critical Care) held in Scottsdale, AZ in May 2023. This conference review highlights the potential for cellular therapies to "reset" the dysregulated immune response and restore physiologic functions to normal. Improvements in medical care systems and technology have increasingly saved lives after major traumatic events. However, many of these patients have complicated post-traumatic sequelae, ranging from short-term multi-organ failure to chronic critical illness. Patients with chronic critical illness have been found to have dysregulated immune responses. These abnormal and harmful immune responses persist for years after the initial insult and can potentially be mitigated by treatment with cellular therapies. The sessions emphasized the need for more research and clinical trials with cellular therapies for the treatment of a multitude of chronic illnesses: post-trauma, radiation injury, COVID-19, burns, traumatic brain injury (TBI) and other chronic infections. [ABSTRACT FROM AUTHOR]

Sarcopenic obesity (SO) is defined as the combination of excess fat mass (obesity) and low skeletal muscle mass and function (sarcopenia). The identification and classification of factors related to SO would favor better prevention and diagnosis. The present article aimed to (i) define a list of factors related with SO based on literature analysis, (ii) identify clinical conditions linked with SO development from literature search and (iii) evaluate their relevance and the potential research gaps by consulting an expert panel. From 4746 articles screened, 240 articles were selected for extraction of the factors associated with SO. Factors were classified according to their frequency in the literature. Clinical conditions were also recorded. Then, they were evaluated by a panel of expert for evaluation of their relevance in SO development. Experts also suggested additional factors. Thirty-nine unique factors were extracted from the papers and additional eleven factors suggested by a panel of experts in the SO field. The frequency in the literature showed insulin resistance, dyslipidemia, lack of exercise training, inflammation and hypertension as the most frequent factors associated with SO whereas experts ranked low spontaneous physical activity, protein and energy intakes, low exercise training and aging as the most important. Although literature and expert panel presented some differences, this first list of associated factors could help to identify patients at risk of SO. Further work is needed to confirm the contribution of factors associated with SO among the population overtime or in randomized controlled trials to demonstrate causality. [ABSTRACT FROM AUTHOR]

Menstrual dysfunction can impact both the physical and emotional health of young people. 1 Multiple chronic diseases have been associated with menstrual dysfunction in adults 2 ; however, there is little research in adolescents, despite nonadherence and suboptimal illness control in this group. We aimed to identify the impact of chronic illness on the age of menarche and the menstrual cycle in adolescents. Studies were extracted of female adolescents aged 10-19 who had a chronic physical illness. Data included outcomes on age of menarche and/or menstrual cycle quality. Exclusion criteria aimed to exclude diseases where menstrual dysfunction was a known part of the disease pathophysiology (ie, polycystic ovarian syndrome) 3 or in which medications were used that directly impacted gonadal function. 4 A literature search (to January 2022) was performed on the EMBASE, PubMed, and Cochrane library databases. Two widely used modified quality analysis tools were used. Our initial search netted 1451 articles, of which 95 full texts were examined and 43 met the inclusion criteria. Twenty-seven papers focused on type 1 diabetes (T1D), with 8 papers examining adolescents with cystic fibrosis and the remaining studying inflammatory bowel disease, juvenile idiopathic arthritis, coeliac disease, and chronic renal disease. Metanalysis of 933 patients with T1D vs 5244 controls demonstrated a significantly later age of menarche in T1D (by 0.42 years; P ≤.00001). There was also a significant association between higher HbA1c and insulin dose (IU/kg) and later age of menarche. Eighteen papers reviewed other aspects of menstruation, including dysmenorrhea, oligomenorrhoea, amenorrhea, and ovulatory function, with variable findings. Most studies were small and in single populations. Despite this, there was evidence of delayed menarche and some evidence of irregular menses in those with cystic fibrosis and T1D. Further structured studies are needed to evaluate menstrual dysfunction in adolescents and how it relates to their chronic illness. [ABSTRACT FROM AUTHOR]

The pipeline from discovery to testing and then implementing evidence-based innovations in real-world contexts may take 2 decades or more to achieve. Implementation science innovations, such as hybrid studies that combine effectiveness and implementation research questions, may help to bridge the chasm between intervention testing and implementation in dementia care. This paper describes hybrid effectiveness studies and presents 3 examples of dementia care interventions conducted in various community-based settings. Studies that focus on outcomes and implementation processes simultaneously may result in a truncated and more efficient implementation pipeline, thereby providing older persons, their families, health care providers, and communities with the best evidence to improve quality of life and care more rapidly. We offer post-acute and long-term care researchers considerations related to study design, sampling, data collection, and analysis that they can apply to their own dementia and other chronic disease care investigations. [ABSTRACT FROM AUTHOR]

Objective: To systematically evaluate health literacy (HL) interventions in chronic conditions by exploring theoretical perspectives, intervention content and effectiveness.Method: We searched MEDLINE, Cochrane, CINAHL, EMBASE, ERIC, Web of Science and PsycINFO. Standardised systematic review methods were used, and sequences informing our research question were extracted and analysed. The study includes a descriptive summary of the included papers.Results: We included 39 unique interventions, with diabetes and heart disease as the most targeted chronic conditions. Fifty-four percent of papers included a definition of HL, but the studies showed significant heterogeneity of theoretical underpinnings, modes, measures and content. We identified 23 HL measures, mostly assessing functional HL. The HL interventions were often more complex than the measures indicated. A significant change in HL was found in 28 studies. Study quality was generally poor.Conclusions: Interventions optimizing HL appear important to improve health outcomes in chronic conditions. To ensure cumulative knowledge development of this field we need theory-based interventions, consistency in methods and more tailored and comprehensive measures to capture the interventions' complexity.Practice Implications: A more valid understanding of HL interventions and measurements is needed to reach an agreed understanding of their components and intentions. [ABSTRACT FROM AUTHOR]

Chronic disease has profound impacts on the structural features of individuals' interpersonal connections such as bridging — ties to people who are otherwise poorly connected to each other. Prior research has documented competing arguments regarding the benefits of network bridging, but less is known about how chronic illness influences bridging and its underlying mechanisms. Using data on 1555 older adults from the National Social Life, Health, and Aging Project (NSHAP), I find that older adults diagnosed with chronic illness tend to have lower bridging potential in their networks, particularly between kin and non-kin members. They also report more frequent interactions with close ties but fewer neighbors, friends, and colleagues in their networks, which mediates the association between chronic illness and social network bridging. These findings illuminate both direct and indirect pathways through which chronic illness affects network bridging and highlight the context-specific implications for social networks in later life. • The paper discusses context-specific implications for social network bridging potential in a novel context of chronic health. • Older adults' bridging potential in personal networks are classified into three distinct types. • Chronic illnesses directly and only reduce the likelihood of bridging kin and non-kin members. • The declining non-kin informal ties accelerate the adverse association between chronic illnesses and social network bridging. [ABSTRACT FROM AUTHOR]

With the increase in the number of patients with chronic diseases, the contradiction between medical resources and the demand for medical services is increasingly stressed. The hierarchical medical system becomes an important measure to efficiently allocate medical resources. Given that the two-way referral of patients is a core issue of a hierarchical medical system, this paper takes the upward referral as an example and constructs a three-way decision model for the hierarchical diagnosis and treatment system of chronic diseases, which takes teleconsultation as a compromise. Firstly, considering the credibility of decision-making information, a new representation of the loss function is proposed by combining the subjective evaluations of doctors with the personal preferences of patients. Secondly, the credibility adjustment rules are designed, subject to the constraints of the loss function. Furthermore, taking into account the doctors' psychological behaviors such as risk attitudes when facing uncertain decisions, a three-way decision model based on the cumulative prospect theory was constructed. The main highlight and contribution of this paper is to put forward a new form of the loss function and the adjustment method of the loss function. A medical decision support system is designed based on the proposed method. Finally, a real case of upward referral of patients with coronary heart disease in First Hospital of Qinhuangdao is given to illustrate the validity of the proposed method, and comparisons are conducted to show the superiority of the method. This study provides methodical support for the hierarchical diagnosis and treatment system in the medical field, and it is conducive to promoting the equalization of basic medical services, which has potential theoretical and practical significance. • Propose a loss function evaluation method combining the preferences of doctors and patients. • Introduce the credibility and design the adjustment rule under the constraint of loss function. • Construct a three-way decision model based on the cumulative prospect theory and DTRSs. • Establish a decision support system for the hierarchical diagnosis and treatment system. • Apply methods on a case of upward referral of patients with coronary heart disease. [ABSTRACT FROM AUTHOR]

Quantitative evidence on the impact of social protection such as livelihood programs (LPs) on reducing vulnerability to poverty (VtP) is scant. Therefore, this paper aims to estimate VtP and the ability of LPs to reduce it. The analysis is based on the primary data collected in 2018–19 from 479 households in a tribal region of eastern India. First, household VtP was estimated using the feasible generalized least squares (FGLS) method. Households were categorized into four groups based on their current and predicted future poverty status: chronic poor, transient poor, escaped poverty, and non-poor. Second, factors influencing this movement of households from current to future poverty states were determined using multinomial logistic regression. Third, the impact of the LP on VtP was investigated using the endogenous switching regression (ESR) approach. The FGLS estimates show that 34.7% of households are vulnerable to future poverty, which exceeds the actual poverty rate of 28.6%. The major factors responsible for exacerbating chronic poverty and causing transient poverty are chronic illness, climate shocks, and the sale of assets. The ESR results indicate that a household's VtP is reduced by 3% for those that participate in LPs. Although the LP evaluated in this study has an average positive impact in reducing vulnerability, there is wide heterogeneity among the beneficiaries as the geographically disadvantaged communities lag behind the others. Therefore, the study suggests strengthening such LPs with a particular focus on disadvantaged and vulnerable communities. [ABSTRACT FROM AUTHOR]

Objective: To conduct a review of current literature to assess whether an association exists between Pentosan Polysulfate Sodium and the development of macular disease, as it is the only oral medication approved by the Food and Drug Administration for the management of interstitial cystitis.Materials and Methods: A systematic review was conducted by the authors separately, with review methods established prior to the conduct of the review. Databases searched included PubMed, Ovid, Medline, EBSCO, and Google Scholar. A search was conducted for the terms "Pentosan Polysulfate Maculopathy," "Pentosan Polysulfate Retinopathy," and "Interstitial Cystitis Maculopathy." All papers reporting on primary data were included. There were no study sponsors.Results: A total of 14 papers reporting on primary data were identified. Most papers reported on the development of macular disease in the setting of chronic pentosan polysulfate sodium exposure. No randomized controlled trials have been performed to date and data was insufficient to perform a meta-analysis. Nevertheless, patients with interstitial cystitis were more likely to receive a diagnosis of maculopathy after several years of the medication use.Conclusion: Although the nature of the published studies renders them prone to confounders, currently available data suggest an increased risk for developing maculopathy after years of pentosan polysulfate sodium use. In light of this, and the marginal effectiveness of the medication for the average individual, we suggest that education be provided as to the possible association and that regular ophthalmic evaluation be recommended for patients who are continued on chronic Pentosan Polysulfate Sodium. [ABSTRACT FROM AUTHOR]

This review identifies the different risk assessment tools that stratify the individual's risk of four of the eight leading causes of death in women: breast cancer, lung cancer, colorectal cancer and osteoporosis. It will be followed by the publication of a second paper that summarizes the risk assessment tools for the other four leading causes of death (myocardial infarction, stroke, diabetes mellitus type 2 and dementia). The different tools were compared by their use of different variables and validation criteria. To corroborate the validation process, validation study papers were considered for each risk assessment tool. Four tables, one for each illness, were designed. The tables provide an outline for each risk assessment tool, which includes its inventor/company, required variables, advantages, disadvantages and validity. These tables simplify the comparison of the different tools and enable the identification of the most suitable one for each patient. [ABSTRACT FROM AUTHOR]

• A paucity of data exists describing pregnancy outcomes for women receiving preconception counselling. • Improved outcomes are described in the studies that we identified. • This supports the routine inclusion of PCC for women with chronic medical conditions. • Further studies are required to broaden the evidence base. Beyond diabetes mellitus little data reports outcomes of women with chronic medical conditions who have received pre-conception counselling (PCC). This study aimed to perform a systematic review of the literature to evaluate evidence regarding the impact of PCC on maternal and fetal outcomes in women with chronic medical conditions aside from diabetes mellitus. A systematic review was conducted in accordance with PRISMA. PubMed, Cochrane, Ovid Medline and Web of Science were searched. Two reviewers screened abstracts and full texts. Inclusion criteria included studies relating to chronic medical disorders of interest published between database inception and 21st May 2022, reporting outcomes relating to disease activity and perinatal outcomes. The search yielded 11,814 results of which six met criteria for inclusion. Two papers describe the demographics of women more likely to receive PCC which included younger age, shorter disease duration, nulliparity, IVF pregnancy and higher education/job security. Two reported the effects of PCC on women's behaviour with improvements demonstrated in correct medication adherence, folic acid intake and smoking cessation. Five studies reported outcomes related to disease activity; those receiving PCC were more likely to have quiescent disease during pregnancy. Improvements in pregnancy outcomes were described including reduced rates of small for gestational age, low birth weight, preterm birth, congenital abnormality and obstetric complications. A paucity of data exists relating to pregnancy outcomes in women with chronic medical conditions receiving PCC. Reported outcomes are favorable, supporting the routine inclusion of PCC in preparation for pregnancy in such patients. [Display omitted] [ABSTRACT FROM AUTHOR]

Diabetes is a chronic disease that affects millions of people throughout the world and studies show that there is a gap between research and smartphone-based solutions. This paper presents an initial investigation into the possibility and viability of using smartphones to predict hypoglycaemia in diabetic patients accurately. This investigation involved the identification of smartphone compatible algorithms and numerous tests for accuracy and performance of the proof-of-concept application. This is achieved through a three-stage approach where the Literature was investigated, followed by the implementation of two selected algorithms – J48 Tree and Fuzzy Lattice Reasoning – and tests to compare them to their smartphone implementation, watching for mobile-based metrics such as CPU, memory usage and execution time. The results show that the mobile implementations of the selected machine-learning algorithms maintain an accuracy rate as high as reported in their studies with regular use of CPU and Memory, and shorter execution time when algorithms are initially trained. Consequently, this paper delivers a proof-of-concept smart application that will serve as a basis for future applications aiming at a broader diabetic population who use smartphones. [ABSTRACT FROM AUTHOR]

Background: To investigate if there is any evidence in favour of autograft or allograft use for anatomic reconstruction of lateral ankle ligaments in patients with symptomatic chronic ankle instability.Methods: A literature search was performed in PubMed MEDLINE, Cochrane Library, EMBASE and Google Scholar databases, over the years 1994-2017, to identify the studies presenting clinical results of anatomic lateral ankle ligaments reconstruction using various combinations of the keywords "lateral ankle ligaments reconstruction", "anatomic reconstruction", "chronic ankle instability", "allograft", "autograft". The surgical procedure was considered anatomic if consistent with the description of lateral ankle ligaments made by Burks and Morgan in 1994.Results: Among the 89 papers matching the search terms, only 12 could be included in which 357 anatomic lateral ankle ligaments reconstructions were performed. One was a comparative case series (level of evidence III - LOE III) while other papers were retrospective case series (LOE IV), the mean Modified Coleman Methodology Score (MCMS) was fair: 56.7 (SD±5.2). Due to the low level of evidence of the available literature only a qualitative analysis was performed. The limited evidence from the studies analysed suggests that there is no difference in graft survivorship, graft-dependent variables, patient's satisfaction, clinical outcome measures and radiographic results between allograft and autograft.Conclusions: Given the low number of studies, their poor methodology score and their low level of evidence it is not possible to determine if allograft is better or safer than autograft.Level Of Evidence: Level IV, review paper of level III and level IV studies. [ABSTRACT FROM AUTHOR]

Using cross-sectional data from a representative sample of the French population (the 2008 Disability Health survey), this paper examines whether the SF-6D, a widely used preference-based measure of health-related quality of life in economic evaluations, fully captures the variation in subjective well-being (SWB) due to chronic illnesses. We conduct a mediation analysis to disentangle the direct and indirect, through the SF-6D, effects of various chronic conditions on SWB (happiness). Our results show that the SF-6D reflects changes in happiness due to most illnesses except mental illness. Changes in SWB mediated by the SF-6D account for 74% of the total effect. The variation unexplained by the SF-6D is significant and increases substantially in the presence of multimorbidity when a chronic illness is combined with anxiety or depression. Overall, our results suggest that the SF-6D incompletely captures the subjective experience of chronically ill patients, especially those with comorbid conditions. • 74% of the effect of chronic illness on happiness is captured by the SF-6D. • The SF-6D does not fully capture the effect of mental illness on happiness. • The effect not captured by the SF-6D increases significantly with multimorbidity. [ABSTRACT FROM AUTHOR]

Introduction: Epidemiologic studies relating health outcomes to dietary patterns captured by diet quality indices have shown better quality scores associated with lower mortality and chronic disease incidence. However, changing chronic disease risk factors only alters population health over time, and initial diet quality systematically varies across the population by sociodemographic status. This study uses microsimulation to examine 30-year impacts of improved diet quality by sociodemographic group.Methods: Diet quality across 12 sex-, race/ethnicity-, and education-defined subgroups was estimated from the 2011-2012 National Health and Nutrition Examination Survey. In 2021, the Future Adults (dynamic microsimulation) Model was used to simulate population health and economic outcomes over 30 years for these subgroups and all adults. The modeled pathway was through lowering risk for heart disease by following U.S. Dietary Guidelines.Results: Diet quality varied across the sociodemographic subgroups, and half of U.S. adults had diet quality that would be classified as poor. Improving U.S. diet quality to that reported for the top 20% in 2 large health professionals' samples could reduce incidence of heart disease by 9.9% (7.6%-13.8% across the 12 sociodemographic groups) after 30 years. Year 30 would also have 37,000 fewer deaths, 694,000 more quality-adjusted life years, and healthcare cost savings of $59.6 billion (2019 U.S. dollars).Conclusions: Dynamic microsimulation enables predictions of socially important outcomes of prevention efforts, most of which are many years in the future and beyond the scope of trials. This paper estimates the 30-year population health and economic impact of poor diet quality by sociodemographic group. [ABSTRACT FROM AUTHOR]

This paper examines the health consequence of rising housing prices in China by exploiting spatial and temporal variation in housing price appreciation linked to individual-level health data from 2000 to 2011. Using an instrumental variable approach, we find that increases in housing prices significantly raise the probability of having chronic diseases. The deep-rooted marriage culture of males being obligated to buy a home before getting married and the growing marriage market competition are the main channels that exacerbate the negative health effects, particularly for parents with marriage-age sons. We also show that increased work intensity, high levels of stress, and lifestyle changes are other possible channels. Our results highlight the unintended health consequences of the real estate market prosperity. [ABSTRACT FROM AUTHOR]

Objectives: To provide an overview of the existing research concerning the use and effects of AR in patient education.Methods: Following PRISMA guidelines four electronic databases were systematically searched.Inclusion Criteria: empirical studies using any type of AR intervention in patient education across all medical specialties. Quality assessment of the retrieved literature was carried out.Results: Ten papers, comprising 788 patients, were identified and included (Randomized controlled trial (RCT)(n = 3), non-randomized controlled trial (n = 3), before-and-after study (n = 3), and qualitative survey (n = 1)). Retrieved literature showed itself to be highly heterogeneous. The studied population included patients suffering from a diverse spectrum of chronic diseases (e.g., prostate cancer, diabetes mellitus, multiple sclerosis, epilepsy). Quantitative results indicated that the use of AR had a positive effect on knowledge retention and patient satisfaction. Qualitative findings suggested that patients liked the technology and felt comfortable with its use for educational purposes. The quality of the retrieved results was shown to be moderate to low.Conclusion: The limited evidence of this topic suggests the possible potential of AR in patient education.Practice Implication: More research, using high-quality study designs and more evidence-based interventions, is needed to fully appreciate the value of AR on patient education. [ABSTRACT FROM AUTHOR]

• Functional and work disability in people with rheumatic diseases remain high despite advances in medical and pharmacological management • Hand therapists can play a vital role in chronic rheumatic disease management to improve self-management and increase participation in meaningful activities. • Patients, primary care, and rheumatology providers need to be educated about the scope of services occupational and physical therapy provide beyond the hand impairments. Invited Clinical Commentary Arthritis is one of the most frequently reported causes of disability in the United States and the prevalence is expected to increase in the coming decades. While many rheumatic diseases involve hand impairments, most are systemic and involve more than the musculoskeletal system. Functional and work disability are high and people would benefit from the services of occupational and physical therapists. This paper reviews concepts of self-management, and symptoms that contribute to limitations and restrictions to participation in daily life in people with rheumatic diseases and suggests roles for hand therapists beyond the immediate hand impairments. The impact of selected rheumatic diseases on functional and work disability are reviewed along with strategies for symptom management and self-management. Upper extremity impairments of selected rheumatic diseases are also discussed. The role for hand therapists in evaluating and addressing the complex needs of persons with rheumatic diseases, including less common diseases, is discussed. Outcome measures for fatigue, muscle involvement, ergonomics and computer use, and work disability are introduced. Finally, strategies for self-management and prevention of work and functional disability, along with symptom management for fatigue and pain are presented. Hand therapists can play a vital role in chronic rheumatic disease management to improve self-management and increase participation in meaningful activities. Patients, primary care and rheumatology providers need to be educated about the scope of services occupational and physical therapists provide beyond the hand impairments. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a silent disease. Most CKD patients are unaware of their condition during the early stages of the disease which poses a challenge for healthcare professionals to institute treatment or start prevention. The trouble with the diagnosis of CKD is that in most parts of the world, it is still diagnosed based on measurements of serum creatinine and corresponding calculations of eGFR. There are controversies with the current staging system, especially in the methodology to diagnose and prognosticate CKD. The aim of this review is to examine studies that focused on the different types of samples which may serve as a good and promising biomarker for early diagnosis of CKD or to detect rapidly declining renal function among CKD patient. The review of international literature was made on paper and electronic databases Nature, PubMed, Springer Link and Science Direct. The Scopus index was used to verify the scientific relevance of the papers. Publications were selected based on the inclusion and exclusion criteria. 63 publications were found to be compatible with the study objectives. Several biomarkers of interest with different sample types were taken for comparison. Biomarkers from urine samples yield more significant outcome as compare to biomarkers from blood samples. But, validation and confirmation with a different type of study designed on a larger population is needed. More comparison studies on different types of samples are needed to further illuminate which biomarker is the better tool for the diagnosis and prognosis of CKD. • Traditional markers are insensitive, over-reliance and lead to extensive time lapses. • Some reviewed biomarkers showed great promise but further validation is required. • Urine is a good and easier sample for clinical diagnosis as compared to blood. • Urine and blood have their own advantages and disadvantages in CKD diagnosis. [ABSTRACT FROM AUTHOR]

Abstract Small area health data are not always available on a consistent and robust routine basis across nations, necessitating the employment of small area estimation methods to generate local-scale data or the use of proxy measures. Geodemographic indicators are widely marketed as a potential proxy for many health indicators. This paper tests the extent to which the inclusion of geodemographic indicators in small area estimation methodology can enhance small area estimates of limiting long-term illness (LLTI). The paper contributes to international debates on small area estimation methodologies in health research and the relevance of geodemographic indicators to the identification of health care needs. We employ a multilevel methodology to estimate small area LLTI prevalence in England, Scotland and Wales. The estimates were created with a standard geographically-based model and with a cross-classified model of individuals nested separately in both spatial groupings and non-spatial geodemographic clusters. LLTI prevalence was estimated as a function of age, sex and deprivation. Estimates from the cross-classified model additionally incorporated residuals relating to the geodemographic classification. Both sets of estimates were compared against direct estimates from the 2011 Census. Geodemographic clusters remain relevant to understanding LLTI even after controlling for age, sex and deprivation. Incorporating a geodemographic indicator significantly improves concordance between the small area estimates and the Census. Small area estimates are however consistently below the equivalent Census measures, with the LLTI prevalence in urban areas characterised as 'blue collar' and 'struggling families' being markedly lower. We conclude that the inclusion of a geodemographic indicator in small area estimation can improve estimate quality and enhance understanding of health inequalities. We recommend the inclusion of geodemographic indicators in public releases of survey data to facilitate better small area estimation but caution against assumptions that geodemographic indicators can, on their own, provide a proxy measure of health status. Highlights • A novel cross-classified extension to small area estimation methodology. • Small area estimation of health indicators can be enhanced by geodemographic data. • Geodemographics and deprivation independently impact small area health estimates. • Deprived urban communities have much worse health than expected. [ABSTRACT FROM AUTHOR]

Abstract The concept of biographical disruption has now enjoyed nearly 40 years of use in medical sociology. This paper argues that taking an embodied approach to biographical disruption helps to explain the concept's enduring efficacy. Drawing on the work of Maurice Merleau-Ponty and contemporary theories of embodiment inspired by his phenomenology, this paper advances that biographical disruption involves, in the first instance, a disruption to the ability to enact an embodied orientation towards the world. Biographical disruption does not, from this perspective, result from illness as such, but from the ways that illness impinges on one's physical ability to engage with daily life. This paper examines the experiences of solid organ transplant recipients for the purpose of shedding light on the conditions under which biographical disruption arises in experience. The analysis includes interviews with 36 post-operative solid organ transplant recipients (heart, liver, lung, and kidney) living in British Columbia or Ontario, Canada. These participants exhibit a wide range of illness experiences, some of which manifest as biographical disruption and others that do not. Tracing the contours of these experiences, this paper argues that the efficacy of biographical disruption for describing the illness experience depends not only on the illness experience but also, fundamentally, on the content of embodiment prior to the onset of that experience. Highlights • The embodiment perspective improves the efficacy of biographical disruption. • The embodied context of an experience structures the illness experience. • Organ transplant recipients present variable experiences of biographical disruption. [ABSTRACT FROM AUTHOR]

Diabetes is a chronic disease that affects millions of people throughout the world and studies show that there is a gap between research and smartphone-based solutions. This paper presents an initial investigation into the possibility and viability of using smartphones to predict hypoglycaemia in diabetic patients accurately. This investigation involved the identification of smartphone compatible algorithms and numerous tests for accuracy and performance of the proof-of-concept application. This is achieved through a three-stage approach where the Literature was investigated, followed by the implementation of two selected algorithms – J48 Tree and Fuzzy Lattice Reasoning – and tests to compare them to their smartphone implementation, watching for mobile-based metrics such as CPU, memory usage and execution time. The results show that the mobile implementations of the selected machine-learning algorithms maintain an accuracy rate as high as reported in their studies with regular use of CPU and Memory, and shorter execution time when algorithms are initially trained. Consequently, this paper delivers a proof-of-concept smart application that will serve as a basis for future applications aiming at a broader diabetic population who use smartphones. [ABSTRACT FROM AUTHOR]

Highlights • Intelligent Hybrid Context-Aware Model for Patients Under-Supervision in Home (IHCAM-PUSH) is proposed to monitor patients with chronic diseases in real-time remotely. • A Hybrid Classification Module (HCM) is proposed to classify patient's health status on dual-mode, on the cloud side (online) or on local side (offline). • The proposed HCM handles the problem of imbalanced datasets in big data. • This paper presents a case study for monitoring elderly patients suffering from blood pressure disorders using (IHCAM-PUSH). Abstract This paper proposes an intelligent hybrid context-aware model for patients under supervision at home that adopts a hybrid architecture with both local and cloud-based components. The cloud-based portion of the model facilitates storing and processing the big data generated by ambient assisted living systems that are used to monitor patients suffering from chronic diseases in their homes, particularly the elderly. The local portion of the model monitors patients in the event of internet disconnections or any other failure in the cloud system. The proposed model utilises context-aware techniques by monitoring physiological signals, ambient conditions, and patient activities simultaneously to derive the real-time health status of the patient. Experimental results demonstrate the effectiveness of our proposed model for monitoring patients and accurately detecting emergencies in imbalanced datasets through a case study on patients suffering from blood-pressure disorders. [ABSTRACT FROM AUTHOR]

Abstract This paper presents conceptual basis and early results within the research project aimed towards the development of a holistic approach for modeling of chronic disease progression for recommendation elaboration and decision making. The key issues which form the research problem include a high diversity of patients' population, simultaneous appearance of multiple chronic diseases, aged patients as a major target group. Also, one of the most important problems being raised in this research is limited observation available for chronic diseases as the long development of chronic disease is usually happening outside the hospital. The approach is based on systematization and collection of data from diverse sources and models describing various aspects of disease progression, life conditions, treatment process within a single comprehensive solution. The goal of such solution is lowering of existing limitation and uncertainty for predictive modeling and simulation of chronic diseases. A target application of the approach considered within the project is decision support systems for both patients and physicians during treatment of chronic disease. Within the presented paper early results are performed on the analysis of arterial hypertension patients treatment process within the developed approach. [ABSTRACT FROM AUTHOR]

The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 is a frequently used cancer-specific health-related quality of life (HRQoL) questionnaire. To aid interpretation of data obtained via EORTC QLQ-C30, general population norm data have been published for many countries. However, despite its frequent use in the United States, no normative data by sex and age exist to date. Therefore, this study aimed to generate sex- and age-specific EORTC QLQ-C30 normative data for the United States. Recruitment and data collection were carried out via online panels as part of a larger cross-sectional study. For the recruitment, the sample was stratified by sex and age (18–39, 40–49, 50–59, 60–69, ≥ 70 years) to achieve a balanced distribution, with n = 100 per subgroup. Descriptive statistics are presented by age and age/sex. A total of N = 1009 respondents completed the survey (n = 508 females, n = 501 males). More than two thirds of participants (72.5%) reported at least one health condition, e.g., arthritis (26%). Across EORTC QLQ-C30 scales, women and men 60 years and older reported generally better/higher functioning and better/lower symptom scores compared to the younger age groups. To date, no specific EORTC QLQ-C30 general population normative data have been published for the United States. This paper provides these important normative data, which will greatly support the interpretation of EORTC QLQ-C30 scale scores obtained from US cancer patients, and also enable comparison with European norms. • EORTC QLQ-C30 is a cancer-specific health related quality of life (HRQoL) measure. • HRQoL normative data from US general population was collected (1009 respondents). • EORTC QLQ-C30 look-up tables for the US general population by sex/age are presented. • Participants ≥ 60 years reported overall better functioning than younger age groups. • Results will enhance interpretation and validity from EORTC QLQ-C30 data in the US. [ABSTRACT FROM AUTHOR]

[Display omitted] • Lactoferrin intake in early life promotes neonates development and later life quality. • Lactoferrin promotes neonates intestinal, immune, nervous and adipocyte development. • Lactoferrin promotes early intestinal microflora establishment. • Early life LF prevents adult allergy, IBD, depression, cancer and obesity potentially. Nutrition during the early postnatal period exerts a profound impact on both infant development and later-life health. Breast milk, which contains lactoferrin, a dynamic protein, plays a crucial role in the growth of various biological systems and in preventing numerous chronic diseases. Based on the relationship between early infant development and chronic diseases later in life, this paper presents a review of the effects of lactoferrin in early life on neonates intestinal tract, immune system, nervous system, adipocyte development, and early intestinal microflora establishment, as well as the preventive and potential mechanisms of early postnatal lactoferrin against adult allergy, inflammatory bowel disease, depression, cancer, and obesity. Furthermore, we summarized the application status of lactoferrin in the early postnatal period and suggested directions for future research. [ABSTRACT FROM AUTHOR]

Chronic liver diseases mainly include chronic viral liver disease, metabolic liver disease, cholestatic liver disease (CLD), autoimmune liver disease, and liver fibrosis or cirrhosis. Notably, the compound formulas of traditional Chinese medicine (TCM) is effective for chronic liver diseases in clinical trials and basic research in vivo , which provide evidence of chronic liver disease treatment with integrated TCM and traditional Western medicine. This paper aims to provide a comprehensive review of the compound formulas of TCM for treating different chronic liver diseases to elucidate the composition, main curative effects, and mechanisms of these formulas and research methods. Different keywords related to chronic liver diseases and keywords related to the compound formulas of TCM were used to search the literature. PubMed, Scopus, Web of Science, and CNKI were searched to screen out original articles about the compound formulas of TCM related to the treatment of chronic liver diseases, mainly including clinical trials and basic in vivo research related to Chinese patent drugs, classic prescriptions, proven prescriptions, and hospital preparations. We excluded review articles, meta-analysis articles, in vitro experiments, articles about TCM monomers, articles about single-medicine extracts, and articles with incomplete or uncertain description of prescription composition. Plant names were checked with MPNS (http://mpns.kew.org). In this review, the clinical efficacy and mechanism of compound formulas of TCM were summarized for the treatment of chronic viral hepatitis, nonalcoholic fatty liver disease, CLD, and liver fibrosis or cirrhosis developed from these diseases and other chronic liver diseases. For each clinical trial and basic research in vivo , this review provides a detailed record of the specific composition of the compound formulas of TCM, type of clinical research, modeling method of animal experiments, grouping methods, medication administration, main efficacy, and mechanisms. The general development process of chronic liver disease can be summarized as chronic hepatitis, liver fibrosis or cirrhosis, and hepatocellular carcinoma. The compound formulas of TCM have some applications in these stages of chronic liver diseases. Owing to the continuous progress of medical technology, the benefits of the compound formulas of TCM in the treatment of chronic liver diseases are constantly changing and developing. [Display omitted] • Review on the progress of compound formulas of TCM in the treatment of chronic liver disease from 1997 to 2023. • Focused on the compound formulas of TCM for HBV, NAFLD, CLD, hepatic fibrosis, etc. • Summarized the research scheme and results of compound formulas of TCM intervention in chronic liver disease. [ABSTRACT FROM AUTHOR]

Background: Little is known about the successful experiences and positive perceptions of people with intellectual disabilities (ID) self-managing Type 2 Diabetes (T2D). This study sought to address this gap using Bandura's (1977) 'Four Sources of Self-Efficacy' as a framework of enquiry.Method: Semi-structured interviews were conducted with 10 adults with ID. Interviews were recorded, transcribed verbatim and analysed using inductive and deductive thematic analysis RESULTS: Nine sub-themes were identified following analysis of the data: 1) Mastery through knowledge; 2) Mastery through tools and strategies; 3) Mastery through autonomy; 4) Influence of social setting; 5) Positive social comparisons; 6) Positive and negative self-statements; 7) Feedback from caregivers; 8) Adjustment experiences; 9) Symptom awareness. These were mapped onto Bandura's (1977) Four Sources of efficacy enhancement model and were consistent with its proposed mechanisms.Conclusion: The Four Sources model serves as a useful mode of enquiry for exploring people with ID's experiences and perceptions of self-managing diabetes. It also confirms the appropriateness of Self-efficacy as a potential intervention component for this population. However, additional support may be required for people with ID to reflect meaningfully on their experiences and thus have a sense of self-efficacy.What This Paper Adds: This paper builds upon the limited existing literature on people with ID self-managing type 2 diabetes and provides a robust, qualitative account of the participants' experiences, whilst confirming some of the existing challenges, both for people with ID and their supporters. To self-manage with autonomy and overcome the difficulties of adjustment, further strategies such as training and education needs are highlighted. In addition, the meaning and relevance of the Self-efficacy construct is evaluated in the context of people with ID self-managing T2D. This provides useful information in terms of tailoring existing mainstream T2D interventions to meet the needs of people with ID, as such programs are commonly theoretically guided by Self-efficacy. Furthermore, this evaluation provides rationale for the exploration of people with IDs' Self-efficacy in relation to other chronic diseases, such as cardiovascular disease, cancer symptoms and gastrointestinal disorders. [ABSTRACT FROM AUTHOR]

Effective public health nutrition interventions are needed to curb the escalating prevalence of non-communicable diseases (NCDs) in many Arab countries. In order to generate the scientific evidence needed for the success of these interventions, an informed research agenda should be developed. The purpose of this review is to identify gaps and opportunities for research on nutrition and NCDs among Arab countries, which is an important step towards the formulation of this research agenda. Published papers that addressed nutrition and NCDs in Arab countries between the years 2006 and 2015 were reviewed (n = 824). The main gaps identified were related to the predominance of laboratory-based studies with few cohort and intervention studies, and the small percentage of articles examining dietary patterns. While food frequency questionnaires were the main dietary assessment method used, only 35% were validated. Very few studies included children and the majority considered nutrition in isolation, excluding other environmental factors. Opportunities identified included the promising momentum in studying nutrition and NCDs among Arab countries, evidenced by an increasing number of articles published over the years, that may be guided in future nutrition research to fill the identified gaps. In addition, the higher number of articles in high-income countries coupled with the impact of papers in middle-income countries suggests an opportunity of synergistic collaboration among these countries. The identified gaps and opportunities in this review may serve as basis for Arab countries to start developing a research agenda in the area of nutrition and NCDs. [ABSTRACT FROM AUTHOR]

Children, adolescents, and young adults with chronic illnesses are often faced with complicated and burdensome treatments that not only require a great deal of time and energy to manage, but will also likely impact relationships with parents, siblings, and peers. Adolescents and young adults with chronic illness are often impacted by several unique and challenging factors that can ultimately impact health behaviors and treatment outcomes. Working with a psychologist can help to ameliorate these unique challenges, which will positively impact health behaviors and health outcomes. The present paper provides an overview of psychological interventions that were designed to target the unique challenges that are often associated with maladaptive health behaviors and ultimately poor health outcomes. As demonstrated in this commentary, when working with adolescents and young adults who have unique developmental challenges, it is important to deliver multi-faceted intervention approaches that utilize a number of different strategies and frameworks. These eclectic intervention approaches provide a unique opportunity to improve health behaviors during critical developmental periods, including the transition from childhood to adolescence to young adulthood. [ABSTRACT FROM AUTHOR]

Objective: To understand how parents view and experience their role as their child with a long-term physical health condition transitions to adulthood and adult healthcare services.Methods: Five databases were systematically searched for qualitative articles examining parents' views and experiences of their child's healthcare transition. Papers were quality assessed and thematically synthesised.Results: Thirty-two papers from six countries, spanning a 17-year period were included. Long-term conditions were diverse. Findings indicated that parents view their child's progression toward self-care as an incremental process which they seek to facilitate through up-skilling them in self-management practices. Parental perceptions of their child's readiness, wellness, competence and long-term condition impacted on the child' progression to healthcare autonomy. A lack of transitional healthcare and differences between paediatric and adult services served as barriers to effective transition. Parents were required to adjust their role, responsibilities and behaviour to support their child's growing independence.Conclusion: Parents can be key facilitators of their child's healthcare transition, supporting them to become experts in their own condition and care. To do so, they require clarification on their role and support from service providers.Practice Implications: Interventions are needed which address the transitional care needs of parents as well as young people. [ABSTRACT FROM AUTHOR]

Instead of diminishing with the spectacular advancement of medical expertise in the country , unqualified biomedical practice in India has been strengthened by the growth of the pharmaceutical production in the twenty first century. In public health discourse, the view that the informal health practitioners have to be punished and abolished has been countered by the recommendation that they could be trained and incorporated in primary health care where public health amenities are inadequate. The quality of care provided by the informal health care practitioners has also been subject to clinical assessment based on standardized patient vignettes. Based on a sociological approach, this paper examines the time line of chronically ill patients under lived conditions to arrive at an understanding of the role of informal health practitioners in long term treatment and highlights the setbacks. This paper draws on 253 household surveys from two villages in Madhya Pradesh, in depth interviews with four unqualified practitioners in the area, twenty five unstructured interviews of chronic patients, twenty five structured interviews on the cases of untimely death and FGDs with health workers in 2021. Informal health care practitioners offer consultation cum dispensing of medicines and are the primary source of biomedical care in the remote study area without any public transport. But they are 'for profit' economic actors who are ill-equipped to handle chronic diseases. What sets them aside from the qualified private doctors in the town is their social obligation to balance their profit motive with the ethics of proximity and neighborly ties with the villagers amidst whom they reside. These features of the market and community place the informal health care practitioners at the cusp of economy and society and defy simple binaries that they are either crooks or assets. • Unqualified health practitioners provide medical care in India where none is available. • Assessing their practices, clientele and exact role is crucial to health care policy. • One point standardized patient vignettes are used to assess their quality of care. • Their treatment of chronically and severely ill patients over time also has to be examined. • They are 'for profit' economic actors, but embedded in the community. [ABSTRACT FROM AUTHOR]

This paper addresses the rapid pace of change in the technologies that support digital interventions; the complexity of the health problems they aim to address; and the adaptation of scientific methods to accommodate the volume, velocity, and variety of data and interventions possible from these technologies. Information, communication, and computing technologies are now part of every societal domain and support essentially every facet of human activity. Ubiquitous computing, a vision articulated fewer than 30 years ago, has now arrived. Simultaneously, there is a global crisis in health through the combination of lifestyle and age-related chronic disease and multiple comorbidities. Computationally intensive health behavior interventions may be one of the most powerful methods to reduce the consequences of this crisis, but new methods are needed for health research and practice, and evidence is needed to support their widespread use. The challenges are many, including a reluctance to abandon timeworn theories and models of health behavior-and health interventions more broadly-that emerged in an era of self-reported data; medical models of prevention, diagnosis, and treatment; and scientific methods grounded in sparse and expensive data. There are also many challenges inherent in demonstrating that newer approaches are, indeed, effective. Potential solutions may be found in leveraging methods of research that have been shown to be successful in other domains, particularly engineering. A more "agile science" may be needed that streamlines the methods through which elements of health interventions are shown to work or not, and to more rapidly deploy and iteratively improve those that do. There is much to do to advance the issues discussed in this paper, and the papers in this theme issue. It remains an open question whether interventions based in these new models and methods are, in fact, equally if not more efficacious as what is available currently. Economic analyses of these new approaches are needed because assumptions of net worth compared to other approaches are just that, assumptions. Human-centered design research is needed to ensure that users ultimately benefit. Finally, a translational research agenda will be needed, as the status quo will likely be resistant to change. [ABSTRACT FROM AUTHOR]

Objective: In recent decades, posterior nasal neurectomy (PNN) with submucosal inferior turbinectomy (ST) has been increasingly used for the treatment of intractable severe rhinitis; however, to the best of our knowledge, there have been few studies regarding its long-term therapeutic effects or its influence on patient quality of life (QOL). Therefore, this study examined the long-term therapeutic effects in patients who underwent PNN with ST, as well as their QOL and medication use after surgery.Methods: This retrospective cohort study initially included 16 consecutive patients who underwent PNN with ST from January 2010 to December 2011. Ten of the 16 patients participated in a paper-based survey questionnaire between June 2018 and November 2018; the responses of these 10 patients were used for analysis in this study. To clarify the effects of surgical treatment on symptoms, QOL, and medication status, data recorded before and 3 months after surgery were compared with data recorded at 8 years after surgery using the Japan Rhinoconjunctivitis Quality of Life Questionnaire No. 1 and Classification of the Severity of Allergic Rhinitis Symptoms I and II.Results: Nasal symptoms including runny nose and nasal congestion, medication score, respective total symptoms medication scores (i.e., combined average total symptoms score and medication score), and the scores of troubles with daily life and total QOL were significantly improved at 3 months and 8 years after surgery, compared with before surgery; scores were not significantly worsened at 8 years after surgery, compared with 3 months after surgery. In addition, there were no adverse events requiring treatment after surgery.Conclusion: Our findings suggest that PNN with ST is effective and safe for long-term treatment of severe chronic rhinitis symptoms, as well as reduction of medication use and improvement of QOL. [ABSTRACT FROM AUTHOR]

[Display omitted] This paper aims to develop smart hydrogels based on functionalized hyaluronic acid (HA) and PLGA-PEG-PLGA (PLGA, poly-(DL-lactic-co-glycolic acid); PEG, polyethylene glycol) for use as intraocular drug-delivery platforms. Anti-inflammatory agent dexamethasone-phosphate (0.2 % w/v) was the drug selected to load on the hydrogels. Initially, different ratios of HA-aldehyde (HA-CHO) and thiolated-HA (HA-SH) were assayed, selecting as optimal concentrations 2 and 3 % (w/v), respectively. Optimized HA hydrogel formulations presented fast degradation (8 days) and drug release (91.46 ± 3.80 % in 24 h), thus being suitable for short-term intravitreal treatments. Different technology-based strategies were adopted to accelerate PLGA-PEG-PLGA water solubility, e.g. substituting PEG1500 in synthesis for higher molecular weight PEG3000 or adding cryopreserving substances to the buffer dissolution. PEG1500 was chosen to continue optimization and the final PLGA-PEG-PLGA hydrogels (PPP1500) were dissolved in trehalose or mannitol carbonate buffer. These presented more sustained release (71.77 ± 1.59 % and 73.41 ± 0.83 % in 24 h, respectively) and slower degradation (>14 days). In vitro cytotoxicity studies in the retinal-pigmented epithelial cell line (RPE-1) demonstrated good tolerance (viability values > 90 %). PLGA-PEG-PLGA hydrogels are proposed as suitable candidates for long-term intravitreal treatments. Preliminary wound healing studies with PLGA-PEG-PLGA hydrogels suggested faster proliferation at 8 h than controls. [ABSTRACT FROM AUTHOR]

Patients with chronic illnesses, such as diabetes, need daily care and follow-up beyond occasional visits to healthcare providers. Research has shown that overcoming a multifaceted illness, such as diabetes, requires patients to be engaged in the monitoring and management of their own health. Health information technology (HIT) has been shown to empower chronically-ill patients to take charge of their healthcare, and alleviate their daily frustrations while they strive to lead a normal life. In this paper, we surveyed 31 patients with diabetes to identify the major frustrations they experience daily, examine the role of HIT in their current treatment, and identify gaps in their current care and education that, if addressed, could improve their quality of life. Themes identified in our survey results include a lack of interaction with healthcare providers, difficulties in scheduling appointments, a lack of timely communication with healthcare providers, and challenges in managing the complex care of diabetes. The contributions of this paper include a detailed set of recommendations on how HIT can be utilized to help chronically-ill patients live a better life despite their illnesses, with a particular emphasis on diabetes care and management. [ABSTRACT FROM AUTHOR]

The paper reports on the analysis of online postings from a Rheumatoid Arthritis asynchronous forum. Despite the rapid increase of internet users, the role of health related online communities is still underexplored. In this paper we draw on sociolinguistics and medical sociology research in order to problematize the online community notion and to unpack the functions of one forum through the analysis of data from newly diagnosed users. The analysis of the threads shows that the users orient to a set of roles which include both task and rapport oriented functions. We close the paper by showing how the members contribute to the construction of a collective identity. Finally we return to the theoretical considerations raised in our paper and identify areas for further research. [ABSTRACT FROM AUTHOR]

Advanced liver disease has long been associated with cerebral abnormalities. These abnormalities, termed acquired hepatocerebral degeneration, are typically visualized as T1 weighted hyperintensity on MRI in the deep gray matter of the basal ganglia. Recent reports, however, have demonstrated that a subset of patients with chronic alcoholic liver disease may also develop white matter abnormalities. Thus far, the morphology of these changes is not well characterized. Previous studies have described these changes as patchy, sporadic white matter abnormalities but have not posited localization of these changes to any particular white matter tracts. This paper hypothesizes that the white matter findings associated with advanced alcoholic liver disease localize to the corticocerebellar tracts. As an initial investigation of this hypothesis, 78 patients with a diagnosis of liver cirrhosis and an MRI showing clearly abnormal T1 weighted hyperintensity in the bilateral globus pallidus, characteristic of chronic liver disease, were examined for white matter signal abnormalities in the corticocerebellar tracts using FLAIR and T2 weighted images. The corticocerebellar tracts were subdivided into two regions: periventricular white matter (consisting of the sum of the centrum-semiovale and corona radiata), and lower white matter (consisting of the corona radiata, internal capsules, middle cerebral peduncles, middle cerebellar peduncles and cerebellum). As compared to matched controls, significantly greater signal abnormalities in both the periventricular white matter and lower white matter regions of the corticocerebellar tracts were observed in patients with known liver cirrhosis and abnormal T1 W hyperintensity in the globi pallidi. This difference was most pronounced in the lower white matter region of the corticocerebellar tract, with statistical significance of p<0.0005. Furthermore, the pathophysiologic mechanism underlying these changes remains unknown. This paper hypothesizes that the etiology of white matter changes associated with advanced liver disease may resemble that of white matter findings in subacute combined degeneration secondary to vitamin B12 deficiency. Specifically, significant evidence suggests that dysfunctional methionine metabolism as well as dysregulated cytokine production secondary to B12 deficiency play a major role in the development of subacute combined degeneration. Similar dysfunction of methionine metabolism and cytokine regulation is seen in alcoholic liver disease and is hypothesized in this paper to, at least in part, lead to white matter findings associated with alcoholic liver disease. [ABSTRACT FROM AUTHOR]

Chronic diseases are becoming more prevalent, and the complexities of managing patients continue to escalate, since their care must be balanced between the home and clinical settings. Diabetes is the most advanced example, where self-monitoring has been shown to be necessary. Glucometers are point-of-care (POC) devices that have become standard platforms at home and clinical settings. Similarly, many other POC biosensors have also been developed. Enzymes are often used in these sensors because of their specificity and the reaction products can be electrochemically transduced for the measurement. When enzymes are immobilized to an electronically active substrate, enzymatic reactions can be transduced by direct electron transport. This paper describes an approach for the development of graphene-based POC devices. This includes modifying enzymes for improved performance, developing methods to bind them to the graphene surface, incorporation of the functionalized graphene on a field-effect transistor (FET), and integration into a microfluidic device suitable for home use. This paper describes an approach for the development of a graphene-based POC biosensor platform using glucose as an example of target molecule. [ABSTRACT FROM AUTHOR]

There is growing evidence suggesting cannabinoids may provide suitable alternatives to conventional treatments in an increasing number of clinical settings. This review evaluates how cannabinoids are used to treat certain benign urological pathologies and to clarify the clinical value of this data. This review includes 62 papers and was undertaken per PRISMA's guidelines, it evidences the therapeutic potential of cannabinoids in the management of specific benign urological diseases, most notably neurogenic bladder dysfunction (clinical studies), renal disease (animal studies), and interstitial cystitis (animal studies). However, whilst cannabinoids are increasingly used, they cannot be considered reliable alternatives to more recognised treatments. [ABSTRACT FROM AUTHOR]

The current coronavirus disease 2019 (COVID-19) pandemic is placing a huge strain on health systems worldwide. Suggested solutions like social distancing and lockdowns in some areas to help contain the spread of the virus may affect special patient populations like those with chronic illnesses who are unable to access healthcare facilities for their routine care and medicines management. Retail pharmacy outlets are the likely facilities for easy access by these patients. The contribution of community pharmacists in these facilities to manage chronic conditions and promote medication adherence during this COVID-19 pandemic will be essential in easing the burden on already strained health systems. This paper highlights the pharmaceutical care practices of community pharmacists for patients with chronic diseases during this pandemic. This would provide support for the call by the WHO to maintain essential services during the pandemic, in order to prevent non-COVID disease burden on healthcare systems particularly in low-and middle-income countries. [ABSTRACT FROM AUTHOR]

Objectives: The growing number of chronic, multimorbid older adults encourages healthcare systems to cope with polypharmacy and non-adherence. However, methodology on how to provide effective interventions to enhance medication adherence is still object of debate.Methods: To describe methodological features of quantitative studies concerning older adults' medication adherence, by means of a PRISMA systematic review (Scopus, PubMed, Medline). A specific focus was devoted to theoretical models and to the ABC Taxonomy model, as stated by the EMERGE guidelines.Results: 55 papers were included. Most of the studies were conducted using randomized control trials (63.6%) and focused on a single disease only (72.7%). Most of the interventions were provided by a single professional figure (70.9%). Medication adherence was mainly evaluated by means of questionnaires (61.8%) and by clinical records (30.9%). Sixteen studies considered a theoretical model in the intervention framework. The Initiation phase (ABC Taxonomy) was the most neglected.Conclusions: Future studies upon medication adherence should account real-life challenges such as multimorbidity, polypharmacy and interdisciplinarity, analyzing adherence as a complex, holistic process.Practice Implications: Theoretical models may be useful to enhance the soundness of the results, to ease their comparability, to calibrate tailored strategies and to plan patient-centered interventions. [ABSTRACT FROM AUTHOR]