Night-shift workers may develop poor cardiovascular health. Studies about heart rate variability (HRV) metrics could identify risk factors in this population and be used to examine the effectiveness ...of interventions for optimizing the health of night-shift workers. The purpose of this review was to examine the use of HRV methodologies in studies about night-shift work. Overall, 34 articles met the selection criteria and underwent a methodological critique. The main conclusion across these studies was that night-shift work could increase the sympathetic influences on the variability between heartbeats. In many cases, however, important methodological details were omitted (e.g., the number and duration of electrocardiogram recordings, sampling rates, R-R segment duration, wavelet transform methods). Recommendations include adding measures of disease outcomes, using ≥250 Hz sampling rates and 600-s R-R segments, and measuring sleep and circadian rhythms. With these approaches, researchers can design investigations that identify therapeutic targets for improving the health of night-shift workers. Int J Occup Med Environ Health. 2020;33(4):409-25.
Shift workers support critical 24-hr operations; their health can be impaired by disrupted circadian rhythms and dysfunctional sleep. Shift work sleep disorder (SWSD) is a prevalent condition with ...significant psychological consequences. Nurse leaders have not yet implemented effective policies to prevent SWSD and optimize shift workers’ mental health. The purpose of this integrative review was to examine research about SWSD within the context of neurobiological, sociological, and psychological perspectives that can inform policy changes. The Centers for Disease Control and Prevention Policy Analytic Framework was used to determine the priority recommendations. A search of three databases provided 19 research articles about SWSD and mental health, which illustrated how SWSD is common around the world in many occupations. Backward-rotating schedules and quick returns were risk factors for SWSD. In addition, SWSD was associated with circadian languidity, sleep reactivity, depressive symptoms, and anxiety. Collectively, the studies lacked objective measures of sleep and circadian rhythms, which has hindered the ability to devise interventions that will target the neurobiological causes of SWSD. The research also lacked attention to important sociological factors, such as workers’ pay and benefits. Using these findings, nurse leaders can contribute to public policy reforms that increase funding for more rigorous SWSD research. Lawmakers should be advised by nurse leaders to enforce new regulations that provide incentives for employers to create healthier workplaces, such as prohibiting the overuse of schedules that make employees vulnerable to SWSD and providing funds for interventions to prevent SWSD and support mental health.
South Asians comprise 20% of the world population. There is a high prevalence of cardiovascular diseases among South Asians, and sleep disorders may be a key risk factor.
The review examined ...literature about cardiovascular and sleep disorders in South Asian countries and in the United States, United Kingdom, Canada, and the Netherlands.
Methods from Arksey and O’Malley’s framework and Peter et al. were used to synthesize findings from 23 research studies.
The studies addressed sleep disorders with hypertension, heart failure, diabetes, and obesity. Obstructive sleep apnea and short sleep duration were common and associated with cardiovascular morbidity and mortality at early ages in South Asians. Researchers analyzed polysomnography-derived sleep measures, vascular functions, polymorphisms, C-reactive protein levels, public knowledge about cardiovascular health, and sleep-related questionnaire scores. Most studies were conducted in major metropolitan areas; no data were available about people living in locations with limited health care resources. Among migrant South Asians, researchers did not explore the role of acculturation on sleep patterns and cardiovascular outcomes.
The review highlights important considerations for researchers who plan to investigate cardiovascular conditions in South Asian communities. There is a need for more knowledge about sleep-related risk factors, and researchers should also examine cultural, political, and socioeconomic factors that affect health care access. This knowledge will be imperative for designing effective and tailored disease prevention strategies for South Asian populations.
•Cardiovascular and sleep disorders develop at young ages in South Asians.•South Asians frequently sleep fewer than 7 h and often suffer from sleep apnea.•Improving sleep and cardiovascular health is critical in rural areas of South Asia.•The impact of acculturation in South Asian immigrants requires more research.
Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today's ...myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances.
This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations.
Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.
Asian family caregivers of older adults with dementia have stressful caregiving situations over long periods; they must become resilient to recover from adversity. A conceptual definition of ...resilience specific to Asian family caregivers is important for understanding their caregiving phenomena and the relationships with mental health and psychological well-being. The purpose of this concept analysis was to define resilience in family caregivers of Asian older adults with dementia using Walker and Avant's method. The findings of the analysis will guide future research about the modifiable factors that will prevent negative health outcomes in this population of caregivers.
Aim
We analysed nurses' experiences during military conflicts since World War II.
Background
Nurses have successfully reduced morbidity and mortality in populations affected by wars; despite ...centuries of nurses' global involvement in wars, there is limited knowledge about their experiences.
Method
We used Rodger's evolutionary concept analysis methodology to understand the antecedents, attributes, consequences, context and implications of nurses' war‐related experiences. We analysed data from quantitative and qualitative research, media reports, editorials, historical reviews and published accounts of nurses' experiences in many locations, including Afghanistan, Bosnia, Croatia, Korea, Kosovo, Iran, Iraq, Israel, Palestine, Russia, Somalia, Ukraine and Vietnam.
Findings
Two antecedent conditions preceded nurses' war involvement: actively responding to human suffering and having resources for readiness. Nurses were defined by five attributes: sacrifice, resourcefulness, tunnel‐vision, survival mindset and comradery. We also found evidence for seven consequences; nurses saved lives (reduced morbidity and mortality), however, some nurses faced professional burnout/disillusionment, restricted practice authority, isolation and post‐traumatic stress after war. In addition, growth and pacifism were consequences for some nurses who were exposed to war.
Conclusion
The findings of our concept analysis illustrate how nurses have fulfilled critical life‐saving roles, but some nurses' post‐war experiences were debilitating, stigmatized and unsupported. We conclude that research about the resourcefulness, innovations and resiliency nurses have developed during wars is essential, and professional support mechanisms must be developed to prevent post‐traumatic stress, burnout and attrition from the profession. Governments can use utilize the knowledge nurses developed during wars to expand emergency preparedness skillsets and promote nurses as the leaders of international efforts to promote peace.
No Patient or Public Contribution
Patients, service users, caregivers and members of the public were not involved in conducting this concept analysis or preparing the manuscript.
Impact statement
By understanding nurses' involvement with post‐WWII conflicts, we have demonstrated the significant public health contributions, challenges and personal and professional growth experienced by nurses.
Nurses' war‐related knowledge should be utilized to innovate healthcare practices during disasters and to advise policymakers in developing, implementing and evaluating peace‐promoting operations.
This systematic review synthesized evidence from randomized controlled trials (RCTs) on the effects of integrated behavioral interventions for adults with alcohol use disorder (AUD).
A comprehensive ...search of three databases was conducted in 2022, utilizing terms related to alcohol/substance use disorders and integrated interventions. The sample included adults aged ≥18 years at low, moderate, or high risk for AUD, and had at least two other mental health conditions. Only RCTs were included and screened using Covidence. The quality of the study was evaluated using Cochrane risk of bias tool.
Across all 11 studies, the total AUD participants were 1543 aged 18 or older. Integrated intervention led to significant reductions in heavy drinking compared to usual care or other interventions. Measures included percent days of alcohol use, grams of alcohol consumed, and increased days of abstinence. Three studies compared integrated treatments with Twelve-Step Facilitation, indicating a better abstinence rate among participants in the integrated group at the end of treatment. Comparisons between delivery modes demonstrated more significant reductions in alcohol consumption with interventionists. Integrated interventions were also compared with various other treatments, including brief intervention, telephone and individual counseling, and psychological education. Participants in the integrated group showed greater improvement in alcohol consumption and depression compared to those in the standalone intervention group.
Integrated behavioral interventions effectively reduce alcohol consumption, decrease heavy drinking and promote alcohol abstinence. However, there is limited evidence to determine whether these interventions are more effective than usual care for individuals with AUD.
•Studies revealed that integrated intervention led to significant reductions in heavy drinking compared to usual care or other interventions.•Limited evidence exists to confirm the effectiveness of integrated interventions over usual care for individuals with AUD.•Compared to usual care, Twelve-Step Facilitation, and other interventions, integrated interventions effectively reduce alcohol use.
Chemerin connects fat to arterial contraction Watts, Stephanie W; Dorrance, Anne M; Penfold, Mark E ...
Arteriosclerosis, thrombosis, and vascular biology,
06/2013, Letnik:
33, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Obesity and hypertension are comorbid in epidemic proportion, yet their biological connection is largely a mystery. The peptide chemerin is a candidate for connecting fat deposits around the blood ...vessel (perivascular adipose tissue) to arterial contraction. We presently tested the hypothesis that chemerin is expressed in perivascular adipose tissue and is vasoactive, supporting the existence of a chemerin axis in the vasculature.
Real-time polymerase chain reaction, immunohistochemistry, and Western analyses supported the synthesis and expression of chemerin in perivascular adipose tissue, whereas the primary chemerin receptor ChemR23 was expressed both in the tunica media and endothelial layer. The ChemR23 agonist chemerin-9 caused receptor, concentration-dependent contraction in the isolated rat thoracic aorta, superior mesenteric artery, and mesenteric resistance artery, and contraction was significantly amplified (more than 100%) when nitric oxide synthase was inhibited and the endothelial cell mechanically removed or tone was placed on the arteries. The novel ChemR23 antagonist CCX832 inhibited phenylephrine-induced and prostaglandin F2α-induced contraction (+perivascular adipose tissue), suggesting that endogenous chemerin contributes to contraction. Arteries from animals with dysfunctional endothelium (obese or hypertensive) demonstrated a pronounced contraction to chemerin-9. Finally, mesenteric arteries from obese humans demonstrate amplified contraction to chemerin-9.
These data support a new role for chemerin as an endogenous vasoconstrictor that operates through a receptor typically attributed to function only in immune cells.
Critical thinking is an essential nursing competency. Faculty can teach students how to think critically by emphasizing the connections between their philosophy and nursing curricula to ensure that ...students recognize the cognitive processes they use to make complex decisions.
The purpose of this article is to examine the definitions, history, and utility of philosophical perspectives that inform critical thinking. We explain several approaches: Socratic inquiry, syllogism, schematic cases, and symbolism.
We conducted a narrative review about educational approaches and their associated philosophies.
Philosophical awareness can enhance students' abilities to examine data, communicate ideas, evaluate diverse opinions, understand theories, and apply innovative solutions to problems they will encounter in clinical practice.
Clinical issue dialogues, dramatizations (that link philosophical and practical themes), self-reflection exercises, and case studies (that are less content-laden and more focused on nurses' theories and decision-making processes) represent important and innovative critical thinking skill-building exercises.
Lower urinary tract symptoms (LUTS) are associated with frailty phenotype, a risk factor for functional decline. Our objective was to determine the association between baseline LUTS and 2-year risk ...of new functional limitation among older men.
We analyzed data from the Osteoporotic Fractures in Men (MrOS) study with baseline at Year 7 and follow-up through Year 9. Participants included 2716 community-dwelling men age ≥ 71 years without any baseline self-reported functional limitation. LUTS severity (American Urologic Association Symptom Index) was classified as none/mild (score 0-7), moderate (8-19), and severe (20-35). At baseline and follow-up, men reported their ability to complete several mobility, activities of daily living (ADLs), and cognition-dependent tasks. Risk was estimated for 3 incident functional limitation outcomes: (1) mobility (any difficulty walking 2-3 blocks or climbing 10 steps), (2) ADL (any difficulty bathing, showering, or transferring), and (3) cognition-dependent (any difficulty managing money or medications). We used Poisson regression with a robust variance estimator to model adjusted risk ratios (ARR) and 95% CIs controlling for age, site, and comorbidities; other demographic/lifestyle factors did not meet criteria for inclusion.
Overall, the 2-year risk was 15% for mobility, 10% for ADLs, and 4% for cognition-dependent task limitations. Compared to none/mild LUTS, risk of incident mobility limitations was increased for moderate (ARR = 1.35, 95% CI: 1.12, 1.63) and severe LUTS (ARR = 1.98, 95% CI: 1.48, 2.64). Men were also at higher risk for incident ADL limitations if they reported moderate (ARR = 1.32, 95% CI: 1.05, 1.67) and severe LUTS (ARR = 1.62, 95% CI: 1.07,2.43). Results were somewhat attenuated after adjusting for the frailty phenotype but remained statistically significant. LUTS were not associated with incident cognition-dependent task limitations.
LUTS severity is associated with incident mobility and ADL limitations among older men. Increased clinical attention to risk of functional limitations among older men with LUTS is likely warranted.
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