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Wu Y, Deng J, Ma J, Chen Y, Hu N, Hao S, Wang B. Unraveling the Pathogenesis of Post-Stroke Depression in a Hemorrhagic Mouse Model through Frontal Lobe Circuitry and JAK-STAT Signaling. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2402152. [PMID: 38946585 DOI: 10.1002/advs.202402152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/13/2024] [Indexed: 07/02/2024]
Abstract
Post-stroke depression is a common complication that imposes significant burdens and challenges on patients. The occurrence of depression is often associated with frontal lobe hemorrhage, however, current understanding of the underlying mechanisms remains limited. Here, the pathogenic mechanisms associated with the circuitry connectivity, electrophysiological alterations, and molecular characteristics are investigated related to the frontal lobe in adult male mice following unilateral injection of blood in the medial prefrontal cortex (mPFC). It is demonstrated that depression is a specific neurological complication in the unilateral hematoma model of the mPFC, and the ventral tegmental area (VTA) shows a higher percentage of connectivity disruption compared to the lateral habenula (LHb) and striatum (STR). Additionally, long-range projections originating from the frontal lobe demonstrate higher damage percentages within the connections between each region and the mPFC. mPFC neurons reveal reduced neuronal excitability and altered synaptic communication. Furthermore, transcriptomic analysis identifies the involvement of the Janus Kinase-Signal Transducer and Activator of Transcription (JAK-STAT) signaling pathway, and targeting the JAK-STAT pathway significantly alleviates the severity of depressive symptoms. These findings improve the understanding of post-hemorrhagic depression and may guide the development of efficient treatments.
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Affiliation(s)
- Yingqing Wu
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400030, China
| | - Jia Deng
- College of Environment and Resources, Chongqing Technology and Business University, Chongqing, 400030, China
| | - Jinsong Ma
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400030, China
| | - Yujie Chen
- Department of Neurosurgery and State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Ning Hu
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400030, China
| | - Shilei Hao
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400030, China
| | - Bochu Wang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400030, China
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Santo BA, Poppenberg KE, Ciecierska SSK, Baig AA, Raygor KP, Patel TR, Shah M, Levy EI, Siddiqui AH, Tutino VM. Hybrid Clot Histomic-Transcriptomic Models Predict Functional Outcome After Mechanical Thrombectomy in Acute Ischemic Stroke. Neurosurgery 2024:00006123-990000000-01180. [PMID: 38829781 DOI: 10.1227/neu.0000000000003003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Histologic and transcriptomic analyses of retrieved stroke clots have identified features associated with patient outcomes. Previous studies have demonstrated the predictive capacity of histology or expression features in isolation. Few studies, however, have investigated how paired histologic image features and expression patterns from the retrieved clots can improve understanding of clot pathobiology and our ability to predict long-term prognosis. We hypothesized that computational models trained using clot histomics and mRNA expression can predict early neurological improvement (ENI) and 90-day functional outcome (modified Rankin Scale Score, mRS) better than models developed using histological composition or expression data alone. METHODS We performed paired histological and transcriptomic analysis of 32 stroke clots. ENI was defined as a delta-National Institutes of Health Stroke Score/Scale > 4, and a good long-term outcome was defined as mRS ≤2 at 90 days after procedure. Clots were H&E-stained and whole-slide imaged at 40×. An established digital pathology pipeline was used to extract 237 histomic features and to compute clot percent composition (%Comp). When dichotomized by either the ENI or mRS thresholds, differentially expressed genes were identified as those with absolute fold-change >1.5 and q < 0.05. Machine learning with recursive feature elimination (RFE) was used to select clot features and evaluate computational models for outcome prognostication. RESULTS For ENI, RFE identified 9 optimal histologic and transcriptomic features for the hybrid model, which achieved an accuracy of 90.8% (area under the curve [AUC] = 0.98 ± 0.08) in testing and outperformed models based on histomics (AUC = 0.94 ± 0.09), transcriptomics (AUC = 0.86 ± 0.16), or %Comp (AUC = 0.70 ± 0.15) alone. For mRS, RFE identified 7 optimal histomic and transcriptomic features for the hybrid model. This model achieved an accuracy of 93.7% (AUC = 0.94 ± 0.09) in testing, also outperforming models based on histomics (AUC = 0.90 ± 0.11), transcriptomics (AUC = 0.55 ± 0.27), or %Comp (AUC = 0.58 ± 0.16) alone. CONCLUSION Hybrid models offer improved outcome prognostication for patients with stroke. Identified digital histology and mRNA signatures warrant further investigation as biomarkers of patient functional outcome after thrombectomy.
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Affiliation(s)
- Briana A Santo
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Kerry E Poppenberg
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, New York, USA
| | | | - Ammad A Baig
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Kunal P Raygor
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Tatsat R Patel
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Munjal Shah
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
| | - Elad I Levy
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Vincent M Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
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Nordin S, Norberg M, Braf I, Johansson H, Lindahl B, Lindvall K, Nordin M, Nyman E, Vallström C, Wennberg P, Liv P, Näslund U. Associations between emotional support and cardiovascular risk factors and subclinical atherosclerosis in middle-age. Psychol Health 2023:1-15. [PMID: 37994844 DOI: 10.1080/08870446.2023.2286296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/31/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To test the hypothesis of low emotional support being associated with lifestyle and biomedical cardiovascular disease (CVD) risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults. METHODS AND MEASURES Cross-sectional data were obtained from participants aged 40-60 years who had one or more conventional CVD risk factor. They underwent assessment based on questionnaires, clinical examination, blood sampling, and carotid ultrasound of plaque formation and carotid intima-media wall thickness (cIMT). Based on the Interview Schedule for Social Interaction, the participants were categorised as either low in emotional support (n = 884) or as a referent (n = 2570). Logistic regression analyses were conducted to study the associations. RESULTS Logistic regression analyses showed that low emotional support was significantly associated with smoking, alcohol consumption and physical inactivity (OR = 1.53 - 1.94), estimated risk of CVD morbidity and mortality (OR = 1.56 - 1.68), and plaque formation (OR = 1.39). No significant associations were found regarding biomedical CVD risk factors or cIMT. CONCLUSION The findings suggest that low social support is associated with lifestyle CVD risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults, encouraging causal evaluation with longitudinal data investigating an impact of emotional support on mechanisms underlying CVD.
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Affiliation(s)
- Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Margareta Norberg
- Section of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Irma Braf
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Helene Johansson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Bernt Lindahl
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kristina Lindvall
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Maria Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Emma Nyman
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Patrik Wennberg
- Section of Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Liv
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Love MF, Brooks AN, Cox SD, Okpala M, Cooksey G, Cohen AS, Sharrief AZ. The effects of racism and resilience on Black stroke- survivor quality of life: Study protocol and rationale for a mixed-methods approach. Front Neurol 2022; 13:885374. [PMID: 36034272 PMCID: PMC9399920 DOI: 10.3389/fneur.2022.885374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Stroke, a life-threatening stressor, often negatively impacts stroke-survivor (SS) quality of life (QoL). Annual age-adjusted incidence and death rates for stroke are significantly higher among Black Americans than among White Americans. Racism, a significant stressor, occurs at structural, cultural, and interpersonal levels and contributes to health disparities for Black SS. Resilience, a dynamic process of positive adaptation to significant stress, is impacted by factors or resources both internal and external to the individual. This study aims to examine the effects of experiences of racism and resilience on Black SS QoL during early stroke recovery. This article presents the study protocol. Methods and analyses This will be a prospective observational mixed-methods study. Black community-dwelling adults who are within 4 weeks of a stroke will be eligible for inclusion. Baseline measures will include the exposure variables of experiences of racism and resilience. Covariates measured at baseline include sociodemographic variables (age, sex, marital status, education, income, health insurance, employment status, number of people in household, residential address), clinical variables (date and type of stroke, inferred Modified Rankin Scale, anxiety and depression screening), and psychosocial variables (COVID-19 stress, perceived stress, mindfulness). The outcome variable (QoL) will be assessed 6-months post-stroke. Multiple-level linear regression models will be used to test the direct effects of experiences of racism, and the direct and indirect effects of resilience, on QoL. Qualitative data will be collected via focus groups and analyzed for themes of racism, resilience, and QoL. Discussion Racism can compound the stress exerted by stroke on Black SS. This study will occur during the COVID-19 pandemic and in the aftermath of calls for social justice for Black Americans. Experiences of racism will be measured with instruments for both “everyday” discrimination and vigilance. Sociodemographic variables will be operationalized to assess specific social determinants of health that intersect with structural racism. Because of the long-standing history of racism in the United States of America (USA), cultural influences and access to resources are central to the consideration of individual-level resilience in Black SS. Study results may inform the development of interventions to support Black SS QoL through enhanced resilience.
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Affiliation(s)
- Mary F. Love
- College of Nursing, University of Houston, Houston, TX, United States
- *Correspondence: Mary F. Love
| | | | - Sonya D. Cox
- College of Nursing, University of Houston, Houston, TX, United States
| | - Munachi Okpala
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
| | - Gail Cooksey
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
| | - Audrey Sarah Cohen
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
| | - Anjail Z. Sharrief
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center Houston, Houston, TX, United States
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Hinwood M, Ilicic M, Gyawali P, Coupland K, Kluge MG, Smith A, Bowden S, Nilsson M, Walker FR. Psychological Stress Management and Stress Reduction Strategies for Stroke Survivors: A Scoping Review. Ann Behav Med 2022; 57:111-130. [PMID: 35689664 PMCID: PMC9899067 DOI: 10.1093/abm/kaac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Stroke can be a life-changing event, with survivors frequently experiencing some level of disability, reduced independence, and an abrupt lifestyle change. Not surprisingly, many stroke survivors report elevated levels of stress during the recovery process, which has been associated with worse outcomes. PURPOSE Given the multiple roles of stress in the etiology of stroke recovery outcomes, we aimed to scope the existing literature on stress management interventions that have been trialed in stroke survivors. METHODS We performed a database search for intervention studies conducted in stroke survivors which reported the effects on stress, resilience, or coping outcome. Medline (OVID), Embase (OVID), CINAHL (EBSCO), Cochrane Library, and PsycInfo (OVID) were searched from database inception until March 11, 2019, and updated on September 1, 2020. RESULTS Twenty-four studies met the inclusion criteria. There was significant variation in the range of trialed interventions, as well as the outcome measures used to assess stress. Overall, just over half (13/24) of the included studies reported a benefit in terms of stress reduction. Acceptability and feasibility were considered in 71% (17/24) and costs were considered in 17% (4/24) of studies. The management of stress was rarely linked to the prevention of symptoms of stress-related disorders. The overall evidence base of included studies is weak. However, an increase in the number of studies over time suggests a growing interest in this subject. CONCLUSIONS Further research is required to identify optimum stress management interventions in stroke survivors, including whether the management of stress can ameliorate the negative impacts of stress on health.
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Affiliation(s)
| | - Marina Ilicic
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia,School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia,Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia
| | - Prajwal Gyawali
- School of Health and Wellbeing, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Darling Heights, QLD, Australia
| | - Kirsten Coupland
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia,School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia,Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia
| | - Murielle G Kluge
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia,Centre for Advanced Training Systems, The University of Newcastle, Callaghan, NSW, Australia
| | - Angela Smith
- HNE Health Libraries, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Sue Bowden
- Consumer Investigator, Moon River Turkey, Bathurst, NSW, Australia
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Abstract
Introduction Stroke is a disease whose consequences have a considerable impact on the quality of the patient’s life. It is a widespread disease that has a disabling impact on life and, in addition to physical changes, brings about a number of psychological and cognitive processes. Goal The goal of the study was to identify and describe the quality of life of post-stroke patients. Methodology The study design was quantitative. A questionnaire of the authors’ own design and the SF-36 questionnaire were used to obtain the data. Results Significant differences in patient quality of life were identified in relation to patient gender. Moreover, the quality of life in all individual SF-36 dimensions, except for mental health, deteriorated with age. With regard to occupational placement, employed respondents gave the highest evaluation of quality of life according to SF-36 and old-age pensioners the lowest. The analysis shows that quality of life in individual dimensions is positively influenced by respondents’ higher education. The evaluation in individual dimensions improves with the time that has passed since the stroke. Conclusion The quality of life of post-stroke patients deteriorates with age. The deteriorating level of patient quality of life in older age requires programmes that include assessments and interventions that lead to the treatment of these patients.
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Wei D, Li J, Chen H, Fang F, Janszky I, Ljung R, László KD. Death of a Child and the Risk of Stroke: A Binational Cohort Study From Denmark and Sweden. Neurology 2022; 98:e1104-e1113. [PMID: 34996877 DOI: 10.1212/wnl.0000000000013263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/14/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The death of a child is an extreme life event with potentially long-term health consequences. Accumulating evidence suggests that parents who lost a child have increased risks of cardiovascular diseases, including ischemic heart disease and atrial fibrillation. Whether bereaved parents have an increased risk of stroke is unclear and was investigated in this study. METHODS We conducted a population-based cohort study including parents who had a child born during 1973-2016 or 1973-2014 and recorded in the Danish and the Swedish Medical Birth Registers, respectively. We obtained information on child's death, parent's stroke and socioeconomic and health-related characteristics through linkage between several population-based registers. We used Poisson regression to examine the association between the death of a child and the risk of stroke. RESULTS Of the 6,711,955 study participants, 128,744 (1.9%) experienced the death of a child and 141,840 (2.1%) had a stroke during the follow-up. Bereaved parents had an increased risk of stroke; the corresponding incidence rate ratio (95% confidence intervals) was 1.23 (1.19-1.27). The association was present for all analyzed categories of causes of child death (cardiovascular, other natural and unnatural death), did not differ substantially according to the age of the deceased child, but was stronger if the parent had no or ≥3 than 1-2 live children at the time of the loss. The association was similar for ischemic and hemorrhagic stroke. The risk for hemorrhagic stroke was highest immediately after the death of a child and decreased afterwards. In contrast, there was no clear pattern over time in case of ischemic stroke. DISCUSSION The death of a child was associated with a modestly increased risk of stroke. The finding that an association was observed in case of unnatural deaths is suggestive of the explanation that bereavement-related stress may contribute to the development of stroke. Though the death of a child can often not be avoided, an understanding of its health-related consequences may highlight the need for improved support and attention from family members and healthcare professionals.
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Affiliation(s)
- Dang Wei
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Hua Chen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Imre Janszky
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rickard Ljung
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Swedish Medical Products Agency, Uppsala, Sweden
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Listopad IW, Esch T, Michaelsen MM. An Empirical Investigation of the Relationship Between Spirituality, Work Culture, and Burnout: The Need for an Extended Health and Disease Model. Front Psychol 2021; 12:723884. [PMID: 34589028 PMCID: PMC8473891 DOI: 10.3389/fpsyg.2021.723884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/28/2021] [Indexed: 11/13/2022] Open
Abstract
Apart from biological, psychological, and social factors, recent studies indicate that spirituality and work culture also play an important role in the onset of burnout. Hence, the commonly applied bio-psycho-social model of health and disease might not be sufficient to comprehensively explain and describe burnout. This study empirically investigates the relationship between spirituality (operationalized by perceived meaningfulness of work) and work culture (operationalized by sense of homeliness of the working environment) with burnout risk and work engagement. For this purpose, an anonymous cross-sectional data collection with fully standardized questionnaires and selected socio-demographic and work-related items was conducted among working adults (n = 439) from different industries via social media and local health service centers. For all scales and subscales, we found significant moderate to strong correlations. Furthermore, positive meaning within the perceived meaningfulness of work scale was the largest beta coefficient for burnout (β = -0.65) and work engagement (β = 0.62). Within sense of homeliness, the largest beta coefficient for burnout was needs fulfillment (β = -0.34) and work engagement emotional connection (β = 0.36). The strong associations suggest that the current health and disease model needs to be expanded to a bio-psycho-socio-spirito-cultural model to be able to sufficiently describe burnout. The perceived meaningfulness of work and a sense of homeliness should be adequately considered when examining the onset of burnout, describing burnout as a concept, and explaining work engagement.
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Affiliation(s)
- Ian W Listopad
- Institute for Integrative Health Care and Health Promotion, Faculty of Health, Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Tobias Esch
- Institute for Integrative Health Care and Health Promotion, Faculty of Health, Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Maren M Michaelsen
- Institute for Integrative Health Care and Health Promotion, Faculty of Health, Department of Medicine, Witten/Herdecke University, Witten, Germany
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Illario M, Zavagli V, Ferreira LN, Sambati M, Teixeira A, Lanata F, Pais S, Farrell J, Tramontano D. The Frailty of the Invincible. TRANSLATIONAL MEDICINE AT UNISA 2021. [PMID: 33457314 PMCID: PMC8370525 DOI: 10.37825/2239-9747.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The COVID-19 pandemic has unveiled the frailty of our societies from too many points of view to look away. We need to understand why we were all caught unprepared. On the one hand, we have all short memories. As we forget too quickly, we were unable to recognize key factors influencing response and preparedness to public health threats. For many years, economic evaluation pushed governments all over the world to cut resources for public health systems, with COVID-19 pandemic the question arises: do we spend too much or too little on health care? What is the right amount to spend on health? Moreover, in many countries, the privatisation, or semi-privatisation, of healthcare may give rise to inequitable access to health care for everyone. Although COVID-19 is very “democratic”, its consequences aren’t. According to OECD, income inequality in OECD countries is at its highest level for the past half century. Three main causes have been recognized, technological revolution, globalization, and “financialisation”. In this scenario, lockdown measures adopted to save lives are showing dramatic economic consequences. To address post COVID-19 reconstruction we need to go beyond GDP. As an economic measure this has many shortcomings in describing the real well-being of a country, and since what we measure affects what we do, new paradigms will have to guide the post COVID-19 reconstruction strategies, as the fate of countries and their citizens is at stake.
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Affiliation(s)
- M Illario
- Health Innovation Unit, General Directorate for Health, Campania Region, and Federico II Department of Public Health, Naples, Italy
| | - V Zavagli
- Psycho-oncology Unit, ANT Italia Foundation, Bologna, Italy
| | - L Noronha Ferreira
- Centre for Health Studies and Research-CEISUC, University of Coimbra, Coimbra, Portugal
| | - M Sambati
- Gruppo Cassa depositi e prestiti, Rome, Italy
| | - A Teixeira
- Research Unit for Sport and Physical Activity, Faculty of Sport Science and Physical Education, University of Coimbra, Portugal.
| | - F Lanata
- Wind & Sun Foundation, Genoa, Italy
| | - S Pais
- Comprehensive Health Research Centre (CHRC) and Algarve Biomedical Center (ABC)-University of Algarve, Faro, Portugal
| | - J Farrell
- EIP on AHA RSCN Bruxelles, Belgium, and LANUA International Healthcare Consultancy, Northern Ireland
| | - D Tramontano
- Dpt of Molecular Medicine and Medical Biotechology, School of Medicine, University of Naples Federico II Naples, Italy.,Italy and GENS Onlus Foundation Naples, Italy
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Abstract
SUMMARYStress-related disorders are diverse and they may be mental and physical. Often, several body systems and organs are involved simultaneously. The pathophysiology of stress-related disorders involves many factors: an observable or perceived stressor, an individual dynamically evolving vulnerability and maladaptation leading to imbalance, as well as environmental, cultural, gender and life-cycle variables. There is a need to develop a comprehensive quantifiable stress assessment instrument. It would be based on the ‘stress factor’, a dimension that would integrate biological, psychological, social, economic and spiritual parameters and would allow for cultural sensitivity. It would contribute to clinical operational sophistication and would illuminate treatment options and multidimensional well-being interventions. Hopefully, it would facilitate development of culturally sensitive pharmaceutical or biophysiological adaptogens and homeostatic interventions.
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11
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Illario M, Zavagli V, Ferreira LN, Sambati M, Teixeira A, Lanata F, Pais S, Farrell J, Tramontano D. The Frailty of the Invincible. Transl Med UniSa 2020; 23:1-15. [PMID: 33457314 PMCID: PMC8370525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
The COVID-19 pandemic has unveiled the frailty of our societies from too many points of view to look away. We need to understand why we were all caught unprepared. On the one hand, we have all short memories. As we forget too quickly, we were unable to recognize key factors influencing response and preparedness to public health threats. For many years, economic evaluation pushed governments all over the world to cut resources for public health systems, with COVID-19 pandemic the question arises: do we spend too much or too little on health care? What is the right amount to spend on health? Moreover, in many countries, the privatisation, or semi-privatisation, of healthcare may give rise to inequitable access to health care for everyone. Although COVID-19 is very "democratic", its consequences aren't. According to OECD, income inequality in OECD countries is at its highest level for the past half century. Three main causes have been recognized, technological revolution, globalization, and "financialisation". In this scenario, lockdown measures adopted to save lives are showing dramatic economic consequences. To address post COVID-19 reconstruction we need to go beyond GDP. As an economic measure this has many shortcomings in describing the real well-being of a country, and since what we measure affects what we do, new paradigms will have to guide the post COVID-19 reconstruction strategies, as the fate of countries and their citizens is at stake.
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Affiliation(s)
- M Illario
- Health Innovation Unit, General Directorate for Health, Campania Region, and Federico II Department of Public Health, Naples, Italy
| | - V Zavagli
- Psycho-oncology Unit, ANT Italia Foundation, Bologna, Italy
| | - L Noronha Ferreira
- Centre for Health Studies and Research-CEISUC, University of Coimbra, Coimbra, Portugal
| | - M Sambati
- Gruppo Cassa depositi e prestiti, Rome, Italy
| | - A Teixeira
- Research Unit for Sport and Physical Activity, Faculty of Sport Science and Physical Education, University of Coimbra, Portugal.
| | - F Lanata
- Wind&Sun Foundation, Genoa, Italy
| | - S Pais
- ComprehensiveHealth Research Centre (CHRC) and Algarve BiomedicalCenter (ABC)-University of Algarve, Faro, Portugal
| | - J Farrell
- EIP on AHA RSCN Bruxelles, Belgium, and LANUA International Healthcare Consultancy, Northern Ireland
| | - D Tramontano
- Dpt of Molecular Medicine and Medical Biotechology, School of Medicine, University of Naples Federico II Naples
- Italy and GENS Onlus Foundation Naples, Italy
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The Factors Associated with the Fatal Outcome of Stroke. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2019-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of this study is to determine the risk factors associated with the fatal outcome of stroke. The research was designed as observational, non-interventional study, conducted by the type of case series, and it included 290 patients hospitalized with a diagnosis of stroke at Neurology Clinic of the Clinical Center Kragujevac during the observed period from 01/02/2013 to 31/01/2014. The data used for the research were: documentation of Neurology Clinic of the Clinical Center Kragujevac, documentation of the Institute of Public Health Kragujevac and patients’ questionnaires. The results of univariate binary logistic regression pointed out a relevant connection between the fatal outcome of stroke and age (p˂ 0.0001), gender (p˂ 0.0001), the severity of the disease (p = 0.002), smoking (p = 0.021), care for the parents’ health (p = 0.018), the concern about business problems (p = 0.018), while the influence of antidepressants was indicative (p = 0.066), whereas using the multivariate binary logistic regression, it was concluded that age (OR=1.096; 95% CI=1.059-1.134; p<0.001), the severity of the disease (OR=4.324; 95% CI=1.256-14.885; p=0.020) and the use of antidepressants (OR=5.578; 95% CI=1.178-26.423; p=0.030) were factors independently associated with the mortality rate. These findings suggest that it would be useful to carry out additional comprehensive research about all potential risk factors for the occurrence of stroke, and also to establish all the steps that can be taken in order to identify and detect risk factors, their elimination or reduction, and, accordingly, to take aggressive measures of primary and secondary prevention.
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Chen Q, Cao C, Gong L, Zhang Y. Health related quality of life in stroke patients and risk factors associated with patients for return to work. Medicine (Baltimore) 2019; 98:e15130. [PMID: 31008934 PMCID: PMC6494282 DOI: 10.1097/md.0000000000015130] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
To clarify dynamic change of quality of life (QOL) in patients with stroke after treatment, and to explore the predictors associated with return to work (RTW) within 48 weeks.Patients diagnosed with stroke were enrolled. All patients enrolled were asked to fill in the Short Form 36 Health Survey. For patients with stroke, SF-36 questionnaires were measured repeatedly 4 weeks after treatment. We used phone call to find out if the patient was RTW. The investigation time was 48 weeks.Patients with stroke had lower scores in terms of physiological dimensions, such as physical functional, role limitations due to physical problems, and general health (P < .001). While patients with strokes scored significantly lower in all mental dimensions including vitality, social functioning, role limitations due to emotional problems, and mental health (P < .001). After 4-weeks treatment, we found that, except for bodily pain, scores in dimensions like physical functioning, role limitations due to physical problems, and general health had increased significantly (P < .001). Multivariate logistic regression analysis was conducted, and the result showed that older age (P = .04) and singleness (P = .03) were risk factors associated with QOL improvement in stroke patients after treatment. Outcomes of stroke patients within 48 weeks were explored. The results showed that 108 out of 136 patients RTW within 48 weeks. Average days it took for patients with cerebral infarction to return to work were 77 ± 79, significantly less than patients with cerebral hemorrhage (206 ± 159 days) and patients with subarachnoid hemorrhage (117 ± 113 days, P < .001). Multivariate analysis indicated that only QOL improvement (P = .04) and subtype of stroke (P = .01) were independent factors associated with RTW within 48 weeks.QOL of stroke patients was significantly reduced. After treatments, the physiological quality of stroke patients increased, but the psychological quality remained low. In addition, patients with cerebral hemorrhage and patients with no significant improvement in QOL are independent risk factors for RTW. Therefore, for this subgroup of the population, early diagnosis, close follow-up and monitor of the psychological state should be provided to avoid the occurrence of adverse events.
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Affiliation(s)
| | - Chunni Cao
- Department of Hyperbaric Oxygen, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong Province, China
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Futch HS, Croft CL, Truong VQ, Krause EG, Golde TE. Targeting psychologic stress signaling pathways in Alzheimer's disease. Mol Neurodegener 2017; 12:49. [PMID: 28633663 PMCID: PMC5479037 DOI: 10.1186/s13024-017-0190-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/08/2017] [Indexed: 12/20/2022] Open
Abstract
Alzheimer's Disease (AD) is the most prevalent progressive neurodegenerative disease; to date, no AD therapy has proven effective in delaying or preventing the disease course. In the search for novel therapeutic targets in AD, it has been shown that increased chronic psychologic stress is associated with AD risk. Subsequently, biologic pathways underlying psychologic stress have been identified and shown to be able to exacerbate AD relevant pathologies. In this review, we summarize the literature relevant to the association between psychologic stress and AD, focusing on studies investigating the effects of stress paradigms on transgenic mouse models of Amyloid-β (Aβ) and tau pathologies. In recent years, a substantial amount of research has been done investigating a key stress-response mediator, corticotropin-releasing hormone (CRH), and its interactions with AD relevant processes. We highlight attempts to target the CRH signaling pathway as a therapeutic intervention in these transgenic mouse models and discuss how targeting this pathway is a promising avenue for further investigation.
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Affiliation(s)
- Hunter S. Futch
- Department of Neuroscience, University of Florida, Gainesville, FL 32610 USA
- Center for Translational Research in Neurodegenerative Disease, University of Florida, Gainesville, FL 32610 USA
- McKnight Brain Institute, University of Florida, 1149 Newell Drive, PO Box 1000015, Gainesville, FL 32610 USA
| | - Cara L. Croft
- Department of Neuroscience, University of Florida, Gainesville, FL 32610 USA
- Center for Translational Research in Neurodegenerative Disease, University of Florida, Gainesville, FL 32610 USA
- McKnight Brain Institute, University of Florida, 1149 Newell Drive, PO Box 1000015, Gainesville, FL 32610 USA
| | - Van Q. Truong
- Department of Neuroscience, University of Florida, Gainesville, FL 32610 USA
- Center for Translational Research in Neurodegenerative Disease, University of Florida, Gainesville, FL 32610 USA
- McKnight Brain Institute, University of Florida, 1149 Newell Drive, PO Box 1000015, Gainesville, FL 32610 USA
| | - Eric G. Krause
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, USA
- McKnight Brain Institute, University of Florida, 1149 Newell Drive, PO Box 1000015, Gainesville, FL 32610 USA
| | - Todd E. Golde
- Department of Neuroscience, University of Florida, Gainesville, FL 32610 USA
- Center for Translational Research in Neurodegenerative Disease, University of Florida, Gainesville, FL 32610 USA
- McKnight Brain Institute, University of Florida, 1149 Newell Drive, PO Box 1000015, Gainesville, FL 32610 USA
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