The mediating role of parenting in the associations between household chaos and children’s representations of family dysfunction

Children’s drawings are thought to reflect their mental representations of self and their interpersonal relations within families. Household chaos is believed to disrupt key proximal processes related to optimal development. The present study examines the mediating role of parenting behaviors in the relations between two measures of household chaos, instability and disorganization, and how they may be evidenced in children’s representations of family dysfunction as derived from their drawings. The sample (N = 962) is from a longitudinal study of rural poverty exploring the ways in which child, family, and contextual factors shape development over time. Findings reveal that, after controlling for numerous factors including child and primary caregiver covariates, there were significant indirect effects from cumulative family disorganization, but not cumulative family instability, on children’s representation of family dysfunction through parenting behaviors. Results suggest that the proximal effects of daily disorganization outweigh the effects of periodic instability overtime.     

Impact of patient information behaviours in online health communities on patient compliance and the mediating role of patients’ perceived empathy

ObjectivePatient health information seeking and physician-patient communication in OHCs proved to have impacts on patient compliance, but related studies from psychological perspectives are limited. This study aims to investigate the impact of patient health information seeking and physician-patient communication in OHCs on patient compliance.MethodsThis study established a research model and proposed six hypotheses. An anonymous investigation was conducted using Chinese OHCs. Confirmatory factor analysis, partial least squares, and structural equation modelling were used to test the hypotheses.ResultsWe received 371 responses, and 316 of them were valid. Patient health information seeking and physician-patient communication frequency in OHCs had positive impacts on patients’ perceived affective and cognitive empathies, which positively impacted patient compliance.ConclusionsPatient compliance can be improved by patient health information seeking and physician-patient communication in OHCs and affective and cognitive empathies. Patients’ perceived affective empathy is the preferred perspective to improve patient compliance.Practice implicationsPhysicians should encourage patients to seek health information and communicate with them through OHCs, be concerned about patients’ experiences, feelings, and attitudes, understand patients’ demands and mental states, and show their patients that they can feel patients’ pain. Increasing physician-patient communication frequency in OHCs can help improve patient compliance.     

The role of shortening reaction in mediating rigidity in Parkinson’s disease

Rigidity in Parkinsons disease (PD) is defined as an increased resistance to passive movement of a joint. The plastic-type rigidity is uniform and constant throughout the entire range of motion, whereas the cogwheel-type rigidity is accompanied by tremor. Rigidity in PD has been understudied. Thus, its pathophysiological basis remains unclear. The purpose of the study is to examine neuromuscular/biomechanical properties of PD rigidity and to provide its physiological characteristics. We hypothesize that PD rigidity presents as a flattened trace of joint torque vs. angular position (torque-angle relation) of the wrist, because the forces generated by lengthening muscles are offset by activation of the antagonist, i.e. shortening reaction (SR). Experiments were conducted on six PD subjects medication OFF and ON. PD severity was assessed based on the unified Parkinsons disease rating scale. Each subject sat on a chair and was instructed to relax, with the wrist coupled to the device. The servomotor applied constant velocity displacement to create wrist flexion/extension. Electromyographic (EMG) responses were monitored from wrist muscles, along with position, velocity and torque. EMG magnitudes were computed over the movement period. Slopes were derived from the torque-angle trace. Results showed that SRs were routinely recorded OFF medication, but substantially reduced ON medication. Due to the interaction of SR, torque-angle relation was flatter OFF medication and became steeper ON medication. Correlation analyses showed that a strong correlation (R=0.65) existed between SR and torque-angle slope OFF medication, exclusively. We suggest that SR may play an important role in mediating the mechanical features of PD rigidity.     

The role of weight bias and role-modeling in medical students’ patient-centered communication with higher weight standardized patients

ObjectivePatients with obesity may experience less patient-centered care. We assessed whether medical students’ implicit/explicit weight-related attitudes and perceptions of normative attitudes are associated with patient-centered care for patients with obesity.MethodsThird and fourth year medical students (N = 111) at one medical school completed a survey and participated in a patient care scenario with a standardized patient with obesity. Encounters were coded for patient-centered behavior. Predictors of patient-centered behaviors were assessed.ResultsStudent perceptions that negative attitudes about patients with obesity are normative in medical school were significantly associated with poorer patient-centered behaviors, including lower attentiveness (b=?0.19, p = 0.01), friendliness (b=?0.28, p < 0.001), responsiveness (b=?0.21, p = 0.002), respectfulness (b=?0.17, p = 0.003), interactivity (b=?0.22, p = 0.003), likelihood of being recommended by observers (b=?0.34, p < 0.001), and patient-centeredness index scores (b=?0.16, p = 0.002). Student reported faculty role-modeling of discrimination against patients with obesity predicted lower friendliness (b=?0.16, p = 0.03), recommendation likelihood (b=?0.22, p = 0.04), and patient-centeredness index score (b=?0.12, p = 0.03).ConclusionsNegative normative attitudes and behaviors regarding obesity in the medical school environment may adversely influence the quality of patient-centered behaviors provided to patients with obesity.Practice implicationsEfforts to improve patient-centered communication quality among medical trainees may benefit from intervention to improve group normative attitudes about patients with obesity.     

Patients’ preferred and perceived decision-making roles,and observed patient involvement in videotaped encounters with medical specialists

ObjectiveTo assess how patients prefer and perceive medical decision making, which factors are associated with their preferred and perceived decision-making roles, and whether observed involvement reflects patients’ perceived role.MethodsWe asked 781 patients visiting a medical specialist from 18 different disciplines to indicate their preferred and perceived decision-making roles. Patient involvement in videotaped consultations was assessed with the OPTION5 instrument.ResultsMost patients preferred and perceived decision making as shared (SDM; 58% and 43%, respectively), followed by paternalistic (26% and 38%), and informative (16% and 15%). A large minority (n = 103, 21%) of patients preferring shared or informative decision making (n = 482) experienced paternalistic decision making. Mean (SD) OPTION5 scores were highest in consultations which patients perceived as informative (26.0 (19.7)), followed by shared (19.1 (17.2)) and lowest in paternalistic decision making (11.8 (13.4) p < 0.001).ConclusionsMost patients want to be involved in decision making. Patients perceive that the physician makes the decision more often than they prefer, and perceive more involvement in the decision than objective assessment by an independent researcher shows.Practice implicationsA clearer understanding of patients’ medical decision-making experiences is needed to optimize physician SDM training programmes and patient awareness campaigns.     

The role of the immune system in Alzheimer’s disease

Alzheimer’s disease (AD) is the most common neurodegenerative disorder where the accumulation of amyloid plaques and the formation of tau tangles are the prominent pathological hallmarks. Increasing preclinical and clinical studies have revealed that different components of the immune system may act as important contributors to AD etiology and pathogenesis. The recognition of misfolded Aβ and tau by immune cells can trigger a series of complex immune responses in AD, and then lead to neuroinflammation and neurodegeneration. In parallel, genome-wide association studies have also identified several immune related loci associated with increased - risk of AD by interfering with the function of immune cells. Other immune related factors, such as impaired immunometabolism, defective meningeal lymphatic vessels and autoimmunity might also be involved in the pathogenesis of AD.Here, we review the data showing the alterations of immune cells in the AD trajectory and seek to demonstrate the crosstalk between the immune cell dysfunction and AD pathology. We then discuss the most relevant research findings in regards to the influences of gene susceptibility of immune cells for AD. We also consider impaired meningeal lymphatics, immunometabolism and autoimmune mechanisms in AD. In addition, immune related biomarkers and immunotherapies for AD are also mentioned in order to offer novel insights for future research.     

Cardiac and autonomic function in patients with Crohn’s disease during remission

Purpose

The aim of the study was to assess cardiac and autonomic function in patients with Crohn’s disease and explore their relation to disease duration using cardiovascular reflex tests.

The association of how time is spent during outpatient visits and patient satisfaction: are there racial differences?

Both satisfaction with the physician and how time is spent in the patient-physician outpatient visit have been shown to differ between African-American and Caucasian patients. This study uses structural equation modeling to examine racial differences in the association between time use during the outpatient visit and patient satisfaction. This cross-sectional study employed direct observation of outpatient visits and surveys of 2,502 adult African-American and Caucasian outpatients visiting 138 primary care physicians in 84 family practices in Northeast Ohio. Patient satisfaction was measured using the Medical Outcome Study (MOS) nine-item Visit Rating Scale. Time use was assessed with the Davis Observation Code, which was used to classify every 20 seconds of a visit into 20 behavioral categories. No difference was found between African-American and Caucasian patients in the association between patient satisfaction with a physician and the time the physician spent chatting, planning treatment, providing health education, structuring the interaction, assessing health knowledge or answering patient questions. Patients were generally satisfied with their physicians, and no racial differences between Caucasians and African Americans were observed. Despite racial differences in how physicians spend time in the outpatient visit encounter, these differences are not associated with racial differences in patient satisfaction. Efforts to understand disparities in satisfaction should address areas other than how physicians allocate time in the physician-patient encounter.     

Control of manipulative forces during unimanual and bimanual tasks in patients with Huntington’s disease

The aim of the study was to investigate grip-load force regulation in Huntington's disease (HD) patients as compared to control subjects during the performance of a manipulative task that required rhythmical unimanual or bimanual isodirectional/non-isodirectional actions in the sagittal plane. Results showed that the profile of grip-load ratio force was characterized by maxima and minima that were attained at upward and downward hand positions, respectively. Minimum force ratio was higher in patients than in controls, which points to an elevated baseline that may be related to the inherent bradykinesia observed in HD. Maximum force ratio was also increased in patients, but this effect depended on the performance condition, with largest amplifications occurring during non-isodirectional movements. The latter rescaling may be associated with the complexity of the coordination mode and its asymmetrical load characteristics. In addition, the temporal delay between the grip and load force peaks was augmented in patients versus controls, indicating a disturbed coupled activation of both forces. Furthermore, the interval was largest during non-isodirectional movements followed by isodirectional and unimanual movements, which denotes that the grip-load force coupling deteriorated as a function of coordinative complexity. Together, these data indicate a deficit in the grip-load force constraint due to HD and illustrate the degrading effect of striatal dysfunction on (bi)manual manipulative function.     

Patient participation during and after a self-management programme in primary healthcare – The experience of patients with chronic obstructive pulmonary disease or chronic heart failure

Objective

Patient participation is facilitated by patients’ ability to take responsibility for and engage in health issues. Yet, there is limited research as to the promotion of these aspects of patient participation in long-term healthcare interactions. This paper describes patient participation as experienced by patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF); the aim was to describe if and how a self-management programme in primary healthcare influenced patient participation.

Is patient behavior during consultation associated with shared decision-making? A study of patients’ questions,cues and concerns in relation to observed shared decision-making in a cancer outpatient clinic

Objectives

To explore how cancer patients actively participate in consultations by asking questions and expressing emotional cues/concerns and to what extent this is associated with physician shared decision making (SDM) behavior.

Shared decision-making in older patients with colorectal or pancreatic cancer: Determinants of patients’ and observers’ perceptions

Objective

To identify determinants of older patients’ perceptions of involvement in decision-making on colorectal (CRC) or pancreatic cancer (PC) treatment, and to compare these with determinants of observers' perceptions.

Cytosolic pH buffering during exercise and recovery in skeletal muscle of patients with McArdle’s disease

Cellular pH control is important in muscle physiology, and for interpretation of ³¹P magnetic resonance spectroscopy (MRS) data. Cellular acidification in exercise results from coupled glycolytic ATP production mitigated by cytosolic buffering, ‘consumption’ of H⁺ by phosphocreatine (PCr) breakdown, and membrane transport processes. Ex vivo methods for cytosolic buffer capacity are vulnerable to artefact, and MRS methods often require assumptions. ³¹P MRS of early exercise, when pH increases unopposed by glycolysis, is conceptually simple, but limited in normal muscle by time resolution and signal-to-noise. A therapeutic trial (Martinuzzi A et al. Musc Nerve 37: 350–357, 2007) in McArdle’s disease (glycogen phosphorylase deficiency), where pH does not decrease with exercise, offered the opportunity to test ³¹P MRS data obtained throughout incremental plantar flexion exercise and recovery in ten McArdle’s patients against the simple model of cellular pH control. Changes in pH, [Pi] and [PCr] throughout exercise and recovery were quantitatively consistent with mean ± SEM buffer capacity of 10 ± 1 mM/(pH unit), which was not significantly different from the control subjects under the initial-exercise conditions where the comparison could be made. The simple model of cellular acid–base balance therefore gives an adequate account of cellular pH changes during both exercise and recovery in McArdle’s disease.     

The role of the basal ganglia in action imitation: neuropsychological evidence from Parkinson’s disease patients

Though previous studies have suggested that the basal ganglia are necessarily involved in action imitation, their precise role is unclear. An important source of evidence concerns patients with Parkinson’s disease (PD) who suffer basal ganglia impairments. Some studies report poor execution of observed meaningful (MF) transitive (tool-related) actions but normal performance with intransitive (non-tool-related) MF and meaningless (ML) actions (Leiguarda et al. in Brain 120:75–90, 1997; Leiguarda 2001 in Neuroimage 14:137–141). In other cases, though, patients with lesions involving the basal ganglia appear impaired in imitating ML as compared to meaningful MF transitive pantomimes. Here, we tested a group of PD patients in a full 2 × 2 design with MF transitive and intransitive pantomimes and matched ML movements. PD patients generated higher scores when imitating MF transitive actions than ML-matched actions. On the other hand, ML than MF intransitive actions did not differ significantly. The performance of the patients on imitating ML transitive actions also correlated with their performance on the Corsi block test of visuospatial memory and their scores at the test of verbal fluency for phonemic categories (FAS) while MF intransitive actions correlated with FAS and the neurological evaluation (UPDRS) The results are discussed in terms of the factors that load on visual memory for action reproduction, as well as the possible role of the basal ganglia in communicative actions (for MF intransitive actions).     

Analysis of the parameters of oxidative stress in patients with Parkinson’s disease

The increasing data provides enough evidences confirming the involvement of free radicals and other reactive oxygen species (ROS) superoxide radical ( ^. O ₂ ^? ), nitric oxide (NO ^. ), hydrogen peroxide (H₂O₂) and hydroxyl radicals ( ^. OH) in a number of physiological and pathological processes. Imbalance between levels of ROS resulting in the body and the capacity of antioxidant defense mechanisms occur oxidative stress (OS). OS is related to a number of structural and functional damages to cells and is involved in the pathogenesis of many diseases, including neurodegenerative diseases such as Alzheimer’s disease, Parkinson’s disease (PD), amyotrophic lateral sclerosis, and Huntington disease. Defects in oxidative phosphorylation and oxidative damage play an important role in neurodegenerative diseases. The aim of this study was to investigate some biomarkers of OS such as the level of lipid peroxidation measured as malondialdehyde (MDA) reactive products and activity of antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) in the blood of PD patients compared with control group of healthy volunteers. By the present research we report higher levels of MDA products and an imbalance in SOD and CAT enzyme activities in PD patients compared to the control group.     

The role of Casoni’s skin test and indirect haemagglutination test in the diagnosis of hydatid disease

Casonis skin test and indirect haemagglutination test (IHA) are still used in Turkey. The preoperative IHA test or Casonis skin test results of 120 patients with surgically confirmed hydatidosis were retrospectively studied during 1997–2004. At the same period, 306 patients with non-hydatid disease had serologic results for echinococcosis. The sensitivity of immediate intradermal reaction, delayed intradermal reaction, and IHA were 70, 62, and 56%, respectively. Casonis skin test components had higher sensitivity than IHA (P<0.01). The specificity of immediate intradermal reaction, delayed intradermal reaction, and IHA were 87, 85, and 84%, respectively. Cystic lesions in non-hydatid patients were localised commonly in the lungs. The occurrence of hydatid disease for pulmonary, hepatic, and renal cysts was 19, 54, and 5%, respectively. An immediate skin reaction to crude hydatid antigens is more useful than IHA.     

The role of the right dorsolateral prefrontal cortex in the Tower of London task performance: repetitive transcranial magnetic stimulation study in patients with Parkinson’s disease

We studied whether one session of high-frequency repetitive transcranial magnetic stimulation (rTMS) applied over either the right or left dorsolateral prefrontal cortex would induce any measurable changes in the Tower of London spatial planning task performance in patients with Parkinson’s disease (PD). Ten patients with PD (with no dementia and/or depression) entered the randomized, sham-stimulation-controlled study with a crossover design. Active and placebo rTMS were applied over either the left or the right dorsolateral prefrontal cortex (in four separate sessions) in each patient. The order of sessions was randomized. The Tower of London task was performed prior to and immediately after each appropriate session. The “total problem-solving time” was our outcome measure. Only active rTMS of the right dorsolateral prefrontal cortex induced significant enhancement of the total problem-solving time, p = 0.038. Stimulation of the left prefrontal cortex or sham stimulations induced no significant effects. Only rTMS applied over the right dorsolateral prefrontal cortex induced positive changes in the spatial planning task performance in PD, which further supports the results of functional imaging studies indicating the causal engagement of the right-sided hemispheric structures in solving the task in this patient population.     

The association between fear of COVID-19 and depression,anxiety, and psychosis among Lebanese chronic patients with schizophrenia: any moderating effect of spirituality?

AimTo assess whether fear of coronavirus disease 2019 (COVID-19) is associated with depression, anxiety, and psychosis and to evaluate if these variables are correlated with the interaction between spirituality and fear of COVID-19.MethodsBetween September and November 2020, this cross-sectional study enrolled 118 chronic schizophrenia patients. The interview with patients included Fear of COVID-19 Scale, Lebanese Anxiety Scale-10, Montgomery-Asberg Depression Rating Scale, Positive and Negative Syndrome Scale (PANSS), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being-12. The results were analyzed by using linear regressions (Enter method), with anxiety, depression, total PANSS score, positive PANSS, negative PANSS, and general psychopathology PANSS subscales as dependent variables. Spirituality, fear of COVID-19, and the interaction of spirituality with fear of COVID-19 were independents variables.ResultsFear of COVID-19 was positively correlated with increased total PANSS scores (Beta = 0.90, P = 0.030). Higher spirituality was significantly associated with lower anxiety (Beta = -0.14, P = 0.009), lower depression (Beta = -0.21, P = 0.001), lower total PANSS score (Beta = -0.90, P = 0.004), lower negative PANSS score (Beta = -0.23, P = 0.009), and lower general psychopathology PANSS score (Beta = -0.61, P = 0.001). In patients with high fear of COVID-19, having low spirituality was significantly associated with higher anxiety, depression, and psychotic symptoms.ConclusionThis study suggests a positive correlation between fear of COVID-19 and higher psychosis among inpatients with schizophrenia. The interaction of spirituality with fear of COVID-19 was correlated with reduced anxiety, depression, and psychosis.

The impact of the SARS-CoV-2 on the central nervous system and the associated neuropsychiatric consequences have not been widely studied. Various types of neuropsychiatric symptoms can emerge during or after an acute infection with a respiratory virus (1-5).An effect of having a psychiatric condition on the vulnerability to coronavirus disease 2019 (COVID-19) has also been reported. Patients who already had a psychiatric disorder had 65% higher incidence of COVID-19 (6). This association was explained by behavioral factors arising from psychiatric conditions such as less adherence to restrictions or by socioeconomic and lifestyle variables such as smoking (6). Additionally, COVID-19 vulnerability might be aggravated by the pro-inflammatory state associated with psychotropic medications use or certain psychiatric disorders (6).Fear of COVID-19 increases the incidence of anxiety and depression in the general population (7), as well as in individuals previously diagnosed with psychiatric disorders (8-10). Fear of COVID-19 was also correlated with female gender and the presence of chronic diseases (8). It was a risk factor for the development of psychotic symptoms correlated with a higher probability of psychotic relapse and a lower stable diagnosis (11).In 1995, spirituality was added as a psychosocial environmental factor in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV (12). Spirituality relieves the sense of dissatisfaction and emptiness in one’s life (13), but may have some disadvantages such as loss of compassion and social solidarity (14). In general, spiritual patients with schizophrenia have shown increased social integration, better quality of life and recovery, reduced risk of suicide, and decreased substance abuse and smoking (15). During stressful situations, individuals frequently turn to spirituality for support and comfort (16). Spirituality has been linked to measures of well-being and has been shown to ameliorate sadness and anxiety in individuals with schizophrenia (17,18). Individuals with schizophrenia may use spiritual coping to facilitate problem-solving during times of stress (19); spiritual coping consists of spiritual beliefs or behaviors that prevent the negative mental consequences of stressful life situations (15). On the other hand, negative spiritual coping increases depression, anxiety, and distress among psychiatric patients (20). The association between spirituality and psychosis has not been investigated in depth (21). However, spirituality appears to be useful for patients with psychosis (22). During the COVID-19 pandemic, increased spirituality was correlated with lower psychosis (23), lower anxiety, and depression (24,25). However, to the best of our knowledge, few studies evaluated the interaction between fear of COVID-19 and spirituality and its association with depression, anxiety, and psychosis among psychiatric patients. During the COVID-19 pandemic, Lebanese people were faced with many multifactorial challenges to the mental health (26). Therefore, the aim of this research was to evaluate the moderating effect of spirituality in the association between fear of COVID-19 and depression, anxiety, and psychosis.     

Genetic association of cyclooxygenase-2 gene polymorphisms with Parkinson’s disease susceptibility in Chinese Han population

Objective: The aim of this study was to explore the genetic association of cyclooxygenase-2 (COX2) gene promoter region polymorphisms with Parkinson’s disease (PD) susceptibility in Chinese Han population. Methods: The genotyping of COX2 gene polymorphisms was conducted by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 122 patients with PD and 120 healthy persons. The association strength of gene polymorphism with disease was measured by odds ratio (OR) and 95% confidence interval (95% CI) calculated using χ² test which also evaluated the Hardy-Weinberg equilibrium (HWE) of gene polymorphism in controls. The linkage disequilibrium and haplotype were also analyzed as evidence in the analysis of association. Results: On condition that the genotypes distributions of COX2 -1290A>G, -1195G>A, -765G>C in the control group all conformed to HWE, however, only the homozygous genotype AA of -1195G>A polymorphism showed an association with PD (OR=0.432, 95% CI=0.196-0.950). In addition, in haplotype analysis, G-A-C haplotype frequency in cases was significantly lower than the controls, compared with the common haplotype A-G-G (P=0.031, OR=0.375, 95% CI=0.149-0.940). Conclusions: COX2 -1195G>A polymorphism might play a protective role in the onset of PD and G-A-C haplotype in this three promoter region polymorphisms also showed a negative association.