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

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

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]

• 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]

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]

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]

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]

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]

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]

We posit that destination vulnerability is the result of chronic conditions whose root causes lie dormant in plain sight, yet rear their ugly head during every crisis. This interdisciplinary review is motivated by the central research question: why do some destinations suffer more acute impacts in the same or similar crises than other destinations? While the paper falls short of providing a satisfactory answer, it reviews concepts such as resilience and vulnerability, the difference between shocks and stressors, and the types of hazards, and proposes a conceptual framework that highlights the physical, social-cultural, economic, ecological/environmental, and institutional dimensions of vulnerability. We also review the main findings in the literature on the experience of destinations during and after hazards, and illustrate the dimensions of destination vulnerability through evidence uncovered by prior studies. The paper affords Destination Management Organizations the language and conceptual understanding to identify vulnerability in their own destinations. [Display omitted] [ABSTRACT FROM AUTHOR]

Medical students with chronic health conditions are an underrepresented and often overlooked population in medical education. Previous research describes the dual roles they hold as both healthcare recipients and providers and details challenges they face related to accommodations and accessibility. However, less is known about how having a chronic health condition shapes the day-to-day aspects of medical education. To address this gap in knowledge, I conducted semi-structured interviews with eighteen medical students with chronic conditions and examined data using reflexive thematic analysis. Findings revealed the competing demands students face between medical school expectations and the need to manage their health. They work to reconcile these demands using tools like accommodations and strategic communication and by reconstructing narratives to re-assess self-imposed expectations. These participants understand having a chronic health condition as just one piece of their larger sense of self. Participants approach this understanding in individualized and nuanced ways, yet all share a cohesive view that their experiences having chronic health conditions inform their medical practice for the better through the development of genuine empathy for patients. This paper concludes with recommendations drawn from participant interviews of how medical schools can better support students with chronic health conditions. • Chronic condition management and medical training compete for time and energy. • Demands are reconciled at structural, interpersonal, and intrapersonal levels. • Having a chronic condition influences but does not define medical training. • First-hand healthcare experiences build genuine empathy and improve patient care. [ABSTRACT FROM AUTHOR]

This paper presents the current status of transforming stressed plants into healthy foods and the future trends in this emerging field. Herein, we describe the three major key elements to advance this field, including a better understanding of the mode of action of oxidative stress on nutraceutical biosynthesis under pre- and postharvest scenarios either converting plants into biofactories of nutraceuticals or creating 'functional fresh produce' while preserving quality. We discuss the need of designing healthy products based on stressed fresh produce and by-products and present a pragmatic strategy to enhance nutraceuticals in plants, and finally we propose designing appropriate studies with stressed plants targeting immunomodulatory properties to determine preventive and therapeutic effects against chronic diseases and the appropriate recommended dose. [Display omitted] • Stressed plants can be transformed into healthy foods. • Oxidative stress plays a key role in nutraceutical biosynthesis. • Fresh produce, by-products, and waste can be used as sources of nutraceuticals. • Immunomodulatory properties of stressed plant bioactives play a key role against chronic diseases. [ABSTRACT FROM AUTHOR]

Fatigue is significantly more prevalent in the chronically ill compared to healthy individuals. Fatigue is one of the most reported and debilitating symptoms in individuals with chronic health conditions. Despite this, there is limited evidence examining the efficacy of psychological interventions to reduce fatigue, with the majority having focused on Cognitive Behaviour Therapy. As Acceptance and Commitment Therapy (ACT) has shown to be efficacious in improving other outcomes for people with chronic health conditions, this systematic review and meta-analysis aimed to determine the efficacy of ACT in reducing fatigue for this population. A systematic search in MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library, US National Library of Medicine Clinical Trial Register and reference lists of relevant papers was conducted to obtain relevant studies. Inclusion criteria specified the study needed to be a randomised controlled trial which implemented an ACT predominant intervention and measured fatigue in adults with a chronic health condition. Data was pooled using the inverse-variance random effects model, with restricted maximum likelihood estimation, providing the standardized mean difference between control and experimental groups post intervention. The current systematic review and meta-analysis included eight RCTs. Participants with a chronic condition (including cancer and fibromyalgia) who received ACT interventions, displayed reduced levels of fatigue, indicative of a small effect (SMD = −0.16, 95% CI [−0.30, −0.01], p = 0.03). While the evidence is limited to cancer and fibromyalgia, ACT shows promise in reducing fatigue. Future research should examine ACT for fatigue in other chronic health condition populations to broaden the scope of these findings. • Fatigue is one of the most reported and debilitating symptoms in chronic health conditions. • ACT has been proposed as a potential psychological intervention for fatigue in chronic health conditions. • ACT interventions show some efficacy for reducing fatigue in chronic health conditions. • Only RCT's relating to chronic health conditions cancer and fibromyalgia met eligibility criteria. [ABSTRACT FROM AUTHOR]

With mHealth apps, data can be recorded in real life, which makes them useful, for example, as an accompanying tool in treatments. However, such datasets, especially those based on apps with usage on a voluntary basis, are often affected by fluctuating engagement and by high user dropout rates. This makes it difficult to exploit the data using machine learning techniques and raises the question of whether users have stopped using the app. In this extended paper, we present a method to identify phases with varying dropout rates in a dataset and predict for each. We also present an approach to predict what period of inactivity can be expected for a user in the current state. We use change point detection to identify the phases, show how to deal with uneven misaligned time series and predict the user's phase using time series classification. In addition, we examine how the evolution of adherence develops in individual clusters of individuals. We evaluated our method on the data of an mHealth app for tinnitus, and show that our approach is appropriate for the study of adherence in datasets with uneven, unaligned time series of different lengths and with missing values. • Change point detection is used to identify phases of attrition; Dynp performs best. • Prediction of attrition phases; XGBoost predicts well even on challenging data. • Automated gap label detection; Fischer–Jenks algorithm outperforms other approaches. • Prediction of gap labels on time series with gaps; 1-NN (+DTW) alone not sufficient. • Clustering to find groups with special adherence patterns; HDBSCAN suitable for task. [ABSTRACT FROM AUTHOR]

Chronic pain conditions like genito-pelvic pain penetration disorder and chronic pelvic pain cause significant morbidity in women worldwide and yet are underdiagnosed and undertreated. While the use of botulinum toxin for pain conditions has expanded, there are few randomized controlled studies of botulinum toxin for pelvic pain conditions in women. This paper provides an update on the current status and context for considering botulinum toxin treatment for these conditions to complement and expand currently available approaches. High quality clinical trials to evaluate safety and efficacy and to determine optimal doses and approaches to injection are urgently needed. • We discuss the current status of botulinum toxin use for these conditions to complement and expand treatment options. • Additional studies are needed on dosing, dilution, and optimizing methods of botulinum toxin injection for these conditions. • High quality trials to evaluate the safety and efficacy of botulinum toxin for these conditions are urgently needed. [ABSTRACT FROM AUTHOR]

Here we propose the term 'biographical dialectics' as a sister term to 'biographical disruption' to capture the ongoing problem solving that characterises the lives of many people living with life limiting chronic illnesses. The paper is based on the experiences of 35 adults with end-stage kidney disease (ESKD) in receipt of haemodialysis. Photovoice and semi-structured interviews showed that ESKD and the use of haemodialysis was widely agreed to be biographically disruptive. In talking about and showing disruption through photographs the participants' ongoing problem solving was universal across their diverse experiences. 'Biographical disruption' and Hegalian dialectical logic, are drawn on to make sense of these actions and to further understand the personal and disruptive experience of chronic illness. Based on this, 'biographical dialectics' captures the work that is required to account for and manage the enduring and biographical impact of chronic illness that follows the initial disruption of diagnosis and continues as life progresses. • Chronic illness can require ongoing problem solving. • The need for regular treatment (such as haemodialysis) can exacerbate disruption. • Biographical dialectics makes sense of ongoing problem solving behaviour. • Biographical dialectics draws on Hegel's dialectical logic. • Biographical dialectics can be used alongside biographical disruption. [ABSTRACT FROM AUTHOR]

This paper studies referral strategy and effort provision of a primary care physician and a specialist who are responsible for the treatment of chronically ill patients who can be in a mild or severe condition. Two organizational settings are compared, a team in which physicians cooperate and solo practices in which they do not. Team care is strictly superior to solo practice care if the difference in expected treatment costs between disease severities is relatively larger for the primary care physician. Otherwise, solo practice care is weakly superior to team care under reasonable assumptions. [ABSTRACT FROM AUTHOR]

Approximately 19 million people die each year from cardiovascular and chronic respiratory diseases. As a result of the recent Covid-19 epidemic, blood pressure, cholesterol, and blood sugar levels have risen. Not only do healthcare institutions benefit from studying physiological vital signs, but individuals also benefit from being alerted to health problems in a timely manner. This study uses machine learning to categorize and predict cardiovascular and chronic respiratory diseases. By predicting a patient's health status, caregivers and medical professionals can be alerted when needed. We predicted vital signs for 180 seconds using real-world vital sign data. A person's life can be saved if caregivers react quickly and anticipate emergencies. The tree-based pipeline optimization method (TPOT) is used instead of manually adjusting machine learning classifiers. This paper focuses on optimizing classification accuracy by combining feature pre-processors and machine learning models with TPOT genetic programming making use of linear and Prophet models to predict important indicators. The TPOT tuning parameter combines predicted values with classical classification models such as Naïve Bayes, Support Vector Machines, and Random Forests. As a result of this study, we show the importance of categorizing and increasing the accuracy of predictions. The proposed model achieves its adaptive behavior by conceptually incorporating different machine learning classifiers. We compare the proposed model with several state-of-the-art algorithms using a large amount of training data. Test results at the University of Queensland using 32 patient's data showed that the proposed model outperformed existing algorithms, improving the classification of cardiovascular disease from 0.58 to 0.71 and chronic respiratory disease from 0.49 to 0.70, respectively, while minimizing the mean percent error in vital signs. Our results suggest that the Facebook Prophet prediction model in conjunction with the TPOT classification model can correctly diagnose a patient's health status based on abnormal vital signs and enables patients to receive prompt medical attention. • Propose an in-depth analysis of the sensors dataset used in the designed model. • Develop the model for chronic respiratory and cardiovascular disease. • Results showed that the designed model outperforms the SOTA approaches. [ABSTRACT FROM AUTHOR]

In this paper, we study a healthcare system consisting of a healthcare provider and heterogeneous patients. We consider that when a patient with a chronic condition is discharged from the hospital, the condition will deteriorate over time and may eventually result in readmissions. To slow chronic disease progression, hospitals need to make a scientific disease monitoring decision over a prespecified period to observe the status of the patient's condition and implement the necessary intervention measures. This work aims to develop a decision-making model from a cost perspective under healthcare warranties for monitoring chronic diseases, where the disease monitoring strategy consists of different types of follow-up checkups. Borrowing from reliability analysis techniques to simulate a system prone to failure, we model the disease dynamics as a reliability problem. We assume that the time to readmission after discharge follows a Weibull distribution and divide patients into different risk groups according to their individual heterogeneity. We also introduce a reduction of intensity model to measure the effect of different follow-up checkups on disease progression. Based on the proposed model, the optimal intervals of the multiple follow-up checkups for monitoring heterogeneous patients under a healthcare warranty can be derived. Finally, a case study involving diabetes patients is presented to validate the proposed model and analyse the effects of critical parameters on the optimal monitoring decisions. This work has potential for reducing hospital readmissions and healthcare costs, and the proposed model can be applied to a broad range of chronic diseases to devise patient-specific disease monitoring plans. • A decision-making model for monitoring chronic disease progression under healthcare warranties is proposed. • The proposed model includes multiple levels of follow-up checkups at different intervals. • Reliability analysis techniques are introduced to model disease dynamics and effectiveness of different follow-up checkups. • A case study is presented to demonstrate the proposed model based on data from a large general hospital in Tianjin, China. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, the patient care delivery paradigm rapidly shifted to remote technological solutions. Rising rates of life expectancy of older people, and deaths due to chronic diseases (CDs) such as cancer, diabetes and respiratory disease pose many challenges to healthcare. While the feasibility of Remote Patient Monitoring (RPM) with a Smart Healthcare Monitoring (SHM) framework was somewhat questionable before the COVID-19 pandemic, it is now a proven commodity and is on its way to becoming ubiquitous. More health organizations are adopting RPM to enable CD management in the absence of individual monitoring. The current studies on SHM have reviewed the applications of IoT and/or Machine Learning (ML) in the domain, their architecture, security, privacy and other network related issues. However, no study has analyzed the AI and ubiquitous computing advances in SHM frameworks. The objective of this research is to identify and map key technical concepts in the SHM framework. In this context an interesting and meaningful classification of the research articles surveyed for this work is presented. The comprehensive and systematic review is based on the "Preferred Reporting Items for Systematic Review and Meta-Analysis" (PRISMA) approach. A total of 2540 papers were screened from leading research archives from 2016 to March 2021, and finally, 50 articles were selected for review. The major advantages, developments, distinctive architectural structure, components, technical challenges and possibilities in SHM are briefly discussed. A review of various recent cloud and fog computing based architectures, major ML implementation challenges, prospects and future trends is also presented. The survey primarily encourages the data driven predictive analytics aspects of healthcare and the development of ML models for health empowerment. [ABSTRACT FROM AUTHOR]

Specialist digital platforms are enabling unprecedented opportunities for changing routines in the context of health self-management. The emergence of app features for self-management of chronic conditions is transforming the use of digital platforms. In this respect, many developers struggle to understand how diverse users use different features for health self-management. The purpose of this paper is to examine the relationship between user characteristics and their use of three common features in specialist healthcare platforms, namely app exercises, app lessons, and app messages. The results indicate that the use of each platform feature may be associated with particular user characteristics. Specifically, pain intensity is positively related to the use of exercises, lessons, and messaging features for health self-management, while the relationships between app use and physical activity, fear of movement, and other chronic conditions vary with the app feature. Thus, our findings highlight the complexity of the use of digital platform features for self-management of chronic conditions. • Use of different digital platform features for health self-management are associated with different user characteristics. • Pain intensity is positively related to use of exercises, lessons, and messaging features for health self-management. • Relationships of app use with physical activity, fear of movement, and other chronic desease vary with the app feature. [ABSTRACT FROM AUTHOR]

[Display omitted] • For the first time, rGO-SnO 2 -SS superstructure is investigated for the detection of HCHO. • Noble metal free sensing material with high sensitivity (10 ppb) towards HCHO at 125 °C. • The rGO-SnO 2 -SS hybrid composite exhibits excellent HCHO selectivity. • Detection of HCHO in the exhaled breath for the screening of lung cancer patients. • e-nose sensor array capable of effectively discriminating between healthy breath and lung cancer breath. Detecting specific biomarkers in human breath is essential for diagnosing various diseases, including lung cancer, asthma, and halitosis. Formaldehyde (HCHO) is a vital biomarker found in the exhaled breath of lung cancer patients. The threshold concentration of HCHO in lung cancer patients is 83 parts per billion (ppb), as opposed to 48 ppb in healthy people. Over the years, several semiconductor metal oxide (SMO)-based gas sensors have been proposed to detect HCHO. However, the detection of HCHO at ppb levels in complex environments at relatively low operating temperatures remains challenging. In this paper, we have discussed a high-performance HCHO sensor that employs three-dimensional (3D) reduced graphene oxide-incorporated SnO 2 nanosphere superstructural architectures (rGO-SnO 2 -SS). The proposed sensor exhibited excellent sensitivity (as low as 100 ppb with a detection limit of 10 ppb at 125 °C). The rGO-SnO 2 -SS sensor exhibited a 4.15-fold, 3.59-fold, 1.44-fold and 2.58-fold increase in sensing response compared to the bare SnO 2 -nanospheres (SnO 2 -NS), rGO-SnO 2 tiny superstructures (rGO-SnO 2 -TSS), rGO-SnO 2 partial superstructures (rGO-SnO 2 -PSS) and rGO-SnO 2 nanocomposite (rGO-SnO 2 -NC) sensors. An evaluation of the ability of the proposed sensor to diagnose lung cancer by detecting HCHO in exhaled breath revealed that in the rGO-SnO 2 -SS hybrid nanocomposite-based e-nose sensor arrays, the signals from healthy and simulated lung cancer breaths did not overlap, i.e., healthy, and unhealthy breaths, could be differentiated with pinpoint accuracy. Thus, the proposed sensor based on rGO-SnO 2 -SS can be effectively used to easily screen lung cancer patients and monitor indoor HCHO concentrations. [ABSTRACT FROM AUTHOR]

• Improvised Grey wolf optimizer for feature selection on medical data. • Proposed method ranks best over other Nature Inspired Algorithms. • Identification of significant features of chronic disease data. • Prediction of the output class for each data using significant features. In the field of Chronic disease prediction, identifying the relevant features plays an important role for early disease diagnosis. With a high dimensionality of data, search for an adequate subset feature increases exponentially and is categorised as NP hard problem. Nature Inspired Algorithm (NIA) have been famous to tackle this problem by finding an optimum solution in a reasonable amount of time. Grey wolf optimizer (GWO) is an emerging and powerful NIA used in wrapper feature selection method. It is well known for its flexibility, simplicity and efficient results. However, GWO have unsatisfactory results on local searching ability, and a slow convergence rate. To improve the local search and find a balance between exploration and exploitation, this paper proposes a Random Walk Grey Wolf Optimizer based on dispersion factor (RWGWO) approach to the feature selection problem. To demonstrate the methodology, a set of classification measures is evaluated and examined on eighteen different chronic disease data. For a fair comparison, RWGWO is compared with several recent state of the art method. Finding shows that RWGWO method ranks best over other NIAs and is able to drastically reduces the features size on each chronic disease data. Further, identification of significant set of features from each data is determined using obtained features of RWGWO. The significant features are able to enhance the classification accuracy of the presented data and solves the dimensionality reduction problem. [ABSTRACT FROM AUTHOR]

Drawing on interviews conducted in 2019–2020, across twenty villages in India, this paper unpacks how people with chronic illness navigate complex care-seeking terrain. We show how the act of seeking care involves navigating through personal, family, social, economic, cultural, and most importantly, difficult health systems spaces—and entails making difficult social, moral, and financial choices. We show how the absence of reliable and accessible points of first contact for primary care results in people running from pillar to post, taking wrong turns, and becoming disappointed, frustrated, and, sometimes, impoverished. We reveal the complex individual and social dynamics of hope and misplaced and misguided expectations, as well as social obligations and their performance that animate the act of navigating care in rural India. We shine light on how a health system with weak primary care and poor regulation amplifies the medical, social, and financial consequences of an otherwise manageable chronic illness, and how these consequences are the worst for those with the least social, network and economic capital. Crucially we highlight the problematic normalisation of the absence of reliable primary care services for chronic illness in India, in rural India specifically. We signpost implications for research, and for policy and practice in India and similar health system contexts, i.e. those with weak primary care and poor regulation of the private sector. We argue that in India, having in place accessible, good quality, and trustworthy sources of advice and care for chronic illness at the first point of call, for all, is critical. We contend that this first point of call should be quality, public primary care services. We conclude that if such arrangements are in place in public services, people will use them. • Lack of reliable, trustworthy advice and care is a big gap in India's health system. • Being misled and suffering catastrophic consequences of ill-health is the result. • People need to be protected from bad actors in their care-seeking journeys. • People want reliable, trustworthy advice and care, at their first point of call. • India's health system must urgently act to ensure appropriate care at all levels. [ABSTRACT FROM AUTHOR]

• Infectious diseases are growing rapidly in the elderly and in the community • IoT devices provide effective access to body data • Immunization algorithms effectively predict transmission trends Due to the global influenza pandemic and the increasing health problems of the elderly, healthcare for the elderly has become an important application of Internet of Things(IoT) technology. However, under the condition of smart healthcare, the privacy of the elderly is not well protected. Therefore, to ensure the information security of the elderly, this paper proposes a management method for elderly chronic diseases based on the IoT security environment, establishes a security protection mechanism, and uses the IoT technology to monitor the vital signs of the elderly in real-time. At the same time, the Disease Immune Rehabilitation Algorithm (DIRA) is constructed based on the physiological data collected by the device to identify healthy people and reduce the number of infected people. Through experiments on several generations, the results show that this method can increase the proportion of the immune population to a certain extent and reduce the number of infected people. [Display omitted] [ABSTRACT FROM AUTHOR]

This paper investigated whether the commonly observed immigrant health advantage persists among undocumented immigrants in the U.S. and provides nationally representative evidence on the health of this vulnerable population. Data were derived from pooled cross-sections of the National Health Interview Survey (NHIS, 2000–2018). The legal status of foreign-born NHIS respondents is imputed using a non-parametric machine learning model built based on information from the 2004, 2008 and 2014 cohorts of the Survey of Income and Program Participation (SIPP). Multivariate logistic regression analysis indicated that, despite exposure to numerous additional risk factors, the undocumented population experienced a more pronounced Healthy Migrant Effect, with lower odds of reporting fair or poor self-rated health, any physician-diagnosed chronic conditions or being obese. The observed patterns in undocumented health outcomes may be related to the additional challenges and exclusionary policies associated with undocumented migration that could in turn lead to a more pronounced selection of healthy and resilient individuals. • Undocumented immigrants had 26% lower odds of reporting poor or fair health. • Undocumented immigrants had 23% lower odds of having been diagnosed with a chronic condition. • Undocumented immigrants had 8% lower odds of being obese. • Differences in health behaviors do not explain the health advantage of undocumented immigrants. • Residence in the US 5+ years is positively associated with worse health outcomes. [ABSTRACT FROM AUTHOR]

Avoidance is a hallmark symptom and a primary maintaining factor in anxiety disorders. Theories of anxiety disorders have focused not only on overt avoidance, but also on more subtle avoidance known as 'safety behaviours'. Safety behaviours involve behaviours which aim to reduce anxiety or prevent a feared outcome from occurring. In the long-term, however, these behaviours prevent the disconfirmation of threat because safety is incorrectly attributed to the safety behaviour, thus perpetuating anxiety. As a result, reducing or eliminating safety behaviours is an important target for many cognitive behaviourally oriented treatments. Notably, despite the relevance of anxiety to people with chronic health problems, the role of safety behaviours is rarely discussed in these contexts. Further, safety behaviours among those with chronic health problems pose a particularly complex problem. Distinguishing adaptive safety precautions from maladaptive safety behaviours can be a difficult task. In this paper, we discuss the role of safety behaviours in maintaining and treating anxiety problems in healthy adults, and whether these same principles apply to those with chronic illness. We propose a functional and contextual model of differentiating between safety behaviours and safety precautions amongst those with chronic physical illness. Lastly, we propose methods for adapting the treatment of anxiety disorders in the context of chronic physical illness. • Safety behaviours in anxiety in the context of ill health have been rarely studied • Some behaviours that aim to increase safety are necessary, that is safety precautions • Other behaviours are disproportionate to the risk and can increase anxiety • We propose a decision matrix to help distinguish between safety behaviours and safety precautions. • Behaviours that are proportionate to a realistic risk, and encourage approach to valued activities can be encouraged. [ABSTRACT FROM AUTHOR]

The patient-provider relationship is considered a cornerstone to delivering high-value healthcare. However, in Medicaid managed care settings, disruptions to this relationship are disproportionately common. In this paper, I evaluate the impact of a primary provider's exit from a Medicaid managed care plan on adult beneficiary healthcare utilization and outcomes. Using an event study approach, I estimate a 5% decrease in the number of beneficiaries with primary care visits in the year following the exit, with slightly larger effects in terms of percentage points for patients with chronic conditions. Additionally, I observe a nearly 50% increase in the number of beneficiaries with a chronic condition who are hospitalized following a disruption. [ABSTRACT FROM AUTHOR]

The study examines dietary advice-giving in regular consultations for patients with chronic conditions in two types of clinical practices: Traditional Chinese Medicine and Western Medicine practiced in mainland China. Dietary habits are unanimously considered relevant to the patient's health, particularly in chronic conditions. This article reports the differences in where and how dietary advice is occasioned and co-constructed by participants in two settings. One significant finding of this paper is that while Traditional Chinese Medicine doctors take dietary talk to instruct patients and put it into the treatment recommendation, WM doctors may treat it as incidental and only valuable for diagnostic assessment, leaving its treatment opaque and not discussed with the patient. Data are in Mandarin Chinese. Using Conversation Analysis, the article describes the interactional organisation of dietary advice delivery in different medical practices and ascribes their differences to clinical pathology. • Diet as a treatment proposal or not. • Infrequent dietary advice-giving in WM encounters. • Frequent dietary advice-giving in TCM closings. • The organisation of advice reflects clinical understandings of diet. [ABSTRACT FROM AUTHOR]

[Display omitted] • Metformin (MF) induces hormetic biphasic dose responses. • MF induces hormesis in various organs, cells, and endpoints. • MF-induced hormesis improves resilience under stress conditions. • Activation of Nrf2 is a key mechanism. • MF hormesis can prevent numerous aging-related health conditions. The present paper demonstrates that metformin (MF) induced a broad spectrum of hormetic biphasic dose responses in a wide range of experimental studies, affecting multiple organ systems, cell types, and endpoints enhancing resilience to chemical stresses in preconditioning and co-current exposure protocols. Detailed mechanistic evaluations indicate that MF-induced hormetic-adaptive responses are mediated often via the activation of adenosine monophosphate-activated kinase (AMPK) protein and its subsequent upregulation of nuclear factor erythroid 2-related factor 2 (Nrf2). Hormesis-induced protective responses by MF are largely mediated via a vast and highly integrated anti-inflammatory molecular network that enhances longevity and delays the onset and slows the progression of neurodegenerative and other chronic diseases. [ABSTRACT FROM AUTHOR]