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Our study investigates the psychosexual impact of human papillomavirus (HPV) diagnosis and its associated conditions on Hispanic women living in Puerto Rico.
A cross-sectional quantitative study was conducted on 205 women between 21 and 65 years old who received services at the Gynecology Clinics of the Medical Sciences Campus from April 2019 to December 2019. After obtaining approval from the institutional review board (March 27, 2019) and the informed consent of participants, participants completed a sociodemographic questionnaire and 4 psychological symptomatology-based questionnaires that measured levels of anxiety, depression, sexual satisfaction, and self-esteem.
Of the participants, 48.8% had a known diagnosis of HPV ( n = 100) compared with 51.2% without a known HPV diagnosis ( n = 105). A Mann-Whitney U test analysis for independent samples was used, which showed that patients with known HPV diagnoses had higher reported levels of anxiety in the Generalized Anxiety Disorder Scale with a statistical significance of 0.03, as compared with patients without a known HPV diagnosis. There was no significant difference in reported levels of depressive symptoms, self-esteem, or sexual satisfaction between the groups.
Our findings show that in this group of Hispanic women living in Puerto Rico, being diagnosed with HPV and its associated conditions can be associated with higher anxiety symptoms. Selleck BI-2493 Further studies are warranted in this population to help improve their health outcomes and access to proper primary and preventive care.
Our findings show that in this group of Hispanic women living in Puerto Rico, being diagnosed with HPV and its associated conditions can be associated with higher anxiety symptoms. Further studies are warranted in this population to help improve their health outcomes and access to proper primary and preventive care.More than one-third of the cases of infective endocarditis (IE) occur in older patients. The disease is often characterized by atypical symptoms. The incidence of neurological complications is high and represents a strong independent predictor of severe outcomes and mortality. IE is a rare but serious complication of transcatheter aortic valve implantation (TAVI). A persistent delirium as a unique manifestation of post-TAVI IE in an older patient is presented in this clinical case.
Frailty is strongly associated with cardiometabolic diseases in observational studies. However, whether the observed association reflects causality requires clarification. We performed a bidirectional Mendelian randomisation (MR) study to assess the causal relationship of frailty, measured by the frailty index (FI), with coronary artery disease (CAD), stroke and type 2 diabetes (T2D).
We extracted summary genome-wide association statistics for the FI (N = 175,226), CAD (Ncase = 60,801, Ncontrol = 123,504), stroke (Ncase = 40,585, Ncontrol = 406,111) and T2D (Ncase = 55,005, Ncontrol = 400,308) among individuals of European ancestry. Independent genetic variants associated with each phenotype at the genome-wide significance level were taken as instruments. Two-sample MR analyses were primarily conducted using the inverse-variance-weighted method, followed by various sensitivity and validation analyses.
Genetically predicted higher FI was significantly associated with increased risk of CAD (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.17-1.96) and T2D (OR 1.80, 95% CI 1.31-2.47) and suggestively associated with higher risk of stroke (OR 1.36, 95% CI 1.01-1.84). In the reverse direction analysis, genetic liability to CAD (beta 0.037, 95% CI 0.019-0.055), stroke (beta 0.096, 95% CI 0.051-0.141) and T2D (beta 0.047, 95% CI 0.036-0.059) showed significant associations with increased FI. Results were stable across sensitivity and validation analyses.
Our study strengthened the evidence for a bidirectional causal association between frailty and cardiometabolic diseases. Further understanding of this association will be critical for the optimisation of care in older adults.
Our study strengthened the evidence for a bidirectional causal association between frailty and cardiometabolic diseases. Further understanding of this association will be critical for the optimisation of care in older adults.
Frailty is common among residential aged care services (RACS) residents; however, little is known about how frailty changes over time in this population. This study aimed to estimate minimally important difference (MID) in frailty to then describe frailty change over 12 months; and factors associated with worsening frailty.
Prospective cohort study across 12 RACS sites of a single aged care organisation in South Australia (n = 548 residents, mean age 87.7 ± 7.2years, 72.6% female). Frailty was measured using a frailty index (FI) with 12 months between baseline and follow-up. MID was calculated cross-sectionally (anchor-based using self-reported health, and ½SD for distribution-based).
Between-person MID for the FI was identified as 0.037 (anchor-based) and 0.063 (distribution-based). Using the conservative value of 0.063 as the basis for change, 32.3% (n = 177) of residents remained stable, 13.7% (n = 75) improved, 33.0% (n = 181) worsened and 21.0% (n = 115) died over 12 months. In a multivariable analysis, significant predictors of the dichotomous outcome of worsening and death at 12 months were being malnourished (odds ratio (OR) = 2.15, 95% confidence interval (CI) = 1.23, 3.75), at risk of malnutrition (OR = 1.98, 95%CI = 1.34, 2.91) and diabetes (OR = 1.61, 95%CI = 1.06, 2.42) compared to those who remained stable or improved.
A 6.3% change in frailty for RACS residents is a conservative MID. Frailty is dynamic in RACS residents, and stability or improvement was possible even for the most-frail. Treatments such as nutritional interventions, exercise and diabetes management are likely to benefit frailty.
A 6.3% change in frailty for RACS residents is a conservative MID. Frailty is dynamic in RACS residents, and stability or improvement was possible even for the most-frail. Treatments such as nutritional interventions, exercise and diabetes management are likely to benefit frailty.
regular physical exercise is essential to maintain or improve functional capacity in older adults. Multimorbidity, functional limitation, social barriers and currently, coronavirus disease of 2019, among others, have increased the need for home-based exercise (HBE) programmes and digital health interventions (DHI). Our objective was to evaluate the effectiveness of HBE programs delivered by DHI on physical function, health-related quality of life (HRQoL) improvement and falls reduction in older adults.
systematic review and meta-analysis.
community-dwelling older adults over 65years.
exercises at home through DHI.
physical function, HRQoL and falls.
twenty-six studies have met the inclusion criteria, including 5,133 participants (range age 69.5 ± 4.0-83.0 ± 6.7). The HBE programmes delivered with DHI improve muscular strength (five times sit-to-stand test, -0.56s, 95% confidence interval, CI -1.00 to -0.11; P = 0.01), functional capacity (Barthel index, 5.01 points, 95% CI 0.24-9.79; P = 0.04) and HRQoL (SMD 0.18; 95% CI 0.05-0.30; P = 0.004); and reduce events of falls (odds ratio, OR 0.77, 95% CI 0.64-0.93; P = 0.008). In addition, in the subgroup analysis, older adults with diseases improve mobility (SMD -0.23; 95% CI -0.45 to -0.01; P = 0.04), and balance (SMD 0.28; 95% CI 0.09-0.48; P = 0.004).
the HBE programmes carried out by DHI improve physical function in terms of lower extremity strength and functional capacity. It also significantly reduces the number of falls and improves the HRQoL. In addition, in analysis of only older adults with diseases, it also improves the balance and mobility.
the HBE programmes carried out by DHI improve physical function in terms of lower extremity strength and functional capacity. It also significantly reduces the number of falls and improves the HRQoL. In addition, in analysis of only older adults with diseases, it also improves the balance and mobility.During cell division, the spindle generates force to move chromosomes. In mammals, microtubule bundles called kinetochore-fibers (k-fibers) attach to and segregate chromosomes. To do so, k-fibers must be robustly anchored to the dynamic spindle. We previously developed microneedle manipulation to mechanically challenge k-fiber anchorage, and observed spatially distinct response features revealing the presence of heterogeneous anchorage (Suresh et al., 2020). How anchorage is precisely spatially regulated, and what forces are necessary and sufficient to recapitulate the k-fiber's response to force remain unclear. Here, we develop a coarse-grained k-fiber model and combine with manipulation experiments to infer underlying anchorage using shape analysis. By systematically testing different anchorage schemes, we find that forces solely at k-fiber ends are sufficient to recapitulate unmanipulated k-fiber shapes, but not manipulated ones for which lateral anchorage over a 3 μm length scale near chromosomes is also essential. Such anchorage robustly preserves k-fiber orientation near chromosomes while allowing pivoting around poles. Anchorage over a shorter length scale cannot robustly restrict pivoting near chromosomes, while anchorage throughout the spindle obstructs pivoting at poles. Together, this work reveals how spatially regulated anchorage gives rise to spatially distinct mechanics in the mammalian spindle, which we propose are key for function.
Good clinical outcomes in orthopaedics are largely dictated by the biomedical model, despite mounting evidence of the role of psychosocial factors. Understanding orthopaedic providers' conceptualizations of good clinical outcomes and what facilitates and hinders them may highlight critical barriers and opportunities for training providers on biopsychosocial models of care and integrating them into practice.
(1) How do orthopaedic trauma healthcare providers define good clinical outcomes for their patients after an acute orthopaedic injury? (2) What do providers perceive as barriers to good outcomes? (3) What do providers perceive as facilitators of good outcomes? For each question, we explored providers' responses in a biopsychosocial framework.
In this cross-sectional, qualitative study, we recruited 94 orthopaedic providers via an electronic screening survey from three Level I trauma centers in geographically diverse regions of the United States (rural southeastern, urban southwestern, and urban northectives and train other providers in biopsychosocial conceptualization and treatment.
Providers' perspectives in this study aligned with a growing body of research on the role of biomedical and psychosocial factors in surgical outcomes and risk of transition to chronic pain. To translate these affirming attitudes into practice, other Level I trauma centers could encourage leaders who adopt biopsychosocial approaches to share their perspectives and train other providers in biopsychosocial conceptualization and treatment.