Could long-term dialysis vintage and abnormal calcium, phosphorus and iPTH control accelerate aging among the maintenance hemodialysis population?

The current status and influencing factors of oral frailty in elderly maintenance hemodialysis patients based on the Andersen Oral Health Outcome Model

OBJECTIVES

To analyse the elements that influence oral frailty in elderly maintenance hemodialysis patients and to comprehend the present state of this condition.

METHODS

A survey of 325 elderly maintenance hemodialysis patients from three hospitals in Huzhou City was conducted using a general information questionnaire, the Oral Health Assessment Tool, the Knowledge, Attitude, and Practice of Oral Health Questionnaire, the Social Frailty, the Frail Scale, and the Oral Frailty Index.

RESULTS

In elderly maintenance hemodialysis patients, the prevalence of oral frailty was 45.2%. Factors influencing it include the Oral Health Knowledge Score (OR = 0.84, 95% CI 0.72-0.98), Oral Health Behavior Score (OR = 0.95, 95% CI 0.92-0.98), insufficient dialysis (OR = 0.30, 95% CI 0.14-0.63), social frailty (OR = 3.72, 95% CI 1.57-8.83), physical frailty (OR = 3.12, 95% CI 1.55-6.30), number of missing teeth (OR = 1.09, 95% CI 1.03-1.15), swallowing abnormalities (OR = 2.84, 95% CI 1.26-6.38), and oral health scores (OR = 1.34, 95% CI 1.14-1.57) (P < 0.05).

CONCLUSION

Patients on elderly maintenance hemodialysis are more susceptible to oral frailty. Nursing staff should develop scientifically sound, effective, and targeted oral management strategies for these patients.

Invasive Listeriosis in End-Stage Kidney Disease (ESKD) Patients Receiving Long-Term Dialysis: A 21-Year Case Series

Background

Listeriosis is caused by the facultative anaerobic bacterium Listeria monocytogenes. Infection from Listeria-contaminated food or water is the main etiology. If Listeria travels outside the intestines, it can cause invasive listeriosis, such as sepsis, meningitis, and meningoencephalitis. Invasive illness is especially dangerous for pregnant women and their newborns, elderly people, and people with compromised immune systems or medical conditions such as end-stage kidney disease (ESKD) patients receiving long-term dialysis.

Purpose

Describe the manifestations and hospital outcomes of invasive listeriosis and identify the risk factors for in-hospital and one-year mortality in ESKD patients receiving long-term dialysis.

Patients and Methods

This retrospective observational study examined hospitalized patient records at a Taiwanese tertiary medical center from August 1, 2000, to August 31, 2021. ESKD patients on chronic dialysis were identified with invasive listeriosis by blood culture and discharge diagnosis. Over 21 years, we accurately recorded 26 cases.

Results

ESKD patients on chronic dialysis with invasive listeriosis have a poor prognosis. Only 53.8% of chronic dialysis patients with invasive listeriosis survived their first hospital episode. 42.3% of hospitalized ESKD patients with invasive listeriosis survived one year later. In univariate analysis, shock, tachypnea (RR ≥ 22), respiratory failure, qSOFA score ≥ 2, and lower initial platelet count were linked to greater in-hospital mortality rates.

Conclusion

ESKD patients with invasive listeriosis have a grave prognosis. Our research reveals that an early blood sample for a bacterial culture may identify invasive listeriosis in chronic dialysis patients with fever, nausea or vomiting, confusion, and respiratory distress. This study is the first to identify a lower platelet count and qSOFA score ≥ 2 as markers of high-risk invasive listeriosis in ESKD patients.

Burnout, emotional distress and sleep quality among Chinese psychiatric healthcare workers during the COVID-19 pandemic: a follow-up study

Background

Different from the very early stages of the COVID-19 pandemic, burnout and chronic mental health problems among health care workers (HCWs) has become a challenge. Research is lacking on the relationship between burnout, stress, emotional distress and sleep quality.

Methods

The Chinese center has been involved in the Cope-Corona project since the second survey (T2). Named after the project, a total of three cross-sectional surveys were distributed: T2 (February 16-20, 2021), T3 (May 10-14, 2022), and T4 (December 20-24, 2022). Burnout, depression, anxiety, sleep quality, workplace factors and individual resources were measured. Using the T4 data, we conducted structural equation model (SEM) to examine the mediating role of burnout in predicting emotional distress and sleep quality.

Results

96, 124, and 270 HCWs were enrolled at T2, T3, and T4, respectively. In line with the epidemic trends, the level of perceived COVID-19 related risks was significantly higher at T4, while the feeling of health and safety decreased significantly. At T4, the percentages of participants with clinically significant levels of depression and anxiety symptoms were 18.9% (51/270) and 9.3% (25/270), respectively, while 30.4% (82/270) of them reported poor or very poor sleep quality. According to the SEM, individual resources and workplace factors mainly had an indirect effect in predicting depression and anxiety via burnout. However, neither burnout nor stress was a mediator or predictor of sleep quality. Instead, individual resources, positive workplace factors, and younger age had a direct effect in predicting good sleep quality.

Conclusion

Measures designed to enhance workplace factors and individual resources should be implemented to improve psychosomatic wellbeing of HCWs.