Impaired Standing Balance in Older Adults with Cognitive Impairment After a Severe Fall

Introduction Fall-related sequelae as well as balance and gait impairments are more pronounced in older adults, who are cognitively impaired (OACI) compared to older adults who are cognitively healthy (OACH). Evidence is scarce about differences in standing balance and gait in OACH and OACI after a fall, even though these are major risks for recurrent falls. Thus, the aim of the study was to investigate early impairments in gait and balance, by adding Inertial Measurement Units (IMUs) to a functional performance test in OACH and OACI after a severe fall with presentation to the emergency department (ED) and immediate discharge. Methods The study sample was stratified into participants with and without probable cognitive impairment using the result of the Montreal Cognitive Assessment total score (maximum of 30 points). The cutoff for probable cognitive impairment was set at ≤ 24. Standing balance and gait parameters were measured using three IMUs in n=69 OACH (72.0 ± 8.2 years) and n=76 OACI (78.7 ± 8.1 years). Data were collected at participants' homes as part of a comprehensive geriatric assessment in the "SeFallED" study within four weeks after presentation to the ED after a severe fall (German Clinical Trials Register ID: 00025949). ANCOVA was used for statistical analysis, adjusted for age. Results The data indicated significantly more sway for OACI compared to OACH during balance tasks, whereas no differences in gait behavior were found. In detail, differences in standing balance were revealed for mean velocity (m/s) during parallel stance with eyes open (ηp2=0.190, p<0.001) and eyes closed on a balance cushion (ηp2=0.059, p=0.029), as well as during tandem stance (ηp2=0.034, p=0.044) between OACI and OACH. Further differences between the two groups were detected for path length (m/s2) during parallel stance with eyes open (ηp2=0.144, p<0.001) and eyes closed (ηp2=0.044, p<0.027) and for range (m/s2) during tandem (ηp2=0.036, p=0.036) and parallel stance with eyes closed (ηp2= 0.045, p=0.032). Conclusion Even though both groups have experienced a severe fall with presentation to the ED in the preceding 4 weeks, balance control among OACI indicated a higher fall risk than among OACH. Therefore, effective secondary falls prevention efforts have to be established, particularly for OACI.

Validation of a noninvasive cardiac output monitor in maternal cardiac disease: comparison of NICOM and transthoracic echocardiogram

BACKGROUND

The physiological changes to the cardiovascular system during pregnancy are considerable and are more pronounced in those with cardiac disease. In the general population, noninvasive hemodynamic monitoring is a valid alternative to pulmonary artery catheterization, which poses risk in the pregnant population. There is limited data on noninvasive cardiac output monitoring in pregnancy as an alternative to pulmonary artery catheterization.

OBJECTIVE

We sought to compare transthoracic echocardiography with a noninvasive cardiac output monitor (NICOM, Cheetah Medical) in pregnant patients with and without cardiac disease.

STUDY DESIGN

This was a prospective, open-label validation study that compared 2-dimensional transthoracic echocardiography with NICOM estimations of cardiac output in each trimester of pregnancy and the postpartum period. Participants with and without cardiac disease with a singleton gestation were included. NICOM estimations of cardiac output were derived from thoracic bioreactance and compared with 2-dimensional transthoracic echocardiography for both precision and accuracy. A mean percentage difference of ±30% between the 2 devices was considered acceptable agreement between the 2 measurement techniques.

RESULTS

A total of 58 subjects were enrolled; 36 did not have cardiac disease and 22 had cardiac disease. Heart rate measurements between the 2 devices were strongly correlated in both groups, whereas stroke volume and cardiac output measurements showed weak correlation. When comparing the techniques, the NICOM device overestimated cardiac output in the control group in all trimesters and the postpartum period (mean percentage differences were 50.3%, 52.7%, 48.1%, and 51.0% in the first, second, and third trimesters and the postpartum period, respectively). In the group with cardiac disease, the mean percentage differences were 31.9%, 29.7%, 19.6%, and 35.2% for the respective timepoints.

CONCLUSION

The NICOM device consistently overestimated cardiac output when compared with 2-dimensional transthoracic echocardiography at all timepoints in the control group and in the first trimester and postpartum period for the cardiovascular disease group. The physiological changes of pregnancy, specifically the mean chest circumference and total body water, may alter the accuracy of the cardiac output measurement by the NICOM device as they are currently estimated. Although NICOM has been validated for use in the critical care setting, there is insufficient data to support its use in pregnancy.

Cardiovascular disease and maternal mortality: perceptions in a Midwest birthing population

BACKGROUND

Missouri has one of the highest rates of maternal mortality in the United States. To date, there are currently no studies describing birthing peoples' knowledge or perceptions of contributing causes of maternal mortality. An improved understanding of population-specific knowledge can help to define how best to design targeted interventions to reduce disease-specific causes of maternal mortality.

OBJECTIVE

This study aimed to examine the knowledge and understanding of maternal mortality in a Missouri birthing population.

STUDY DESIGN

A 46-question, cross-sectional survey to assess the familiarity with local maternal mortality rates, groups affected, and causality was developed by the Missouri Perinatal Quality Collaborative and the Maternal-Child Learning and Action Network and emailed to a random sample of birthing people across Missouri. Those who identified as someone with birthing potential with a Missouri zip code and who were ≥18 years of age were eligible for inclusion. Unadjusted descriptive statistics were generated and stratified by age, race, and region.

RESULTS

Among 2196 surveys sent, 1738 people completed the survey. Of those who responded, 78.2% were aware of the risk of pregnancy-related death with 14.7% reporting that they intimately knew someone who died. When asked if a certain group is affected disproportionately more, 66.4% responded affirmatively. Black (58.7%), uninsured (61.8%), poor (71.0%), those with substance abuse disorders (57.4%), and Native American (28.8%) birthing people were identified as groups that were perceived as suffering higher rates of maternal death. When polled on etiology, severe bleeding (56.9%) was believed to be the leading cause of death, and the second stage of labor was thought to be the period of highest risk (42.3%). Beliefs about the timing of death differed by age (P=.042) but not race (P=.81) or region (P=.191).

CONCLUSION

Missouri birthing people are cognizant of the social factors associated with increased maternal mortality but are unaware of the leading causes of death, namely cardiovascular disease and mental health conditions. Future Perinatal Quality Collaborative work should focus on campaigns that raise public awareness about cardiovascular disease and mental health-related birthing risks and the importance of monitoring early warning signs after delivery.

Recruiting patients for falls prevention in the emergency department - worth the challenge

BACKGROUND

Severe falls escalate the risk of future falls and functional decline as indicated by recent global guidelines. To establish effective falls prevention, individuals at highest risk must be thoroughly studied and, therefore, successfully recruited.

OBJECTIVE

Recruiting from an emergency department (ED) may mitigate common selection biases, such as overrepresentation of individuals with a higher social status and healthier lifestyle. However, this approach presents unique challenges due to ED-specific conditions. Hence, we present the successes and challenges of an ED-based recruitment for an observational study.

METHODS

The SeFallED study targets older adults aged ≥60 years, who present to either of two hospitals in Oldenburg after a fall without subsequent admission. A study nurse addressed individuals in the EDs. Subsequently, potential participants were contacted by phone to arrange a home visit for obtaining written consent. Data of participants were compared with total admissions during the recruitment period to determine recruitment rate and compare patients' characteristics.

RESULTS

Over 1.500 individuals met the inclusion criteria. Of these, 288 participants were successfully recruited. Most patients presented to the ED outside of the study team's working hours, and some opted not to participate (main reason: too unwell (40%)). Compared to working hours, a participant was recruited every 14 h. Comparing characteristics, a trend towards better health and younger age was observed.

CONCLUSION

ED-based recruitment offers the opportunity to include more diverse individuals in falls prevention. To achieve adequate sample sizes, flexibility in working days and hours of the research team are obligatory.

TRIAL REGISTRATION

DRKS00025949.

Blended-ALMAMAR app for inpatient mental health care for refugees: study protocol for a multicenter implementation study within the I-REACH consortium (Internet based REfugee mentAl healtH Care)

BACKGROUND

Refugees are at high risk for developing mental illnesses. Due to language and cultural barriers, there is need for specifically adapted therapeutic procedures for refugees in inpatient mental health care settings. Internet-based applications in refugee mother tongues have the potential to improve the outcomes of mental health care for this vulnerable population. The key research question of the present implementation study is whether the newly developed "blended ALMAMAR" app for Arabic and Farsi speaking refugees in Germany is used and accepted by patients and professionals in routine inpatient mental health care (blended care).

METHODS

We present the design of an observational, prospective multicenter implementation study in eight psychiatric hospitals. We plan to recruit 100 Farsi or Arabic speaking refugees receiving in-patient treatment due to depression, anxiety disorder, posttraumatic stress disorder or substance use disorders. These patients will get access to the "blended ALMAMAR" app during their inpatient stay in a blended-care approach. We will assess the usage (e.g., duration and frequency of use of the app) as well as subjective acceptability and usability of the intervention. To identify sociodemographic and clinical factors associated with "blended ALMAMAR" usage, we will also perform clinical and questionnaire assessments.

DISCUSSION

The newly developed "blended ALMAMAR" app may help to close communication gaps for the hard-to reach and vulnerable group of refugees in inpatient mental health care. It is the first blended-care intervention that addresses severely mentally ill refugees in an inpatient psychiatric setting in Germany.

TRIAL REGISTRATION

The trial was registered in the German Clinical Trials Register on November 11, 2021 (DRKS00025972) and adapted on November 14, 2023.

The impact of shift work on pain recognition, a robust ability among intensive care nurses

BACKGROUND

Pain empathy is essential for high-quality of care. The cognitive ability to identify and understand the pain in others remains underexplored in the context of hospital shift work. This study aimed to observe the early subliminal ability to detect pain in other faces and to investigate pain intensity evaluations during day and night shifts.

METHODS

Twenty-one nurses (31 ± 7 years, 20 women) from cardio-paediatric intensive care participated in this study. Eighteen nurses completed all testing in the morning and evening hours, before and after the 12-hour day and night shift. In the first test, the nurses had to decide if facial stimuli presented subliminally showed pain or not. During the second test, they consciously determined the intensity of the painful faces on a numerical scale. Sleep, sleepiness and empathy were also measured.

RESULTS

Recognition accuracy and pain sensitivity remained stable over time, only sensitivity increased following the work shift (F(1,15) = 7.10, p = 0.018). Intensity ratings remained stable. Sleepiness at the end of the night shift was negatively correlated with accuracy (ρ = -0.51, p = 0.018) and positively correlated with prior night shifts (ρ = -0.50, p = 0.022).

CONCLUSION

The judgement of facial pain expressions seems robust across shift types, only individual factors such as sleepiness interfere with pain recognition. Pain sensitivity may be enhanced during working hours.

SIGNIFICANCE STATEMENT

Some professions need to know how to assess pain 24/7 and a lack of sleep can disrupt the cognitive processes necessary for this assessment. Night shifts provoke a bias in pain management, and sleep deprivation, a decrease in pain evaluation. By conducting a repeated measure study in the field that applied a different paradigm (subliminal recognition of facial cues) we add evidence to the understanding of pain recognition and the impact of sleep deprivation on the early processing of pain in others.

Effect of transcutaneous vagus nerve stimulation on stress-reactive neuroendocrine measures in a sample of persons with temporal lobe epilepsy

OBJECTIVE

Dysregulation of stress-reactive neuroendocrine measures, as well as subjective stress, have been found to worsen epilepsy. Transcutaneous vagus nerve stimulation (tVNS) is a relatively new treatment option for epilepsy. We were interested in its effect on the activity of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) as well as subjective stress and tiredness in patients with temporal lobe epilepsy (TLE).

METHODS

Twenty patients (age 44 ± 11 years, 13 women) were enrolled in the study. They were free of seizures for more than 1 year. All took part in two sessions with 4 h of stimulation (tVNS vs. sham) in a randomized order. Saliva samples and subjective stress and tiredness levels were measured at five time points each session (before and after stimulation and three time points every hour in between). Data were analyzed using repeated measures analysis of variance as well as paired t-tests.

RESULTS

There was a dampened salivary cortisol (sCort) decrease during tVNS (time × condition effect: F[2.38, 38.15]  = 6.50, P = 0.002, partial η2  = 0.29). Furthermore, we detected a dampened increase in salivary flow rate during tVNS (time × condition effect: F[3.28, 55.67]  = 2.82, P = 0.043, partial η2  = 0.14). There was neither a difference in overall sCort or salivary alpha-amylase (sAA) levels nor in subjective stress or tiredness levels between conditions. sAA levels at the last measurement point were slightly higher during tVNS (t(19)  = 2.26, P = 0.035, d = 0.51), but this effect failed to reach significance when controlled for multiple comparisons.

SIGNIFICANCE

Our results partially support that tVNS influences the regulation of stress-reactive neuroendocrine systems (namely the HPA axis and ANS) in epilepsy. More research with larger samples is needed on the difference between short-term and repeated long-term stimulation.

Tuning Nanobodies' Bioactivity: Coupling to Ultrasmall Gold Nanoparticles Allows the Intracellular Interference with Survivin

Nanobodies are highly affine binders, often used to track disease-relevant proteins inside cells. However, they often fail to interfere with pathobiological functions, required for their clinical exploitation. Here, a nanobody targeting the disease-relevant apoptosis inhibitor and mitosis regulator Survivin (SuN) is utilized. Survivin's multifaceted functions are regulated by an interplay of dynamic cellular localization, dimerization, and protein-protein interactions. However, as Survivin harbors no classical "druggable" binding pocket, one must aim at blocking extended protein surface areas. Comprehensive experimental evidence demonstrates that intracellular expression of SuN allows to track Survivin at low nanomolar concentrations but failed to inhibit its biological functions. Small angle X-ray scattering of the Survivin-SuN complex locates the proposed interaction interface between the C-terminus and the globular domain, as such not blocking any pivotal interaction. By clicking multiple SuN to ultrasmall (2 nm) gold nanoparticles (SuN-N), not only intracellular uptake is enabled, but additionally, Survivin crosslinking and interference with mitotic progression in living cells are also enabled. In sum, it is demonstrated that coupling of nanobodies to nanosized scaffolds can be universally applicable to improve their function and therapeutic applicability.

'You're never pregnant in the same way again': prior early pregnancy loss influences need for health care and support in subsequent pregnancy

STUDY QUESTION

What are couples' needs for health care and support in a subsequent pregnancy after prior early pregnancy loss (PL) and how do needs change across the pregnancy?

SUMMARY ANSWER

Couples described unmet needs for pregnancy care in the first 20 weeks of pregnancy and were more satisfied with the care provided during the remainder of the pregnancy.

WHAT IS KNOWN ALREADY

Despite early PL being common (∼25% of pregnancies), there is a paucity of research to guide practice to optimize treatment and support future pregnancies. There has been low priority for the issue in research and a pervasive acceptance that couples should 'just try again' after experiencing PL. Women with prior PL report increased anxiety during the first trimester of pregnancy compared to those without previous PL. No longitudinal studies explore what couples' needs are throughout the pregnancy and how these needs shift across time.

STUDY DESIGN SIZE DURATION

This was a qualitative longitudinal dyadic (joint) interview study. In total, 15 couples who were pregnant after a prior PL were interviewed four times over their pregnancy. Couples were recruited from the Copenhagen Pregnancy Loss Cohort Research Programme. Interviews were held in person at the hospital or university, or online. Interviews ranged from 20 to 91 min (mean = 54 min).

PARTICIPANTS/MATERIALS SETTING METHODS

Inclusion criteria included couples with one to two prior early PL(s) who self-reported a new pregnancy and were willing to be interviewed together and in English. Couples were interviewed four times: after a positive pregnancy test and once in each trimester. Interviews were transcribed and data were analysed using thematic analysis to compare and contrast needs of the couples at each of the four time periods in the pregnancy and across the entire pregnancy. One same-sex couple and 14 heterosexual couples participated.

MAIN RESULTS AND THE ROLE OF CHANCE

Couples' needs were categorized into two main longitudinal themes across the pregnancy, divided by the 20-week scan. Within each longitudinal theme, there were two themes to represent each time period. In the longitudinal theme 'The first 20 weeks: a 'scary' gap in care' there were two themes: Positive pregnancy test: 'Tell them it's not the same pregnancy' and First trimester: 'We craved that someone was taking care of us'. The standard pregnancy care offered in the public healthcare system in Denmark includes a scan at 12 and 20 weeks. While all couples wished for additional access to scans and monitoring of the foetus in early pregnancy to provide reassurance and detect problems early, they described considerable variation in the referrals and care they were offered. Both partners expressed a high degree of worry and anxiety about the pregnancy, with pregnant women in particular describing 'surviv[ing] from scan to scan' in the early weeks. Couples took scans wherever offered or paid for comfort scans, but this resulted in fragmented care. Instead, they wished for continuity in care, and acknowledgement and sensitivity that a pregnancy after PL is not the same as a first pregnancy. In the longitudinal theme 'The second 20 weeks: Safety in the care system' there were two themes: Second trimester: 'I think we are in good hands' and Third trimester: 'It's more of a 'nice to know' everything is OK than a 'need to know'. Couples reported their distress was lower and overall needs for care were met during this time. They expressed general satisfaction with regular or extended antenatal support although, as in the first 20 weeks, additional acknowledgement and sensitivity regarding their history of PL was desired. Couples said they felt more secure given that they had access to a 24-hour telephone support by midwife/nurse if they had any concerns or questions.

LIMITATIONS REASONS FOR CAUTION

Participants were self-selected from an ongoing cohort study of patients presenting at hospital with PL. Single women were not included in the study. This study was limited to data collection in Denmark; however, other countries with public healthcare systems may have similar offerings with regard to their provision of antenatal care, care provided in recurrent pregnancy loss (RPL) clinics and the availability of private scans.

WIDER IMPLICATIONS OF THE FINDINGS

The findings underscore that an early PL creates an increased need for monitoring and care in a subsequent pregnancy. This study highlights a gap in pregnancy care for those with a history of PL given that their need for monitoring and support is high in the early weeks of a new pregnancy before they have access to antenatal care, and before they have had multiple PLs and can be referred to the RPL unit.

STUDY FUNDING/COMPETING INTERESTS

This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 101028172 for E.K. The Copenhagen Pregnancy Loss Cohort is funded by a grant from the BioInnovation Institute Foundation. H.S.N. has received scientific grants from Freya Biosciences, Ferring Pharmaceuticals, BioInnovation Institute, Ministry of Education, Novo Nordisk Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, Ole Kirks Fond, and Independent Research Fund Denmark. H.S.N. received personal payment or honoraria for lectures and presentations from Ferring Pharmaceuticals, Merck, Astra Zeneca, Cook Medical, Gedeon Richter, and Ibsa Nordic. All other authors declare no competing interests.

Comparison of machine learning approaches for near-fall-detection with motion sensors

Introduction

Falls are one of the most common causes of emergency hospital visits in older people. Early recognition of an increased fall risk, which can be indicated by the occurrence of near-falls, is important to initiate interventions.

Methods

In a study with 87 subjects we simulated near-fall events on a perturbation treadmill and recorded them with inertial measurement units (IMU) at seven different positions. We investigated different machine learning models for the near-fall detection including support vector machines, AdaBoost, convolutional neural networks, and bidirectional long short-term memory networks. Additionally, we analyzed the influence of the sensor position on the classification results.

Results

The best results showed a DeepConvLSTM with an F1 score of 0.954 (precision 0.969, recall 0.942) at the sensor position "left wrist."

Discussion

Since these results were obtained in the laboratory, the next step is to evaluate the suitability of the classifiers in the field.

Novel evidence that the ABO blood group shapes erythropoiesis and results in higher hematocrit for blood group B carriers

The ABO blood group (BG) system is of great importance for blood transfusion and organ transplantation. Since the same transcription factors (TFs) and microRNAs (miRNAs) govern the expression of ABO BG antigens and regulate erythropoiesis, we hypothesized functional connections between both processes. We found significantly higher hemoglobin and hematocrit values in BG B blood donors compared to BG A. Furthermore, we observed that erythropoiesis in BG B hematopoietic stem/progenitor cells (HSPCs) was accelerated compared to BG A HSPCs. Specifically, BG B HSPCs yielded more lineage-specific progenitors in a shorter time (B: 31.3 ± 2.2% vs. A: 22.5 ± 3.0%). Moreover, non-BG A individuals exhibited more terminally differentiated RBCs with higher enucleation rates containing more hemoglobin compared to BG A. Additionally, we detected increased levels of miRNA-215-5p and -182-5p and decreased expression of their target TFs RUNX1 and HES-1 mRNAs in erythroid BG B precursor cells compared to BG A. This highlights the important roles of these factors for the disappearance of differentiation-specific glycan antigens and the appearance of cancer-specific glycan antigens. Our work contributes to a deeper understanding of erythropoiesis gene regulatory networks and identifies its interference with BG-specific gene expression regulations particularly in diseases, where ABO BGs determine treatment susceptibility and disease progression.

Identifying genomic regions determining shoot and root traits related to nitrogen uptake efficiency in a multiparent advanced generation intercross (MAGIC) winter wheat population in a high-throughput phenotyping facility

In the context of a continuously increasing human population that needs to be fed, with environmental protection in mind, nitrogen use efficiency (NUE) improvement is becoming very important. To understand the natural variation of traits linked to nitrogen uptake efficiency (UPE), one component of NUE, the multiparent advanced generation intercross (MAGIC) winter wheat population WM-800 was phenotyped under two contrasting nitrogen (N) levels in a high-throughput phenotyping facility for six weeks. Three biomass-related, three root-related, and two reflectance-related traits were measured weekly under each treatment. Subsequently, the population was genetically analysed using a total of 13,060 polymorphic haplotypes and singular SNPs for a genome-wide association study (GWAS). In total, we detected 543 quantitative trait loci (QTL) across all time points and traits, which were pooled into 42 stable QTL (sQTL; present in at least three of the six weeks). Besides Rht-B1 and Rht-D1, candidate genes playing a role in gibberellic acid-regulated growth and nitrate transporter genes from the NPF gene family, like NRT 1.1, were linked to sQTL. Two novel sQTL on chromosomes 5 A and 6D showed pleiotropic effects on several traits. The high number of N-specific sQTL indicates that selection for UPE is useful specifically under N-limited conditions.

Explaining the intention to get vaccinated against COVID-19: General attitudes towards vaccination and predictors from health behavior theories

The goal of our study was to examine the intention to get vaccinated using predictors from the 5C Model of vaccination attitudes, the Theory of Planned Behavior (TPB) and the Health Belief Model (HBM). Between August and November 2020, an online survey was delivered to 1428 participants in the UK and Germany (mean age = 40.6; 57% women), assessing socio-demographic and health factors, general vaccination attitudes, TBP and HBM variables, and COVID-19 vaccination intention. Vaccination intentions did not differ by country or survey period. Predictors of intention with the highest explanatory power in a relative weight analysis were confidence, collective responsibility (5C) perceived behavioral control, social norms, attitudes (especially negative affect & TPB cognitions), and perceived benefits (HBM). Women reported lower intention, although the effect size was small. Predictors from the TPB and HBM were effective to explain the intention to receive COVID-19 vaccines over and above socio-demographic variables, health-related factors and general vaccination attitudes. The results are interpreted in the context of current vaccination campaigns. Messages promoting sense of autonomy and control over the decision to get vaccinated, approval from significant others and reassurance that getting vaccinated will not be associated with fear or other negative feelings are important facilitators of vaccine uptake.

FEELING YOUNG TODAY, FEELING GOOD TOMORROW? MICROLONGITUDINAL DYNAMICS IN SUBJECTIVE AGE

Insights into the short-term dynamics and micro-longitudinal consequences of subjective age can drive our understanding of its long-term mechanisms across adulthood. Using data from 80 newly retired individuals (aged 59 to 76 years; 59% women) collected on 21 days, we made use of a recent methodological advance—multilevel dynamic structural equation modeling. As possible same-day correlates and micro-longitudinal consequences of subjective age, we investigated physical activity, step number, sleep quality, affect, and stress, which were either assessed via wearables (FitBit Charge HR) or daily diaries. Analyses suggest a weak autoregression of subjective age, indicating that how old one feels is determined via daily rather than lasting experiences. Indeed, there were significant same-day relations to all suggested correlates. The one effect lasting across several days was from an older subjective age on subsequent negative affect—a potential short-term mechanism contributing to the detrimental long-term influence of an older subjective age.

Association between oral health and oral health-related quality of life in patients before hip and knee endoprosthesis surgery: a cross-sectional study

Objectives

Aim of this cross-sectional study was the assessment of oral health-related quality of life (OHRQoL) health-related quality of life (HRQoL), oral health behaviour and oral health status in patients before hip and knee endoprosthesis (EP) surgery. Moreover, associations between OHRQoL, HRQoL and oral health should be examined.

Methods

Consecutive patients before hip and/or knee EP implantation were recruited and referred to the dental clinic for oral examination including: number of remaining teeth, dental findings (DMF-T-Index), periodontal condition (periodontal treatment need, Staging/Grading) and temporomandibular joint screening. OHRQoL was assessed by the German short form of oral health impact profile (OHIP G14), HRQoL by short-form 36 survey.

Results

Hundred and sixty two patients with a mean age of 66.80 ± 11.10 years were included, which had on average 18.22 ± 8.57 remaining teeth and a periodontal treatment need of 84.5%. The OHIP G14 sum score revealed a median of 1 (mean: 2.7 ± 4.4, 25–75th percentile: 0–4) and its dimension oral function of 0 (mean: 0.8 ± 1.8, 25–75th percentile: 0–1), what was also found for psychosocial impact (median: 0, mean: 1.4 ± 2.6, 25–75th percentile: 0–2). The OHIP G14 sum score and both dimensions were significantly associated with mental component summary (p < 0.01). A higher number of remaining teeth as well as remaining molars/premolars were associated with lower OHIP G14 sum score (p = 0.02). This was also found for the dimension oral function (p < 0.01).

Conclusion

Patients prior to hip and knee EP had an unaffected OHRQoL, although they had an insufficient oral health. Individuals before EP implantation need increased attention in dental care, fostering information, sensibilization and motivation of the patients.

Unraveling Genomic Regions Controlling Root Traits as a Function of Nitrogen Availability in the MAGIC Wheat Population WM-800

An ever-growing world population demands to be fed in the future and environmental protection and climate change need to be taken into account. An important factor here is nitrogen uptake efficiency (NUpE), which is influenced by the root system (the interface between plant and soil). To understand the natural variation of root system architecture (RSA) as a function of nitrogen (N) availability, a subset of the multiparent advanced generation intercross (MAGIC) winter wheat population WM-800 was phenotyped under two contrasting N treatments in a high-throughput phenotyping system at the seedling stage. Fourteen root and shoot traits were measured. Subsequently, these traits were genetically analyzed using 13,060 polymorphic haplotypes and SNPs in a genome-wide association study (GWAS). In total, 64 quantitative trait loci (QTL) were detected; 60 of them were N treatment specific. Candidate genes for the detected QTL included NRT1.1 and genes involved in stress signaling under N-, whereas candidate genes under N+ were more associated with general growth, such as mei2 and TaWOX11b. This finding may indicate (i) a disparity of the genetic control of root development under low and high N supply and, furthermore, (ii) the need for an N specific selection of genes and genotypes in breeding new wheat cultivars with improved NUpE.

Management of May Thurner Syndrome in Pregnant Patients

May Thurner Syndrome contributes to thromboembolic disease and can cause significant morbidity in pregnant patients secondary to exaggerated anatomic relationships and physiologic changes in the hematologic system favoring thrombogenesis. Because this condition is both underrecognized and underreported, management in pregnant and postpartum patients is based on expert opinion without any formal evidence-based guidance. Herein, we review five pregnancies in four patients with May Thurner Syndrome and general management strategies. Through collaborative and multidisciplinary care, patients with May Thurner Syndrome can be safely and successfully managed during pregnancy and the postpartum period with appropriate anticoagulation.

Online information seeking and attitudes towards COVID-19 vaccination in Germany

Background

A large proportion of the European population seeks information about the COVID-19 vaccination on the internet. The population seems to split into those with positive stance on the vaccination and those with negative stance, but there are still individuals who do not have a final position yet. By now, there is a lack of understanding about the online information seeking behavior in these three groups. The current analysis sheds light on differences in internet usage and requested qualities of online information regarding the COVID-19 vaccination.

Methods

An online survey with N = 1,000 people (18-74 years) living in Germany was conducted between November 26 and December 8, 2021. The questionnaire included closed questions about frequency, information channels, formats and reasons of online information seeking, as well as one open question about requested qualities of online content. We conducted bivariate analysis for differences in information seeking behavior and content analysis for the requests.

Results

Information seeking behavior differed significantly by attitude towards the vaccination regarding frequency, almost all types of formats, three of ten listed information channels, and three of six reasons for online information seeking. Undecided participants and those who support COVID-19 vaccination used the internet more often than participants who are against the vaccination. Individuals supporting vaccination preferred reading text contributions (e.g. online articles). Informative videos were more often consumed by those who are undecided or against vaccination. Those who have not decided yet preferred online resources providing full information about side-effects and showing reliable facts by credible sources.

Conclusions

Our findings support an online vaccination communication that is tailored to target groups with different attitudes towards the vaccination. Overall, online campaigns should focus on transparent, reliable and complete information.

Key messages

• Online information seeking behavior regarding COVID-19 vaccination varies between individuals with different attitudes towards the vaccination.

• Online information about the COVID-19 vaccination should focus on transparency and reliable information.

P03.09.A Proton beam therapy for adults medullobastoma

Background

Although Medulloblastoma (MB) is the most common primary malignant intracranial tumor in childhood, in adults it is extremely rare. Therefore, available data is scarce and experience with radiation and proton beam therapy (PBT) is very limited. The treatment typically includes tumour resection, irradiation of the craniospinal axis (CSI) followed by a boost, +/- concomitant chemotherapy, and maintenance therapy. Herein, we present our preliminary analysis of outcome and toxicity after PBT.

Material and Methods

Patients ≥ 18 years with primary MB treated with PBT between January 2017 and March 2020 enrolled in the prospective registry study (DRKS00004384) were evaluated in this analysis. Within the registry, adverse events were documented according to CTCAE v4.0 before, during, and after PT. The overall survival (OS), local control (LC) and higher-grade toxicity (≥ grade 3) were analyzed.

Results

A total of 19 patients (13 males, 6 females) with a median age of 23 years (range, 18.5- 39 years) were included in this study. Histopathology type were classic, desmoplastic /extensive nodularity or anaplastic MB in 52.6%, 26.3% and 21.1 % of patients, respectively. Complete tumor resection was performed in 57.8 % of patients. 68.4 % of patients had local disease without any metastases. Median total CSI dose was 35.2 Gy(RBE) (range, 23.4-40 Gy) with a median single dose of 1.6 Gy(RBE) (range, 1-1.8 Gy). All patients received either boost to the posterior fossa (57.9%) or to the tumor bed only (42.1%). The median total tumor dose was 18.8 Gy(RBE) (range, 54-68 Gy). Concomitant chemotherapy was given to 63.1% of patients. The median follow-up time after first diagnosis was 28.2 months (range, 8-56 months). No higher-grade acute or late adverse event was documented so far. One patient developed local disease progression. Another patient deceased due to an acute pulmonary embolism during maintenance chemotherapy without evidence of disease. The 3-year LC and OS rate were 89 % and 94 %, respectively.

Conclusion

Early results display good feasibility and high tumor control of PT in adult patient with MB. Results will need to be confirmed in larger cohort with longer follow-up time.&lt;Bookmark(28)&gt;

Counting the cost of public and philanthropic R&D funding: the case of olaparib

Background

Lack of transparency around manufacturing costs, who bears the bulk of research and development costs and how total costs relate to the pricing of products, continue to fuel debates. This paper considers the case of olaparib (Lynparza®), recently indicated for use among BRCA-mutant breast cancer patients, and estimates the extent of public and philanthropic R&D funding.

Methods

We know from previous work that attempting to ascertain the amount of public and philanthropic funding using purely bibliographic sources (i.e., authors’ declarations of funding sources and amounts traced through funders) is limited. Since we knew that a publically funded research unit was pivotal in developing olaparib, we decided to supplement bibliographic data with a Freedom of Information request for administrative records on research funding data from this research centre.

Research

In terms of stages of product development, work conducted in the pre-clinical research stage was the most likely to report non-industry funding (> 90% of pre-clinical projects received public or philanthropic funding). Clinical trials were least likely to be funded through non-industry sources—although even here, contrary to the popular assertion that this is wholly industry-financed, we found public or philanthropic funding declared by 23% of clinical trials. Using information reported in the publications, we identified approximately £128 million of public and philanthropic funding that may have contributed to the development of olaparib. However, this amount was less than one-third of the total amount received by one research institute playing a pivotal role in product discovery. The Institute of Cancer Research reported receiving 38 funding awards to support olaparib work for BRCA-mutant breast cancer totalling over £400 million.

Conclusions

Government or charitable funding of pharmaceutical product development is difficult to trace using publicly available sources, due to incomplete information provided by authors and/or a lack of consistency in funding information made available by funders. This study has shown that a Freedom of Information request, in countries where such requests are supported, can provide information to help build the picture of financial support. In the example of olaparib, the funding amounts directly reported considerably exceeded amounts that could be ascertained using publically available bibliographic sources.

P-497 Men’s attitude towards two fertility education interventions and preferences for future fertility awareness initiatives

Study question

What are men's preferences for communication of fertility information and how to target prevention efforts to promote men to make informed decisions regarding family formation?

Summary answer

Men preferred fertility education interventions to use positive language to create new knowledge, include personal stories as conversation starters, and be provided in different formats.

What is known already

The far majority of men in Denmark wants to become fathers; however, 20% of 50-year-old men are childless compared to 12% among women. Around 40% of men in Denmark have reduced semen quality. Previous studies have found that men have insufficient knowledge about fertility, infertility and associated risk factors, and that men want to receive more information about fertility when they are young. Only few intervention studies have been performed about how to increase men’s and women’s fertility knowledge, and even fewer studies have focused only on men.

Study design, size, duration

Qualitative focus group discussions with 13 men assigned into five focus groups were carried out. Two interventions were introduced; an episode from the podcast “Actually you don’t have to wait that long” about two couples who have become parents in their mid-twenties, and an informational poster developed by The International Fertility Education Initiative was shown during the group discussions. The interviews took place online over Zoom in January 2021. Interviews ranged in average 91 minutes.

Participants/materials, setting, methods

All participants were recruited through Facebook and social networks. The interviewed men were young, childless aged 25-32 in a committed relationship and all residents in Copenhagen, Denmark. Focus group questions were semi-structured and examined the men’s reactions to the podcast and poster and preferences for communication of fertility information. The focus group discussions were recorded, anonymized and transcribed. Data were analyzed using Graneheim and Lundman's method of qualitative content analysis.

Main results and the role of chance

The overall themes were: “Poster: source of information”, “Podcast: report from the lived life” and “Information targeting men”. The men’s reactions to the poster and podcast were categorized into the sub-themes benefits and critiques and suggestions. Benefits of the poster was that it included important knowledge and was relevant to a large target group. Critiques were that it had too much information and lacked the emotional aspect of family formation. They wished for more positive languaging and communication about the fertility information on the poster. The benefit of the podcast was the use of personal stories to highlight the emotional aspect of family formation which was a conversation starter for partners. Critiques were that some men found the personal stories unrelatable and believed it didn’t contribute new knowledge. They suggested to include couples with fertility problems with an expert. According to men, future interventions should focus on how information is communicated. It should be factual, include humor and not be negative or shameful. Different formats to provide fertility information including TV-programs, podcasts, and social media interventions should be used to reach the most men in different ways. They also suggested fertility information should be included in sexual education in school.

Limitations, reasons for caution

All men were residents of the capital city Copenhagen, and men with a short education were underrepresented. Therefore, our results may not represent the opinions of all men aged 25-32 years in Denmark.

Wider implications of the findings

In the future fertility awareness campaigns should be developed in cooperation with the target group together with clinicians, and concurrent intervention studies on the developed methods should be performed. In all probability, a mix of different interventions will be necessary to attain the desired effect to ensure long-lasting fertility awareness.

Trial registration number

Not applicable

O-143 “You’re never pregnant in the same way again”: Prior early pregnancy loss influences needs for health care and support in subsequent pregnancy

Study question

What are couples’ needs for health care and support in subsequent pregnancy after prior early pregnancy loss and do these needs change across the pregnancy?

Summary answer

Couples described unmet needs for pregnancy care in the first 20 weeks of pregnancy and were satisfied with care provided the remainder of the pregnancy. 

What is known already

Despite early pregnancy loss (PL) being common (∼25% of pregnancies), there is a paucity of research to guide practice to optimize treatment and support future pregnancies. There has been low priority in research and pervasive acceptance that couples should “just try again” after experiencing PL.  However, the notion that PL is a single event without wider implications has been challenged. Women with prior PL report increased anxiety during the first trimester of pregnancy compared to those without previous PL. No longitudinal studies explore whether anxiety persists across trimesters, how partners are impacted, and what couples' needs are throughout the pregnancy.

Study design, size, duration

This was a qualitative longitudinal study. During first year of data collection, 13 couples who were pregnant after a prior pregnancy loss were interviewed four times over their pregnancy. Couples were recruited from the Copenhagen Pregnancy Loss Research Programme at Hvidovre Hospital, Denmark. Interviews were held in person at the hospital or university or online. Interviews ranged from 20 to 90 minutes (average= 52 min). Data collection is ongoing and full data will be presented.

Participants/materials, setting, methods

Couples with at least one prior pregnancy loss who self-reported a new pregnancy and were willing to be interviewed together and in English were eligible to participate. Couples were interviewed together after a positive pregnancy test and once in each trimester. Interviews were transcribed and data was analyzed using thematic analysis to compare and contrast needs and experiences within and across the four time-periods. One same-sex couple and 12 heterosexual couples participated.

Main results and the role of chance

Couples’ needs were categorized into two themes:

The first 20 weeks: high needs for pregnancy care with low/varied access: Couples wished for access to regular scans and close monitoring of the fetus to provide reassurance and detect problems early, but described considerable variation in the early pregnancy care offered, with many expressing unmet needs. Their need was more acute during the first 12 weeks, but persisted until the 20-week scan. Women described “surviving from scan to scan” with anxiety and fear about the safety of the fetus.  Some paid for private comfort scans if they did not have access. Both partners continued to process the grief and self-described “trauma” of the prior pregnancy loss and wished for psychological support during this period.

The second 20 weeks: met needs for pregnancy care with high access: Couples expressed satisfaction with care including access to regular or extended antenatal support, access to 24 hour telephone support by midwife/nurse, and confirmation of good health at 20 week scan. They felt reassured there was some plan for their care. They felt more hopeful and shifted their focus to the current pregnancy and future birth, especially given increasing “signs of life” whilst the baby started to kick.

Limitations, reasons for caution

Participants were self-selected thus findings cannot be generalized to all pregnant couples after early pregnancy loss. Single women were not included in the study.

Wider implications of the findings

The findings underscore that an early pregnancy loss is not a single event without wider implications, but rather creates vulnerability and increased need for monitoring and care in a subsequent pregnancy, which in many cases is not met by existing early pregnancy care.

Trial registration number

No

P-500 How do we talk to teenagers and young adults about fertility? A qualitative study on young peoples’ thoughts about fertility

Study question

What are teenagers and young adults’ attitudes towards learning about fertility, and how do they want to receive fertility information?

Summary answer

Young people find it important to learn about fertility from professionals when they are young, and want to hear about fertility in a multifaceted way.

What is known already

During the past 30 years women and men in many high-income countries increasingly postpone family formation. It is estimated that 16-26% of the Danish population who want children will experience infertility at some point during their reproductive years. Several studies have shown that women and men tend to underestimate the decline in fecundity with increasing age and overestimate the success rate of medically assisted reproductive technologies. A growing body of research suggests that young people want to know more about fertility, preferably as part of their education.

Study design, size, duration

Semi-structured qualitative focus group interviews were conducted with teenagers (age 18-19) and young adults (age 20-26). Data collection is still ongoing.

Participants/materials, setting, methods

The study participants (N = 40) were single or cohabiting men and women throughout Denmark. They were between 18 to 26 years old and recruited from both vocational schools and high schools. The interviews were audiotaped, anonymized and transcribed in full. Data were analyzed using qualitative content analysis following the method by Graneheim and Lundman.

Main results and the role of chance

Overall the participants found it very important to learn about fertility as a mandatory part of the curriculum at their educations and they wanted to hear about it in a multifaceted way (e.g., social media, podcasts, theatre and personal stories). The participants want to learn about fertility at an early age, so they have the information they need prior to starting their family in the future. They want to feel involved and heard and have the possibility to ask questions. Knowledge should be provided by a professional other than their teacher. They prefer explanations, rather than listing facts. The participants stressed that personal stories and humor are also important when talking with young people about fertility. They feel a conflict between having a healthy lifestyle to take care of their fertility and the behaviour that they believe is a part of being young.

Limitations, reasons for caution

The study participants had all chosen to be a part of this study. Hence, the results may not be directly transferred to all young people in regard to attitudes towards how to talk to teenagers and young adults about fertility.

Wider implications of the findings

This study contributes to the understanding and implementation of future fertility awareness educational interventions and campaigns targeted to and effective among young people. These findings can be useful in the process of increasing the fertility awareness in this population.

Trial registration number

N/A

One Third of Patients before Endoprosthesis Implantation Show an Oral Focus as Potential Source of Infectious Complication—The Value of Pre-Operative Dental Risk Stratification in a German Cohort

Objective: The aim of this cross-sectional cohort study was to evaluate a comprehensive dental examination and referral concept for patients prior to endoprosthesis (EP) implantation in an interdisciplinary setting. Methods: Patients, who were prepared for EP surgery in the clinic for orthopaedics, were referred to the dental clinic for a dental examination. Thereby, dental and periodontal treatment need, radiographic and temporomandibular joint findings were assessed. Based on oral and radiographic investigation, a risk classification for potential source of prosthetic infection was performed. If potential oral foci of EP infection were present (e.g., apically radiolucent teeth, severe periodontitis or additional inflammatory findings), patients were classified as at high risk for EP infection with oral origin. Those individuals were allocated to their family dentist or special clinic for dental treatment prior to EP surgery. Results: A total of 311 patients were included (mean age: 67.84 ± 10.96 years, 51% male). A dental treatment need of 33% was found, while the periodontal treatment need was 83%. Thirty-one percent of patients showed at least one apical radiolucency (a sign of chronic infection/inflammation). Furthermore, additional findings such as radiographic signs of sinusitis maxillaris were found in 24% of patients. Temporomandibular disease was probable in 17% of individuals. One-third (34%) were assigned to the high risk group for an EP infection with oral origin. Conclusion: German patients before EP have a high periodontal treatment need and show frequently (34%) a potential oral focus of infection, underlining the necessity of including dental examination and risk stratification as part of the pre-operative assessment prior to EP implantation. Therefore, an approach as applied in this study appears reasonable for those individuals.

Multiplexed apolipoprotein profiling advances the assessment of residual lipid-related cardiovascular risk

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Background and Purpose

Low-density lipoprotein cholesterol (LDL-C) is among the conventional lipid parameters used to predict risk of cardiovascular disease (CVD). Statins lower blood levels of pro-atherogenic LDL-C, but a residual cardiovascular risk remains in some individuals with therapeutically optimised LDL-C levels. Although the metabolism of LDL-C and other lipoprotein particles is governed by a range of different apolipoproteins, only apolipoproteins A-I and B are measured in clinical assays. Using a more comprehensive apolipoprotein panel in a large epidemiological cohort, this study aimed to determine the association of individual apolipoprotein levels with risk of coronary heart disease (CHD).

Methods

Bottom-up multiple reaction monitoring–mass spectrometry (MRM–MS) was used in conjunction with stable isotope-labelled peptide standards to quantify plasma levels of 13 apolipoproteins in participants of the Precocious Coronary Artery Disease (PROCARDIS) study (N = 1916; 941 cases of CHD, 975 controls). The relationship between apolipoprotein levels and CHD was assessed after adjusting for established risk factors for CVD and correcting for statin use.

Results

The strongest positive associations with CHD in the PROCARDIS study were seen for triglyceride-related apolipoproteins C-I (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.63–3.46), C-III (OR 2.95, 95% CI 1.85–4.71) and E (OR 2.35, 95% CI 1.54–3.58), as well as for apolipoprotein (a) (kringle IV type 2 repeat, OR 2.84, 95% CI 2.04–3.95). Comparing these with associations of apolipoproteins with CVD in the Bruneck study (N = 688) revealed consistency across the two cohorts. Robust inverse associations with CHD were observed for apolipoproteins A-IV (OR 0.45, 95% CI 0.31–0.65) and M (OR 0.29, 95% CI 0.19–0.44).

Conclusion

Analysing two large epidemiological cohorts, Bruneck and PROCARDIS, demonstrated that multiplexed apolipoprotein profiling improves the understanding of cardiovascular risk independent of conventional lipid parameters. Most prominently, triglyceride-related apolipoproteins were shown to positively associate with residual cardiovascular risk. The findings of this study support the need for development and implementation of standardised, MRM–MS-based apolipoprotein profiling assays to guide novel lipid-modifying therapies beyond statins.

A proteomic atlas of atherosclerosis: regional proteomic signatures for plaque inflammation and calcification

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): This study was mainly supported from the British Heart Foundation (BHF) supporting Prof. Manuel Mayr as a Chair Holder (CH/16/3/32406) with BHF programme grant support (RG/16/14/32397) and Dr. Theofilatos with BHF programm grant support (G/20/10387).

Background

Using proteomics, we strove to reveal novel molecular subtypes of human atherosclerotic lesions, study their associations with histology and imaging and relate them to long-term cardiovascular outcomes.

Methods

219 samples were obtained from 120 patients undergoing carotid endarterectomy. Sequential protein extraction was combined with multiplexed, discovery proteomics. Parallel reaction monitoring for 135 proteins was deployed for targeted validation. A combination of statistical, bioinformatics and machine learning methods was used to perform differential expression, network, pathway enrichment analysis and train and evaluate prognostic models.

Results

Our extensive proteomics analysis from the core and periphery of plaques doubled the coverage of the plaque proteome compared to the largest proteomics study on atherosclerosis thus far. Plaque inflammation and calcification signatures were inversely correlated and validated with targeted proteomics. The inflammation signature was enriched with neutrophil-derived proteins, including calprotectin (S100A8/9) and myeloperoxidase. The calcification signature contained fetuin-A, osteopontin, and gamma-carboxylated proteins. Sex differences in the proteome of atherosclerosis were explained by a higher proportion of calcified plaques in women. Single-cell RNA sequencing data attributed the inflammation signature predominantly to neutrophils and macrophages and the calcification signature to smooth muscle cells, except for certain plasma proteins that were not expressed but retained in the plaque, i.e., fetuin-A. Echogenic lesions reflect the collagen content and calcification of plaque but carotid Duplex ultrasound fails to capture the extent of inflammatory protein changes in symptomatic plaques. Applying dimensionality reduction and machine learning on the proteomics data defined 4 distinct plaque phenotypes and revealed key protein signatures linked to smooth muscle cell content, plaque calcification and structural extracellular matrix, which improved the 9-year prognostic AUC by 25% compared to ultrasound and histology. A biosignature of four proteins (CNN1, PROC, SERPH, and CSPG2) independently predicted the progression of atherosclerosis and cardiovascular mortality with an AUC of 75%

Conclusion

We combined discovery and targeted proteomics with network reconstruction and clustering techniques to provide molecular insights into protein changes in atherosclerotic plaques. The application of proteomics and machine learning techniques revealed distinct clusters of plaques that inform on disease progression and future adverse cardiovascular events.

Proteomics to assess myocardial remodelling in human heart failure and explore the effect of medications and comorbidities

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Background

Myocardial remodelling is a hallmark of heart failure (HF). Our previous proteomics analyses demonstrated a profound effect of beta blockers on cardiac extracellular matrix composition in ischaemic HF patients (1). No comprehensive proteomics characterizations has been performed in non-ischaemic HF patients.

Methods

Mass spectrometry was used to analyze intracellular and extracellular protein extracts from left ventricular samples obtained from patients with ischemic (n=65) and non-ischaemic (n=114) HF after heart transplantation, as well as non-failing controls (n=19). All HF patients had ventricular dilatation and reduced ejection fraction (EF%).

Results

The proteomics comparison across 198 cardiac samples with two tissue extracts revealed hallmarks of HF in both groups of patients compared to controls, including elevated levels of atrial natriuretric peptides and the fibroblast marker vimentin, as well as decreases in creatine kinase M/B, troponin C, and myosin light chain 2 (Figure 1). In comparison to ischaemic HF patients, non-ischaemic HF patients showed elevated levels of proteins involved in proteasome activation, consistent with the notion of increased protein degradation in cardiomyocytes even at the end stage of the disease (2). Despite similar clinical characteristics, myocardial remodelling in response to HF medications and the presence of comorbidities was different between the two HF groups. In ischaemic HF patients the use of β-blockers resulted in reduced proteoglycan deposition. In non-ischaemic patients, few protein changes were associated with medication. Instead, comorbidities such as atrial fibrillation and hypertension were critical determinants of myocardial protein remodelling in these HF patients (Figure 2). Notably, hypertensive HF patients showed a marked reduction in angiotensin converting enzyme 2 (ACE2) compared to normotensive patients, and this was accompanied by a reduction in Cysteine And Glycine Rich Protein 3 (CSRP3), a key player in the organization of cytosolic structures in cardiomyocytes, and the nuclear lamina proteins lamin A/C and B. The inflammation-related galectin 3-binding protein was reduced in hypertensive patients as were the extracellular proteases matrix metalloprotease 2, cathepsin G and chymase 1.

Conclusion

Our study constitutes the largest proteomics analysis of HF to date. We observed distinct protein remodelling processes in ischaemic and non-ischaemic HF patients and discerned the myocardial effects of medications and comorbidities such as hypertension.

Comparative secretome analysis of obese perivascular adipose tissue reveals impaired adipose-neuronal crosstalk

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): BHF Programme Grant (RG/16/14/32397)

VASCage-Research Center on Vascular Ageing and Stroke (No. 868624)

Background

While canonical adipose tissue (AT) depots have been extensively characterised in health and disease, comparatively little is known about the pathological changes affecting the perivascular AT’s (PVAT) physiology during obesity.

Purpose

The aim of this study was to study the impact of obesity on the secretory activity of the murine PVAT.

Methods

We exploited proteomics to profile the secretome of peri-aortic and canonical AT depots in wild-type (wt) and obese (ob/ob) mice. In parallel, fat tissues were processed for biochemical and histological analysis and mechanistical experiments were performed in vitro on primary neuronal cultures.

Results

Proteomics on ATs conditioned media from wt mice revealed that each fat depot displays a unique secretory profile. The enrichment of neuronal cell-adhesion molecules detected in PVAT secretomes reflected a higher content of intra-parenchymal sympathetic projections compared to non-perivascular ATs. A significant decrease of the same neuronal proteins in PVAT conditioned media from ob/ob mice was found to be associated with a substantial reduction of the perivascular sympathetic innervation. Intriguingly, a similar decrease of sympathetic markers was detected in the epicardial AT from obese patients. Mechanistically, the conditioned media from ob/ob AT explants was found to exert a deleterious effect on the axons of primary sympathetic neurons in vitro, indicating that this neuropathy is due to local alterations of the PVAT secretome that detrimentally impact on the embedded sympathetic neurites. Among proteins significantly down-regulated in the secretomes of ob/ob PVAT samples, neuronal growth regulator 1 (Negr1) was found to promote axonal elongation and branching on sympathetic neurons in vitro. Administration of recombinant Negr1 also partially restored the neurotrophic effect of ob/ob AT secretomes on sympathetic axons both in vitro and in vivo.

Conclusions

Obesity-related alterations in the secretome of PVAT severely affect the homeostasis of the perivascular environment, leading to a loss of perivascular sympathetic innervation. A novel neurotrophic role is unveiled for Negr1, whose locus has been associated with human obesity.

The symbiosis of healthcare professionals and patients: Understanding the dynamics of long-term care relationships between healthcare professionals and patients in oncology

12134

Background: Chronic diseases are a significant source of physical, emotional, mental, and social distress to not only patients but also their friends and family. Healthcare professionals (HCPs) also share in the burden as they strive to provide the best possible care. In particular, cancer patients face great burden as they grapple with the uncertainty of their futures. Given the respective difficulties associated with cancer treatment, fostering a collaborative environment in which patients, caregivers, and HCPs mutually encourage each other becomes necessary to improve the quality of life of everyone involved. This study aims to investigate factors that influence a healthy long-term care relationship between patients and HCPs. Methods: This study is a qualitative analysis of HCPs’ experiences with patients and their caregivers at a large metropolitan academic medical center. This study analyzed reflective essays written by HCPs as part of the Pacemakers initiative at the medical center, which seeks to empower HCPs, patients, and caregivers in creative ways along the management journey. The essays focused on HCPs’ participation in meaningful experiences with patients and caregivers such as patient/caregiver award ceremonies celebrating their resilience and hope. A total of 22 essays ( N = 22) were thematically analyzed by two independent coders to produce meaning-making codes and themes (italicized). Results: The presence of support networks ( n = 10) was very important for the patients and caregivers. Conveying solidarity ( n = 21) was also central in helping patients experience companionship and fellowship in their community with their medical team, family, and friends. It was also noted that little means much ( n = 10); small acts of kindness showing genuine interest led to meaningful interactions that provided encouragement for the patients. Compassion ( n = 19) and patient-centeredness ( n = 17) were important in fostering a receptive environment in which patients and caregivers felt heard. Celebrating and honoring the patients’ resilience ( n = 10) made patients feel recognized, and this process of celebration was also found to bolster a renewed sense of purpose for the HCPs ( n = 11). Conclusions: The results of this study highlight the importance of supporting patients and their caregivers holistically. Understanding and meeting this need through creative encouragement empowers not only the patients and caregivers but also the HCPs. Trust is built and patients are strengthened to pursue their health to the best of their abilities as HCPs show their deep care for their struggles and resiliency. This sacred experience of entrusting one’s life to another builds the best environment for healing and recovery. This study shares a glimpse of how to best support patients as well as HCPs in long-term care relationships.

Has the COVID-19 pandemic affected older adults' personal and general views on aging? Evidence for losses and gains

The coronavirus disease (COVID-19) pandemic might have affected older adults' personal and general views on aging (VoA) because they were frequently, particularly during the early phase of the pandemic, portrayed as a homogeneous, vulnerable group in the media and in public debates. Also, their higher risk of severe COVID-19 disease progression as well as other pandemic-related stressors and restrictions might have impacted how older adults perceive their own aging. In this study, it was examined to which extent middle-aged and older adults' personal and general VoA changed due to the pandemic by distinguishing between normative age-graded change across multiple measurement occasions and potentially pandemic-specific history-graded change. Multiple VoA indicators (personal VoA: attitude toward own aging, subjective age, awareness of age-related change [gains and losses]; general VoA: domain-specific age stereotypes) of 423 German adults aged 40 years and older were assessed across three prepandemic measurement occasions (2012, 2015, and 2017) and one occasion after the pandemic's outbreak (summer 2020). Normative age-graded changes and pandemic-specific changes were estimated and compared using longitudinal multilevel regression analyses. Both perceived age-related gains and age-related losses decreased between 2012 and 2017, but increased thereafter between 2017 and 2020. Further, the overall change trend toward less positive attitude toward own aging slowed down from 2017 to 2020. There was also a slight trend toward younger subjective ages from 2017 to 2020. For most age stereotypes, pandemic-specific trends indicated a shift toward more negative stereotypes. These findings suggest that pandemic-specific changes in VoA are multidirectional, comprising perceptions of both losses and gains. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Preventing healthcare professional burnout in oncology: How creative patient encouragement can go both ways

11020

Background: Cancer treatment is a difficult process that not only affects the patients themselves, but also their caregivers and healthcare professionals (HCPs). A cancer diagnosis is often a life-changing experience for both patients and caregivers, who may feel vulnerable and stressed in the face of such a complex disease. HCPs in oncology, who are constantly present on the frontline between life and death, often experience emotional and physical exhaustion. Such burnout of HCPs can lead to adverse effects on patient care. Therefore, it becomes important to prevent and manage HCPs’ fatigue to not only improve patient care, but also HCPs’ quality of life. Methods: This study qualitatively examined the experiences of HCPs who collaboratively interacted with patients and caregivers in the clinical setting. The Pacemakers initiative was developed and piloted in a large urban academic medical center with the aim to promote creative encouragement and companionship among HCPs and patients/caregivers. HCPs held ceremonies with personal awards for patients/caregivers during their treatment course, and their experience with the ceremonies was evaluated qualitatively with a survey. A thematic analysis was subsequently performed on the HCPs’ reflective essays ( N = 22) to identify recurring themes (italicized) in their experiences. Results: In general, we found that the HCPs felt that they were benefiting from taking part in the creative patient encouragement ceremonies. Many described the experience as motivating or inspiring ( n = 15), highlighting how such collaboration renews optimism and prevents burnout. The HCPs also reported feeling acknowledged for their behind-the-scenes work and support ( n = 5) and grateful to be given the opportunity to acknowledge their patients and caregivers ( n = 13), as well. Another common theme was that the HCPs felt that they were able to connect emotionally ( n = 14) with the patients and caregivers, describing moments of shared laughter and tears. Lastly, the HCPs reported feeling a sense of togetherness with patients and caregivers ( n = 13), often describing the relationship as akin to a team or family, and many stated that they were able to develop a more personal connection ( n = 15) with patients and caregivers through the ceremonies. Conclusions: Overall, we find that the benefits of encouraging patients and caregivers extend to HCPs. The positive impact of identifying and celebrating small but meaningful joys in the clinical setting is considerable especially upon HCPs, who find such experiences to be rewarding and refreshing. HCP burnout is common in oncology, and the findings of this analysis suggest that inspiring mutual encouragement and fostering collaboration between HCPs, patients, and caregivers are critical in reducing and preventing such fatigue.

Accumulating Birth Histories Across Surveys for Improved Estimates of Child Mortality

Producing reliable estimates for childhood mortality rates is essential to monitor progress towards the United Nations Sustainable Development Goals (UN SDGs) and correctly evaluate policies designed to reduce childhood mortality rates. Different model-based approaches have been proposed to assess levels and trends in childhood mortality indicators. In this paper, we propose a design-based complement that accumulates birth histories across different household surveys to increase the precision of childhood mortality rates estimates. We accumulate birth histories across different cross-sectional Demographic Health Surveys/Multiple Cluster Indicator Surveys collected in Senegal and Malawi and estimate pooled childhood mortality rates based on calendar years. We show that accumulating birth histories smoothens fluctuations in time series for national and sub-national mortality rates, establishes more stable and reliable time trends, and results in estimated standard errors of the cumulated rates that are about 50–60% lower than their counterparts from separate surveys.

The Relationship between Exercise Self-Efficacy, Intention, and Structural Barriers for Physical Activity after a Cancer Diagnosis

Simple Summary

Despite numerous benefits of physical activity for cancer patients, the majority is insufficiently active. Previous research has shown that structural barriers negatively affect patients’ physical activity behavior. Identifying underlying mechanisms could help to develop effective strategies that alleviate those barriers and increase physical activity levels. In the current survey study, we investigated whether cancer patients’ self-efficacy, i.e., their confidence in their ability, and their intention to exercise mediated the relationship between structural barriers and physical activity. The results revealed a negative relation between structural barriers and patients’ self-efficacy. Lower self-efficacy, in turn, decreased patients’ intention and their likelihood to engage in physical activity. This mediating effect especially applied to those individuals who were sufficiently active before the diagnosis. Thus, the findings suggest that interventions directly addressing the perception of structural barriers or patients’ self-efficacy in dealing with these barriers might be effective in improving the physical activity levels of cancer patients.

Abstract

Previous research has shown that structural barriers negatively influence the physical activity (PA) behavior of cancer patients, but underlying mechanisms are unclear. The aim of the current study was to explore the potential mediating role of social-cognitive factors, namely PA self-efficacy and PA intention in this context. A total of 856 cancer patients completed a questionnaire on sociodemographic and medical characteristics, pre- and post-diagnosis PA, PA self-efficacy, PA intention, and PA impediment by structural barriers. A serial mediation model was used to test whether the association between structural barriers and post-diagnosis PA was mediated by PA self-efficacy and/or PA intention, in the overall sample and in subsamples defined by individuals’ pre-diagnosis PA. The results confirmed that structural barriers were not directly (95%CI [−0.45; 0.10]) but indirectly associated with post-diagnosis PA. Higher impediment by structural barriers decreased the likelihood of sufficient post-diagnosis PA via lower PA self-efficacy (95%CI [−0.25; −0.06]) and via the serial pathway of lower PA self-efficacy and lower PA intention (95%CI [−0.19; −0.05]). Investigating differences in these mediations by pre-diagnosis PA yielded significance only among previously active cancer patients. Both structural barriers and PA self-efficacy might hence be relevant target points for interventions aiming to improve PA behavior, especially among pre-diagnosis active cancer patients.

Oxidized Hyaluronic Acid-Gelatin-Based Hydrogels for Tissue Engineering and Soft Tissue Mimicking

Hydrogels are ideal materials for mimicking and engineering soft tissue. Hyaluronic acid is a linear polysaccharide native to the human extracellular matrix. In this study, we first develop and characterize two hydrogel compositions built from oxidized HA and gelatin with and without alginate-di-aldehyde (ADA) crosslinked by ionic and enzymatic agents with potential applications in soft tissue engineering and tissue mimicking structures. The stability under incubation conditions was improved by adjusting crosslinking times. Through large-strain mechanical measurements, the hydrogels' properties were compared to human brain tissue and the samples containing ADA revealed similar mechanical properties to the native tissue specimens in cyclic compression-tension. In vitro characterization demonstrated a high viability of encapsulated mouse embryonic fibroblasts and a spreading of the cells in case of ADA-free samples.

Changes in US Clinician Waivers to Prescribe Buprenorphine Management for Opioid Use Disorder During the COVID-19 Pandemic and After Relaxation of Training Requirements

This case series examines numbers of US clinicians receiving waivers from the Drug Enforcement Administration allowing them to prescribe buprenorphine for opioid use disorder before and during the COVID-19 pandemic.

PRISM (Pictorial Representation of Illness and Self-Measure) as Visual Tool to Support Oral Health Education Prior to Endoprosthetic Joint Replacement-A Novel Approach in Dentistry

Objective: This study aims to evaluate the application of Pictorial Representation of Illness and Self-Measure (PRISM) in educating patients regarding oral health before endoprosthesis (EP). Methods: The study consisted of two parts: (I) a cross-sectional study, where patients received a PRISM interview, oral health briefing and oral examinations (treatment need, oral focus). (II) In an observational part, patients were randomly assigned to either PRISM task (Test) or flyer-based verbal briefing (Control). Before and after the interviews, patients answered a questionnaire regarding importance of oral health for EP. Results: (I) 122 patients were included. The distance between subject (“myself”) and objects (oral health issues or EP) in the PRISM task were mainly not associated with age, gender, and oral conditions. In part (II), 80 patients (PRISM: n = 40, Control: n = 40) were included. After the interview, the values for perceived relationship between EP and teeth (p < 0.01), EP and gums (p < 0.01), and EP and dental consultations (p < 0.01) significantly increased in both groups. Both groups perceived a high benefit of the interview and felt well educated. Conclusions: PRISM has comparable positive effects like a flyer-based verbal briefing. PRISM as a novel visual tool can support the patient education regarding oral health before EP.

Challenging T > MIC Using Meropenem vs. Escherichia coli and Pseudomonas aeruginosa

Objective: For meropenem 40%T > MIC is associated with optimal killing of P. aeruginosa and E. coli. However, it is unknown how the distribution of %T > MIC through a treatment day impacts the antimicrobial effect in vitro. Therefore, we investigated the in vitro antibiotic activity of meropenem, precisely if 40%T > MIC is achieved in one single long period (single dose), 2 × 20% periods (dosing-bid), or 3 × 13.3% (dosing t.i.d.) thereby keeping the overall period of T > MIC constant.

Material/Methods: Time kill curves (TKC) with P. aeruginosa-ATCC-27853 and E. coli-ATCC-25922 and five clinical isolates each were implemented over 24 h in CAMHB with concentrations from 0.25×MIC-32×MIC. Periods over and under MIC were simulated by centrifugation steps (discarding supernatant and refilling with fresh CAMHB). Double and triple dosing involved further addition and removal of antibiotic. Complementary growth controls (GC) with and without centrifugation steps were done and the emergence of phenotypical resistance was evaluated (repeated MIC-testing after antibiotic administration).

Results: No impact of centrifugation on bacterial growth was seen. TKC with P. aeruginosa showed the best killing in the triple dosage, followed by the double and single dose. In multiple regimens at least a concentration of 4×MIC was needed to achieve a recommended 2-3 log10 killing. Likewise, a reduction of E. coli was best within the three short periods. Contrary to the TKCs with P. aeruginosa we could observe that after the inoculum reached a certain CFU/mL (≥10^8), no further addition of antibiotic could achieve bacterial killing (identified as the inoculum effect). For P. aeruginosa isolates resistance appeared within all regimens, the most pronounced was found in the 40%T > MIC experiments indicating that a single long period might accelerate the emergence of resistance. Contrary, for E. coli no emergence of resistance was found.

Conclusion/Outlook: We could show that not solely the %T > MIC is decisive for an efficient bacterial eradication in vitro, but also the distribution of the selected %T > MIC. Thus, dividing the 40%T > MIC in three short periods requested lowers antibiotic concentrations to achieve efficient bacterial killing and reduces the emergence of resistance in P. aeruginosa isolates. The distribution of the %T > MIC did impact the bacterial eradication of susceptible pathogens in vitro and might play an even bigger role in infections with intermediate or resistant pathogens.

Work site access to fluoridated tap water and retail beverages: An assessment of the University of California, San Francisco campuses

BACKGROUND

Employees with fluoridated drinking water access at work can reap oral health benefits. The purpose of this study was to assess the availability, appeal, and promotion of fluoridated tap water in publicly accessible spaces compared with retail beverages at the University of California, San Francisco.

METHODS

The authors collected information on beverages available in publicly accessible spaces at University of California, San Francisco hospitals and campuses in San Francisco, California, from December 2019 through February 2020 using a web-based survey tool. Data collected included fluoridated water and retail beverage locations; type of water or retail beverage source; number of water sources per station; cleanliness, flow, and any obstruction of water sources; proximity of water stations to retail beverage locations; signage near the beverage locations about water and beverage consumption; and type of retail beverages available.

RESULTS

Fluoridated water stations were identified in 230 locations and had 377 water sources (for example, traditional drinking fountain and motion-sensor bottle-filling station). One water station was available for every 80 students and employees; however, 25% were obstructed, dirty, or had unsatisfactory flow. Approximately 1 in 5 watercoolers lacked disposable cups. Of 41 retail beverage locations identified, 29% had a water station within sight. Only 11% of beverage locations had signage encouraging healthier beverage choices.

CONCLUSIONS

A systematic assessment of work site access to fluoridated water can provide actionable evidence to improve availability, appeal, and promotion.

PRACTICAL IMPLICATIONS

This study provides a model to assess work site availability of fluoridated drinking water that can be used for future evaluations.

Evaluation of dose, volume and outcome in children with localized, intracranial ependymoma treated with proton therapy within the prospective KiProReg Study

Background

Radiotherapy (RT) of ependymoma in children is an important part of the interdisciplinary treatment concept. However, feasibility and dose concepts are still under investigation, particularly in very young children. The aim of this study was to evaluate the standard dose and volume of proton therapy (PT) in children with ependymoma.

Methods

In this analysis, 105 patients with localized, intracranial ependymoma under the age of 18 years treated with PT between 2013 and 2018 were included. Patient characteristics, treatment, outcome, and follow-up data were analyzed using descriptive statistics, Kaplan-Meier, and Cox regression analysis.

Results

The median age of patients at PT was 2.8 years (0.9-17.0 years). The molecular subgroup analysis was performed in a subset of 50 patients (37 EP-PFA, 2 EP-PFB, 7 EP-RELA, 2 EP-YAP, 2 NEC [not elsewhere classified]). The median total dose was 59.4 Gy (54.0-62.0 Gy). The median follow-up time was 1.9 years. The estimated 3-year overall survival (OS), local control (LC), and progression-free survival (PFS) rates were 93.7%, 74.1%, and 55.6%, respectively. Within univariable analysis, female gender and lower dose had a positive impact on OS, whereas age ≥4 years had a negative impact on OS and PT given after progression had a negative impact on PFS. In the multivariable analysis, multiple tumor surgeries were associated with lower PFS. New ≥3° late toxicities occurred in 11 patients.

Conclusion

For children with localized ependymoma, PT was effective and well tolerable. Multiple surgeries showed a negative impact on PFS.

Assisted reproductive technology treatment and risk of breast cancer: a population-based cohort study

STUDY QUESTION

Is there an increased risk of breast cancer among women after ART treatment including ovarian hormone stimulation?

SUMMARY ANSWER

The risk of breast cancer was slightly increased among women after ART treatment compared to age-matched, untreated women in the background population, and the risk was further increased among women initiating ART treatment when aged 40+ years.

WHAT IS KNOWN ALREADY

The majority of breast cancer cases are sensitive to oestrogen, and ovarian hormone stimulation has been suggested to increase the risk of breast cancer by influencing endogenous oestrogen levels. Previous studies on ART treatment and breast cancer have varied in their findings, but several studies have small sample sizes or lack follow-up time and/or confounder adjustment. Recent childbirth, nulliparity and higher socio-economic status are breast cancer risk factors and the latter two are also associated with initiating ART treatment.

STUDY DESIGN, SIZE, DURATION

The Danish National ART-Couple II (DANAC II) cohort includes women treated with ART at public and private fertility clinics in 1994-2016.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women with no cancer prior to ART treatment were included (n = 61 579). Women from the background population with similar age and no prior history of ART treatment were randomly selected as comparisons (n = 579 760). The baseline mean age was 33.1 years (range 18-46 years). Results are presented as hazard ratios (HRs) with corresponding CIs.

MAIN RESULTS AND THE ROLE OF CHANCE

During follow-up (median 9.69 years among ART-treated and 9.28 years among untreated), 5861 women were diagnosed with breast cancer, 695 among ART-treated and 5166 among untreated women (1.1% versus 0.9%, P < 0.0001). Using Cox regression analyses adjusted for nulliparity, educational level, partnership status, year, maternal breast cancer and age, the risk of breast cancer was slightly increased among women treated with ART (HR 1.14, 95% CI 1.12-1.16). All causes of infertility were slightly associated with breast cancer risk after ART treatment. The risk of breast cancer increased with higher age at ART treatment initiation and was highest among women initiating treatment at age 40+ years (HR 1.37, 95% CI 1.29-1.45). When comparing women with a first birth at age 40+ years with or without ART treatment, the increased risk among women treated with ART persisted (HR 1.51, 95% CI 1.09-2.08).

LIMITATIONS, REASONS FOR CAUTION

Although this study is based on a large, national cohort of women, more research with sufficient power and confounder adjustment is needed, particularly in cohorts with a broad age representation.

WIDER IMPLICATIONS OF THE FINDINGS

An increased risk of breast cancer associated with a higher age at ART treatment initiation has been shown. Ovarian stimulation may increase the risk of breast cancer among women initiating ART treatment when aged 40+ years. Age-related vulnerability to hormone exposure or higher hormone doses during ART treatment may explain the increased risk.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by a PhD grant to D.V. from the Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. Funding for establishing the DANAC II cohort was received from the Ebba Rosa Hansen Foundation. The authors report no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Subjectively perceived healthcare provision during the first wave of the COVID-19 pandemic

Background

An OECD benchmark (2020) shows that Germany has, in effect, an above-average healthcare infrastructure to face COVID-19. Nevertheless, at the beginning of the pandemic, there were restrictions and uncertainties in the use of health-related services. The following analysis examines the subjective perception of respondents with their healthcare provision whether there were sociodemographic differences.

Methods

Data from an online cross-sectional survey conducted between 29 April and 8 May 2020 were used (N = 1,570; 18-74 years). Bivariate test methods were used for analysis, stratified by age group, subjective social status (SSS) and chronic illness. The subjective perception was assessed via subjects' subjectively perceived worries, fears and difficulties of not receiving an adequate healthcare provision during the COVID-19 pandemic. Thus, an index was constructed with a range of values from 3 to 12 (Cronbach's α = 0.886). A higher index implies a poorer perception of the healthcare provision.

Results

Compared to the groups 50-59-year-olds and 60 years and older the 18-29-year-olds (MRank 431.1) had a significantly (p < 0.05) poorer perception of their healthcare provision during COVID-19. In addition, probands with low SSS were found to have a significantly (p < 0.05) worse perception (MRank 423.0) than subjects with medium SSS (MRank 374.1). Chronically ill subjects suffered significantly poorer perception (MRank 406.1; p < 0.05) compared to healthy subjects (MRank 366.0).

Conclusions

Vulnerable groups with poorer perceptions of their health care provision during COVID-19 can be identified. More investigation is needed to identify subjective or COVID-19 related predictors that cause this subjective perception.

Reference

OECD (2020). Beyond Containment: Health systems responses to COVID-19 in the OECD.

Available: https://read.oecd-ilibrary.org/view/?ref=119_119689-ud5comtf84&title=Beyond_Containment:Health_systems_responses_to_COVID-19_in_the_OECD (Accessed: 14.04.2021)

Key messages

It was found that respondents perceived their subjective healthcare provision during COVID-19 differently, according to sociodemographic stratification.

Especially younger, chronically ill, and socioeconomically deprived respondents experienced a poorer perception of their healthcare provision during the first wave of the COVID-19 pandemic.

Web-based planning tool for obesity prevention in childhood and youth – first trial period

Background

The systematic and theory-based development of interventions is complex and requires time and personnel resources. WEPI is a web-based planning tool for municipalities and schools, that follows the evidence-based intervention mapping approach (IMA) but also supports the planning process of obesity prevention user oriented. The project is supported by the Federal Ministry of Health, Germany.

Methods

Data of a systematic literature review (SLR), expert interviews and focus group discussions served as the foundation for the first version of WEPI. Two further SLR were conducted in the databases Pubmed, LIVIVO and Cochrane on evidence-based determinants of obesity development and on proven obesity intervention methods, to meet the requirements of the IMA. In October 2020 the second version of WEPI was tested with selected municipalities and schools. The prototype as a third version was tested by three municipalities and two schools in February 2021. Feedback was collected through questionnaires and interviews.

Results

In a total of 806 hits of the first SLR, determinants for the development of obesity were identified in 8 guidelines and 37 reviews. They were adopted in form of 15 problem areas which support the WEPI user to conduct an evidence-based problem analysis. Result of the second SLR are 25 obesity prevention interventions which were developed using the IMA. Based on this, 192 evaluated methods were identified and integrated as good practice examples into WEPI. In the first trial the expert feedback revealed aspects of content and user-friendliness as well as technical aspects that should be optimized. The feedback of the municipalities and schools underlines, that scientific findings need to be translated into practical logic.

Conclusions

WEPI provides a comprehensive roadmap to the planning process, guiding the user step by step. Acceptance and usability of the planning tool will be evaluated with municipalities and schools from April to November 2021.

Key messages

WEPI enables user oriented, structured and evidence-based planning of prevention interventions. Requirements resulting from practice were considered in the development of the planning tool.

Exploring the burden of xerosis cutis and the impact of dermatological skin care from patient's perspective

BACKGROUND

Xerosis cutis is recognized as a burdensome and stressful condition of the skin, resulting in impaired health-related quality of life (HRQoL). Therefore, it should be treated as a relevant skin disease with detailed care and treatment recommendations.

METHODS

This cross-sectional, exploratory study aimed to examine xerosis cutis-related burden from patient's perspective and compare it with individuals without xerosis cutis. Within-group comparisons were also performed among patients with xerosis cutis associated with atopic dermatitis (AD) or not. The second aim was to assess the effect of a routinely applied basic skin care therapy in terms of burden release.

RESULTS

Overall, 127 participants were included in the study. Patients with xerosis cutis reported a lower quality of life (p = .041), more dysmorphic concerns (p < .001), and higher general anxiety (p = .029) than individuals without xerosis cutis. The presence of AD was associated with lower HRQoL (p = .023), more depression (p = .008) and anxiety symptoms (p = .003), and more stigmatization experiences at baseline (p < .001).

CONCLUSION

Patients with xerosis cutis showed higher psychosocial burden than participants without xerosis cutis. Additionally, patients with xerosis and AD had more psychosocial impairments than patients with xerosis without AD.

Combining proactive transcranial stimulation and cardiac biofeedback to substantially manage harmful stress effects

BACKGROUND

Previous studies have identified the dorsolateral prefrontal cortex (dlPFC) as a core region in cognitive emotional regulation. Transcranial direct current stimulations of the dlPFC (tDCS) and heart-rate variability biofeedback (BFB) are known to regulate emotional processes. However, the effect of these interventions applied either alone or concomitantly during an anticipatory stress remains unexplored.

OBJECTIVE

The study investigated the effect of anodal tDCS and BFB, alone or combined, on psychophysiological stress responses and cognitive functioning.

METHODS

Following a stress anticipation induction, 80 participants were randomized into four groups and subjected to a 15-min intervention: neutral video viewing (ctrl), left dlPFC anodal tDCS (tdcs), heart-rate variability biofeedback (bfb), or a combined treatment (bfb + tdcs). Participants were then immediately confronted with the stressor, which was followed by an assessment of executive functions. Psychophysiological stress responses were assessed throughout the experiment (heart rate, heart-rate variability, salivary cortisol).

RESULTS

The tdcs did not modulate stress responses. Compared with both ctrl and tdcs interventions, bfb reduced physiological stress and improved executive functions after the stressor. The main finding revealed that bfb + tdcs was the most effective intervention, yielding greater reduction in psychological and physiological stress responses than bfb.

CONCLUSIONS

Combining preventive tDCS with BFB is a relevant interventional approach to reduce psychophysiological stress responses, hence offering a new and non-invasive treatment of stress-related disorders. Biofeedback may be particularly useful for preparing for an important stressful event when performance is decisive.