脑小血管疾病血脑屏障通透性与MRI总负担的相关性

目的 通过动态增强MRI（DCE-MRI）探讨血脑屏障（BBB）通透性与脑小血管疾病（CSVD）MRI总负担之间的关系。方法 对104例患者以5分制CSVD影像学总负担评分表进行评价，包括腔隙性梗死（lacunes）、脑白质高信号（WMH）、脑微出血（CMB）、血管周围间隙扩大（EPVS）和脑萎缩（BA），并根据得分0~5分为CSV0组（0分）~CSVD5组（5分）共6组。对各组均行DCE-MRI，并以Patlak双室药代动力学模型测量WMH、常规MRI表现正常的脑白质区（NAWM）、皮层灰质区（CGM）以及深部灰质区（DGM）BBB通透性。结果 最终纳入99名，校正年龄、性别和血管危险因素后，NAWM、WMH、CGM及DGM 4个区域的CSVD影像学总负担与渗漏速率（K_trans）和曲线下面积（AUC）均呈显著正相关（P均<0.05）；NAWM、CGM及DGM区域CSVD影像学总负担与局部脑血浆容量（V_p）呈显著负相关（P<0.05）。结论 CSVD患者BBB通透性增高与其MRI所示总CSVD负担相关；BBB受损可能是CSVD病理生理过程的关键因素之一。     

多模态MRI评价皮层下血管性认知功能障碍白质高信号半暗带

目的探讨不同MR成像技术评价皮层下血管性认知功能障碍(SVCI)患者脑白质高信号(WMH)半暗带(WMH-P)的价值。方法对29例SVCI患者行弥散加权成像(DTI)、三维动脉自旋标记(3D-ASL)和酰胺质子化学交换饱和转移(CEST APT)扫描及神经心理学评估。将WMH周围1 cm范围为定义WMH-P,分别测量WMH、WMH-P及WMH-P以外正常表观白质(NAWM)的各项成像参数值,并与认知评分进行相关性分析。结果FA和MD值在WMH、WMH-P及WMH-P以外NAWM之间差异均有统计学意义(P均<0.05),脑血流量(CBF)在WMH-P与WMH-P以外NAWM以及WMH与WMH-P以外NAWM之间均有统计学意义(P均<0.05)。WMH-P和WMH-P以外NAWM的FA值与MoCA评分呈显著正相关(P均<0.05)。结论DTI技术与3D-ASL能反映SVCI患者脑白质病变范围及进展趋势;WMH-P的FA值能较好地评价SVCI患者认知功能水平。     

White matter hyperintensities do not impact cognitive function in patients with newly diagnosed Parkinson's disease

The objective of this study was to investigate total volume and spatial distribution of white matter hyperintensities (WMH) in a large sample of newly diagnosed Parkinson's disease (PD) patients with and without mild cognitive impairment (MCI) compared to normal controls (NC). Furthermore, we aimed to examine the impact of the WMH on attention–executive performance in PD. MCI is regarded as a pre-dementia stage. Studies on MCI have found WMH associated with reduced cognitive function, especially in the attention and executive domains. The present study included 163 incident, drug-naïve PD patients (66.2 ± 9.1 years and disease duration 27.1 ± 19.8 months) and 102 age-matched NC (65.7 ± 9.4 years). Thirty (30) subjects in the PD sample presented MCI, whereas 133 did not. MCI was classified based on tests for memory, attention–executive and visuospatial function compared to the NC group, taking age, sex and education into consideration. WMH were outlined on FLAIR scans using a semi-automated technique. Total WMH volumes were compared between the 3 study groups, and spatial distribution of normalized WMH masks in each group were compared using voxel-wise probability maps. Regression analysis examined the possible impact of WMH on attention–executive scores in the PD group. Analysis showed that there were no significant differences between the 3 groups in total volume or spatial distribution of WMH. In addition there was no significant relationship between total volume or spatial distribution of WMH and attention–executive functions in PD. We conclude that in this PD cohort, cognitive impairment seems to be independent of WMH damage.     

The effect of postintensive care syndrome on the quality of life of intensive care unit survivors: A secondary analysis

BackgroundDespite increasing interest in postintensive care syndrome and the quality of life of intensive care unit survivors, the empirical literature on the relationship between these two variables is limited.ObjectivesThis study aimed to examine whether postintensive care syndrome predicts the quality of life of intensive care unit survivors.MethodsWe analysed secondary data, which were collected as part of a larger cross-sectional study. The participants were recruited from six health institutions in Korea. The data of 496 survivors who had been admitted to an intensive care unit for at least 48 h during the past year were analysed. They responded to measures of postintensive care syndrome and quality of life.ResultsThe participants' mean physical and mental component summary scores (quality of life) were 40.08 ± 8.99 and 40.24 ± 11.19, respectively. Physical impairment (β = ?0.48, p < 0.001), unemployment (β = ?0.19, p < 0.001), low income (β = ?0.11, p = 0.004), older age (β = ?0.08, p = 0.039), and cognitive impairment (β = ?0.11, p = 0.045) predicted lower physical component summary scores. Mental (β = ?0.49, p < 0.001) and cognitive impairment (β = ?0.14, p = 0.005) and low income (β = ?0.09, p = 0.014) predicted mental component summary scores.ConclusionsThe participants reported poor physical and mental health–related quality of life. Postintensive care syndrome, unemployment, low income, and older age were the main predictors of poor quality of life. In addition, postintensive care syndrome was a stronger risk factor for poor quality of life than demographic characteristics and intensive care unit treatment factors.     

动态增强MRI定量评价缺血性脑白质病患者血脑屏障通透性

目的 采用动态增强MRI（DCE-MRI）观察缺血性脑白质病变患者血脑屏障（BBB）通透性的改变及其与认知功能的相关性。方法 对71名受试者行常规MR、DCE-MR检查、简易智力状况检查量表（MMSE）评分及Fazekas评分,并根据Fazekas评分将其分为病例组和对照组。测量脑白质FLAIR高信号区及周围常规MRI表现正常脑白质区的渗透率（K_trans）、渗透曲线下面积（AUC）和血浆容积分数（V_p）值,比较2组间差异,并分析各参数与MMSE评分的相关性。结果 病例组脑白质FLAIR高信号区及脑白质正常区K_trans、AUC值均高于对照组（P均<0.001）,其脑白质正常区V_p值较对照组减低（P=0.015）,脑白质高信号区K_trans、AUC值与MMSE评分呈负相关（r=-0.440、-0.540,P均<0.001）。结论 缺血性脑白质病患者脑白质FLAIR高信号区及周围脑白质表现正常区BBB通透性增加,且与认知功能相关。     

Lateral epicondylitis: Are we missing out on radial nerve involvement? A cross-sectional study

IntroductionLateral epicondylitis (LE) is a common ailment causing pain and functional limitations. There is an inadequate understanding of its etiopathogenesis. Involvement of the radial nerve (RN) as the primary causative factor for this condition remains debatable. The aim of the present study was to assess the RN thickness in patients with LE and compare it with the unaffected side.MethodsThe study included seventy eligible patients (M:F, 22:48) in the age group of 30–60 years with a clinical diagnosis of LE. The cross-sectional area of RN was measured at the spiral groove (SG) and around the antecubital fossa (AF) using ultrasound and compared with the unaffected side. Numeric Pain Rating Scale (NPRS) and the QuickDASH scale were used to assess pain and functional impairment.ResultsThickness of RN at the AF (p = 0.026) and the SG (p = 0.0117) on the affected were statistically significant compared to the unaffected side in the cohort comprising of all the 70 patients. Out of 70 patients, increased thickness was seen in 23 at the SG and 19 at the AF. QuickDASH was statistically significant in patients who had thickened nerves compared to the unaffected side at the SG (p = 0.04) but not at the AF (p = 0.16). NPRS was not statistically significant at either the AF (p = 0.34) or the SG (p = 0.71) in patients with thickened nerves.ConclusionTennis elbow needs to be no longer acknowledged only as tendinopathy. It also requires consideration of the involvement of the RN.     

系统性红斑狼疮患者脑小血管病变的MRI初步研究

目的:应用MRI常规序列对系统性红斑狼疮(SLE)患者脑内血管周围间隙扩大(EPVS)、白质高信号(WMH)及腔隙灶进行评估,初步分析SLE患者脑小血管病变的MRI表现。材料与方法:回顾性收集29例SLE患者及29例年龄、性别与SLE组相匹配的健康体检者作为对照组。通过观察EPVS、WMH及腔隙灶的情况,对其进行相应的分级及评分。并记录SLE患者临床及化验室检查指标。应用SPSS 24.0版统计软件进行数据分析,等级资料用Kolmogorov-Smirnov Z检验分析组间差异,应用Spearman相关分析法分析EPVS、WMH及腔隙灶与临床、实验室检查之间的相关性。结果:在半卵圆中心,SLE组的EPVS评分(2.52±0.91)显著高于对照组(1.34±0.55,P<0.01);SLE组脑室周围白质高信号(PVH)和深部脑白质高信号(DWMH)均较对照组更明显(P<0.01);SLE组腔隙灶的发生率高于对照组(P<0.05)。并且半卵圆中心EPVS及PVH与补体C3相关(r=0.505,0.400,P均<0.05);EPVS和WMH与病程呈正相关(r=0.460、0.428、0.416、0.404,P均<0.05)。结论:脑小血管病变是SLE中枢神经系统病变的常见表现,并与补体C3及病程具有关联性。     

脑白质病变与老年首次短暂性脑缺血/轻型卒中患者认知功能障碍的研究

目的探讨老年首次短暂性脑缺血/轻型卒中患者认知功能障碍与脑白质高信号（WMHs）的关系。 方法选取2015年1月至2018年12月无锡市锡山人民医院神经内科收治的,符合标准的105例老年首次短暂性脑缺血/轻型卒中患者,均行头颅MRI等检查,患者认知障碍根据蒙特利尔认知评估量表（MoCA）评分结果分为无认知障碍组、暂时性认知障碍组和持续性认知障碍组。采用单因素方差分析比较3组间年龄、美国国立卫生院卒中量表评分、MoCA评分的差异,组间差异两两比较应用q检验;采用χ²检验比较组间性别（男性）、高血压、糖尿病、高脂血症、MRI影像改变及梗死部位的差异;采用多因素Logistic回归分析老年首次短暂性脑缺血/轻型卒中患者发生认知功能障碍的危险因素。 结果持续性认知障碍组患者的年龄、男性比例和WMHs比例高于无认知障碍组,差异均具有统计学意义（P<0.05）;而在高血压、糖尿病、高脂血症、脑微出血、血管间隙扩大、腔隙性缺血灶、磁共振弥散加权成像（DWI）阳性病变及DWI显示脑梗死病变部位比较差异均无统计学意义（P均>0.05）。WMHs病变程度越严重,发生认知障碍的比例越高,差异具有统计学意义（P<0.05）。经校正年龄、性别、高血压、糖尿病等因素后,年龄和中-重度WMHs病变为老年首次短暂性脑缺血/轻型卒中后持续性认知功能障碍发生的独立危险因素（OR：1.08,95%CI：1.01~1.15,P=0.021;OR：1.66,95%CI：0.79~2.89,P=0.042）。 结论年龄和WMHs中-重度病变为老年首次短暂性脑缺血/轻型卒中患者第90天后发生持续性认知障碍的危险因素。     

Poor long-term recovery after critical COVID-19 during 12 months longitudinal follow-up

ObjectivesThis study aimed to describe the burden of illness and impact on health and working situation among former intensive care patients treated for COVID-19.MethodsA prospective cohort study was performed at one intensive care unit of a university hospital in Sweden during the first wave of COVID-19 in spring 2020. The burden of illness in health status, cognitive, physical, and psychological outcomes, and working situation were assessed at four and 12 months after discharge from intensive care, using nine validated instruments.ResultsForty-six participants treated for COVID-19 participated in both follow-ups and were included in this study. General fatigue was reported by 37 of 46 participants (82%) at both follow-ups (p = 1.000). For overall health status 28 (61%) participants at the first follow-up and 26 (57%) (p = 0.414) at the second reported lower values than the general population. Cognitive impairment was seen in 22 (52%) participants at four months and in 13 (31%) at 12 months (p = 0.029). The proportion of participants on sick-leave decreased between the first and second follow-up (24% vs 13%, p = 0.025), but the proportion of participants working full-time was almost the same at both follow-ups (35% vs 37%, p = 0.317).ConclusionsThe burden of illness of patients treated in intensive care due to COVID-19 included cognitive, physical, and psychological impacts. Cognitive functions were improved after 12 months, but no clear improvements could be distinguished in the physical or psychological outcome. Higher burden of illness was associated with inability to return to work.     

Correlation between functional capacity and oxidative stress and inflammation in hemodialysis patients

IntroductionPatients with chronic kidney disease (CKD) may present impaired functional capacity due to peripheral muscle involvement. Oxidative stress and inflammation are probably involved in this pathophysiology. This study aimed to evaluate the association between functional capacity and biomarkers of oxidative stress as well as biomarkers of inflammation in patients under chronic hemodialysis therapy.MethodCross-sectional study including 41 patients from a single hemodialysis center. Functional capacity was assessed through the 6-min walk test (6MWT). The assessed blood biomarkers were: malondialdehyde (MDA) (oxidative stress, TBARS method) and angiopoietin-2 (Ang-2) (inflammation, ELISA). The influence of gender on impairment of functional capacity was further explored.ResultsThere was an inversely proportional correlation between the 6MWD and MDA (r = -,322 and p = 0.040) and Ang-2 (r = -, 376 and p = 0.016) values. 6MWD was 370.9 ± 101.2 m and 391.4 ± 108.2 m in women and men, respectively (p < 0.001), which means 29.3% and 34.3% reduction of the expected values for healthy individuals from the same age range.ConclusionPatients with CKD under hemodialysis, regardless of gender, presented impaired performance in 6MWT and this impairment was associated with oxidative stress and inflammation.     

Effect of an exercise program with blood flow restriction on the muscular strength of patients with chronic kidney disease: A randomized clinical trial

IntroductionAn arteriovenous fistula (AVF) is performed in chronic kidney disease (CKD) patients before hemodialysis, who may benefit from exercise. The aim of this study was to evaluate the effect of an exercise program associated with partial limb blood flow restriction (BFR) on handgrip strength (HGS) and forearm circumference of CKD patients.MethodsA total of 26 patients with CKD were randomized to the BFR experimental group (EG, n = 12) and to the non-BFR control group (CG, n = 14) prior to AVF, and underwent isometric exercises for the flexor muscles of the fingers and elbow where the AVF will be performed.ResultsThere were no differences at the end of eight weeks of training between the EG and CG groups [F (1.23) = 0.03, p = 0.96] regarding the HGS and the forearm circumference [F (1.23) = 0.90, p = 0.76], however muscle strength [F (1.23) = 189.84, p < 0.001] and forearm circumference [F (1.23) = 540.90, p < 0.001] improved between baseline and the results at the end of the program.ConclusionPartial BFR training was not superior to the CG for the outcomes evaluated in this study. Further studies should be conducted so that an indication of an exercise protocol for the evaluated outcomes is prescribed in order to be effectively offered in clinical practice.     

Multi-stage segmentation of white matter hyperintensity, cortical and lacunar infarcts

Cerebral abnormalities such as white matter hyperintensity (WMH), cortical infarct (CI), and lacunar infarct (LI) are of clinical importance and frequently present in patients with stroke and dementia. Up to date, there are limited algorithms available to automatically delineate these cerebral abnormalities partially due to their complex appearance in MR images. In this paper, we describe an automated multi-stage segmentation approach for labeling the WMH, CI, and LI using multi-modal MR images. We first automatically segment brain tissues (white matter, gray matter, and CSF) based on the T1-weighted image and then identify hyperintense voxels based on the fluid attenuated inversion recovery (FLAIR) image. We finally label the WMH, CI, and LI based on the T1-weighted, T2-weighted, and FLAIR images. The segmentation accuracy is evaluated using a community-based sample of 272 old adults. Our results show that the automated segmentation of the WMH, CI, and LI is comparable with manual labeling in terms of spatial location, volume, and the number of lacunes. Additionally, the WMH volume is highly correlated with the visual grading score based on the Age-Related White Matter Changes (ARWMC) protocol. The evaluations against the manual labeling and ARWMC visual grading suggest that our algorithm provides reasonable segmentation accuracy for the WMH, CI, and LI.     

Predictors of poor haematopoietic stem cell mobilisation in patients with haematological malignancies at a South African centre

BackgroundAutologous stem cell transplant (ASCT) is an established consolidation strategy in the treatment of haematological malignancies, however poor mobilisation (PM) can contribute to patient morbidity and high resource utilisation. Identifying the incidence, risk factors for PM and engraftment outcomes are important goals in our resource limited setting.MethodsWe retrospectively analyzed patients with haematological malignancies that consecutively underwent ASCT at Groote Schuur hospital, Cape Town, South Africa from January 2013 to January 2019.Results146 patients – majority with multiple myeloma (MM)(41,8%), F:M= 1:2, underwent leukapheresis with median age of 32 years (range, 9 – 66 years). PM occurred in 25/146 (17%), mobilisation failure (MF) in 3/146 (2%) and super mobilisation (SMs) in 99/146 (68%), respectively. Risk factors for PM were: diagnosis of acute leukaemia (RR = 25, 95% CI 3.4 – 183, p = 0.002) and Hodgkin lymphoma (RR = 19, 95% CI 2.6 – 142, p = 0.004); low white cell count (WCC) at harvest (WCC < 9 × 10⁹/L (RR=4.3, 95% CI 2.3 – 8.3, p < 0.0001) and two vs one line of prior therapy (RR = 3.1, 95% CI 1.45 – 6.7, p = 0.0037). Median days to neutrophil and platelet engraftment were 14 days (95% CI 14–15 days) and 16 days (95% CI 15–16 days) respectively.ConclusionPM occurred in 17% of a contemporary South African ASCT cohort, albeit with a low MF rate (2%). There was surprisingly high rate (68%) of SMs, possibly reflective of superfluous mobilisation strategy in MM patients. We identified predictive factors for PM that will lead to enhanced cost-effective use of plerixafor.     

Identifying and quantifying robust risk factors for mortality in critically ill patients with COVID-19 using quantile regression

ObjectiveMany laboratory indicators form a skewed distribution with outliers in critically ill patients with COVID-19, for which robust methods are needed to precisely determine and quantify fatality risk factors.MethodA total of 192 critically ill patients (142 were discharged and 50 died in the hospital) with COVID-19 were included in the sample. Quantile regression was used to determine discrepant laboratory indexes between survivors and non-survivors and quantile shift (QS) was used to quantify the difference. Logistic regression was then used to calculate the odds ratio (OR) and the predictive power of death for each risk indicator.ResultsAfter adjusting for multiple comparisons and controlling numerous confounders, quantile regression revealed that the laboratory indexes of non-survivors were significantly higher in C-reactive protein (CRP; QS = 0.835, p < .001), white blood cell counts (WBC; QS = 0.743, p < .001), glutamic oxaloacetic transaminase (AST; QS = 0.735, p < .001), blood glucose (BG; QS = 0.608, p = .059), fibrin degradation product (FDP; QS = 0.730, p = .080), and partial pressure of carbon dioxide (PCO₂), and lower in oxygen saturation (SO₂; QS = 0.312, p < .001), calcium (Ca²⁺; QS = 0.306, p = .073), and pH. Most of these indexes were associated with an increased fatality risk, and predictive for the probability of death. Especially, CRP is the most prominent index with and odds ratio of 205.97 and predictive accuracy of 93.2%.ConclusionLaboratory indexes provided reliable information on mortality in critically ill patients with COVID-19, which might help improve clinical prediction and treatment at an early stage.     

Visual and haptic verticality misperception and trunk control within 72 h after stroke

IntroductionStroke patients often exhibit an altered perception of verticality, but there are no studies evaluating verticality perception in the first 72 h after stroke and its relationship with trunk control. Therefore, this study aimed to analyze visual and haptic verticality in the acute phase of stroke.MethodsThis was a cross-sectional study conducted with two groups: (a) 13 individuals with stroke and (b) 12 healthy participants. We assessed verticality via the subjective visual vertical (SVV) and the subjective haptic vertical (SHV); and we measured trunk control with the Trunk Impairment Scale (TIS). We performed t-tests to compare the SVV and SHV between groups. Pearson correlation was performed between verticality tests with National Institutes of Health Stroke Scale (NIHSS) and the TIS.ResultsParticipants with recent stroke presented higher true and absolute SVV deviation values than did the control group. There was significant negative correlation between absolute (r = −0.57; p = 0.02) and true SVV (r = −0.54; p = 0.01) with TIS scores There was also significant positive correlation between absolute (r = 0.63; p = 0.009) and true SVV (r = 0.61; p = 0.003) with NIHSS. A significant negative correlation between NIHSS and TIS scores also was found (r = −0.80; p = 0.005).ConclusionIndividuals with acute stroke presented larger variability in their perceptions of visual verticality than did healthy controls, and verticality perceptions were positively correlated with trunk impairment.     

Do patients with low back pain and central sensitization have differences in physical fitness?

IntroductionLow back pain is one of the main musculoskeletal complaints, and may be associated with central sensitization (CS). The physical capacity of patients with low back pain and CS is not very clear.MethodsA cross-sectional study, with 92 patients divided into two groups according to their risk of CS. The patient's physical capacity ability was assessed using 6-min walking test (6MWT); timed up and go test (TUG); sit-to-stand test (STS); and trunk flexor, extensor and side-bridge endurance tests. In addition, participants completed questionnaires regarding disability, kinesiophobia, catastrophization and quality of life.ResultsThe group with a higher risk of CS had worst performance in the 6MWT (U = 1248; p < 0.001), STS (t(83) = 3.63; p < 0.001) and TUG (t(83) = −4.46; p < 0.001). Similarly, endurance in the right (U = 1453,5; p = 0,002) and left (U = 1467; p = 0,003) side-bridge tests, and the trunk extensor test (U = 1546; p = 0,003) was worse. Disability (U = 1272; p < 0.001), physical capacity kinesiophobia (t(83) = -2.21; p = 0.03) work kinesiophobia (U = 1452; p < 0.001), and pain catastrophization (t(77.57) = -5.03; p < 0.001), were also higher in the group with a higher risk of CS. Quality of life indicators were worse in the higher risk group for all domains of the EQ-5D-3L: Mobility (X²(1) = 12.92; p < 0.001), self-care (X²(1) = 16,3; p = 0,012), usual activities (X²(2) = 14.14; p = 0.001), pain (X²(2) = 27.79; p < 0.001), anxiety and depression (X²(2) = 15.05; p = 0.001).ConclusionPatients with low back pain and higher risks of CS appear to show lower performance in physical capacity tests, higher rates of disability, kinesiophobia, pain catastrophization, and lower quality of life compared to those with lower risks of CS.     

Improvement of quality of life and postural balance of institutionalized elderly people undergoing to a treadmill walking training

IntroductionInstitutionalized older adults have fewer opportunities to participate in daily living activities and tasks in an independent manner, with greater deleterious effects on the physiological losses inherent to aging and with increased gait and balance impairment compared to community-dwelling older adults. The use of a treadmill for rehabilitation, with or without partial weight support, has been studied in different groups, but not on institutionalized older adults.ObjectivesTo assess the effects of a treadmill walking program on the postural balance and quality of life of institutionalized older adults.MethodsThirty-seven institutionalized older adults: intervention group (n = 23, 75.7 ± 7.8 years) and control group (n = 14, 78.9 ± 10.2 years). A total of 10 weeks of treadmill walking, twice a week (intervention group) vs. no training (control group). Postural balance was assessed by the Tinetti test, 6-min walk test (6MWT), and 10-m walk test and Quality of life with the WHOQOL-Bref questionnaire.ResultsSignificant improvement was observed in balance parameters (6MWT distance: p < 0.001; gait speed 6MWT: p < 0.001; gait speed 10MWT: p < 0.001; Tinetti scale: p = 0.001), and in the physical (p = 0.01), psychological (p = 0.002), self-assessed quality of life (p = 0.01) and overall quality of life domains (p = 0.002).ConclusionsTreadmill walking program had positive effects on the postural balance and quality of life of institutionalized older adults.     

Executive dysfunction is associated with self-care confidence in patients with heart failure

AimTo explore differences in self-care maintenance, management and confidence levels between American heart failure (HF) patients with and without executive dysfunction.BackgroundEvidence indicates some aspect of cognitive impairment is prevalent in up to 75% of the HF patient population. Moreover, cognitive impairment has been identified as a barrier to adequate self-care contributing to poor outcomes. There is limited understanding of the role executive function, a domain of cognitive performance, has on self-care behaviors for patients with HF.MethodThis secondary analysis examined the role of executive function, measured by the Clock Drawing Test (CDT), in relation to self-care measures. The Self Care of Heart Failure Index v6.2 (SCHFI v6.2) was used to measure self-care maintenance, management, and confidence.ResultsParticipants had a mean age of 75.1 ± 12.5 years, identified as male (59.4%), with New York Heart Association (NYHA) class III (57.3%). Executive function impairment was present in 28% of the sample. Comparison of self-care maintenance and management scores between the two groups were not significant. However, participants with executive dysfunction demonstrated an average self-care confidence score of 48.6 ± 23.3, while participants with no executive function impairment demonstrated a higher average self-care confidence score of 61.5 ± 18.4. Differences in self-care confidence scores between the groups were statistically significant (p = .014).ConclusionsHF self-care confidence is considered a moderator of self-care behaviors. Understanding the influence executive function has on self-care confidence may lead to a better understanding of those needing greater support with self-care behaviors.     

Gender and occupational role differences in work-related post-traumatic stress symptoms,burnout and global functioning in emergency healthcare workers

ObjectivesTo explore gender and occupational role impact on work-related Post-Traumatic Stress Symptoms, Post-Traumatic Stress Disorder, burnout and global functioning in a sample of emergency healthcare workers.DesignA cross-sectional study.Participants/setting126 healthcare workers of the Emergency Department, including Intensive Care Unit, Emergency Room and Emergency Medicine, of a major University Hospital in central Italy were recruited.Main outcome measuresParticipants were assessed by means of the: Trauma and Loss Spectrum-Self Report (TALS-SR) to explore Post-Traumatic Stress Spectrum Symptoms, Professional Quality of Life (ProQOL) Scale to assess Compassion Satisfaction, Burnout and Compassion Fatigue and Work and Social Adjustment Scale (WSAS) to measure global functioning.ResultsThe present findings showed females were more prone to develop Post-Traumatic Stress Symptoms, particularly re-experiencing (p = .010) and hyperarousal (p = .026) symptoms and medical doctors reporting higher Burnout (p < .001) and lower Compassion Satisfaction (p = .009) mean scores than nurses. Higher levels of functioning impairment emerged amongst medical doctors rather than nurses, in both social (p = .029) and private (p = .020) leisure activities. Linear correlations highlighted relationships between the TALS-SR, ProQOL and WSAS scores. Finally, medical doctor status was significantly associated with lower Compassion Satisfaction (p = .029) and higher Burnout (p = .015).ConclusionOur results highlight high post-traumatic stress symptoms and burnout levels in emergency healthcare workers with a relevant impact of female gender and occupational role, supporting the need for preventive strategies, also in light of the current COVID-19 pandemic.