The endogenous amino acids serine and aspartate occur at high concentrations in free D-form in mammalian organs, including the central nervous system and endocrine glands. D-serine (D-Ser) is largely ...localized in the forebrain structures throughout pre and postnatal life. Pharmacologically, D-Ser plays a functional role by acting as an endogenous coagonist at N-methyl-D-aspartate receptors (NMDARs). Less is known about the role of free D-aspartate (D-Asp) in mammals. Notably, D-Asp has a specific temporal pattern of occurrence. In fact, free D-Asp is abundant during prenatal life and decreases greatly after birth in concomitance with the postnatal onset of D-Asp oxidase expression, which is the only enzyme known to control endogenous levels of this molecule. Conversely, in the endocrine system, D-Asp concentrations enhance after birth during its functional development, thereby suggesting an involvement of the amino acid in the regulation of hormone biosynthesis. The substantial binding affinity for the NMDAR glutamate site has led us to investigate the in vivo implications of D-Asp on NMDAR-mediated responses. Herein we review the physiological function of free D-Asp and of its metabolizing enzyme in regulating the functions of the brain and of the neuroendocrine system based on recent genetic and pharmacological human and animal studies.
The patient was being treated with methadone, diazepam and escitalopram. Because of this symptomatology—fatigue and weight loss—the patient had already undergone several outpatient visits ...(psychiatric, neurological, nutritional) and a hospitalisation and discharged with a diagnosis of Helicobacter pylori infection, resolved. On the basis of this result, interferon-gamma release assay (Quantiferon) was performed, which resulted positive. ...the patient underwent lung CT scan documenting ‘the presence of coarse nodulations in the upper lobes of both lungs, with greater extension to the right, the greater of which on the right with axial diameters of 23×11 mm, formed by dense tissue, mostly with small contextual calcified nodules, some of which surrounded by spicules that penetrate into lung parenchyma and connected with the pleura’ (figure 1B–C). From a posteriori point of view, basing on anamnestic data, the patient should have been considered at high risk for TB. ...tuberculosis outbreaks had been described in marijuana users,3 and psychiatric comorbidities represent a risk factor for delayed TB diagnosis.4 The present case, in the era of hyper-technological medicine, calls back physicians to the importance of medical history and physical examination to perform a correct diagnosis.
Aim
The purpose of the this study was to test the factorial structure, internal consistency reliability and concurrent validity of the Caregiver Contribution to Self‐Care Chronic Illness Inventory.
...Background
Existing measures of caregiver contribution to self‐care are disease‐specific or behaviour‐specific; no generic measures exist.
Design
A cross‐sectional study.
Method
Between April 2017 ‐ December 2018, we enrolled a convenience sample of 358 patients with chronic illnesses and their caregivers. Patients completed the Self‐Care of Chronic Illness Inventory while caregivers completed the Caregiver Contribution to Self‐Care of Chronic Illness Inventory, a modification of the Self‐Care of Chronic Illness Inventory, which includes three scales as follows: the Caregiver Contribution to Self‐Care Maintenance, the Caregiver Contribution to Self‐Care Monitoring and the Caregiver Contribution to Self‐Care Management. Of each scale, we tested the factorial structure with confirmatory factor analysis and reliability with the factor score determinacy coefficient, the global reliability index for multidimensional scale and Cronbach's alpha. Also, we used Pearson's correlations for concurrent validity purposes.
Results
Confirmatory factor analysis supported the two‐factor structure of the Caregiver Contribution to Self‐Care Maintenance and Management scales and the one‐factor structure of the Caregiver Contribution to Self‐Care Monitoring scale. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model (Comparative Fit Index = 0.933). Reliability estimates ranged between 0.701 and 0.961 across the three scales. Concurrent validity of Caregiver Contribution to Self‐Care of Chronic Illness Inventory with the Self‐Care of Chronic Illness Inventory was not sufficiently supported since weak correlations were found.
Conclusion
The Caregiver Contribution to Self‐Care of Chronic Illness Inventory is valid and reliable and can be used in clinical practice and research.
Impact
The Caregiver Contribution to Self‐Care of Chronic Illness Inventory is an useful instrument to evaluate the extent to which caregivers contribute to patient self‐care in chronic illnesses.
目的
本研究旨在检验慢性疾病护理人员自我照顾贡献量表的因子结构、内部一致信度及并发效度。
背景
现有护理人员对自我照顾的贡献衡量标准均是以疾病或行为为基础;无通用衡量标准。
设计
横断面研究。
方法
2017年4月至2018年12月间,我们对358名慢性病患者及其护理人员进行随机抽样调查。患者已填写慢性疾病自我照顾量表,且护理人员已填写其对慢性病自我照顾贡献量表,此量表是在慢性疾病自我照顾量表的基础上修订,包括三个量表:护理人员对自我照顾的贡献,护理人员对自我照顾监控的贡献以及护理人员对自我照顾管理的贡献。各量表中,我们通过验证性因子分析对因子结构进行检验,并用因子得分确定系数、多维量表整体信度指标和克隆巴赫系数,以进行信度检验。同时,我们利用皮尔逊相关系数进行并发效度分析。
结果
验证性因子分析可在护理人员自我照顾共享维持与管理量表中所列双因素结构和护理人员自我照顾监测量表中所列单因素结构中适用。一般模型可在组合项目的同时验证性因素分析中适用(比较拟合指数=0.933)。经预计,上述三个量表的信度介于0.701到0.961之间。慢性疾病护理人员自我照顾量表与慢性疾病患者自我照顾量表的并发效度呈弱相关,因此,慢性疾病患者自我照顾量表未充分使用。
结论
慢性疾病护理人员自我照顾贡献量表有效、可靠,可在临床实践和研究中使用。
影响
慢性疾病护理人员自我照顾贡献量表是评估护理人员对慢性疾病患者自我照顾的贡献程度的有效工具。
Individuals with Chronic Kidney Disease (CKD) are at high risk for cardiovascular morbidity and mortality. The aim of this study was to examine the relationship between renal dysfunction and ...all-cause mortality in a sample of subjects undergoing coronary angiography (CA). We evaluated 1017 subjects who consecutively underwent CA. Glomerular filtration rate (eGFR) was estimated by CKD-EPI and urinary albumin excretion reported as urinary albumin-to-creatinine ratio. Vital status was ascertained by interrogating the Italian Health Card Database. One-thousand-seventeen subjects (759 M/258F) were enrolled into the study from 2016 to 2018. One-hundred-fourteen deaths occurred during a median follow-up of 44 months. The whole population was divided in two subgroups according to the presence/absence of low eGFR (i.e. < 60 ml/min/1.73 m
2
). Subjects with low baseline eGFR had a worse clinical profile than subjects with preserved kidney function. The risk of death in subjects with eGFR < 60 ml/min/1.73 m
2
was almost three times higher than in subjects with preserved kidney function: fully adjusted HR 2.70 (95% CI 1.56–4.67). The presence of albuminuria also predicted a high risk of death: fully adjusted HR 2.09 (95% CI 1.17–3.73) and HR 4.26 (95% CI 2.18–8.33), microalbuminuria or macroalbuminuria, respectively, being normoalbuminuria the reference group. Again, the increased risk remained significant after adjusting for several potential confounders. In conclusion, kidney disease measures (i.e. low eGFR or albuminuria) independently predict increased risk for all-cause death in a large sample of subjects undergoing CA. These results have a relevant clinical impact.
: The COVID-19 pandemic has strongly impacted on healthcare services' organization and healthcare workers' mental health, increasing the risk of psychological symptoms and burnout. Italy has been one ...of the most affected countries, especially the northern regions, even with exceptions in some rural provinces.
: We chose to investigate the mental health conditions of healthcare workers operating in the rural province of Rovigo (a small town in Veneto, northern Italy), where relatively few deaths and contagions were reported during the pandemic, even if Veneto-globally-was one of the most affected regions of Italy. We wanted to verify the psychological outcomes of health workers operating in a context where the impact of the pandemic appeared to be relatively mild.
: Through an online survey, we investigated perceived difficulties at work and in daily life, perceived loneliness and social support, coping strategies, and level of psychological distress (sample size: 749; mean age = 48.04 years, SD = 10.66). The questionnaire had both open- (2) and close-ended questions (5 single-choice and 13 multiple-choice). We verified possible associations between sex, age group, work department and percentage of responses with chi-square tests of independence on each question. Data cleaning excluded all contradictory answers from the multiple-choice questions from the analyses (final sample size: 640).
: Frontliners and non-frontliners reported a similar experience of the COVID-19 pandemic (without significant differences in perceived difficulties, coping strategies and sources of support). Nevertheless, they still reported various forms of negative emotions (e.g., helplessness-40.94%; sadness-36.56%; frustration-32.66%) and lack of support from the health organization (especially frontliners-28.72%). However, psychological help was scarcely requested.
: Despite the province not being massively affected by the pandemic, healthcare workers felt the need for clearer and more supportive guidance. They seem to perceive collective opportunities to share needs and difficulties as more useful than individual interventions (as those provided by the ad hoc created listening service).
‘Bony’ heart Mirijello, Antonio; Curci, Serafino; D’Errico, Maria Maddalena ...
BMJ case reports,
08/2019, Letnik:
12, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Echocardiography showed severe left ventricular concentric hypertrophy with sparkling myocardium, mildly reduced ejection fraction with severe diastolic dysfunction (restrictive pattern), biatrial ...dilatation and severe aortic stenosis (AVA 0.6 cm2, 0.38 cm2/m2) with a low transvalvular gradient due to the reduced stroke volume secondary to left ventricle hypertrophy (paradoxical ’low-flow low-gradient'). Physicians, particularly the internist, should be aware of clinical characteristics of this diagnosis in order to recognise patients at risk. 99mTc-HMDP bone scintigraphy is cost-effective for identifying this ‘bony heart’ and performing a correct diagnosis,5 highly impacting the prognosis of these patients, even considering newly available drugs. Suggestive symptoms can be represented by diastolic heart failure, thick and sparkling ventricular wall, low QRS voltages, first degree AVB and aortic stenosis, particularly if ‘low-flow low-gradient’.
Coronary artery disease (CAD), particularly three-vessel coronary disease (3VD), is the main cause of death in industrialized countries. Chronic kidney disease is an independent risk factor for CAD. ...The CHA2DS2-VASc score shows a good ability to predict CV events in high-risk population independently from atrial fibrillation. The aim of the present study was to evaluate the association between the R2CHA2DS2-VASc score and 3VD in a population of patients at high cardiovascular risk. Monocentric prospective study evaluated 1017 patients undergoing coronary angiography. The R2CHA2DS2-VASc score was obtained by adding 2 points to the CHA2DS2-VASc score in case of eGFR < 60 ml/min/1.73m2. Coronary lesions causing ≥ 50% reduction of a major epicardial vessel diameter were considered significant. Patients were grouped based on R2CHA2DS2-VASc tertiles and according to the severity of CAD: 3VD vs No-3VD. The 3VD group showed significantly higher R2CHA2DS2-VASc score than the No-3VD group (4.20 ± 2.18 vs 3.36 ± 2.06, p < 0.001). The risk of 3VD increased by 21% for every 1-point increase in the score (OR 1.21; 95% CI 1.13-1.28, p < 0.001). The prevalence of 3VD was higher among patients belonging to higher tertiles of R2CHA2DS2-VASc (17.2% vs 26.7% vs 33.6% for first, second, and third tertile respectively, p < 0.001) with a risk more than doubled for the third tertile compared to the first one (OR 2.45; 95% CI 1.71-3.49, p < 0.001). The R2CHA2DS2-VASc score is independently associated with 3VD in patients at high cardiovascular risk. The score could be considered a useful tool for clinicians to identify patients who are at high risk of 3VD.Coronary artery disease (CAD), particularly three-vessel coronary disease (3VD), is the main cause of death in industrialized countries. Chronic kidney disease is an independent risk factor for CAD. The CHA2DS2-VASc score shows a good ability to predict CV events in high-risk population independently from atrial fibrillation. The aim of the present study was to evaluate the association between the R2CHA2DS2-VASc score and 3VD in a population of patients at high cardiovascular risk. Monocentric prospective study evaluated 1017 patients undergoing coronary angiography. The R2CHA2DS2-VASc score was obtained by adding 2 points to the CHA2DS2-VASc score in case of eGFR < 60 ml/min/1.73m2. Coronary lesions causing ≥ 50% reduction of a major epicardial vessel diameter were considered significant. Patients were grouped based on R2CHA2DS2-VASc tertiles and according to the severity of CAD: 3VD vs No-3VD. The 3VD group showed significantly higher R2CHA2DS2-VASc score than the No-3VD group (4.20 ± 2.18 vs 3.36 ± 2.06, p < 0.001). The risk of 3VD increased by 21% for every 1-point increase in the score (OR 1.21; 95% CI 1.13-1.28, p < 0.001). The prevalence of 3VD was higher among patients belonging to higher tertiles of R2CHA2DS2-VASc (17.2% vs 26.7% vs 33.6% for first, second, and third tertile respectively, p < 0.001) with a risk more than doubled for the third tertile compared to the first one (OR 2.45; 95% CI 1.71-3.49, p < 0.001). The R2CHA2DS2-VASc score is independently associated with 3VD in patients at high cardiovascular risk. The score could be considered a useful tool for clinicians to identify patients who are at high risk of 3VD.
Gastric cancer (GC) is the fifth-most common cancer worldwide and an important cause of cancer-related-death. The growing knowledge of its molecular pathogenesis has shown that GC is not a single ...entity, but a constellation of different diseases, each with its own molecular and clinical characteristics. Currently, surgery represents the only curative approach for localized GC, but only 20% of patients (pts) showed resectable disease at diagnosis and, even in case of curative resection, the prognosis remains poor due to the high rate of disease relapse. In this context, multimodal perioperative approaches were developed in western and eastern countries in order to decrease relapse rates and improve survival. However, there is little consensus about the optimal treatment for non-metastatic GC. In this review, we summarize the current status and future developments of perioperative chemotherapy in resectable GC, attempting to find clear answers to the real problems in clinical practice.
Aims
To test the psychometric properties of the Chinese version of the Self‐Care in Chronic Obstructive Pulmonary Disease Inventory on a sample of patients with chronic obstructive pulmonary disease ...in China.
Background
Measuring the self‐care of patients with chronic obstructive pulmonary disease is vital to promote the performance of effective self‐care behaviours. However, few instruments have been developed to measure self‐care in chronic obstructive pulmonary disease, and the existing instruments lack theoretical support and satisfactory psychometrics properties. The Self‐Care in Chronic Obstructive Pulmonary Disease Inventory based on Middle‐Range Theory of Self‐Care of Chronic Illness has been developed and tested previously in Italian and US population.
Design
A cross‐sectional instrument development study.
Methods
Construct validity was tested by confirmatory factor analysis and hypothesis testing, and reliability internal consistency using factor score determinacy coefficients.
Results
A convenience sample of 185 patients with chronic obstructive pulmonary disease was recruited from September 2020 to January 2022. The instrument consists of three scales: self‐care maintenance, self‐care monitoring and self‐care management. Confirmatory factor analysis performed on the three scales produced good fit indices. The internal consistency was adequate with factor score determinacy coefficients ranging from 0.891 to 0.953 in Self‐Care Maintenance Scale, 0.990 to 0.993 in Self‐Care Monitoring Scale and 0.750 to 0.976 in Self‐Care Management Scale.
Conclusions
The Chinese version of the Self‐Care in Chronic Obstructive Pulmonary Disease Inventory has acceptable reliability and validity. Some differences from the original instrument were identified. Further validation studies should be conducted to confirm the psychometric properties of the instrument in Chinese population.
Summary statement
What is already known about this topic?
The Middle‐Range Theory of Self‐care of Chronic Illness has been used to direct clinical nursing practice for coronary heart disease, heart failure, hypertension, chronic obstructive pulmonary disease and other chronic illnesses and has been shown to have good guiding significance for clinical nursing practice for the self‐care of clinical chronic illness.
In patients with chronic obstructive pulmonary disease, self‐care has a significant positive effect on preserving disease stability and enhancing health‐related quality of life.
There is a shortage of moderate length evaluation instruments for chronic obstructive pulmonary disease self‐care with comprehensive theoretical assessment content, but the Self‐Care in Chronic Obstructive Pulmonary Disease Inventory, based on the Middle‐Range Theory of Self‐care of Chronic Illness, has been demonstrated to have positive application effects in Italy and the United States. However, its applicability in China is unclear.
What this paper adds?
This paper indicates that the Chinese version of the Self‐Care in Chronic Obstructive Pulmonary Disease Inventory has good reliability and validity and can reflect the self‐care ability of patients with chronic obstructive pulmonary disease in China.
The implications of this paper:
The results show that the Chinese version of the Self‐Care in Chronic Obstructive Pulmonary Disease Inventory is simple and accessible, and nurses can use it to assess patients' capacity for self‐care regularly.
The Chinese version of the Self‐Care Scale has different dimensions from the original scale, indicating that different medical backgrounds and varying understanding of concept of self‐care in various nations may result in various self‐care behaviours.
To ensure its wider application, the development of this scale necessitates cross‐cultural adaptation of populations in more countries.
Aim
The Self‐Care Self‐Efficacy Scale (SCSES) was newly developed as a self‐report measure for self‐care self‐efficacy for chronic illness. This study investigated its measurement equivalence (ME) in ...different cultural groups, including United States, China (Hong Kong), Italy, and Brazil.
Design
A multi‐national study for cross‐cultural validation of the Scale.
Methods
From January 2015 ‐ December 2018, investigators recruited 957 patients (United State: 200; Hong Kong: 300; Italy: 285; and Brazil: 142) with chronic illness from inpatient and outpatient settings. The SCSES was administered and clinical and demographic data were collected from participants. Based on the Meredith framework, multi‐group confirmatory factor analysis evaluated the configural, metric, scalar, and strict invariance of the scale across the four populations through a series of nested models, with evaluation of reliability and coherence of the factor solution.
Results
The mean ages of the groups ranged from 65–77 years, 56.4% was male. The Cronbach's alpha coefficients of the single‐factor SCSES were 0.93, 0.89, 0.92, and 0.90 for the United States, China (Hong Kong), Italy, and Brazil, respectively. Three of the four levels of ME were partially or totally supported. The highest level achieved was partial scalar invariance level (χ2 52 = 313.4, p < 0.001; RMSEA = 0.067; 95% CI = 0.056–0.077; CFI = 0.966; TLI = 0.960, SRMR = 0.080).
Conclusion
Patients from the four countries shared the same philosophical orientation towards scale items, although some of the items contributed differently to represent the concept and participants shared the same schemata for score interpretation.
Impact
Self‐efficacy is important in producing effective and sustainable self‐care behavioural changes. Cultural ideation shapes the ways individuals interpret and report their self‐care self‐efficacy. The study findings support cross‐cultural and cross‐national utility of the SCSES for research on self‐care across United States, China (Hong Kong), Italy, and Brazil.
目的
自我护理自我效能量表(SCSES)是一种最新制定的对慢性病自我护理自我效能的自我报告测量方法。本研究调查了其在美国、中国(香港)、意大利、巴西等不同文化群体的测量等效性(ME)。
设计
量表跨文化验证的跨国研究。
方法
自2015年1月至2018年12月,研究员招募了957位患有慢性病的住院患者和门诊患者(美国:200;香港:300;意大利:285;以及巴西:142)进行了自我护理自我效能量表测量,并收集了参与者的门诊和人口数据。基于Meredith框架,多组验证性因素分析通过一系列嵌套模型评估了这四类人群的量表构型、度量、标量以及严格等值,并评估了因素解决方案的可靠性和一致性。
结果
各组的平均年龄为65岁至77岁,其中男性占总参与者人数的56.4%。美国的单因素自我护理自我效能量表的克隆巴赫系数为0.93、中国(香港)为0.89、意大利为0.92、巴西为0.90。测量等效性的四个等级中的三个得到了部分或全部支持。达到的最高等级为部分标量不变性等级。(χ2 52 = 313.4、 p < 0.001、 RMSEA = 0.067、95% CI = 0.056–0.077、CFI = 0.966、TLI = 0.960、SRMR = 0.080)
结论
尽管部分项目不同(观念不同),但是来自四个国家的患者在思想上对量表项目有着相同的选择,并且参与者有着相同的评分解读图解。
影响
在有效并持续改变自我护理行为时,自我效能非常重要。文化观念的形成塑造了个人解释和报告其自我护理自我效能的方式。研究调查结果支持在美国、中国(香港)、意大利和巴西的自我护理研究中采用跨文化跨国的自我护理自我效能量表。
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