Search results for: physical therapy intervention

Authors: Yasmin Sayed, Hala Hamdy, Hafez Bazaraa, Hanaa Rady, Sherif Elanwary

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Intravenous and inhaled magnesium sulfate (MgSO₄) had been recently used as an adjuvant therapy in cases suffering from the wheezy chest. Objective: We aimed to determine the possible change in the hemodynamic state in cases received intravenous or inhaled MgSO₄ in comparison to cases received standard treatment in critically ill infants and children with the wheezy chest. Methods: A randomized controlled trial comprised 81 patients suffering from wheezy chest divided into 3 groups. In addition to bronchodilators and systemic steroids, MgSO₄ was given by inhalation in group A, intravenously in group B, and group C didn't receive MgSO₄. The hemodynamic state was determined by assessment of blood pressure, heart rate, capillary refill time and the need for shock therapy or inotropic support just before and 24 hours after receiving treatment in 3 groups. Results: There was no significant difference in the hemodynamic state of the studied groups before and after treatment. Means of blood pressure were 102.2/63.2, 105.1/64.8 before and after inhaled MgSO₄; respectively. Means of blood pressure were 105.5/64.2, 104.1/64.9 before and after intravenous MgSO₄; respectively. Means of blood pressure were 107.4/62.8, 104.4/62.1 before and after standard treatment, respectively. There was a statistically insignificant reduction of the means of the heart rate in group A and group B after treatment rather than group C. There was no associated prolongation in capillary refill time and/or the need for inotropic support or shock therapy after treatment in the studied groups. Conclusion: MgSO₄ is a safe adjuvant therapy and not associated with significant alteration in the hemodynamic state in critically ill infants and children with the wheezy chest.

Keywords: critically ill infants and children, inhaled MgSO₄, intravenous MgSO₄, wheezy chest

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Authors: Andrew Anis Fakhrey Mosaad

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Introduction: Sports- and physical activity-related injuries may be more likely if there is a genetic predisposition, improper coaching and/or training, and no follow-up care from sports medicine. Goal: To evaluate the frequency of injuries among athletes receiving care at a sportsfocused physical therapy clinic. Methods: The survey of injuries in athletes' treatment records over a period of eight years of activity was done to obtain data. The data collected included: the patient's features, the sport, the type of injury, the injury's characteristics, and the body portion injured. Results: The athletes were drawn from 1090 patient/athlete records, had an average age of 25, participated in 44 different sports, and were 75% men on average. Joint injuries were the most frequent type of injury, then damage to the muscles and bones. The most prevalent type of injury was chronic (47%), while the knee, ankle, and shoulder were the most frequently damaged body parts. The most injured athletes were seen in soccer, futsal, and track and field, respectively, out of all the sports. Conclusion: The most popular sport among injured players was soccer, and the most common injury type was joint damage, with the knee being the most often damaged body area. The majority of the injuries were chronic.

Keywords: sports injuries, athletes, joint injuries, injured players

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Authors: Dongjoo Chin

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The purpose of this study was to investigate the effectiveness of an Early Intensive Behavioral Intervention (EIBI) program on infants with autism spectrum disorder (ASD) and to explore the factors predicting the effectiveness of the program, focusing on the infant's age, language ability, problem behaviors, and parental stress. 19 pairs of infants aged between 2 and 5 years who have had been diagnosed with ASD, and their parents participated in an EIBI program at a clinic providing evidence-based treatment based on applied behavior analysis. The measurement tools which were administered before and after the EIBI program and compared, included PEP-R, a curriculum evaluation, K-SIB-R, K-Vineland-II, K-CBCL, and PedsQL for the infants, and included PSI-SF and BDI-II for the parents. Statistical analysis was performed using a sample t-test and multiple regression analysis and the results were as follows. The EIBI program showed significant improvements in overall developmental age, curriculum assessment, and quality of life for infants. There was no difference in parenting stress or depression. Furthermore, measures for both children and parents at the start of the program predicted neither PEP-R nor the degree of improvement in curriculum evaluation measured six months later at the end of the program. Based on these results, the authors suggest future directions for developing an effective intensive early intervention (EIBI) program for infants with ASD in Korea, and discuss the implications and limitations of this study.

Keywords: applied behavior analysis, autism spectrum disorder, early intensive behavioral intervention, parental stress

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Authors: Fairuz Fadzilah Rahim

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Introduction: Indigenous adolescents are at higher risk of dog associated zoonotic infections (DAZI) as they live closely with free-roaming dogs and have limited access to veterinary care. This study aims to determine the effectiveness of health education interventions towards knowledge, attitudes, and preventive practices (KAP) of adolescents on DAZI. Methods: This one-group pre-and post-intervention study in 5 months period was conducted among Jahai adolescents aged 12 years and above. Jahai is one of the three major tribes of indigenous people in Peninsular Malaysia. Health education intervention programs using posters, slide presentations, comics, video clips, and discussion on DAZI were employed. Repeated measures of within-subjects analysis were used to identify the pre- and post- KAP of the adolescents. Results: There were 54 adolescents participated in this study with a mean age of 15.72 (SD: 2.49) and equal proportions of males (50%) and females (50%). Among the adolescents, 22.2% were married, 5.6% were illiterate, and 44.4% not continuing education at the time of data collection. The majority of them keep dogs as pets (64.8%), and few used dogs for hunting (11.1%). There was significant increase in mean scores of knowledge (F = 40.92, p < 0.001) and attitudes (F = 6.43, p = 0.014) of the adolescents. However, the preventive practices towards DAZI showed non-significant improvement on the intervention. Conclusions: The health education intervention programs showed to be effective in improving the attitudes and practices related to dog associated zoonotic infections. Emphasis on sustained health education programs is important to foster good health and wellbeing of the indigenous community.

Keywords: adolescent health, dog associated infection, zoonotic, KAP, indigenous

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Authors: T. Noichl, M. Cramer, G. E. Dlugosch, I. Hosenfeld

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Teachers are exposed to a variety of stresses in their work context. These can have a negative impact on physical and psychological well-being. The online training ‘Better Living! Self-care for teachers’ is based on the training ‘Better Living! Self-care for mental health professionals’, which has been proven to be effective over a period of 3 years. The training for teachers is being evaluated for its effectiveness between October 2021 and March 2023 in a study funded by the German Federal Ministry of Education and Research. The aim of the training is to promote self-care and mindfulness among participants and thereby to foster well-being. The concept of self-care was already mentioned in antiquity and was also named as an imperative by philosophers such as Socrates and Epictetus. In the absence of a universal understanding of self-care today, the following definition was developed within the research group: Self-care is 1) facing oneself in a loving and appreciative way, 2) taking one's own needs seriously, and 3) actively contributing to one's own well-being. The study is designed as a randomized wait-control group repeated-measures design with 4 (treatment group) resp. 6 (wait-control group) measurement points. Central dependent variables are self-care, mindfulness, stress, and well-being. To assess the long-term effectiveness of training participation, these constructs are surveyed at the beginning and the end of the training as well as five weeks and one year later. Based on the results of the evaluation with mental health professionals, it is expected that participation will lead to an increase in subjective well-being, self-care, and mindfulness. The first results of the evaluation study are presented and discussed with regard to the effectiveness of the training among teachers.

Keywords: longitudinal intervention study, mindfulness, self-care, teachers’ mental health, well-being

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Authors: Tabassum Yasmin, Hamid Pahlevan

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HIV/Hepatitis C co-infection treatments have evolved substantially and they have similar sustained virologic response rates as those of Hepatitis C monoinfected population. There are a few studies on therapy of patients with dual genotypes, especially in HIV/Hepatic C coinfected group. Most studies portrayed case reports of dual genotype chronic Hepatitis C coinfection treatment with Sofosbuvir/Ledipasvir and Ribavirin. A 79-year-old male with a history of HIV on Truvada and Isentress had chronic Hepatitis C with 1a and 2 genotypes. The patient has a history of alcohol intake for 40 years but recently stopped drinking alcohol. He has a history of intravenous drug use in the past and currently is not using any recreational drugs. Patient has Fibro score of 0.7 with Metavir score F2 to F4. AFP is 3.2. The HCV RNA is 493,034 IU/ML. The HBV viral DNA is < 1.30 (not detected). The CD4 is 687CU/MM. The FIB 4 is 3.34 with APRI index 0.717. The HIV viral load is 101 copies/ML. MRI abdomen did not show any liver abnormality. Fixed dose Sofosbuvir/Ledipasvir was used for therapy without Ribavirin. He tolerated medication except for some minor gastrointestinal side effects like abdominal bloating. He demonstrated 100% adherence rate. Patient completed 12 weeks of therapy. HCV RNA was undetectable at 4 and 12 weeks. He achieved SVR at week 12 and subsequently had undetectable RNA for 2 years. Dual genotype prevalence in chronic hepatitis C population is rare, especially in HIV/hepatic coinfection. Our case demonstrates that dual genotypic cases can still be successfully treated with Direct Acting Antiviral agents. The newer agents for therapy for pan genotypes were not available at the time the patient was being treated. We demonstrated that dual agent therapy was still able to maintain SVR in our patient.

Keywords: HIV/Hepatitis C, SVR (sustained virologic response), DAA (direct active antiviral agents, dual genotype

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Authors: Maciej Sobczak, Julita Pietrzak, Tomasz Płoszaj, Agnieszka Robaszkiewicz

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Brg1, a member of SWI/SNF complex, plays a role in chromatin remodeling, therefore, regulates expression of many genes. Brg1 is an ATPase of SWI/SNF complex, thus its activity requires ATP. Through its bromodomain recognizes acetylated histone residues and evicts them, thus promoting transcriptionally active state of chromatin. One of the enzymes that is responsible for acetylation of histone residues is Ep300. It was previously shown in the literature that cooperation of Brg1 and Ep300 occurs at the promoter regions that have binding sites for E2F-family transcription factors as well as CpG islands. According to literature, approximately 20% of human cancer possess mutation in Brg1 or any other crucial SWI/SNF subunit. That phenomenon makes Brg1-Ep300 a very promising target for anti-cancer therapy. Therefore in our study, we investigated if physical interaction between Brg1 and Ep300 exists and what impact those two proteins have on key for breast cancer cells processes such as DNA damage repair and cell proliferation. Bioinformatical analysis pointed out, that genes involved in cell proliferation and DNA damage repair are overexpressed in MCF7 and MDA-MB-231 cells. Moreover, promoter regions of these genes are highly acetylated, which suggests high transcriptional activity of those sites. Notably, many of those gene possess within their promoters an E2F, Brg1 motives, as well as CpG islands and acetylated histones. Our data show that Brg1 physically interacts with Ep300, and together they regulate expression of genes involved in DNA damage repair and cell proliferation. Upon inhibiting Brg1 or Ep300, expression of vital for cancer cell survival genes such as CDK2/4, BRCA1/2, PCNA, and XRCC1 is decreased in MDA-MB-231 and MCF7 cells. Moreover, inhibition or silencing of either Brg1 or Ep300 leads to cell cycle arrest in G1. After inhibition of BRG1 or Ep300 on tested gene promoters, the repressor complex including Rb, HDAC1, and EZH2 is formed, which inhibits gene expression. These results highlight potentially significant target for targeted anticancer therapy to be introduced as a supportive therapy.

Keywords: brg1, ep300, breast cancer, epigenetics

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Authors: Dana Zelicha

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A 6-week mindfulness programme was launched to improve the well being and performance of 20 managers (including the supervisor) of an international corporation in London. A unique assessment methodology was customised to the organisation’s needs, measuring four parameters: prioritising skills, listening skills, mindfulness levels and happiness levels. All parameters showed significant improvements (p < 0.01) post intervention, with a remarkable increase in listening skills and mindfulness levels. Although corporate mindfulness programmes have proven to be effective, the challenge remains the low engagement levels at home and the implementation of these tools beyond the scope of the intervention. This study has offered an innovative approach to enforce home engagement levels, which yielded promising results. The programme launched with a 2-day introduction intervention, which was followed by a 6-week training course (1 day a week; 2 hours each). Participants learned all basic principles of mindfulness such as mindfulness meditations, Mindfulness Based Stress Reduction (MBSR) techniques and Mindfulness Based Cognitive Therapy (MBCT) practices to incorporate into their professional and personal lives. The programme contained experiential mindfulness meditations and innovative mindfulness tools (OWBA-MT) created by OWBA - The Well Being Agency. Exercises included Mindful Meetings, Unitasking and Mindful Feedback. All sessions concluded with guided discussions and group reflections. One fundamental element of this programme was engagement level outside of the workshop. In the office, participants connected with a mindfulness buddy - a team member in the group with whom they could find support throughout the programme. At home, participants completed online daily mindfulness forms that varied according to weekly themes. These customised forms gave participants the opportunity to reflect on whether they made time for daily mindfulness practice, and to facilitate a sense of continuity and responsibility. At the end of the programme, the most engaged team member was crowned the ‘mindful maven’ and received a special gift. The four parameters were measured using online self-reported questionnaires, including the Listening Skills Inventory (LSI), Mindfulness Attention Awareness Scale (MAAS), Time Management Behaviour Scale (TMBS) and a modified version of the Oxford Happiness Questionnaire (OHQ). Pre-intervention questionnaires were collected at the start of the programme, and post-intervention data was collected 4-weeks following completion. Quantitative analysis using paired T-tests of means showed significant improvements, with a 23% increase in listening skills, a 22% improvement in mindfulness levels, a 12% increase in prioritising skills, and an 11% improvement in happiness levels. Participant testimonials exhibited high levels of satisfaction and the overall results indicate that the mindfulness programme substantially impacted the team. These results suggest that 6-week mindfulness programmes can improve employees’ capacities to listen and work well with others, to effectively manage time and to experience enhanced satisfaction both at work and in life. Limitations noteworthy to consider include the afterglow effect and lack of generalisability, as this study was conducted on a small and fairly homogenous sample.

Keywords: corporate mindfulness, listening skills, organisational well being, prioritising skills, mindful leadership

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Authors: E. H. Walsh, J. McMahon, M. P. Herring

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Post-primary school-based suicide prevention (PSSP) is a valuable avenue to reduce suicidal behaviours in adolescents. The aims of this meta-analysis and meta-regression were 1) to quantify the effect of PSSP interventions on adolescent suicide ideation (SI) and suicide attempts (SA), and 2) to explore how intervention effects may vary based on important contextual and intervention factors. This study provides further support to the benefits of PSSP by demonstrating lower suicide outcomes in over 30,000 adolescents following PSSP and mental health interventions and tentatively suggests that intervention effectiveness may potentially vary based on intervention factors. The protocol for this study is registered on PROSPERO (ID=CRD42020168883). Population, intervention, comparison, outcomes, and study design (PICOs) defined eligible studies as cluster randomised studies (n=12) containing PSSP and measuring suicide outcomes. Aggregate electronic database EBSCO host, Web of Science, and Cochrane Central Register of Controlled Trials databases were searched. Cochrane bias tools for cluster randomised studies demonstrated that half of the studies were rated as low risk of bias. The Egger’s Regression Test adapted for multi-level modelling indicated that publication bias was not an issue (all ps > .05). Crude and corresponding adjusted pooled log odds ratios (OR) were computed using the Metafor package in R, yielding 12 SA and 19 SI effects. Multi-level random-effects models accounting for dependencies of effects from the same study revealed that in crude models, compared to controls, interventions were significantly associated with 13% (OR=0.87, 95% confidence interval (CI), [0.78,0.96], Q18 =15.41, p=0.63) and 34% (OR=0.66, 95%CI [0.47,0.91], Q10=16.31, p=0.13) lower odds of SI and SA, respectively. Adjusted models showed similar odds reductions of 15% (OR=0.85, 95%CI[0.75,0.95], Q18=10.04, p=0.93) and 28% (OR=0.72, 95%CI[0.59,0.87], Q10=10.46, p=0.49) for SI and SA, respectively. Within-cluster heterogeneity ranged from no heterogeneity to low heterogeneity for SA across crude and adjusted models (0-9%). No heterogeneity was identified for SI across crude and adjusted models (0%). Pre-specified univariate moderator analyses were not significant for SA (all ps < 0.05). Variations in average pooled SA odds reductions across categories of various intervention characteristics were observed (all ps < 0.05), which preliminarily suggests that the effectiveness of interventions may potentially vary across intervention factors. These findings have practical implications for researchers, clinicians, educators, and decision-makers. Further investigation of important logical, theoretical, and empirical moderators on PSSP intervention effectiveness is recommended to establish how and when PSSP interventions best reduce adolescent suicidal behaviour.

Keywords: adolescents, contextual factors, post-primary school-based suicide prevention, suicide ideation, suicide attempts

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Authors: Cristina Costa-Lobo, Ana Medeiros, Ana Campina

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This study refers to the appropriateness of the psychopedagogical intervention programs focused on the adjustment and psychological well-being of children with characteristics of giftedness and the interests of promoting specialized and permanent follow-up to these children. It was intended to find out the impact on perceived self-efficacy in children with characteristics of giftedness after the frequency of a psychopedagogical intervention program. For this was applied to Multidimensional Scale Perceived Self-Efficacy, in two times (pre and post program frequency), in a quasi-experimental design. Innovative data are presented in reports to the relationship of perceived self-efficacy with giftedness, highlighting the evidence of this program focusing on the development of personal, social and emotional skills, applied to 20 children with characteristics of giftedness, in Northern Portugal, in the 2014-2015 school year, have no influence on perceived self-efficacy of children with characteristics of giftedness. The main implication of this research is congruent with the conclusions of studies that point that the greatest challenge in the education of children with characteristics of giftedness is to extend the traditional investment in intellectual production and creative capital to include an equal investment in social capital and the development of competencies of executive functions, dimensions that development programs stimulate. This study appeals to the need of children with characteristics of giftedness to be targets of psychopedagogical intervention programs with the constant specialization and constant updating of the knowledge of the professionals who work with them, motivated by being individuals with such specific and ever-changing characteristics reflecting an inclusive school life.

Keywords: giftedness, perceived self-efficacy, EMAEP, psychopedagogical intervention programs

Procedia PDF Downloads 273

Authors: K. S. Vimal, D. Bodhini, K. Ramya, N. Lakshmipriya, R. M. Anjana, V. Sudha, J. A. Lovegrove, V. Mohan, V. Radha

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Gene-lifestyle interaction studies have been carried out in various populations. However, to date there are no studies in an Asian Indian population. Hence, we examined whether lifestyle factors such as diet and physical activity modify the association between fat mass and obesity–associated (FTO) gene variants and obesity and type 2 diabetes (T2D) in an Asian Indian population. We studied 734 unrelated T2D and 884 normal glucose-tolerant (NGT) participants randomly selected from the Chennai Urban Rural Epidemiology Study (CURES) in Southern India. Obesity was defined according to the World Health Organization Asia Pacific Guidelines (non-obese, BMI < 25 kg/m2; obese, BMI ≥ 25 kg/m2). Six single nucleotide polymorphisms (SNPs) in the FTO gene (rs9940128, rs7193144, rs8050136, rs918031, rs1588413 and rs11076023) identified from recent genome-wide association studies for T2D were genotyped by polymerase chain reaction-restriction fragment length polymorphism and direct sequencing. Dietary assessment was carried out using a validated food frequency questionnaire and physical activity was based upon the self-report. Interaction analyses were performed by including the interaction terms in the model. A joint likelihood ratio test of the main SNP effects and the SNP-diet/physical activity interaction effects was used in the linear regression analyses to maximize statistical power. Statistical analyses were performed using STATA version 13. There was a significant interaction between FTO SNP rs8050136 and carbohydrate energy percentage (Pinteraction=0.04) on obesity, where the ‘A’ allele carriers of the SNP rs8050136 had 2.46 times higher risk of obesity than those with ‘CC’ genotype (P=3.0x10-5) among individuals in the highest tertile of carbohydrate energy percentage. Furthermore, among those who had lower levels of physical activity, the ‘A’ allele carriers of the SNP rs8050136 had 1.89 times higher risk of obesity than those with ‘CC’ genotype (P=4.0x10-5). We also found a borderline interaction between SNP rs11076023 and carbohydrate energy percentage (Pinteraction=0.08) on T2D, where the ‘A’ allele carriers in the highest tertile of carbohydrate energy percentage, had 1.57 times higher risk of T2D than those with ‘TT’ genotype (P=0.002). There was also a significant interaction between SNP rs11076023 and physical activity (Pinteraction=0.03) on T2D. No further significant interactions between SNPs and macronutrient intake or physical activity on obesity and T2D were observed. In conclusion, this is the first study to provide evidence for a gene-diet and gene-physical activity interaction on obesity and T2D in an Asian Indian population. These findings suggest that the association between FTO gene variants and obesity and T2D is influenced by carbohydrate intake and physical activity levels. Greater understanding of how FTO gene influences obesity and T2D through dietary and exercise interventions will advance the development of behavioral intervention and personalised lifestyle strategies predicted to reduce the development of metabolic diseases in ‘A’ allele carriers of both SNPs in this Asian Indian population.

Keywords: dietary intake, FTO, obesity, physical activity, type 2 diabetes, Asian Indian.

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Authors: Hui Fang Huang Su, Leanne Lai, Pei-Fen Li, Mei-Hwei Ho, Yu-Wen Chiu

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This study aimed to provide a practical, systematic, and comprehensive intervention for children with Autism Spectrum Disorder (ASD). A pilot study of quasi-experimental pre-post intervention with control group design was conducted to evaluate if the mathematical intervention (Project MIND - Math Is Not Difficult) increases the math comprehension of children with ASD Children with ASD in the primary grades (K-1, 2) participated in math interventions to enhance their math comprehension and cognitive ability. The Bracken basic concept scale was used to evaluate subjects’ language skills, cognitive development, and school readiness. The study found that our systemic interventions of Project MIND significantly improved the mathematical and cognitive abilities in children with autism. The results of this study may lead to a major change in effective and adequate health care services for children with ASD and their families. All statistical analyses were performed with the IBM SPSS Statistics Version 25 for Windows. The significant level was set at 0.05 P-value.

Keywords: autism, mathematics, technology, family

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Authors: Robert L. Williamson

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A 'token economy' refers to a method of positive behaviour support whereby ‘tokens’ are delivered to students as a reward for exhibiting specific behaviours. Students later exchange tokens to ‘purchase’ items of interest. Unfortunately, implementation fidelity can be problematic as some find physical delivery of tokens while teaching difficult. This project developed and tested a prototype, iPad-based tool that enabled teachers to deliver and track tokens electronically. Using an alternating treatment design, any differences in on-task individual and/or group behaviours between the virtual versus physical token delivery systems were examined. Results indicated that while students and teachers preferred iPad-based implementation, no significant difference was found concerning on-task behaviours of students between the two methodologies. Perhaps more interesting was that the teacher found implementation of both methods problematic and suggested a second person was most effective in implementing a token economy method. This would represent a significant cost to the effective use of such a method. Further research should focus on the use of a lay volunteer regarding method implementation fidelity and associated outcomes of the method.

Keywords: positive behaviour support, inclusion, token economy, applied behaviour analysis

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Authors: Mathilde Blondon, Salla Aicha Dieng, Catherine Pfister

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In a paradoxical way, teenagers nowadays seem to use suicidal attempts to elaborate on their trauma abuses and regain some kind of control in their lives. As their behavior becomes life-threatening, the hospital offers a variety of expertise to address their need, with Child Protective Services also joining in, to a point when teenagers could have a feeling of losing control of their lives, which results in them making more suicidal attempts. Our goal here is to walk with these foster teenagers long enough to step therapy up first, then as their mental health is restored enough to step the therapy down in a way that is secure and will give them their life back. This would prevent them from making suicidal attempts to get a feeling of control over their life. We’ll present a clinical case of a 14-year-old girl named Sofia, who was suffering from parental deprivation, an identity disorder, and severe depression disorder. Our intervention took place in January 2024, after Sofia had undergone four hospitalizations, including a two-month period in a specialized clinic. In a stepping-up effort, a substantial setting has been built around Sofia. She was coming three days a week to therapeutic activities at the Child Psychiatry Day Hospital, she had one psychotherapy session a week at the Medical-Psychological Center, and she was meeting with the Adolescent Psychiatrist on a regular basis. However, her suicidal attempts frequency continued to increase to the point when she couldn’t stay more than four days outside the hospital unit without harming herself and being brought back to the Emergency Unit. We were all stuck in some kind of medical deadlock, writing to clinics that had no room for her while social workers were calling foster homes that wouldn’t even accept her either. At some point, a clinical decision was made by the psychiatrist to stop what appeared to be a global movement of traumatic repetition, which involved Sofia’s family, the medical team and the social workers as one. This decision to step therapy down created a surprise and put an end to the cycle. It provided a new path, a new solution where Sofia could securely settle without being unfaithful to her family. Her suicidal attempts stopped for four weeks. She had one relapse, then didn’t make another attempt so far. There is a fine line between too little and too much, a pathway with the right amount of care and support. We believe it is not a steady line but rather a path up and down the hill. It’s about building up this moment when medication and mental processes have improved the subject’s condition enough to allow the medical team to step therapy down and give more control back to the subject. These needed variations used to come from a change of hospital or medical team. Stepped care avoids any breaking of bonds and appears to be decisive in stopping teenagers’ suicidal attempts.

Keywords: child protection, adolescent psychiatry, teenager suicidal attempt, foster teenagers, parental deprivation, stepped care

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Authors: Kelsey Fortin, Susan Harvey

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The intersection between hunger and health outcomes is beginning to gain traction among the research community. With new interventions focusing on collaborations between the medical and social service sectors, this study aimed to understand the acceptability and approach of a health coaching intervention within a county-wide Midwest food pantry. Through formative research, the study used mixed methods to review secondary data and conduct surveys and semi-structured interviews with food pantry clients (n=30), staff (n=7), and volunteers (n=10). Supplemental secondary data collected and provided by pantry staff were reviewed to understand the broader pantry context of clientele health and health behaviors, annual food donations, and current pantry programming. Results from secondary data showed that the broader pantry client population reported high rates of chronic disease, low consumption of fruits and vegetables, and poor self-reported health, while annual donation data showed increases in produce availability on pantry shelves. This disconnect between produce availability, client health status, and behaviors was supported in the current study, with pantry staff and volunteers reporting lack of knowledge in produce selection and preparation being amongst the most common client inquiries and barriers to healthy food selection. Additional supports to secondary data came from pantry clients in the current study through self-reported high rates of both individual (60%, n=18) and household (43%, n=13 ) disease diagnosis, low consumption of fruits and vegetables averaging zero to one servings of vegetables (67%, n=20) and fruits (47%, n=14) per day, and low levels of physical activity averaging zero to 120 minutes per week (67%, n=20). Further, pantry clients provided health coaching programmatic recommendations through interviews with feedback such as non-judgmental coaching, accountability measures, and providing participant incentives as considerations for future program design and approach. Volunteers and staff reported the need for client education in food preparation, basic nutrition and physical activity, and the need for additional health expertise to educate and respond to diet related nutrition recommendations. All three stakeholder groups supported hosting a health coach within the pantry to focused on nutrition, physical activity, and health programming, with one client stating, 'I am hoping it really works out [the health coaching program]. I think it would be great for something like this to be offered for someone that isn’t knowledgeable like me.' In conclusion, high rates of chronic disease, partnered with low food, nutrition, and physical activity literacy among pantry clients, demonstrates the need to address health behaviors. With all three stakeholder groups showing acceptability of a health coaching program, partnered with existing literature showing health coaching success as a behavior change intervention, further research should be conducted to pilot the design and implementation of such a program in the pantry setting.

Keywords: food insecurity, formative research, food pantries, health coaching, hunger and health

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Authors: Ghorbanali Mohammadi

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Background: Due to the widespread outbreak of the COVID-19 virus, a large number of people become infected with the disease every day and go to hospitals. The acute condition of this disease has caused the death of many people. Since all the stages of treatment for these people happen in the hospitals, nurses are at the forefront of the fight against this virus. This causes nurses to suffer from physical and mental health problems. Methods: Physical and mental problems in nurses were assessed using the Depression, Anxiety and Stress Scale (DASS-42) of Lovibond (1995) and the Nordic Questionnaire. Results: 90 nurses from emergency, intensive care, and coronary care units were examined, and a total of 180 questionnaires were collected and evaluated. It was found that 37.78%, 47.78%, and 21.11% of nurses have symptoms of depression, anxiety, and stress, respectively. 40% of the nurses had physical problems. In total, 65.17% of them were involved in one or more mental or physical illnesses. Conclusions: Of the three units surveyed, the nurses in intensive care, emergency room, and coronary care units worked more than ten hours a day. Examining the interaction of physical and mental health problems indicated that physical problems can aggravate mental problems.

Keywords: depression anxiety and stress scale of Lovibond, nordic questionnaire, mental health of nurses, physical health problems in nurses

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Authors: Maggie Mosher, Adam Carreon, Sean Smith

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A systematic literature review was conducted to explore the evidence base on the use of augmented reality (AR), virtual reality (VR), mixed reality (MR), and extended reality (XR) to present social skill instruction to school-age students with autism spectrum disorder (ASD). Specifically, the systematic review focus was on a. the participants and intervention agents using AR, VR, MR, and XR for social skill acquisition b. the social skills taught through these mediums and c. the social validity measures (i.e., goals, procedures, and outcomes) reported in these studies. Forty-one articles met the inclusion criteria. Researchers in six studies taught social skills to students through AR, in 27 studies through non-immersive VR, and in 10 studies through immersive VR. No studies used MR or XR. The primary targeted social skills were relationship skills, emotion recognition, social awareness, cooperation, and executive functioning. An intervention to improve many social skills was implemented by 73% of researchers, 17% taught a single skill, and 10% did not clearly state the targeted skill. The intervention was considered effective in 26 of the 41 studies (63%), not effective in four studies (10%), and 11 studies (27%) reported mixed results. No researchers reported information for all 17 social validity indicators. The social validity indicators reported by researchers ranged from two to 14. Social validity measures on the feelings toward and use of the technology were provided in 22 studies (54%). Findings indicated both AR and VR are promising platforms for providing social skill instruction to students with ASD. Studies utilizing this technology show a number of social validity indicators. However, the limited information provided on the various interventions, participant characteristics, and validity measures, offers insufficient evidence of the impact of these technologies in teaching social skills to students with ASD. Future research should develop a protocol for training treatment agents to assess the role of different variables (i.e., whether agents are customizing content, monitoring student learning, using intervention specific vocabulary in their day to day instruction). Sustainability may be increased by providing training in the technology to both treatment agents and participants. Providing scripts of instruction occurring within the intervention would provide the needed information to determine the primary method of teaching within the intervention. These variables play a role in maintenance and generalization of the social skills. Understanding the type of feedback provided would help researchers determine if students were able to feel rewarded for progressing through the scenarios or if students require rewarding aspects within the intervention (i.e., badges, trophies). AR has the potential to generalize instruction and VR has the potential for providing a practice environment for performance deficits. Combining these two technologies into a mixed reality intervention may provide a more cohesive and effective intervention.

Keywords: autism, augmented reality, social and emotional learning, social skills, virtual reality

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Authors: Shankar Ganesh, Rishee Patel, Vikram Dwivedi, Balakishore P., Deepak Chhabra, Anandhi Dakshinamoorthy, Parminder Kaur

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Background: The World Health Organization has recommended a moderate intensity physical activity of 150 minutes, or 75 minutes vigorous-intensity physical activity per week to achieve optimal health benefits. It is not known if Indian public who indulge in leisure time physical exercises satisfy these recommendations. Methods: This study used a questionnaire to obtain data regarding demographic details, current engagement in leisure time physical activities, and dosages of these exercises from participants between 18-64 years of age. Results: Data was collected from a total of 390 participants (231 males and 159 females). 50.76% and 34.35% o of the participants reported exercising voluntarily and for health benefits respectively. Most participants (94.61%) indicated exercising without prescription. 55.38% and 12.82% of the participants under and above 38 years of age perform moderate to vigorous intensity exercises respectively. Conclusion: The over-all results of this study indicate that the participants’ choices of leisure time physical exercises are based on their personal choices and beliefs. The exercise intensities undertaken do not meet the global recommended intensities, especially in those above 38 years of age. Professionals and facilities to engage the public in the WHO recommended intensities of physical activity needs to be established.

Keywords: physical activity, exercise, India, sedentary

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Authors: Jungbin Lim, Bohee Kang, Heelim Lee, Sunjin Kim, GeumHee Choi, Jae-Suk Jung, Suk Ji

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Nonsurgical periodontal therapies have, for several decades, been the basis of periodontal treatment concepts. The aim of this paper is to investigate the effectiveness of non-surgical periodontal therapy according to the severity of periodontitis disease. Methods: Retrospective data of patients who visited Department of periodontics in Ajou University Medical Center from 2016 to 2022 were collected. Among the patients, those who took full mouth examination of clinical parameters and non-surgical periodontal therapy were chosen for this study. Selected patients were divided into initial, moderate, and severe periodontitis based on severity and complexity of management (2018 World Workshop EFP/AAP consensus). Recall visits with clinical periodontal examination were scheduled for 1,2,3 months or 1,3,6 months after the treatment. The results were evaluated by recordings of mean probing pocket depth (mean PD), mean clinical attachment levels (mean CAL), bleeding on probing (BOP%), mean gingival index (mean GI), mean regression, mean sulcus bleeding index (mean SBI), mean plaque scores (mean PI). All statistical analyses were performed with R software, version 4.3.0. A level of significance, P<0.05, was considered to be statistically significant. Results: A total of 92 patients were included in this study. 15 patients were diagnosed as initial periodontitis, 14 moderate periodontitis, and 63 severe periodontitis. The all parameters except for mean recession decreased over time in all groups. The amount of mean PD decreased were the greatest in severe periodontitis group followed by moderate and initial, which was found to be statistically significant. The changes of mean PD were 0.15±0.05 mm, 0.37±0.06 mm, and 1.01±0.07 mm (initial, moderate, and severe, respectively, P<0.001). When comparing before and after treatment, the reductions in BOP(%), mean GI, mean SBI, and mean PI were statistically significant. Conclusion: All patients who received non-surgical periodontal therapy showed periodontal healing in terms of improvements in clinical parameters, and it was greater in the severe group.

Keywords: periodontology, clinical periodontology, oral treatment, comprehensive preventive dentistry, non-surgical periodontal therapy

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Authors: B. A. N. Madubashini, S. Anojan, S. Thurka, N. M. C. J. Nawasinghe, G. A. S. Milanga, W. M. I. S. Weerakoon, I. D. N. Ihalahewage

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Evidence-based health promotional approaches are known to be successful ways of reducing tobacco consumption in a rural village. Hence tobacco prevention is essential in improving lives of people, and community-based approaches are considered as effective. This community-based health promotion intervention implemented to reduce high consumption of tobacco in a rural area in Sri Lanka. This intervention was conducted in a rural village of Sri Lanka. In the beginning, facilitation discussions conducted with community members to identify determinants leading to tobacco consumption among villagers. Intervention was planed based on those determinants. Community actions through small active groups to demote smoking were generated. Children groups displayed cigarette buds collected around common places such as temple to community gatherings including funeral welfare society elaborating the cost and the money spent on cigarettes. A till (expenditure box) was introduced, and smokers in family were encouraged to put money on a cigarette to it when they decide to smoke instead. This way they could monitor potential savings if quit. Children groups introduced a tool 'Engalanthe puthata (for overseas son)' to shops. Shop owners agreed to add a pebble to a box whenever they sell a cigarette. The money spent on cigarettes in that shop was calculated regularly, and that was considered as money sent to tobacco company overseas, so to the son of the company owner. This was useful to encourage quitting and to stop selling cigarette in the shops. All four shops in the community volunteered to stop selling cigarettes. Eleven percent of users quitted smoking and 37% users reduced smoking. Child empowerment was high, and 60% of children had shown their disapproval on smoking publicly at least once. Similar community-based health promotion intervention can be used to generate community actions leading to reduction of tobacco consumption.

Keywords: cigarette, community, empowerment, health promotion, intervention

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Authors: M. Wisnu Pamungkas, Patrianef Darwis

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Introduction: Critical limb ischemia (CLI) is a vascular disease that has a significant amputation and mortality risk with diabetes mellitus, the most significant risk factor in CLI, is very common among Indonesian. Endovascular intervention (EVI) is preferred in treating CLI because it is noninvasive and effective. Balloon angioplasty and stent angioplasty are the most common method of EVI in Indonesia. This study aims to compare the effectiveness of balloon angioplasty and stent angioplasty on wound healing in CLI. Method: A cross-sectional study enrolled 90 subjects of CLI who underwent endovascular intervention using balloon angioplasty and stent angioplasty from January 2013 to July 2017 in dr. Cipto Mangunkusumo General Hospital, Jakarta. The wound healing period between balloon angioplasty dan stent angioplasty was analyzed using unpaired T-test with p<0,05 considered as statistically significant. Data of intervention method wound healing period, and subjects characteristic data (age, amputation, BMI, smoking habit, DM, occlusion site, and blood profile) were obtained. Result: The wound healing period in balloon angioplasty and stent angioplasty distributed normally. Mean value of wound healing period in balloon angioplasty and stent angioplasty are 84,8+/-2,423 and 59,93 +/- 2,423 days with a mean difference of 25 days. The difference in wound healing period in both groups is statically significant (p<0,05). The amputation event in balloon angioplasty and stent angioplasty is 22 and 16 event with no difference statistically. Conclusion: Stent angioplasty is a better method than balloon angioplasty for wound healing in patients with CLI.

Keywords: critical limb ischemia, endovascular intervention, wound healing, angioplasty

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Authors: Liudmila Garzanova, Lidia Ananyeva, Olga Koneva, Olga Ovsyannikova, Oxana Desinova, Mayya Starovoytova, Rushana Shayahmetova, Anna Khelkovskaya-Sergeeva

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Objectives. There is very few data on changes of the musculoskeletal manifestations (artritis, arthralgia, muscle weakness, etc.) in systemic sclerosis (SSc) on rituximab (RTX) therapy. The aim of our study was to assess the severity of the musculoskeletal involvement in SSc patients (pts) and its changes during RTX therapy. Methods. Our study included 103 pts with SSc. The mean followup period was 12.6±10.7 months. The mean age was 47±12.9 years, female-87 pts (84%), the diffuse cutaneous subset of the disease had 55 pts (53%). The mean disease duration was 6.2±5.5 years. All pts had interstitial lung disease (ILD) and were positive for ANA, 67% of them were positive for antitopoisomerase-1. All patients received prednisolone at a dose of 11.3±4.5 mg/day, immunosuppressants at inclusion received 47% of them. Pts received RTX due to the ineffectiveness of previous therapy for ILD. The cumulative mean dose of RTX was 1.7±0.6 grams. Arthritis was observed in 22 pts (21%), arthralgias in 47 pts (46%). Muscle weakness was observed in 17 pts (17%). Tendon friction rubs was established in 7 pts (7%). The results at baseline and at the end of the follow up are presented in the form of mean values. Results. There was an improvement of all outcome parameters and musculoskeletal manifestations on RTX therapy. There was a decrease in the number of pts with arthritis from 22 (21%) to 10 (9%), a decrease in the number of pts with arthralgias from 47 (46%) to 31 (30%). The number of pts with muscle weakness decreased from 17 (17%) to 7 (7%). The number of pts with tendon friction rubs decreased from 7 (7%) to 3 (3%). The creatine phosphokinase decreased from 365.5±186 to 70.8±50.4 (p=0.00006). The C-reactive protein (CRP) decreased from 23.2±31.3 to 8.62±7.4 (p=0.001). The dose of prednisolone was reduced from 11.3±4.5 to 9.8±3.5 mg/day (p=0.0004). Conclusion. In our study, musculoskeletal involvement was detected in almost half of the patients with SSc-ILD. There was an improvement of musculoskeletal manifestations despite a small cumulative dose of RTX. We also managed to reduce the dose of glucocorticosteroids. The improvement of musculoskeletal manifestations was accompanied by a decrease in laboratory parameters - creatine phosphokinase and CRP. RTX is effective option for treatment of musculoskeletal manifestations in SSc.

Keywords: arthritis, musculoskeletal involvement, systemic sclerosis, rituximab

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Authors: Jennifer Bradley

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With opportunities to live and work abroad on the rise, effective preparation and support for international employees needs to be addressed within the work-site. International employees must build new habits, routines and social networks in an unfamiliar culture. Culture shock typically occurs within the first year and can affect both physical and psychological health. Employers have the opportunity to support staff through the adaptation process and foster healthy habits and routines. Cross-cultural training that includes a combination of instructional teaching, cultural experiences, and practice, is shown to increase the international employee adaptation process. However, little evidence demonstrates that organizations provide all of these aspects for international employees. The occupational therapy practitioner (OTP) offers a unique perspective focusing on the employee transactional relationship and engagement of meaningful occupations to enhance and enable participation in roles, habits and routines within new cultural contexts. This paper examines one such program developed and implemented by an OTP at the New England Center for Children, in Abu Dhabi, United Arab Emirates. The effectiveness of the program was assessed via participant feedback and concluded that an international employee support program that focuses on a variety of meaningful experiences and knowledge can empower employees to navigate healthy practices, develop habits and routines, and foster positive inter-cultural relationships in the organization and community.

Keywords: occupational therapy practitioner, cross cultural training, international employee health, international employee support

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Authors: Xu Qian

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This abstract examines the concept of resilience in adolescents from both adolescent medicine and child psychology perspectives. It discusses the role of healthcare providers in fostering resilience among adolescents, encompassing physical, psychological, and social aspects. The paper highlights evidence-based interventions and practical strategies for promoting resilience in this population. Introduction: Resilience plays a crucial role in the healthy development of adolescents, enabling them to navigate through the challenges of this transitional period. This abstract explores the concept of resilience from the perspectives of adolescent medicine and child psychology, shedding light on the collective efforts of healthcare providers in fostering resilience. By integrating the principles and practices of these two disciplines, this abstract emphasizes the multidimensional nature of resilience and its significance in the overall well-being of adolescents. Methods: A comprehensive literature review was conducted, encompassing research articles, empirical studies, and expert opinions from both adolescent medicine and child psychology fields. The search included databases such as PubMed, PsycINFO, and Google Scholar, focusing on publications from the past decade. The review aimed to identify evidence-based interventions and practical strategies employed by healthcare providers to promote resilience among adolescents. Results: The review revealed several key findings regarding the promotion of resilience in adolescents. Firstly, resilience is a dynamic process influenced by individual characteristics, environmental factors, and the interaction between the two. Secondly, healthcare providers play a critical role in fostering resilience by addressing the physical, psychological, and social needs of adolescents. This entails comprehensive healthcare services that integrate medical care, mental health support, and social interventions. Thirdly, evidence-based interventions such as cognitive-behavioral therapy, social skills training, and positive youth development programs have shown promising outcomes in enhancing resilience. Discussion: The integration of adolescent medicine and child psychology perspectives provides a comprehensive framework for promoting resilience in adolescents. By acknowledging the interplay between physical health, psychological well-being, and social functioning, healthcare providers can tailor interventions to address the specific needs and challenges faced by adolescents. Collaborative efforts between medical professionals, psychologists, educators, and families are vital in creating a supportive environment that fosters resilience. Additionally, the findings highlight the importance of early identification and intervention, emphasizing the need for routine screening and assessment to identify adolescents at risk and provide timely support. Conclusion: Promoting resilience in adolescents requires a holistic approach that integrates adolescent medicine and child psychology perspectives. By recognizing the multifaceted nature of resilience, healthcare providers can implement evidence-based interventions and practical strategies to enhance the well-being of adolescents. The collaboration between healthcare professionals from different disciplines, alongside the involvement of families and communities, is crucial for creating a resilient support system. By investing in the promotion of resilience during adolescence, we can empower young individuals to overcome adversity and thrive in their journey toward adulthood.

Keywords: psychology, clinical psychology, child psychology, adolescent psychology, adolescent

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Authors: Iman Abrishamchi

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The aim of this study is to investigate the effect of Positive psychology micro coaching (PPMC) on nonexecutive employees' psychological capital and the relation between goal-related self-efficacy and goal attainment. This study was in the form of a control trial design for 150 people in the factory over a period of 5 weeks; the intervention method was a strength-based approach. Participants were divided into two experimental groups (EX) and the waiting list group (WL). The measurement methods were a mix of quantitative and qualitative and included the psychological capital measurement questionnaire, a 2X2 ANOVA to analyze the within-subject factors and between-subject factors, t-tests for evaluating the time effect, and data analysis by the SPSS 25.0 statistical program. The results of the study showed that PPMC could increase psychological capital in employees, and goal-related self-efficacy can predict goal attainment, so this contributes to successful organizational outcomes.

Keywords: psychological capital, goal attainment, positive psychology, micro-coaching intervention, goal related self-efficacy

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Authors: Terrell Strayhorn

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The lack of diversity in science, technology, engineering, and mathematics (STEM) fields is a persistent and concerning issue. One contributing factor to the underrepresentation of minority groups in STEM fields is a lack of sense of belonging, which can lead to lower levels of academic engagement, motivation, and achievement. In particular, Black students have been shown to experience lower levels of sense of belonging in STEM compared to their white peers. This study aimed to explore the effects of a psychological intervention on Black students' sense of belonging in physics and math courses at historically Black colleges and universities (HBCUs) and predominantly white institutions (PWIs). The study used a randomized controlled trial design and included 305 Black undergraduate students enrolled in physics or math courses at HBCUs and PWIs in the United States. Participants were randomly assigned to either an intervention group or a control group. The intervention consisted of a brief psychological, video-based intervention designed to enhance sense of belonging, which was delivered in a single session. The control group received no intervention. The primary outcome measure was sense of belonging in physics and math courses, as assessed by a validated self-report measure. Other outcomes included academic engagement, motivation, and achievement as measured by physics and math (course) grades. Preliminary results show that the intervention has a significant positive effect on Black students' sense of belonging in physics and math courses, with a moderate effect size. The intervention also had a significant positive effect on academic engagement and motivation, but not on academic achievement. Importantly, the effects of the intervention were larger for Black students enrolled at PWIs compared to those enrolled at HBCUs. Findings, at present, suggest that a brief psychological web-based intervention can enhance Black students' sense of belonging in physics and math courses, and that the effects may be particularly strong for Black students enrolled at PWIs, although they are not negligible for Black students at HBCUs. This is an important finding given the persistent underrepresentation of Black students in STEM fields, the growing number of Black students at PWIs, and the potential for enhancing sense of belonging to improve academic outcomes and increase diversity in these fields. The study has several limitations, including a relatively small sample size and a lack of long-term follow-up. Future research could explore the generalizability of these findings to other minority groups and other STEM fields, as well as the potential for longer-term interventions to sustain and enhance the effects observed in this study. Overall, this study highlights the potential for psychological interventions to enhance sense of belonging and improve academic outcomes for Black students in STEM courses, and underscores the importance of addressing sense of belonging as a key factor in promoting diversity and equity in STEM fields.

Keywords: sense of belonging, achievement, racial equity, postsecondary education, intervention

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Authors: Kailash Ghimire, Manoj Thapa

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This study focuses on early identification of deficiencies in pre-required areas of students who are enrolled in College Algebra and Calculus I classes. The students were given pre-diagnostic tests on the first day of the class before they are provided with the syllabus. The tests consist of prerequisite, uniform and advanced content outlined by the University System of Georgia (USG). The results show that 48% of students in College Algebra are lacking prerequisite skills while 52% of Calculus I students are lacking prerequisite skills but, interestingly these students are prior exposed to uniform content and advanced content. The study is still in progress and this paper contains the outcome from Fall 2017 and Spring 2018. In this paper, early intervention used in these classes: two days vs three days meeting a week and students’ self-assessment using exam wrappers and their effectiveness on students’ learning will also be discussed. A result of this study shows that there is an improvement on Drop, Fail and Withdraw (DFW) rates by 7%-10% compared to those in previous semesters.

Keywords: student at risk, diagnostic tests, identification, intervention, normalization gain, validity of tests

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Authors: Gesti Prastiti, Maylina Adani, Yuyun darma A. N., M. Khilmi F., Yunita Wahyu Pratiwi

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Combination therapy may allow interaction on two drugs or more that can give adverse effects on patients. Simvastatin is a drug of antihyperlipidemia it can interact with drugs which work on cytochrome P450 CYP3A4 because it can interfere the performance of simvastatin. Flavonoid found in plants can inhibit the cytochrome P450 CYP3A4 if taken with simvastatin and can increase simvastatin levels in the body and increases the potential side effects of simvastatin such as myopati and rhabdomyolysis. Green tea leaves and mint are herbal medicine which has the effect of antihiperlipidemia. This study aims to determine the potential interaction of simvastatin with herbal drinks (green tea leaves and mint). This research method are experimental post-test only control design. Test subjects were divided into 5 groups: normal group, negative control group, simvastatin group, a combination of green tea group and the combination group mint leaves. The study was conducted over 32 days and total cholesterol levels were analyzed by enzymatic colorimetric test method. Results of this study is the obtainment of average value of total cholesterol in each group, the normal group (65.92 mg/dL), the negative control group the average total cholesterol test in the normal group was (69.86 mg/dL), simvastatin group (58.96 mg/dL), the combination of green tea group (58.96 mg/dL), and the combination of mint leaves (63.68 mg/dL). The conclusion is between simvastatin combination therapy with herbal drinks have the potential for pharmacodynamic interactions with a synergistic effect, antagonist, and a powerful additive, so the combination therapy are no more effective than a single administration of simvastatin therapy.

Keywords: hyperlipidemia, simvastatin, herbal drinks, green tea leaves, mint leaves, drug interactions

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Authors: Niyada Naksuk, Thoetchai Peeraphatdit, Vitaly Herasevich, Peter A. Brady, Suraj Kapa, Samuel J. Asirvatham

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Introduction: Little is known about the safety of antipsychotic therapy for delirium in the coronary care unit (CCU). Our aim was to examine the effect of delirium and antipsychotic therapy among CCU patients. Methods: Pre-study Confusion Assessment Method-Intensive Care Unit (CAM–ICU) criteria were implemented in screening consecutive patients admitted to Mayo Clinic, Rochester, the USA from 2004 through 2013. Death status was prospectively ascertained. Results: Of 11,079 study patients, the incidence of delirium was 8.3% (n=925). Delirium was associated with an increased risk of in-hospital mortality (adjusted OR 1.49; 95% CI, 1.08-2.08; P=.02) and one-year mortality among patients who survived from CCU admission (adjusted HR 1.46; 95% CI, 1.12-1.87; P=.005). A total of 792 doses of haloperidol (5 IQR [3-10] mg/day) or quetiapine (25 IQR [13-50] mg/day) were given to 244 patients with delirium. The clinical characteristics of patients with delirium who did and did not receive antipsychotic therapy were not different (baseline corrected QT [QTc] interval 460±61 ms vs. 457±58 ms, respectively; P = 0.57). In comparison to baseline, mean QTc intervals after the first and third doses of the antipsychotics were not significantly prolonged in haloperidol (448±56, 458±57, and 450±50 ms, respectively) or quetiapine groups (459±54, 467±68, and 462±46 ms, respectively) (P > 0.05 for all). Additionally, in-hospital mortality (adjusted OR 0.67; 95% CI, 0.42-1.04; P=.07), ventricular arrhythmia (adjusted OR 0.87; 95% CI, 0.17-3.62; P=.85) and one-year mortality among the hospital survivors (adjusted HR 0.86; 95% CI 0.62-1.17; P = 0.34) were not different in patients with delirium irrespective of whether or not they received antipsychotics. Conclusions: In patients admitted to the CCU, delirium was associated with an increase in both in-hospital and one-year mortality. Low doses of haloperidol and quetiapine appeared to be safe, without an increase in risk of sudden cardiac death, in-hospital mortality, or one-year mortality in carefully monitored patients.

Keywords: arrhythmias, haloperidol, mortality, qtc interval, quetiapine

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Authors: Sarah Hamdan Al-Jahdali, Khaled Alsaad, Abdullah Al-Sayyari

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Objectives: To study the prevalence, clinicopathological features, risk factors and outcome of biopsy proven polyoma (BK) virus infection among Saudi kidney transplant recipients and compare them to negative BK virus group. Methods: We retrospectively reviewed the charts of all the patients with biopsy-proven polyoma (BK) virus infection in King Abdulaziz Medical City in Riyadh between 2005 and 2011. The details of clinical presentation, the indication for kidney biopsy, the laboratory findings at presentation, the natural history of the disease, thepathological findings, the prognosis as well as the response to therapy were all recorded. Results: Kidney biopsy was performed in 37 cases of unexplained graft dysfunction. BK virus was found in 10 (27%). Out of those 10, 3 (30%) ended with graft failure. BK virus occurred in all patients who received ATG induction therapy 100% versus 59.3% in the non BK virus patients (p=0.06). Furthermore, the risk of BK virus was much less in those who received acyclovir as an anti-viral prophylaxis as compared to those who did not receive it (p=0.01). Also, patients with BK virus weighed much less (mean 46.7±20.6 Kgs) than those without BK virus at time of transplantation (mean 64.3±12.1). Graft survival was better among deceased donor kidneys compared to living ones (P=0.016) and with older age (P=0.005). Conclusion: Our findings suggest the involvement of ATG induction therapy, the lack of antiviral prophylaxis therapy and lower weight at transplant as significant risk factors for the development of BK virus infection.

Keywords: BKVAN, BKV, kidney transpant, Saudi Arabia

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