Pregnancy is known to increase the risk of aneurysm formation, likely by a combination of histological changes in vessel walls associated with the hormones of pregnancy and the haemodynamic changes ...to the circulation. To our knowledge this is the first case of a pregnant woman with a brachial-cephalic arterio-venous fistula (AVF) that had never been needled for haemodialysis, yet became hugely aneurysmal during her pregnancy.
Within palliative care, clear and open communication about death is encouraged. Euphemisms are discouraged as threats to promoting clear understanding of the prognosis; to opening communication about ...what a good death means to individual patients and families; and to fostering collaborative planning aimed at achieving this ‘good death’. Principles of patient-centred and culturally competent care, however, which reflect trends of individualisation, plurality and multiculturalism that are characteristic of late modernity, encourage respect for and support of patients' and families' preferences. These may include wishes to avoid open communication, preferences for euphemisms, and definitions of a ‘good death’ that vary from the practitioner's, and within families. The aim of this study was to examine how physicians navigate these competing priorities. Analysis is based on interviews with 23 doctors, ranging in experience from medical students through to senior palliative care specialists, and eight recorded observations of palliative care multidisciplinary team meetings with 52 clinicians collected in 2017 at two hospitals in one Australian metropolitan area. Findings show that synonyms familiar to clinicians are often used to communicate prognoses in multidisciplinary meetings. In communication with patients and families, doctors rely on emotional and cultural cues to decipher the preferred terminology and response. Drawing on a late modern re-imagination of emotion management, we conceptualise the work performed in this context as emotionally reflexive labour. These findings suggest that blanket protocols for direct communication overlook the complexity of end-of-life communication in an era where a ‘good death’ is understood to be culturally relative.
•Definitions of dying well in late modernity are individually and culturally relative.•Doctors perform emotionally reflexive labour to tailor communication.•In interactions with other clinicians, placeholders for death are widely used.•Blanket protocols for direct end-of-life communication may be inappropriate.
Modifiable risk factors such as smoking and sedentary lifestyle adversely affect multiple sclerosis (MS) progression. Few multimodal behavioural interventions have been conducted for people with MS, ...and follow-up beyond 1 year is rare for lifestyle interventions. This study assessed adoption and adherence to healthy lifestyle behaviours and health outcomes 3 years after a lifestyle modification intervention, using generalized estimating equation models to account for within-participant correlation over time.
95 people with MS completed baseline surveys before participating in 5-day MS lifestyle risk-factor modification workshops. 76 and 78 participants completed the 1-year and 3-year follow-up surveys respectively. Mean age at 3-year follow-up was 47 years, 72% were female, most (62.8%) had MS for 5 years or less, and 73% had relapsing remitting MS (RRMS).
Compared to baseline, participants reported clinically meaningful increases in physical (mean difference (MD): 8.0, 95% Confidence Interval (CI): 5.2-10.8) and mental health (MD: 9.2, CI: 5.8-12.6) quality of life (QOL) at 1-year, and physical (MD: 8.7, CI: 5.3-12.2) and mental health (MD: 8.0, CI: 4.2-11.8) QOL at 3-year follow-up. There was a small decrease in disability from baseline to 1-year follow-up (MD: 0.9, CI: 0.9,1.0) and to 3-year follow-up (MD: 1.0, CI: 0.9,1.0), which was not clinically meaningful. Of those with RRMS, compared to baseline, fewer had a relapse during the year before 1-year follow-up (OR: 0.1, CI 0.0-0.2) and 3-year follow-up (OR: 0.15, CI 0.06-0.33). Participants' healthy diet score, the proportion meditating ≥1 hours a week, supplementing with ≥ 5000IU vitamin D daily, and supplementing with omega-3 flaxseed oil increased at 1-year follow-up and was sustained, although slightly lower at 3-year follow-up. However, there was no evidence for a change in physical activity and not enough smokers to make meaningful comparisons. Medication use increased at 1-year follow-up and at 3-year follow-up.
The results provide evidence that lifestyle risk factor modification is feasible and sustainable over time, in a small self-selected and motivated sample of people with MS. Furthermore, participation in a lifestyle intervention is not associated with a decrease in MS medication use.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Most evidence suggests anthropogenic edges negatively affect rain-forest bird communities but little has been done to test this in Australasia. In this study, avifaunal detection frequency, species ...richness and community composition were compared between the edge and interior and between flat and more complex-shaped edges of riparian rain-forest tracts in Tropical North Queensland. The detection frequency and richness of guilds based on diet, foraging strata and habitat specialism were also compared. This study detected 15.1% more birds at the rain-forest edge compared with the interior but no difference in species richness. Edge shape had no effect on detection frequency or richness. Many guilds (subcanopy, closed forest, frugivorous and insectivorous species) experienced increased detection frequency at the edge relative to the interior, but for some guilds this response was reduced (habitat generalists) or reversed (understorey and mixed-flock species) along complex edges. Overall community composition was affected by edge distance but not by edge shape. Edge habitat was shorter and had more open canopy than the interior, supporting habitat-based explanations for the observed avifaunal edge effects. These results suggest generally positive edge effects in Australian rain-forest bird communities, possibly reflecting local resource distributions or a disturbance-tolerant species pool.
For fast-flying birds, the ability to respond to wind during landing is critical, as errors can lead to injury or even death. Nonetheless, landing ability, and its ecological significance, remain ...unstudied. We show that for auks, 60% of attempts to land at their cliff nests fail in a strong breeze (80% in near-gale winds). This is most likely because wind interferes with the ability to maintain flight control in the last phase of landing. Their extreme flight costs mean that the energetic penalty for multiple landing attempts is high. We propose that exposure, and ability to respond to, such conditions will influence the suitability of breeding habitat. In support of this (i) auk colonies appear to be orientated away from prevailing winds and (ii) landing success within colonies is higher on crowded ledges with more airspace for manoeuvring. More generally, the interplay between wind and flight capacities could impact breeding distributions across species and scales.
Multiple sclerosis (MS) is a complex, demyelinating disease of the central nervous system. Fatigue is commonly reported by people with MS (PwMS). MS-related fatigue severely affects daily activities, ...employment, socioeconomic status, and quality of life.
We conducted this systematic review and meta-analysis to determine whether psychological interventions are effective in managing fatigue in PwMS.
We performed systematic searches of Medline, EMBASE, PsycINFO, and CINAHL to identify relevant articles published from database inception to April 5, 2017. Reference lists from relevant reviews were also searched.
Two independent reviewers screened the papers, extracted data, and appraised the included studies. A clinical psychologist verified whether interventions were psychological approaches. A narrative synthesis was conducted for all included studies. For relevant randomized controlled trials that reported sufficient information to determine standardized mean differences (SMDs) and 95% confidence intervals (CIs), meta-analyses were conducted using a random-effects model.
Of the 353 identified articles, 20 studies with 1,249 PwMS were included in this systematic review. Narrative synthesis revealed that psychological interventions reduced fatigue in PwMS. Meta-analyses revealed that cognitive behavioral therapy decreased levels of fatigue compared with non-active controls (SMD = -0.32; 95% CI: -0.63 to -0.01) and compared with active controls (relaxation or psychotherapy) (SMD = -0.71; 95% CI: -1.05 to -0.37). Meta-analyses further showed that both relaxation (SMD = -0.90; 95% CI: -1.30 to -0.51), and mindfulness interventions (SMD = -0.62; 95% CI: -1.12 to -0.12), compared with non-active control, decreased fatigue levels. The estimates of heterogeneity for the four meta-analyses varied between none and moderate.
This study found that the use of psychological interventions for MS-related fatigue management reduced fatigue in PwMS. While psychological interventions are generally considered first-line therapy for MS-related fatigue, further studies are needed to explore the long-term effect of this therapy.
To explore the association between combined lifestyle risk factors with quality of life in people with multiple sclerosis (MS) over 2.5 years.
People with MS were recruited to participate in a ...comprehensive online survey regarding their demographic and clinical characteristics, health-related quality of life (HRQOL), and lifestyle behaviors including physical activity, alcohol consumption, cigarette smoking, body mass index, and dietary habits measured at baseline and 2.5-year follow-up. A combined healthy lifestyle index score (HLIS) was constructed by assigning scores of 0-4 to each of the lifestyle risk factors, for which higher values indicate healthier lifestyle behavior. Multivariable linear regression modeling was used to assess whether the HLIS at baseline was associated with the physical and mental HRQOL over the study period in this sample of people with MS.
Of 2,466 participants with confirmed MS, 1,401 (57%) completed the follow-up. Multivariable linear regression analyses demonstrated that every 5-point increase (of a possible total of 20) in the baseline HLIS was associated with 1.7 (95% CI: 0.2-3.2) and 2.5 (95% CI: 1.0-4.0) higher scores in the change in physical and mental HRQOL components from baseline to follow-up respectively.
Findings suggest the importance of healthy lifestyle behavior in quality of life in MS. A healthy lifestyle program focusing on these behaviors has the potential to positively influence health-related quality of life for people with MS.
Energy harvesting by animals is important because it provides the power needed for all metabolic processes. Beyond this, efficient food finding enhances individual fitness 1 and population viability ...2, although rates of energy accumulation are affected by the environment and food distribution. Typically, differences between individuals in the rate of food acquisition are attributed to varying competencies 3, even though food-encounter rates are known to be probabilistic 4. We used animal-attached technology to quantify food intake in four disparate free-living vertebrates (condors, cheetahs, penguins, and sheep) and found that inter-individual variability depended critically on the probability of food encounter. We modeled this to reveal that animals taking rarer food, such as apex predators and scavengers, are particularly susceptible to breeding failure because this variability results in larger proportions of the population failing to accrue the necessary resources for their young before they starve and because even small changes in food abundance can affect this variability disproportionately. A test of our model on wild animals indicated why Magellanic penguins have a stable population while the congeneric African penguin population has declined for decades. We suggest that such models predicting probabilistic ruin can help predict the fortunes of species operating under globally changing conditions.
•There is extreme variation in the probability of food finding in vertebrate species•Decreasing probability increases inter-individual variation in foraging duration•This variability can result in individual or breeding ruin•Apex predators are most likely to incur ruin under changing environmental conditions
Animals need to find food to survive and breed. Wilson et al. look at foraging in four disparate vertebrates to find that food finding contains an appreciable element of luck and that rarer food increases inter-individual variability in foraging success. Species taking rare food are therefore more liable to starve and fail at breeding.
We aimed to describe website traffic and qualitatively analyze an e-health community discussion forum.
Participants in this study were people affected by multiple sclerosis visiting the Overcoming ...Multiple Sclerosis (OMS) website.
This mixed methods study combined descriptive analysis of website traffic over 7 years and 1 month, and qualitative analysis of 1 week of posts in the meditation topic, coded into theme groups using qualitative thematic analysis.
There were 166 meditation topics posted with 21,530 initial views of primary post and 785 sub-post responses. Meditation posts and sub-posts received 368,713 replies. Number of views increased from 4,684 in 2011 to over 80,000 in 2017, a considerably greater rate of increase than overall traffic.
Qualitative analysis of posts on the meditation forum identified themes of barriers and enablers to utilization of meditation resources. Enablement themes dominated, observed across six of the seven theme groups with various forms of positive social and emotional support to learn and practice meditation. One theme, negative emotion, was identified as a barrier.
The OMS peer-to-peer patient online discussion forum serves important functions in encouraging, educating and enabling its growing online community. Our analysis may help improve and innovate online support for lifestyle management in many chronic diseases.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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