Anticipatory grief prevalence among caregivers of persons with a life-threatening illness: A meta-analysis

OBJECTIVES

Caring for a family member with a life-threatening illness may lead to increased levels of psychological morbidity. Given the lack of recognition of caregivers' grief, this study aimed to determine the prevalence of anticipatory grief disorders in caregivers of persons with a life-threatening illness for better intervention and management.

METHODS

CINAHL, Cochrane, Embase, Medline, PubMed, Scopus, PsycINFO and Web of Science were searched up to 21 March 2021 without language and time restrictions. The quality of the included studies was assessed with Hoy's criteria. A random-effects model was applied to calculate pooled prevalence rates, and multi-regression was performed to examine heterogeneity among studies.

RESULTS

A total of 3278 citations were retrieved, and 18 studies met the eligibility criteria involving 5470 caregivers. The pooled prevalence of anticipatory grief was 24.78% (95% CI 19.04% to 30.99%). The prevalence rates were significantly higher in female caregivers (16.64%; 95% CI 12.24% to 21.53%) compared with male caregivers (6.11%; 95% CI 4.55% to 7.87%). The married group also had a higher risk (14.66%; 95% CI 10.66% to 19.16%) than single group (5.47%; 95% CI 4.31% to 6.76%).

CONCLUSIONS

The overall pooled prevalence is substantially higher compared with after-loss grief in the general population and supported the presumptions that preloss grief has a greater magnitude compared with after-loss grief. Bereavement support, educational programmes and relevant resources should be delivered even before the actual loss to address the burden of caregivers.

Global prevalence of low resilience among the general population and health professionals during the COVID-19 pandemic: A meta-analysis

Objective

To estimate the global prevalence of low resilience among the general population and health professionals during the COVID-19 pandemic.

Methods

Embase, Ovid-MEDLINE, PubMed, Scopus, Web of Science, CINAHL, WHO COVID-19 databases, and grey literature were searched for studies from January 1, 2020, to August 22, 2022. Hoy's assessment tool was used to assess for risk of bias. Meta-analysis and moderator analysis was performed using the Generalized Linear Mixed Model with a corresponding 95 % confidence interval (95 % CI) adopting the random-effect model in R software. Between-study heterogeneity was measured using I² and τ² statistics.

Results

Overall, 44 studies involving 51,119 participants were identified. The pooled prevalence of low resilience was 27.0 % (95 % CI: 21.0 %–33.0 %) with prevalence among the general population being 35.0 % (95 % CI: 28.0 %–42.0 %) followed by 23.0 % (95 % CI: 16.0 %–30.9 %) for health professionals. The 3-month trend analysis of the prevalence of low resilience beginning January 2020 to June 2021 revealed upward then downward patterns among overall populations. The prevalence of low resilience was higher in females, studied during the delta variant dominant period, frontline health professionals, and undergraduate degree education.

Limitations

Study outcomes showed high heterogeneity; however, sub-group and meta-regression analyses were conducted to identify potential moderating factors.

Conclusions

Globally, 1 out of 4 people among the general population and health professionals experienced low resilience due to COVID-19 adversity. The prevalence of low resilience was twice as much among the general population compared to health professionals. These findings provide information for policymakers and clinicians in the development and implementation of resilience-enhancing programs.

Efficacy of multi-domain cognitive function training on cognitive function, working memory, attention, and coordination in older adults with mild cognitive impairment and mild dementia: A one-year prospective randomised controlled trial

Background

Cognitive function, working memory, attention, and coordination are higher-level functions sharing a complex relationship. Limited evidence exists on the effectiveness of multi-domain cognitive function interventions to improve cognitive outcomes. We evaluated the effectiveness of such interventions on cognitive function, working memory, attention, and coordination in older adults with mild cognitive impairment and mild dementia.

Methods

We conducted a double-blind, two-arm, parallel-group randomised controlled trial in community care centres of Northern Taiwan. We recruited 72 participants aged≥65 years and randomly allocated them using 1:1 block randomization (block size = 4) into experimental (multi-domain cognitive function training) (MCFT) and control groups (passive information activities) (PIA) (n = 36/group). We administered the interventions in both groups for 30 minutes per session, three sessions per week for eight weeks, for a total of 24 sessions. The outcome indicators were cognitive function assessed (mini-mental status examination), working memory (digit span), selective attention (Stroop test), visual-spatial attention (trail making test-A (TMT-A)), divided attention (trail making test-B (TMT-B)), and coordination (Berry visual-motor integration (Berry-VMI)). We evaluated the study outcomes at baseline, immediate post-test, one-month follow-up, and one-year follow-up.

Results

We found no significant differences between the groups at baseline except for education. The average age of participants was 82.3 years, and most (76.4%) were female. We analysed the results by generalised estimating equations (GEE) based on the intention-to-treat (ITT) principle. The multi-domain cognitive function training was effective in improving cognitive function (β = 1.7; 95% confidence interval (CI) = 0.63-2.31; P = 0.001), working memory (β = -1.45; 95% CI = -2.62, -0.27; P = 0.016), and selective attention (β = -23.3; 95% = CI -43.9, -2.76; P = 0.026) compared to passive information activities at 1-month follow-up. The effects of multi-domain cognitive function training on cognitive function (β = 1.51; 95% CI = 0.40-2.63; P = 0.008), working memory (β = -1.93; 95% CI -3.33, -0.54; P = 0.007), selective attention (β = -27.8; 95% CI = -47.1, -8.48; P = 0.005), and coordination (β = 1.61; 95% CI = 0.25, 2.96; P = 0.020) were maintained for one year. There were no significant improvements in attention outcomes (visual-spatial and divided attention) after training.

Conclusions

MCFT intervention demonstrated favourable effects in improving global cognitive function, working memory, selective attention, and coordination among older adults with mild cognitive impairment and mild dementia. Thus, applying multi-domain cognitive training in older adults with mild cognitive impairment and mild dementia could help to delay the cognitive decline.

Registration

Chinese Clinical Trial Registry (ChiCTR2000039306).

Comparative Effectiveness of Combined and Single Neurostimulation and Traditional Dysphagia Therapies for Post-Stroke Dysphagia: A Network Meta-Analysis

BACKGROUND

Comparative therapeutic benefits of combined and single neurostimulation therapies including neuromuscular electrical stimulation (NMES), pharyngeal electrical stimulation (PES), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and traditional dysphagia therapy (TDT) remain unknown in post-stroke dysphagia (PSD) rehabilitation. Therefore, we performed the first network meta-analysis (NMA) to determine comparative effectiveness of combined and single neurostimulation and traditional dysphagia therapies for PSD.

METHODS

A frequentist NMA model was performed with therapy effect sizes presented as standardized mean differences (SMD) and corresponding 95% confidence interval (95% CI) for therapy comparisons while netrank function ranked the therapies in R-Software. Meta-regression models for study characteristics were analyzed using Bayesian NMA Model.

RESULTS

Overall, 50 randomized controlled studies with 2250 participants were included. NMES + TDT 3.82 (95% CI, 1.62-6.01), tDCS + TDT 3.34 (95% CI, 1.09-5.59), rTMS + TDT 3.32 (95% CI, 1.18-5.47), NMES 2.69 (95% CI, 0.44-4.93), and TDT 2.27 (95% CI, 0.12-4.41) demonstrated very large effect in improving swallowing function. NMES + TDT -0.50 (95% CI, -0.68 to -0.32, rTMS + TDT -0.44 (95% CI, -0.67 to -0.21), TDT -0.28 (95% CI, -0.46 to -0.10), and NMES -0.19 (95% CI, -0.34 to -0.04) demonstrated medium to small effect in reducing pharyngeal transit time (PTT). rTMS -0.51 (95% CI, -0.93 to -0.08) demonstrated medium effect in reducing oral transit time (OTT). No significant therapy comparison differences were found for reducing aspiration/penetration. The highest ranked therapy was NMES + TDT for better swallowing function and reduction of PTT, rTMS for reduction of OTT, and tDCS + TDT for reduction of aspiration/penetration. Therapeutic effects of the therapies were moderated by frequency, sessions, and duration.

CONCLUSION

Combined therapies including NMES + TDT, tDCS + TDT, and rTMS + TDT demonstrate better therapeutic effect for improved swallowing function and reduction of PTT, OTT, and aspiration/penetration for PSD.

Relationships between stroke prevalence, health literacy, and oral health-related quality of life in middle-aged and older adults: a national survey study

BACKGROUND

Stroke may cause debilitating neurological deficiencies that result in motor, sensory, and cognitive deficits and poorer psychosocial functioning. Prior studies have provided some initial evidence for the significant roles of health literacy and poor oral health for old people. However, few studies have focused on the health literacy of individuals who had a stroke; therefore, the relationships between the health literacy and oral health-related quality of life (OHRQoL) among middle-aged and older adults who had a stroke are unknown. We aimed to assess the relationships between stroke prevalence, health literacy status, and OHRQoL in middle-aged and older adults.

METHODS

We retrieved the data from The Taiwan Longitudinal Study on Aging, a population-based survey. For each eligible subject, we gathered data in 2015 on age, sex, level of education, marital status, health literacy, the activity daily living (ADL), stroke history and OHRQoL. We evaluated the respondents' health literacy by using a nine-item health literacy scale and categorized their health literacy level as low, medium, or high. OHRQoL was identified based on the Taiwan version of the Oral Health Impact Profile (OHIP-7T).

RESULTS

The final study contained 7702 community-based dwelling elderly people (3630 male and 4072 female) were analysis in our study. Stroke history was reported in 4.3% of participants, 25.3% reported low health literacy, and 41.9% had at least one ADL disability. Furthermore, 11.3% of participants had depression, 8.3% had cognitive impairment, and 3.4% had poor OHRQoL. Age, health literacy, ADL disability, stroke history, and depression status were significantly associated with poor OHRQoL after sex and marital status was adjusted. Medium (odds ratio [OR] = 1.784, 95% confidence interval [CI] = 1.177, 2.702) to low health literacy (OR = 2.496, 95% CI = 1.628, 3.828) was significantly associated with poor OHRQoL.

CONCLUSIONS

Base our study results, people with stroke history had poor OHRQoL. Lower health literacy and ADL disability were associated with worse QHRQoL. Further studies are necessary to define practical strategies for reducing the risk of stroke and oral health with constantly lower health literacy, thereby improving the quality of life and providing health care of older people.

Effectiveness of respiratory rehabilitation in patients with COVID-19: A meta-analysis

AIM

Examine effectiveness of respiratory rehabilitation and moderating factors on lung function and exercise capacity in post-COVID-19 patients.

DESIGN

Meta-analysis.

METHODS

R software 4.0.2 assessed the effectiveness of respiratory rehabilitation adopting the random-effects model and presenting standardised mean differences (SMDs). Heterogeneity was determined by Cochran's Q and I² . The Cochrane Risk of Bias 2.0 and MINORS evaluated quality of the included studies.

DATA SOURCES

A comprehensive search was undertaken in Cochrane, Embase, Ovid-MEDLINE, Scopus, NCBI SARS-CoV-2 Resources, ProQuest, Web of Science and CINAHL until March 2022.

RESULTS

Of the 5703 identified studies, 12 articles with 596 post-COVID-19 patients were included. Eleven of our twelve studies had moderate to high quality and one study had high risk of bias assessed with MINORS and RoB 2 tool. Overall, respiratory rehabilitation was effective in improving forced expiratory volume in 1 s (1.14; 95%CI 0.39-1.18), forced vital capacity (0.98; 95%CI 0.39-1.56), total lung capacity (0.83; 95%CI 0.22-1.44), 6-minute walk distance (1.56; 95%CI 1.10-2.02) and quality of life (0.99; 95%CI 0.38-1.60). However, no significant differences were observed for ratio of the forced expiratory volume in 1 s to the forced vital capacity of the lungs, anxiety and depression. Respiratory rehabilitation for post-COVID-19 patients was effective in those without comorbidities, performed four types of exercise programs, frequency ≥3 times/week and rehabilitation time 6 weeks.

CONCLUSIONS

Respiratory rehabilitation improved lung function, exercise capacity and quality of life in post-COVID-19 patients. The findings suggest rehabilitation programs for post-COVID-19 patients should use multiple respiratory exercise programs with frequency of ≥3 times per week for longer than 6 weeks.

IMPACT

These findings will help improve the implementation of respiratory rehabilitation programs for post-COVID-19 patients.

IMPLICATIONS FOR THE PROFESSION

Our findings can be used to develop patient-centred respiratory rehabilitation interventions by nurses and clinicians for post-COVID-19 patients.

REPORTING METHOD

PRISMA guideline was followed.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Prevalence of grief symptoms and disorders in the time of COVID-19 pandemic: A meta-analysis

Millions of people worldwide are mourning the loss of loved ones due to the COVID-19 epidemic, which may adversely impact their mental health. This meta-analysis aimed to investigate pandemic grief symptoms and disorders for developing policy, practice, and research priorities. The databases of Cochrane, Embase, Ovid-MEDLINE, WHO COVID-19, NCBI SARS-CoV-2, Scopus, Web of Science, CINAHL, and Science Direct were comprehensively searched until July 31, 2022. The Joanna Briggs Institute's and Hoy's criteria were used to evaluate the studies. A pooled prevalence was presented in a forest plot figure with a corresponding 95% confidence interval (CI) and prediction interval. Between-study heterogeneity was measured using the I² and Q statistics. Variations in the prevalence estimates in different subgroups were examined by moderator meta-analysis. The search identified 3677 citations, of which 15 studies involving 9289 participants were included in the meta-analysis. The pooled prevalence rate of grief symptoms was 45.1% (95%CI: 32.6%-57.5%), and grief disorder was 46.4% (95%CI: 37.4%-55.5%). Grief symptoms were significantly higher in <6 months (45.8%; 95%CI: 26.3%-65.3%) compared to the period of more than 6 months. Unfortunately, moderator analyses for grief disorders could not be performed due to limited studies. The prevalence of grief problems during the pandemic was substantially higher than in non-pandemic conditions; therefore, it is crucial to strengthen bereavement support to reduce psychological distress. The results provide a foundation for nurses and healthcare workers to anticipate a heightened need for support and provision of bereavement care in the post-pandemic era.

Prevalence of sleep-related breathing disorders and associated risk factors among people with dementia: A meta-analysis

OBJECTIVE

Sleep-related breathing disorders (SRBD) have shown to cause worsened cognitive impairment among people with dementia. Therefore, we conducted the first meta-analysis to estimate the prevalence of SRBD among people with dementia.

METHODS

Comprehensive searches were conducted in Embase, Ovid-MEDLINE, PubMed, PsycINFO, Scopus, Web of Science, and CINAHL. The generalized linear mixed model (GLMM) was used for the pooled prevalence analysis and heterogeneity using I² test and Cochran's Q-statistic in R-software. Study quality was assessed by Hoy's risk of bias assessment tool. Overall, 20 studies from 1282 studies were included with 1461 participants.

RESULTS

The pooled prevalence of SRBD among dementia was 59% (95%CI: 44%-73%) with 55% (95%CI: 34%-74%) for obstructive sleep apnea (OSA), 49% (95%CI: 25%-73%) for unspecified SRBD, and 11% (95%CI: 5%-21%) for central sleep apnea (CSA). Regarding dementia subtypes, the prevalence of SRBD was 89% (95%CI: 61%-97%) for Alzheimer's dementia, 56% (95%CI: 48%-63%) for Parkinson's and Idiopathic Parkinson's dementia, and 16% (95%CI: 8%-30%) for Huntington's dementia. Significant moderator variables were male, body mass index, larger waist and hip circumference, waist-hip ratio, and comorbidities including hypertension, dyslipidemia, renal disease, diabetes, heart disease, and stroke.

CONCLUSIONS

There is considerable high prevalence of SRBD among dementia people, with OSA and unspecified SRBD being fivefold higher than CSA. Regarding dementia subtypes, Parkinson's and Idiopathic Parkinson's, and Alzheimer's dementia had four to sixfold increased risk of presenting with SRBD than Huntington's dementia. Therefore, assessment and management of SRBD in Alzheimer's, and Parkinson's and Idiopathic Parkinson's dementia deserves more attention in future research.

Prevalence of oropharyngeal dysphagia and risk of mortality among hospitalized COVID-19 patients: A meta-analysis

Background

Post-extubation and neurologic complications in COVID-19 patients have been shown to cause oropharyngeal dysphagia (OD). We performed the first meta-analysis to explore and estimate the pooled prevalence of OD, risk of mortality, and associated factors among hospitalized COVID-19 patients.

Methods

We searched Scopus, PubMed, Embase, CINAHL, WHO COVID-19 database, and Web of Science for literature on dysphagia in COVID-19 patients. We used the generalized linear mixed model (GLMM) to determine the prevalence estimates of OD in the R software and the DerSimonian-Lard random-effects model in the Comprehensive Meta-Analysis software to explore the risk of mortality and associated factors of OD, presented as odds ratios (ORs) and corresponding 95% confidence intervals (CIs). We used Cochran's Q, τ², and the I² statistic to assess heterogeneity and conducted a moderator analysis to identify moderator variables.

Results

We included eighteen studies with a total of 2055 participants from the 910 studies retrieved from electronic databases. The prevalence of OD among hospitalized COVID-19 patients was estimated at 35% (95% CI = 21-52; low certainty of evidence) associated with a high risk of mortality (OR = 6.41; 95% CI = 1.48-27.7; moderate certainty of evidence). Intubation (OR = 16.3; 95% CI = 7.10-37.3; high certainty of evidence), use of tracheostomies (OR = 8.09; 95% CI = 3.05-21.5; high certainty of evidence), and proning (OR = 4.97; 95% CI = 1.34-18.5; high certainty of evidence) among hospitalized COVID-19 patients were highly associated with developing OD. The prevalence of OD was higher among hospitalized COVID-19 patients who were admitted in intensive care units (ICU), intubated, and mechanically ventilated.

Conclusions

The prevalence of OD among hospitalized COVID-19 patients is estimated at 35% associated with a high risk of mortality. OD assessment among hospitalized COVID-19 patients who are managed in an ICU, prone position, intubated, and mechanical ventilated deserves more attention.

Registration

PROSPERO CRD42022337597.

Prevalence of sleep disorders among first responders for medical emergencies: A meta-analysis

Background

Shift work and irregular work schedules among first responders have been associated with physical and psychological problems such as sleep disorders. We conducted the first meta-analysis to explore and estimate the prevalence of sleep disorders among first responders for medical emergencies.

Methods

We searched four databases: Web of Science, Psych Info, CINAHL, and PubMed. The Generalized Linear Mixed model (GLMM) was used to estimate the prevalence estimates of sleep disorders in R software and the DerSimonian-Lard random-effects model in Comprehensive Meta-Analysis was used to explore associated comorbidities for OSA and insomnia, presented as odds ratios (ORs) and confidence intervals (CIs). The Cochran's Q, τ², and the statistics were used to assess heterogeneity and the moderator analysis was conducted to identify moderator variables.

Results

Twenty-eight studies with 100 080 first responders were included from the total of 1119 studies retrieved from the databases. The prevalence rates for sleep disorders were 31% (95% CI = 15%-53%) for shift work disorder (SWD), 30% (95% CI = 18%-46%) for obstructive sleep apnea (OSA), 28% (95% CI = 19%-39%) for insomnia, 28% (95% CI = 24%-33%) for excessive daytime sleepiness (EDS), 2% (95% CI = 1%-4%) for restless leg syndrome, and 1% (95% CI = 0%-5%) for narcolepsy. Anxiety (OR = 2.46; 95% CI = 1.99%-3.03%), cardiovascular disease (CVD) (OR = 2.03; 95% CI = 1.43-2.88), diabetes mellitus (DM) (OR = 1.93; 95% CI = 1.41-2.65), depression (OR = 1.89; 95% CI = 1.01-3.56), gastroesophageal reflux disease (GERD) (OR = 1.83; 95% CI = 150-2.22), and post-traumatic stress disorder (PTSD) (OR = 1.78; 95% CI = 1.33-2.39) were associated with OSA. Depression (OR = 9.74; 95% CI = 4.67-20.3), anxiety (OR = 9.22; 95% CI = 3.81-22.3), and PTSD (OR = 7.13; 95% CI = 6.27-8.10) were associated with insomnia. Age, gender, first responders, continent, study quality, study design, and assessment tool were significant moderator variables for OSA, insomnia, and EDS.

Conclusions

This meta-analysis found a substantially high prevalence of sleep disorders including SWD, OSA, insomnia, and EDS among first responders for medical emergencies. Early assessment and management of sleep disorders among first responders is necessary to promote good, quality sleep to help prevent anxiety, depression, CVD, DM, GERD, and PTSD.

[Hospital Safety Climate and Nursing Staff Mental Health: The Example of Workplace Violence]

Workplace violence is recognized as a serious psychosocial work hazard in the workplace. Nurses face higher risks of workplace violence and poor mental health than other medical professionals. In addition to addressing personal factors, workplace violence should be understood and managed in the context of the organizational climate. In this article, the definition and types of workplace violence and a socio-ecological perspective on workplace violence are introduced. In addition, the prevalence and impact on mental health of workplace violence are described. Lastly, the concept of safety climate and its influence on mental health are proposed. We hope this article provides readers with a better understanding of workplace violence and a contextual perspective on this issue. In addition to understanding workplace violence and learning coping strategies and skills, hospital managers should promote a positive climate of safety to reduce the occurrence of workplace violence and the impact of workplace violence on nurses.

Direction and magnitude of social jetlag are associated with obesity: Results from a sample of hospital employees

Social jetlag, the discrepancy between social and biological timing, has been suggested to disturb metabolic functions. However, the relationship between social jetlag and obesity has been inconsistent in other studies. In this study we examined the association between social jetlag and obesity among day and shift workers. We invited 2508 day workers and 1383 shift workers from a hospital worker health cohort to participate in a 2018-2019 survey on their sleep behaviors. Shift-specific social jetlag was quantified using the Munich ChronoType Questionnaire, and body mass index was measured during annual physical examinations. The distributions of shift-specific social jetlag were illustrated, and logistic regression analysis was used to examine the association between social jetlag and obesity. We found that high level of social jetlag (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.08-1.47) and positive social jetlag (OR = 2.25, 95% CI = 1.30-3.90) during evening shifts were associated with obesity after adjustment for age, sex, health behaviors, and sleep quality. During night shift periods, sleep time varied greatly on free days, but the participants slept at similar times, namely 16:00, on workdays. In conclusion, phase advance on workdays and high levels of social jetlag were associated with obesity. Sleep timing should therefore be recommended according to the relative phase of individuals' preferred sleep time and work time.

Sex-Influenced Risk Factors for Cognitive Impairment Among Community-Dwelling Older Adults

The current study aimed to explore sex-influenced risk factors for cognitive impairment among community-dwelling older adults in Taiwan. This cross-sectional study was a secondary analysis using a population-based design. We accessed and analyzed data from the Taiwan Longitudinal Study on Aging survey of 2011. Participants were older adults aged ≥55 years living in non-indigenous townships. A total of 3,392 community-dwelling older adults were included. Results showed that the prevalence of cognitive impairment in females and males was 15.3% and 5.7%, respectively. Having a low educational level and being single (i.e., single, widowed, or divorced) were risk factors for cognitive impairment in both sexes. Males who had more than two chronic diseases had a higher risk of cognitive impairment. Self-reported hearing loss and depression increased risk of cognitive impairment in older females. Older age, lower educational level, and single marital status were associated with cognitive impairment among community-dwelling older adults in Taiwan. The effects of self-reported hearing loss, depression, and chronic disease on cognitive impairment were influenced by sex. [Journal of Gerontological Nursing, 48(6), 19-25.].

Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis

Background

Post-stroke dysphagia (PSD) has been associated with high risk of aspiration pneumonia and mortality. However, limited evidence on pooled prevalence of post-stroke dysphagia and influence of individual, disease and methodological factors reveals knowledge gap. Therefore, to extend previous evidence from systematic reviews, we performed the first meta-analysis to examine the pooled prevalence, risk of pneumonia and mortality and influence of prognostic factors for PSD in acute stroke.

Methods

Our search was conducted in CINAHL, Cochrane Library, EMBASE, Ovid-Medline, PubMed, and Web of Science an initial search in October 2020 and a follow-up search in May 2021. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and the DerSimonian-Lard random-effects model for prognostic factors and outcomes of PSD.

Results

The pooled prevalence of PSD was 42% in 42 studies with 26,366 participants. PSD was associated with higher pooled odds ratio (OR) for risk of pneumonia 4.08 (95% CI, 2.13–7.79) and mortality 4.07 (95% CI, 2.17–7.63). Haemorrhagic stroke 1.52 (95% CI, 1.13–2.07), previous stroke 1.40 (95% CI, 1.18–1.67), severe stroke 1.38 (95% CI, 1.17–1.61), females 1.25 (95% CI, 1.09–1.43), and diabetes mellitus 1.24 (95% CI, 1.02–1.51) were associated with higher risk of PSD. Males 0.82 (95% CI, 0.70–0.95) and ischaemic stroke 0.54 (95% CI, 0.46–0.65) were associated with lower risk of PSD. Haemorrhagic stroke, use of instrumental assessment method, and high quality studies demonstrated to have higher prevalence of PSD in the moderator analysis.

Conclusions

Assessment of PSD in acute stroke with standardized valid and reliable instruments should take into account stroke type, previous stroke, severe stroke, diabetes mellitus and gender to aid in prevention and management of pneumonia and thereby, reduce the mortality rate.

Trial registration

https://osf.io/58bjk/?view_only=26c7c8df8b55418d9a414f6d6df68bdb.

Supplementary information

The online version contains supplementary material available at 10.1186/s12877-022-02960-5.

Effectiveness of prone position in acute respiratory distress syndrome and moderating factors of obesity class and treatment durations for COVID-19 patients: A Meta-Analysis

Objectives

To examine the effectiveness of prone positioning on COVID-19 patients with acute respiratory distress syndrome with moderating factors in both traditional prone positioning (invasive mechanical ventilation) and awake self-prone positioning patients (non-invasive ventilation).

Research methodology

A comprehensive search was conducted in CINAHL, Cochrane library, Embase, Medline-OVID, NCBI SARS-CoV-2 Resources, ProQuest, Scopus, and Web of Science without language restrictions. All studies with prospective and experimental designs evaluating the effect of prone position patients with COVID-19 related to acute respiratory distress syndrome were included. Pooled standardised mean differences were calculated after prone position for primary (PaO₂/FiO₂) and secondary outcomes (SpO₂ and PaO₂)

Results

A total of 15 articles were eligible and included in the final analysis. Prone position had a statistically significant effect in improving PaO₂/FiO₂ with standardised mean difference of 1.10 (95%CI 0.60–1.59), SpO₂ with standardised mean difference of 3.39 (95% CI 1.30–5.48), and PaO₂ with standardised mean difference of 0.77 (95% CI 0.19–1.35). Patients with higher body mass index and longer duration/day are associated with larger standardised mean difference effect sizes for prone positioning.

Conclusions

Our findings demonstrate that prone position significantly improved oxygen saturation in COVID-19 patients with acute respiratory distress syndrome in both traditional prone positioning and awake self-prone positioning patients. Prone position should be recommended for patients with higher body mass index and longer durations to obtain the maximum effect.

Global prevalence and associated risk factors of posttraumatic stress disorder during COVID-19 pandemic: A meta-analysis

BACKGROUND

The COVID-19 pandemic has negatively impacted the psychological well-being of individuals and society. Previous studies conducted on coronavirus outbreaks including Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome pandemic found that posttraumatic stress disorder (PTSD), depression, and anxiety were the most common mental health problems and long-term consequences of these outbreaks. Currently, comprehensive and integrated information on the global prevalence of PTSD due to the COVID-19 pandemic is lacking.

OBJECTIVE

In the present meta-analysis, we examined the global prevalence and associated risk factors of PTSD in patients/survivors of COVID-19, health professionals, and the population at large.

DESIGN

Meta-analysis.

DATA SOURCE

Cochrane, CINAHL, Embase, MEDLINE, PubMed, Scopus, Web of Science, and manual search up to June 2021.

METHODS

We included studies evaluating the prevalence of PTSD during the COVID-19 pandemic in either patients/survivors, health professionals, and the population at large. The data were analyzed using logit transformation with the random-effects model. Risk of bias assessment was conducted using Hoy and colleagues.

RESULTS

A total of 63 studies (n = 124,952) from 24 different countries were involved. The overall pooled estimate of PTSD prevalence was 17.52% (95% CI 13.89 to 21.86), with no evidence of publication bias (t=-0.22, p-value=0.83). This study found a high prevalence of PTSD among patients with COVID-19 (15.45%; 95% CI 10.59 to 21.99), health professionals (17.23%; 95% CI 11.78 to 24.50), and the population at large (17.34%; 95% CI 12.21 to 24.03). Subgroup analyses showed that those working in COVID-19 units (30.98%; 95% CI, 16.85 to 49.86), nurses (28.22%; 95% CI, 15.83 to 45.10), those living in European countries (25.05%; 95% CI 19.14 to 32.06), and studies that used Clinician-Administered PTSD Scale for DSM-5 (30.18%, 95% CI 25.78 to 34.98) demonstrated to have the highest PTSD prevalence compared to other subgroups. Meta-regression analyses revealed that the elderly (above age 65) had lower PTSD prevalence (-1.75, 95% CI -3.16 to -0.34) than the adult population.

CONCLUSION AND IMPLICATIONS

Substantial PTSD prevalence was found in patients with COVID-19, health professionals, and the population at large. Moderator analysis revealed that age, unit of work, health profession, continent, and assessment tools as significant moderators. Mental health services are needed for everyone, especially adults under the age of 65, those who work in COVID-19 units, nurses, and people in the European continent.

REGISTRATION

The study protocol was registered with the International database of prospective registered systematic reviews (PROSPERO): CRD42020218762. Tweetable abstract: The pooled PTSD prevalence during COVID-19 pandemic for patients with COVID-19, health professionals, and the population at large was 17.52%.

Effects of work conditions and organisational strategies on nurses' mental health during the COVID-19 pandemic

AIMS

This study aims to examine coronavirus disease 2019 (COVID-19) pandemic-related work factors for adverse effects on the mental health and whether organisational strategies attenuate these effects.

BACKGROUND

COVID-19 pandemic has led to increased work burden and mental health risks for nurses.

METHODS

A total of 1499 Taiwanese full-time nurses completed a web-based questionnaire between July and December 2020. Pandemic-related work conditions, namely, increased working hours, caring for COVID-19 patients, occupational stigma and redeployment, were assessed. Organisational strategies to combat pandemic-related work stressors including compensation to workers and adequate protection equipment were surveyed. Outcome measures were intention to leave, burnout and depression assessed using validated questionnaires.

RESULTS

Redeployment, increased working hours and occupational stigma were associated with adverse mental health and intention to leave in logistic regression analysis. Caring for COVID-19 patients was negatively associated with depression. Adequate compensation for workers modified the association between redeployment and burnout.

CONCLUSIONS

Pandemic-related work conditions were associated with adverse mental health and intention to leave. Organisational strategies attenuated the adverse impact of the pandemic.

IMPLICATIONS FOR NURSING MANAGEMENT

Efforts to decrease stigma and organisational strategies including compensation for workers and adequate protection equipment provision should be adopted to improve nurses' health during a pandemic.

Psychometric Testing of the Bahasa Version of the Brief Illness Perception Questionnaire among Indonesians with Type 2 Diabetes Mellitus

The Brief Illness Perception Questionnaire (B-IPQ) has been recommended to validate illness perception. Nevertheless, this measurement has yet to be validated with an assessment of the construct and convergent validities and reliability in Indonesia. Our study aimed to psychometrically test the 8-item B-IPQ among Indonesians with type 2 diabetes mellitus (T2DM). Data included 294 patients with T2DM with stratified multistage clustering. The 36-item Short Form Survey, 21-item Depression Anxiety Stress Scale, and fasting blood glucose (FBG) were used to examine convergence and divergence. The validity analysis included the construct and convergent validities with significant person correlations. Cronbach's alpha, composite reliability (CR), and average variance extracted (AVE) were used to assess reliability. Confirmatory and exploratory factor analyses indicated a multidimensional structure, including cognitive with a five-item structure and emotional illness representation with a three-item structure, with an acceptable goodness of model fit. The tool revealed good internal consistency for the cognitive, emotional, and overall domains and was positively moderately correlated with FBG, stress, anxiety, and depression but negatively correlated with the overall quality of life and mental and physical component scores. Findings provide empirical evidence that the Bahasa version of the B-IPQ showed adequate internal consistency, exploratory and confirmatory, and thus is valid and reliable for illness perception assessments among Indonesians with T2DM.

Evaluation of the performance of instruments to diagnose grief disorders: A diagnostic meta-analysis

BACKGROUND

Prolonged or complicated grief disorder occurs in 9.8% of bereaved adults and can progress into adverse health effects if left unresolved. Evidence on the appropriate and specific diagnostic instrument for the assessment of prolonged or complicated grief disorders is lacking.

OBJECTIVE

The purpose of this study was to evaluate the performance of the most widely used instruments to diagnose grief disorders, including The Inventory of Complicated Grief, The Inventory of Complicated Grief - Revised, and the Prolonged Grief Disorder-13.

DESIGN

Diagnostic meta-analysis.

DATA SOURCES

PubMed, EMBASE, CINAHL, Medline, Scopus, Web of Science, and Cochrane were searched up to July 1, 2020.

METHODS

We included studies evaluating the sensitivity and specificity of grief disorders diagnostic tools against the comparator tests in individuals who experienced the loss of a family member. A diagnostic meta-analysis of pooled sensitivity and specificity, likelihood ratios, and area under curve were performed with a random-effect and hierarchical model.

RESULTS

In the current study, 3540 participants were involved. The six studies of the Inventory of Complicated Grief had pooled sensitivity of 0.93 (95% confidence interval: 0.87 to 0.97) and specificity of 0.96 (95% confidence interval: 0.92 to 0.98). The positive likelihood ratio was 23.4 (95% confidence interval: 11.2 to 49.0) and the negative likelihood ratio was 0.07 (95% confidence interval: 0.04 to 0.14) with area under curve value at 0.96 (95% confidence interval: 0.97 to 0.99). For Prolonged Grief Disorder-13, the three included studies' pooled sensitivity was 0.51 (95% confidence interval: 0.42 to 0.60), and the pooled specificity was 0.96 (95% confidence interval: 0.93 to 0.98). The Inventory of Complicated Grief-Revised evaluation could not be performed as only two articles from the same study were identified in this meta-analysis.

CONCLUSIONS

The Inventory of Complicated Grief is a highly recommend instrument to differentiate the case of grief disorders. Nurses and health care professionals can use the Inventory of Complicated Grief in the diagnosis of prolonged or complicated grief disorders due to its high sensitivity and specificity values. Further evaluations are needed for the use of Prolonged Grief Disorder-13 and Inventory of Complicated Grief-Revised.

REGISTRATION

The study is registered with the Open Science Framework (https://osf.io/bs8n6/?view_only=109e76e59efb4d7699153f62564f57ed). Tweetable abstract: Inventory of Complicated Grief is a highly recommend instrument with high sensitivity and specificity for diagnosing grief disorders.

Air Pollutants Are Associated With Obstructive Sleep Apnea Severity in Non-Rapid Eye Movement Sleep

STUDY OBJECTIVES

The relationship between seasonal variation of obstructive sleep apnea and ambient temperature and pollutants has been inconsistent in previous studies. It is also unknown whether the seasonal variation in apnea-hypopnea index influences continuous positive airway pressure treatment dose. This study aims to examine the seasonality of obstructive sleep apnea and continuous positive airway pressure treatment, and the association between air pollutants and apnea-hypopnea index in adults with different sleep apnea severity during different sleep stages.

METHODS

Polysomnography of 5,413 patients referred to one sleep center during 2008-2015 were examined retrospectively. Ambient conditions and air pollutants levels were collected from the official air condition surveillance database. Cosinor analysis was used to examine seasonal variances. The general linear model was used to examine associations between air conditions and apnea-hypopnea index adjusted for seasonality. Models for apnea-hypopnea index in different sleep stages, sex groups, and obstructive sleep apnea severity groups were analyzed separately.

RESULTS

Seasonal variations for continuous positive airway pressure treatment were not significant. Particulate matter less than or equal to 10 μm, ozone, sulfur dioxide, and relative humidity were associated with apnea-hypopnea index only in patients with severe obstructive sleep apnea. The association was significant only in non-rapid eye movement sleep.

CONCLUSIONS

An adjustment for continuous positive airway treatment dose by season is not warranted. Protection for air pollutant-vulnerable groups should be provided. The exact mechanism of the associations between apnea-hypopnea index and air conditions only in non-rapid eye movement sleep must be clarified.

Psychosocial safety climate, workplace violence and self-rated health: A multi-level study among hospital nurses

AIMS

To validate the Chinese version Psychosocial Safety Climate scale (PSC-12), and examine the associations between PSC, workplace violence and self-rated health (SRH).

BACKGROUND

Psychosocial safety climate moderates the negative effect of workplace violence on health. To address workplace violence experienced by nurses across the Asia-Pacific region, it is important to develop and apply a Chinese language version of the tool.

METHODS

We conducted a two-part study. In the first part, the Chinese version PSC-12 was developed and tested for its validity in 405 nurses. In the second part, a total of 1690 nurses from 73 hospitals filled a questionnaire concerning their work and health conditions. Multi-level modelling was used to examine the association between PSC, workplace violence and SRH.

RESULTS

A comparable validity and reliability of the Chinese version PSC-12 with the original PSC was found. PSC scores were negatively associated with workplace violence. In the hierarchical linear model, participants from hospitals with the lowest PSC score had twofold risks of having poor SRH.

CONCLUSIONS

The Chinese version PSC-12 is a valid tool. Hospital-level PSC was associated with poor health status in female nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Psychosocial safety climate should be evaluated and promoted to prevent workplace violence in nurses.

A Comparison of International Drunk-Driving Policies and the Role of Drinking Patterns

INTRODUCTION

Effective drunk-driving policies are not adopted consistently in many countries. To understand how drinking behaviors influence national drunk-driving policymaking, the associations between drunk-driving policies and country-level drinking volumes and patterns were examined.

METHODS

Data for 194 countries were obtained from the WHO 2012 Global Information System on Alcohol and Health. Country-level drinking behaviors were measured using average drinking volumes and patterns of drinking scores based on six attributes of risky drinking. Drunk-driving policies were categorized into preemptive measures (random breath testing, breath alcohol concentration limits for driving a vehicle, and sobriety checkpoints), penalties (community service, short- or long-term detention, fines, suspension or revocation of license, and vehicle impoundment), mandatory treatment, and ignition interlock. Data analysis was conducted in 2017. The percentages of each policy adoption were examined in countries with different drinking behaviors. The internal consistencies of preemptive measures were calculated using Cronbach's α. A structural equation model was established to examine the associations between drinking behaviors and drunk-driving policy categories, after adjusting for national income levels and general alcohol policies.

RESULTS

Mandatory treatment and preemptive measures were less commonly adopted than penalties were. The adoption of preemptive measures had a low consistency level, and the consistency level decreased with drinking pattern riskiness. Risky drinking patterns were negatively associated with mandatory treatment policy.

CONCLUSIONS

Drinking patterns are associated with national drunk-driving policymaking. Accessible medical treatment and comprehensive preemptive measures should be advocated in countries with risky drinking patterns.

Associations of neighborhood-level workplace violence with workers' mental distress problems: a multilevel analysis of Taiwanese employees

OBJECTIVE

Workplace violence is known to pose mental health risks. However, whether or not workplace violence in a surrounding area might further increase the risk of mental distress in workers has rarely been examined.

METHODS

The study subjects were 9,393 male and 7,716 female employees who participated in a nationwide survey in 2010. Their personal experiences of workplace violence over the past 1 year were ascertained by a standardized questionnaire. Also assessed were their psychosocial work characteristics and mental distress problems. Neighborhood-level workplace violence was computed based on aggregated data at the county level and was categorized into low-, medium-, and high-level categories. Multilevel logistic regression models were constructed to examine the associations between neighborhood-level workplace violence and individual-level mental distress problems, with adjustment of individual-level experience of workplace violence.

FINDINGS

The neighborhood-level prevalence of workplace violence ranged from 4.7 to 14.7% in men and from 6.4 to 14.8% in women across 22 counties. As compared with those who live in counties of the lowest tertile of workplace violence, female workers who lived in counties of the highest tertile of workplace violence had a 1.72-fold increased risk for mental distress problems after controlling for individual experience of workplace violence and other psychosocial work characteristics.

CONCLUSION

Neighborhood-level workplace violence was associated with poor mental health in female workers. Preventative strategies targeting workplace violence should pay attention to neighborhood factors and gender-specific effects that might influence societal tolerance of abusive work practices and workers' vulnerability to mental health impacts of workplace violence.

Reliability and validity of a Chinese version of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF-C)

AIM AND OBJECTIVES

To examine the psychometric properties of the Chinese version of the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF-C) for use in Chinese-speaking countries.

BACKGROUND

The assessment of fatigue is a challenging task for most researchers because culture may influence perceptions of meaning of fatigue. The lack of examination of the psychometric properties of the fatigue measures across studies limits the scientific rigour for generating additional research on the concept of 'fatigue.'

DESIGN

A cross-sectional study.

METHODS

The study recruited 107 cancer inpatients from two medical centres in Taiwan. The MFSI-SF-C was examined using a two step process: (1) Translation and back-translation of the instrument; and (2) Examination of internal consistency reliability, test-retest reliability, content validity and construct validity.

RESULTS

The results showed that the Cronbach's α of MFSI-SF-C total scale and subscales ranged between 0·83-0·92. The content validity index was 0·93. The difference between the fatigue of cancer patients and the comparison group of healthy people in the community was significant. The results demonstrated good convergent validity when comparing fatigue with depression and quality of life. Factor analysis confirmed the four dimensions of fatigue: physical, emotional, mental and vigour. It showed moderate intercorrelation between subscales and high factor loadings also helped to clarify the psychometric meaning.

CONCLUSIONS

The reliability and validity information presented in this article support the use of the Chinese version of the MFSI-SF as a research instrument for measuring fatigue in Chinese populations. This study also provides evidence that the MFSI-SF possesses robust psychometric properties.

RELEVANCE TO CLINICAL PRACTICE

The MFSI-SF-C is an effective and comprehensive tool for measuring fatigue in Chinese patients with cancer.

Appropriate use of second-generation antihistamines

Antihistamines, one of the most frequently used groups of medications in the United States, are primarily used in treating allergic rhinitis and urticaria and also anaphylactic reactions, pruritus, and symptoms of anxiety. Second-generation antihistamines are safe and effective for treating allergic conditions. Control of nasal congestion may require additional medication. Further studies will determine if second-generation antihistamines can be used for other medical conditions.

Shared IgE-binding sites among separated components of natural rubber latex

BACKGROUND

IgE-mediated allergy to proteins present in natural rubber latex is a well-recognized problem. Latex contains a complex mixture of proteins ranging in molecular weight from 6 to > 200 kD.

OBJECTIVE

The aim of this study was to determine whether shared allergenic sites exist on separate latex components.

METHODS

Following electrophoresis, latex components at 14, 24, and 46 kD were electroeluted from SDS-polyacrylamide gels and used in ELISA inhibition and immunoblot inhibition studies of human latex-specific IgE antibodies.

RESULTS

A minimum of 4 major allergenic sites (for convenience labeled A through D) were found to exist in 3 components of nonammoniated latex. Minimally, 2 are present in the 14-kD component (A, B) and 3 in the 24-kD component (A-C). The 46-kD fraction has 3 or more antigenic sites (A, C, D) but lacks one (B) that is present in both the 14- and 24-kD components.

CONCLUSIONS

Four different IgE-binding moieties were detected among three latex protein components (14, 24 and 46 kD). Some of these allergenic sites were shared by two or more components. Recovery of these and others from fragmented latex components will allow identification of their amino acid composition and their availability will ultimately lead to better diagnostic and therapeutic options for patients with latex allergy.

Latex hypersensitivity in emergency medical service providers

BACKGROUND

Emergency medical service providers have a high degree of exposure to latex products. Patients utilizing emergency medical services can be allergic to latex products used during rescue efforts.

OBJECTIVE

To determine the prevalence of latex hypersensitivity among emergency medical service providers.

METHODS

Study questionnaires were distributed to a group of emergency medical service providers. Skin prick testing was performed using latex, common aeroallergens, and food extracts. Patch testing was done using latex and individual rubber additives. Serum latex-specific IgE was also measured.

RESULTS

A total of 93 completed surveys were collected. Average exposure to latex in the work environment was 8.2 years. Eighty-four (90%) used latex gloves routinely at work. Of those, thirteen (14%) gave history of reaction to latex gloves. Sixty-two percent were not aware of the possibility of latex allergy in themselves or their patients. Forty-one (44%) had skin testing. Of those, four (10%) had positive prick tests for at least one of the four latex preparations used. Five had positive skin tests to avocado extract without supporting clinical history. Two had positive skin tests to banana, one with supporting clinical history for banana allergy. No food cross-reactivity with latex was demonstrated. Latex-specific serum correlated with prick skin test results. No positive reactions were noted with patch testing.

CONCLUSIONS

A significant percentage of emergency medical service providers were not aware of the occupational risk of latex allergy or the potential risk in their patients. A positive prick skin test for latex was present in 4 of 41 (10%), representing one-third of those who reported symptoms from latex exposure.

A guinea pig model of hypersensitivity to allergenic fractions of natural rubber latex

Allergy to natural rubber latex is a growing medical problem with life-threatening aspects. The aim of this study was to learn if guinea pigs could serve as a suitable model for immediate-type hypersensitivity to latex. Guinea pigs were immunized either with whole non-ammoniated latex extract, or with one of nine SDS-PAGE-separated components. Other animals were injected with electroeluted latex components localized on gel at 14, 24 and a cluster around 45 kD. Before and after immunization, sera from the animals were examined by ELISA, immunoblots, passive cutaneous anaphylaxis (PCA) and passive systemic anaphylaxis. Latex-specific antibodies were detected by ELISA and immunoblots in sera from all immunized animals. PCA assays showed that the guinea pigs had homocytotropic antibodies dilutable to 1:250. PCA was abolished when sera from animals immunized with allergens in alum were heated at 56 degrees C for 30 min indicating the antibodies were of the E isotype. Passive systemic anaphylaxis was induced in 4 of 10 guinea pigs. The results show that guinea pigs are capable of making antibodies to latex protein components that mediate dermal and systemic anaphylaxis, paralleling the spectrum of clinical and laboratory findings of humans with immediate-type clinical latex hypersensitivity.

Antibody response to trimellityl hemoglobin in trimellitic anhydride-induced lung injury

Sprague-Dawley rats were exposed to trimellitic anhydride by inhalation, and the antibody response to trimellityl (TM)-conjugated hemoglobin (HB) and TM rat serum albumin (RSA) was compared. Groups of rats were exposed to trimellitic anhydride by inhalation 6 hours per day for 2, 6, or 10 days at 100 micrograms/m3 and compared to a control group exposed to filtered air. The IgG antibody response to TM-HB in both serum and bronchoalveolar lavage (BAL) fluid was measured with ELISA. IgG antibody levels to TM-HB rose significantly throughout the exposure. A positive correlation was found between IgG to TM-HB in serum and BAL fluid. In addition, this response in both serum and BAL fluid correlated with the IgG antibody response to TM-RSA. Cross-inhibition studies indicated the existence of shared antigenic determinants on TM-RSA and TM-HB. The IgG antibody to both antigens was specific for new antigenic determinants and not for the TM hapten.

Minimal complications in a surgical population with severe asthma receiving prophylactic corticosteroids

Sixty-eight patients with asthma followed by the Northwestern Allergy Service underwent a total of 92 surgical procedures from July 1973 to December 1986. In 41 of 92 procedures outpatient prednisone was administered, and in 92 procedures a pretreatment regimen of 100 mg hydrocortisone parenterally every 8 hours beginning the night before surgery was administered. Postoperatively, the overall incidence of pulmonary complications (either pulmonary infection or asthma) was 9.7%. Three patients developed pneumonia, demonstrated by an infiltrate on chest x-ray examination, and two patients developed wheezing requiring epinephrine, giving a complication rate of 5.4%. In addition, four patients developed mild wheezing postoperatively. Statistical analyses to compare the overall infection rate in this asthmatic population with that in two other surgical populations showed no statistical differences. There were no deaths and no patient developed any wound complication or adrenocortical insufficiency. These results indicate that patients with asthma in optimal respiratory condition who have received preoperative clinical evaluation and a hydrocortisone pretreatment regimen can undergo surgery with minimal complications.