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PURPOSE: Adolescent and young adult (AYA) cancer patients, aged between 15 to 39 years old, suffer from long-term psychological distress, confronting low self-efficacy and various psychological problems. This study constructs a group online-based peer support intervention combined with offline activities to explore its impact on the psychological distress of AYA cancer patients. METHODS: A randomized, two-arm clinical trial was conducted in which 90 AYA cancer patients were recruited. The control group (N = 45) received conventional psychological care and treatment, and the experimental group (N = 45) received 8 weeks of an online peer support intervention. Outcome measures included psychological distress (Distress Thermometer, DT), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), perceived peer support (Cancer Peer Support Scales, CaPSS), and readiness for return to work (Readiness to Return-To-Work Scale, RRTW). RESULTS: Eight-week peer support intervention was effective in improving psychological distress, anxiety, and depressive symptoms in the experimental group with statistically significant differences (P < 0.05). Time affected psychological distress, anxiety, and depressive symptoms in AYA cancer patients (P < 0.05), and there was an interaction with intervention factors (P < 0.05). The intervention has a positive effect on relieving the psychological status of AYA cancer patients. For readiness for return to work, the experimental group was in the preparation for the action-behavioral stage immediately, 1 month and 3 months after the end of the intervention (P < 0.01), supporting AYA cancer patients who have not returned to work to maintain optimal return-to-work readiness. CONCLUSIONS: The group online-based peer support intervention is popular and has good scientificity, effectiveness, and practical significance for AYA cancer patients. TRIAL REGISTRATION: This study was registered at clinicaltrials.gov. (ChiCTR2100053091, registered on 10 November 2021).
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Neoplasias , Grupo Paritario , Distrés Psicológico , Apoyo Social , Humanos , Adolescente , Femenino , Masculino , Adulto Joven , Adulto , Neoplasias/psicología , Neoplasias/terapia , Depresión/terapia , Depresión/etiología , Depresión/psicología , Ansiedad/etiología , Ansiedad/terapia , Estrés Psicológico/etiología , Estrés Psicológico/terapia , Intervención basada en la InternetRESUMEN
Shift work is a recognized work pattern for nurses worldwide. The disruption of shift workers' biological clocks usually leads to sleep disorders and affects their awareness at work. Eveningness and occupational stress might be effective in causing burnout syndrome. Therefore, this study aimed to evaluate the chronotype, job burnout and perceived stress among Chinese tertiary hospital nurses, and understand the predictors of circadian rhythm in this group. Between July and September 2020, 23 hospitals were randomly selected from 113 tertiary hospitals in Hunan Province. Twenty-five percent of the nurses working in each hospital were targeted for selection. 28.1% and 17.6% of nurses reported eveningness type and morningness type, respectively. The scores for emotional exhaustion, depersonalization, and perceived stress of eveningness nurses were higher than those of morningness counterparts. Eveningness nurses also reported a lower sense of personal accomplishment. Risk factors of eveningness included being under 30 years old, never exercising, having the stressors of late-night shifts and career development, higher levels of emotional exhaustion, sleep latency, sleep duration, and hypnotic use. Shifts may be unavoidable for nurses, nevertheless, understanding the predictors and related factors of chronotype for nurses is necessary for nursing educators and managers to develop a reasonable shift system and appropriate measures to assist nurses in adjusting their work.
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Agotamiento Profesional , Cronotipo , Enfermeras y Enfermeros , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , China/epidemiología , Estudios Transversales , Pueblos del Este de Asia , Personal de Enfermería en Hospital/psicología , Estrés Laboral , Factores de Riesgo , Horario de Trabajo por Turnos , Sueño/fisiología , Encuestas y Cuestionarios , Centros de Atención Terciaria , Tolerancia al Trabajo ProgramadoRESUMEN
PURPOSE: Many countries have developed clinical decision-making support tools, such as the smart work injury management (SWIM) system in Hong Kong, to predict rehabilitation paths and address global issues related to work injury disability. This study aims to evaluate the accuracy of SWIM by comparing its predictions on real work injury cases to those made by human case managers, specifically with regard to the duration of sick leave and the percentage of permanent disability. METHODS: The study analyzed a total of 442 work injury cases covering the period from 2012 to 2020, dividing them into non-litigated and litigated cases. The Kruskal-Wallis post hoc test with Bonferroni adjustment was used to evaluate the differences between the actual data, the SWIM predictions, and the estimations made by three case managers. The intra-class correlation coefficient was used to assess the inter-rater reliability of the case managers. RESULTS: The study discovered that the predictions made by the SWIM model and a case manager possessing approximately 4 years of experience in case management exhibited moderate reliability in non-litigated cases. Nevertheless, there was no resemblance between SWIM's predictions regarding the percentage of permanent disability and those made by case managers. CONCLUSION: The findings indicate that SWIM is capable of replicating the sick leave estimations made by a case manager with an estimated 4 years of case management experience, albeit with limitations in generalizability owing to the small sample size of case managers involved in the study. IMPLICATIONS: These findings represent a significant advancement in enhancing the accuracy of CDMS for work injury cases in Hong Kong, signaling progress in the field.
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INTRODUCTION: Depression is a major global health problem, with high prevalence rates of depressive symptoms observed among the elderly population in China, particularly exacerbating in rural areas. Due to a lack of professional mental health training and inadequate psychotherapy capacity within primary medical staff, rural elderly individuals grappling with depressive symptoms often encounter challenges in receiving timely diagnosis and treatment. In this landscape, the modified behavioural activation treatment (MBAT) emerges as a promising approach due to its practicality, ease of therapist training and application, patient acceptability, and broad applicability. However, existing evidence for MBAT mainly hails from developed countries, leaving a gap in its adaptation and implementation within rural China. This study aims to develop an MBAT training programme for primary medical staff to manage depressive symptoms among rural elderly and evaluate its effectiveness. METHODS AND ANALYSIS: A cluster randomised controlled trial will be conducted in 10 randomly selected township hospitals in Lengshuijiang and Lianyuan, Hunan Province. We aim to recruit 150 participants, with 5 township hospitals selected for each group, each consisting of 15 participants. The intervention group will implement the MBAT training programme, while the control group will receive usual care training programme. Depressive symptoms, psychosocial functioning, quality of life and satisfaction will be measured at baseline, immediately post-intervention, and at 3 and 6 months post-intervention. Effectiveness will be assessed using linear or generalised linear mixed models. ETHICS AND DISSEMINATION: This study has obtained approval from the Institutional Review Board of the Third Xiangya Hospital, Centre South University (No.: 2022-S261). Results will be disseminated through publication in international peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER: ChiCTR2300074544.
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Depresión , Población Rural , Humanos , China , Depresión/terapia , Anciano , Ensayos Clínicos Controlados Aleatorios como Asunto , Femenino , Masculino , Calidad de Vida , Personal de Salud/educación , Personal de Salud/psicología , Terapia Conductista/métodos , Atención Primaria de SaludRESUMEN
AIM: To establish a supportive care framework for addressing unmet needs among breast cancer survivors, providing practical guidance for healthcare providers to assess and manage these needs, ultimately enhancing the health outcomes and quality of life of breast cancer survivors. DESIGN: We conducted a two-round Delphi survey to gather expert opinions regarding the unmet needs supportive care framework for breast cancer survivors. METHODS: Initial framework identification and inquiry questionnaire creation was achieved via literature search and expert group discussions, which included 15 experts from nursing practice, clinical medicine, nursing management and nursing education was conducted using a Delphi survey. To establish consensus, a two-round Delphi poll was done, using criteria based on the mean (≥4.0), coefficient of variation (CV < 0.25) and percentage for entire score (≥20%). RESULTS: Experts reached a consensus, leading to six care modules, and 28 care entries: Tumour Detection Support (three care entries), Management of Complications of Antitumor Therapy (seven care entries), Healthy Lifestyle Management (five care entries), Sexual and Fertility Support (four care entries), Psychosocial Support (four care entries) and Resource and Linkage Support (five care entries). CONCLUSION: To address breast cancer survivors' unmet needs, a supportive framework was developed to actively enhance their health outcomes. However, further refinement and feasibility testing using mobile devices or artificial intelligence are required. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: This pioneering framework prioritises addressing unmet needs and equips healthcare providers to assess and manage these needs effectively, facilitating the implementation of programs aimed at improving the well-being of breast cancer survivors. REPORTING METHOD: This study was guided by a modified guideline for the Conducting and Reporting of Delphi Studies (CREDES) (Palliative Medicine, 31(8), 684, 2017). PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. TRIAL AND PROTOCOL REGISTRATION: The Delphi study methodology does not require registration.
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Neoplasias de la Mama , Supervivientes de Cáncer , Humanos , Femenino , Neoplasias de la Mama/terapia , Neoplasias de la Mama/psicología , Calidad de Vida/psicología , Técnica Delphi , Inteligencia Artificial , Encuestas y Cuestionarios , Necesidades y Demandas de Servicios de SaludRESUMEN
OBJECTIVE: This study aimed to examine the bidirectional associations between dietary diversity and clinical depressive symptoms in adult women, and influencing factors of clinical depressive symptoms. METHODS: This longitudinal study included a total of 22,385 participants, each of whom underwent at least two data collections. We used convenience sampling to recruit women from a health management center of a general hospital in southern China from April 2015 to December 2021. They completed an online self-reported health questionnaire, which included demographic characteristics, lifestyle information, the Dietary Diversity Scale (DDS), and the Patient Health Questionnaire-9. RESULTS: New-onset depressive symptoms and low dietary diversity were observed in this study among 1285 and 3223 participants, respectively. Negative associations were observed between baseline low dietary diversity and new-onset depressive symptoms (P < 0.05) and between baseline depressive symptoms and low dietary diversity (P < 0.001). Cross-lagged panel analysis indicated that dietary diversity negatively and prospectively predicted depressive symptoms, but vice versa (P < 0.05). Strong evidence of a nonlinear association between DDS scores and incident depressive symptoms was found (P nonlinear < 0.05) regardless of whether the variables were adjusted. Besides, age, menarche age, physical activity, sleep duration, longer sedentary behavior and other lifestyle factors were influencing factors of depressive symptoms (P < 0.05). CONCLUSIONS: The present study identified bidirectional associations between dietary diversity and depressive symptoms, and the associations were found to have a non-linear pattern. Adherence to dietary diversity and a healthy lifestyle could be effective non-pharmacological preventive measures to reduce the incidence of depressive symptoms.
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Depresión , Dieta , Adulto , Humanos , Femenino , Estudios Longitudinales , Depresión/epidemiología , Depresión/etiología , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Low-diversity diets and sedentary status are risk factors for depressive symptoms, while knowledge workers were ignored before. The purpose of this current study was to examine the relationship between dietary diversity, sedentary time spent outside of work, and depressive symptoms among knowledge workers. STUDY DESIGN AND METHODS: This was a multicenter and cross-sectional design that included 118,723 knowledge workers. Participants self-reported online between January 2018 and December 2020. Demographic information, the Dietary Diversity Scale, the Patient Health Questionnaire-9, dietary habits (which included eating three meals on time, midnight snacking, overeating, social engagement, coffee consumption, sugary drink consumption, smoking and alcohol use), sedentary time spent outside of work and physical activity were investigated. RESULTS: The relationships between demographic information, dietary habits and dietary diversity, and depressive symptoms were estimated. Compared with the first and second levels of dietary diversity, the third level of dietary diversity (OR: 0.91; 95% CI: 0.84-0.98) reduced the risk of depressive symptoms. Knowledge workers with different degrees of sedentary status (2-4 h (OR: 1.11; 95% CI: 1.07-1.14), 4-6 h (OR: 1.21; 95% CI: 1.17-1.26), and > 6 h (OR: 1.49; 95% CI: 1.43-1.56), presented a progressively higher risk of depressive symptoms. CONCLUSION: High amounts of sedentary time spent after work and low levels of dietary diversity are risk factors for depressive symptoms. In addition, an irregular diet and overeating are also major risk factors for knowledge workers.
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Depresión , Conducta Sedentaria , Humanos , Depresión/epidemiología , Depresión/etiología , Estudios Transversales , Dieta , HiperfagiaRESUMEN
BACKGROUND: Youth mental health problems are a public health priority. Multiple healthy lifestyle behaviors may cluster into healthy lifestyle behavioral patterns (HLBPs) that increase mental health risks in adolescents and older adults, but little is known regarding young adults. This study aimed to explore the associations between cluster HLBPs and mental health problems in young adults. METHODS: We selected 161,744 young adults aged 20-39 as participants from the database of a Chinese general hospital health management center for the years 2015-2020. The latent class analysis was used to identify HLBPs. RESULTS: A total of 15.0 % of young adults have at least one mental health problem. Five clusters of HLBPs were identified, characterized as low-risk class (1.6 %), moderate-risk class 1 (12.0 %), moderate-risk class 2 (2.1 %), moderate-risk class 3 (56.8 %), and high-risk class (27.4 %). The odds ratios (ORs) for young adults with two mental health problems increased with the risk grade of HLBPs, while the ORs for young adults with one or three mental health problems ranged from high to low according to the risk grade of HLBPs: high-risk class, moderate-risk class 2, moderate-risk class 3, moderate-risk class 1. LIMITATIONS: Cross-sectional design and no causal conclusions could be drawn. CONCLUSION: Young adults demonstrated a cluster phenomenon of healthy lifestyle behaviors and significant associations between HLBPs and mental health problems. Young adults with a higher risk grade for HLBPs were more likely to have mental health problems. Different HLBPs should be taken into account when implementing mental health interventions.
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Estilo de Vida Saludable , Salud Mental , Adolescente , Humanos , Adulto Joven , Anciano , Análisis de Clases Latentes , Estudios Transversales , China/epidemiologíaRESUMEN
PURPOSE: Serum cortisol and inflammatory markers may play a role in depression and anxiety, but little is known about whether various features of serum cortisol and inflammatory markers have different associations with depression and anxiety. This study examines the associations of serum cortisol and inflammatory marker features with depression and anxiety in young women with gynecologic cancer. METHODS: Sixty-four young women with gynecologic cancer, aged 15-39 years, were recruited in a tertiary general hospital and a tertiary hospital specializing in oncology in China from May to December 2021. The Hospital Anxiety and Depression Scale was used to evaluate depression and anxiety. Blood samples were taken at 8 am, 4 pm, and 10 pm on the same day to examine the various features (average, variability, and diurnal patterns) of serum cortisol and inflammatory markers, namely C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α). RESULTS: Young women with gynecologic cancer who reported depression/anxiety had significantly higher average levels of serum cortisol, IL-6 and TNF-α than those who did not. The dysregulations in the diurnal patterns of serum cortisol and IL-6 were associated with depression and anxiety. Serum cortisol levels were significantly higher in the depression/anxiety group at 10 pm. Depression and anxiety were associated with elevated levels of IL-6 and TNF-α at each time point. CONCLUSION: This study revealed various associations of serum cortisol and inflammatory marker features with depression and anxiety in young women with gynecologic cancer. Further research is needed to understand the role of serum cortisol and inflammatory marker features in the progression of depression and anxiety.
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Neoplasias de los Genitales Femeninos , Hidrocortisona , Femenino , Humanos , Depresión/etiología , Interleucina-6 , Factor de Necrosis Tumoral alfa , Ansiedad/epidemiología , Ansiedad/etiologíaRESUMEN
Introduction: Given the high prevalence of thyroid nodules and the potential for malignancy, it is imperative to understand the various factors that contribute to their development. This study aimed to explore the relationship between metabolic syndrome, lifestyle, and thyroid nodules in adult men in southern China. Methods: This study enrolled a total of 183,990 subjects at a medical examination center in a general hospital in southern China between January 1, 2015, and December 31, 2020. Multivariate logistic regression analysis was utilized to evaluate the relationship between metabolic syndrome, lifestyle factors, and thyroid nodules. Furthermore, structural equation modeling elucidated the intricate relationships among these variables. Results: The prevalence of thyroid nodules among Chinese adult males was 14.9%. Several factors were identified as risk factors for thyroid nodules, including advanced age, irregular meal time, smoking or quitting smoking, quitting drinking, heavy manual labor, hypertension, diabetes, dyslipidemia and centripetal obesity, and those belonging to ethnic minorities and drinking alcohol were found to be protective factors against thyroid nodules. Structural equation modeling highlighted metabolic syndrome's mediating role amidst lifestyle influences on thyroid nodules. Conclusion: The prevalence of thyroid nodules in Chinese adult males is relatively moderate to low. The factors identified in this study can help clinicians identify high-risk patients and develop targeted screening strategies for the timely detection of thyroid nodules. However, further mechanistic research and longitudinal studies are necessary to explore the underlying causes and establish causal relationships.
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Síndrome Metabólico , Nódulo Tiroideo , Masculino , Humanos , Adulto , Nódulo Tiroideo/epidemiología , Síndrome Metabólico/epidemiología , Estudios Transversales , Pueblos del Este de Asia , Estilo de VidaRESUMEN
INTRODUCTION: Ocular artifact has long been viewed as an impediment to the interpretation of electroencephalogram (EEG) signals in basic and applied research. Today, the use of blind source separation (BSS) methods, including independent component analysis (ICA) and second-order blind identification (SOBI), is considered an essential step in improving the quality of neural signals. Recently, we introduced a method consisting of SOBI and a discriminant and similarity (DANS)-based identification method, capable of identifying and extracting eye movement-related components. These recovered components can be localized within ocular structures with a high goodness of fit (>95%). This raised the possibility that such EEG-derived SOBI components may be used to build predictive models for tracking gaze position. METHODS: As proof of this new concept, we designed an EEG-based virtual eye-tracker (EEG-VET) for tracking eye movement from EEG alone. The EEG-VET is composed of a SOBI algorithm for separating EEG signals into different components, a DANS algorithm for automatically identifying ocular components, and a linear model to transfer ocular components into gaze positions. RESULTS: The prototype of EEG-VET achieved an accuracy of 0.920° and precision of 1.510° of a visual angle in the best participant, whereas an average accuracy of 1.008° ± 0.357° and a precision of 2.348° ± 0.580° of a visual angle across all participants (N = 18). CONCLUSION: This work offers a novel approach that readily co-registers eye movement and neural signals from a single-EEG recording, thus increasing the ease of studying neural mechanisms underlying natural cognition in the context of free eye movement.
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Electroencefalografía , Movimientos Oculares , Humanos , Electroencefalografía/métodos , Artefactos , Algoritmos , Cognición , Procesamiento de Señales Asistido por ComputadorRESUMEN
BACKGROUND: The concept of dignity remains disputed, with most studies defining dignity based on its external dimension. Although its inherent dimension is a rooted attribute of dignity, it has received scarce attention. Caregivers have close relationships with their care recipients and thus may perceive their patient's inherent as well as external dimensions of dignity. Therefore, in this study, we aimed to identify, analyze, and synthesize evidence on human dignity presented in qualitative studies from the perspective of caregivers to gain a deeper comprehension of the preservation of patients' dignity by their caregivers. METHODS: A qualitative meta-synthesis was performed by searching for relevant qualitative literature via systematic electronic databases, including MEDLINE, PsycINFO, ProQuest, CINAHL, Embase, Health Source, and Web of Science, from inception to March 15, 2022. RESULTS: Nine studies were eligible for inclusion and included in the meta-synthesis. Three overarching categories were identified: integrated person, "rootedness" and "growth" atmosphere, and balanced state. CONCLUSIONS: Dignity is rooted in its inherent dimension, whereas its external dimension may promote individual dignity. Furthermore, caregiver-patient relationships may be a key factor linking the inherent dimension of dignity with its external dimension. Thus, further studies should focus on the mechanism of relationships in preserving dignity.
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Cuidadores , Respeto , Humanos , Pacientes , Investigación Cualitativa , AtenciónRESUMEN
Chemotherapy-induced cognitive impairment (chemobrain) and muscle wasting (cachexia) are persisting side effects which adversely affect the quality of life of cancer survivors. We therefore investigated the efficacy of physical exercise as a non-pharmacological intervention to reverse the adverse effects of chemotherapy. We examined whether physical exercise in terms of voluntary wheel running could prevent chemotherapy-induced cognitive and motor impairments in mice treated with the multi-kinase inhibitor sorafenib. Adult male BALB/c mice were subdivided into runner and non-runner groups and orally administered with sorafenib (60 mg/kg) or vehicle continuously for four weeks. Mice could freely access the running wheel anytime during sorafenib or vehicle treatment. We found that sorafenib treatment reduced body weight gain (% of change, vehicle: 3.28 ± 3.29, sorafenib: -9.24 ± 1.52, p = 0.0004), impaired hippocampal-dependent spatial memory in the Y maze (exploration index, vehicle: 35.57 ± 11.38%, sorafenib: -29.62 ± 7.90%, p < 0.0001), increased anhedonia-like behaviour in the sucrose preference test (sucrose preference, vehicle: 66.57 ± 3.52%, sorafenib: 44.54 ± 4.25%, p = 0.0005) and impaired motor skill acquisition in rotarod test (latency to fall on day 1: 37.87 ± 8.05 and day 2: 37.22 ± 12.26 s, p > 0.05) but did not induce muscle wasting or reduce grip strength. Concomitant voluntary running reduced anhedonia-like behaviour (sucrose preference, sedentary: 44.54 ± 4.25%, runners: 59.33 ± 4.02%, p = 0.0357), restored impairment in motor skill acquisition (latency to fall on day 1: 50.85 ± 15.45 and day 2: 168.50 ± 37.08 s, p = 0.0004), but failed to rescue spatial memory deficit. Immunostaining results revealed that sorafenib treatment did not affect the number of proliferating cells and immature neurons in the hippocampal dentate gyrus (DG), whereas running significantly increased cell proliferation in both vehicle- (total Ki-67+ cells, sedentary: 16,687.34 ± 72.63, exercise: 3320.03 ± 182.57, p < 0.0001) and sorafenib-treated mice (Ki-67+ cells in the ventral DG, sedentary: 688.82.34 ± 38.16, exercise: 979.53 ± 73.88, p < 0.0400). Our results suggest that spatial memory impairment and anhedonia-like behaviour precede the presence of muscle wasting, and these behavioural deficits are independent of the changes in adult hippocampal neurogenesis. Running effectively prevents body weight loss, improves motor skill acquisition and reduces anhedonia-like behaviour associated with increased proliferating cells and immature neurons in DG. Taken together, they support physical exercise rehabilitation as an effective strategy to prevent chemotherapy side effects in terms of mood dysregulation and motor deficit.
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Anhedonia , Actividad Motora , Ratones , Masculino , Animales , Actividad Motora/fisiología , Sorafenib , Antígeno Ki-67 , Calidad de Vida , Aprendizaje por Laberinto/fisiología , Hipocampo , Trastornos de la Memoria , Neurogénesis/fisiología , Cognición/fisiología , Ratones Endogámicos C57BLRESUMEN
Breast cancer is the leading cancer type among women globally. Since breast cancer has a high survival rate, most survivors are likely to return to work (RTW). In recent years, breast cancer cases have risen significantly in younger age groups. As self-efficacy is an important factor in the success of RTW, this study performed a translation and cross-cultural adaptation of the Chinese version of the Return-To-Work Self-Efficacy Scale (CRTWSE-19) and examined its psychometric properties in patients with breast cancer. This validation study followed standard guidelines, including forward translation, back translation, cross-cultural adaptation, and psychometric testing. The results of this study show that the CRTWSE-19 met reliability standards, including high internal reliability for the total scores and subscales. An exploratory factor analysis of 19 items extracted 3 factors showing consistency with the original version of the RTWSE-19. Criterion validity was demonstrated by comparing subdomains with the Fear of Cancer Recurrence Inventory. Furthermore, the known-group validity was studied by comparing mean scores among the unemployed group and the employed group. We conclude that the CRTWSE-19 has very good screening accuracy and is able to discriminate between working and unemployed populations. It can facilitate health care professionals in triaging, planning, and evaluating interventions in clinical practice.
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Neoplasias de la Mama , Supervivientes de Cáncer , Humanos , Femenino , Reinserción al Trabajo , Comparación Transcultural , Autoeficacia , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Recurrencia Local de Neoplasia , Sobrevivientes , PsicometríaRESUMEN
As occupational rehabilitation services are part of the public medical and health services in Hong Kong, work-injured workers are treated along with other patients and are not considered a high priority for occupational rehabilitation services. The idea of a work trial arrangement in the private market occurred to meet the need for a more coordinated occupational rehabilitation practice. However, there is no clear service standard in private occupational rehabilitation services nor concrete suggestions on how to offer rehabilitation plans to injured workers. Electronic Health Records (EHRs) data can provide a foundation for developing a model to improve this situation. This project aims at using a machine-learning-based approach to enhance the traditional prediction of disability duration and rehabilitation plans for work-related injury and illness. To help patients and therapists to understand the machine learning result, we also developed an interactive dashboard to visualize machine learning results. The outcome is promising. Using the variational autoencoder, our system performed better in predicting disability duration. We have around 30% improvement compared with the human prediction error. We also proposed further development to construct a better system to manage the work injury case.
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BACKGROUND: More than 80% of adolescent and young adult cancer patients (AYACPs) experienced psychological distress. Physical activity and behavioral activation are effective to relieve the psychological distress in AYACPs. METHODS: Participants aged 15-39 years diagnosed with malignant tumors were included. A total of 143 eligible AYACPs were randomly assigned to three groups. The treatment-as-usual group (N = 48) received routine care, the physical activity group (N = 47) received 8 weeks of physical activity program based on intelligent wearable devices, and the behavioral activation group (N = 48) received an internet-based modified behavioral activation program for 8 weeks. Objective outcome measures included salivary cortisol and testosterone. RESULTS: Linear mixed-model analyses showed significant differences between treatment-as-usual, physical activity and behavioral activation in salivary cortisol, as well as total scores on depression and anxiety, physical activity, self-efficacy, and social support. Significantly stronger effect sizes for physical activity group compared with behavioral activation group were found on physical activity (d = 0.53) (1 week after intervention), moderate activity (d = 0.61), and walking activity (d = 0.57) (3-month follow-up). CONCLUSIONS: Intelligent, wearable, device-based physical activity program is more effective in alleviating anxiety and depression, reducing saliva cortisol, and improving physical activity in AYACPs than internet-based modified behavioral activation program. Intelligent, wearable, device-based physical activity program can reduce the time cost of AYACPs to ensure that the intervention is carried out.
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Neoplasias , Distrés Psicológico , Humanos , Adolescente , Adulto Joven , Depresión , Hidrocortisona , Proyectos Piloto , Ejercicio Físico , Neoplasias/terapiaRESUMEN
Abstract Objective: To explore the clinical or sociodemographic predictors for both successful and failed extubation among Chinese extremely and very preterm infants Methods: A retrospective cohort study was carried out among extremely and very preterm infants born at less than 32 weeks of gestational age (GA). Results: Compared with the infants who experienced extubation failure, the successful infants had higher birth weight (OR 0.997; CI 0.996-0.998), higher GA (OR 0.582; 95% CI 0.499-0.678), a caesarean section delivery (OR 0.598; 95% CI 0.380-0.939), a higher five-minute Apgar score (OR 0.501; 95% CI 0.257-0.977), and a higher pH prior to extubation (OR 0.008; 95% CI 0.001-0.058). Failed extubation was associated with older mothers (OR 1.055; 95% CI 1.013-1.099), infants intubated in the delivery room (OR 2.820; 95% CI 1.742-4.563), a higher fraction of inspired oxygen (FiO2) prior to extubation (OR 5.246; 95% CI 2.540-10.835), higher partial pressure of carbon dioxide (PCO2) prior to extubation (OR 7.820; 95% CI 3.725-16.420), and higher amounts of lactic acid (OR 1.478;95% CI1.063-2.056). Conclusions: Higher GA, higher pre-extubation pH, lower pre-extubation FiO2 and PCO, and lower age at extubation are significant predictors of successful extubation among extremely and very preterm infants.
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Objectives: Psychoeducation, motivational interviewing, cognitive remediation training, and social skills training have been found to be effective interventions for patients with schizophrenia spectrum disorders. However, their efficacy on psychosocial functioning when provided in combination remains unclear, compared with all types of control conditions. It would also be meaningful to explore the differences of efficacy in patients with first-episode psychosis (FEP) and those with longer term of illness. Methodology: The present review followed the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Full-text English journal articles of randomized controlled trials published in the past decade in the databases of PubMed, CINAHL Complete, Embase, and PsycINFO were searched. Included studies were all randomized controlled trials (RCTs) with participants diagnosed with schizophrenia spectrum disorders. The included studies should test combined interventions with at least two components from: psychoeducation, motivational interviewing, cognitive remediation training, and social skills training and incorporate assessment of psychosocial functioning at least at baseline and post-intervention. Results: Seven studies were included for systematic review, and six of them were eligible for meta-analysis. Five out of the seven studies reported effects on psychosocial functioning that favored combined interventions over any type of control condition. A significant pooled effect was derived from the six studies, SMD = 1.03, 95% CI [0.06, 2.00], Z = 2.09, p = 0.04, I 2 = 96%. However, the pool effect became insignificant when synthesizing five of the studies with non-FEP patients as participants and four of the studies testing relative effects of combined interventions compared with stand-alone interventions/interventions with one less component. None of the included studies adopted motivational interviewing and only one of the studies worked with FEP patients. Conclusion: Psychoeducation, cognitive remediation training, and social skills training in combination can effectively enhance psychosocial functioning of patients with schizophrenia spectrum disorders. It is warranted to conduct more RCTs to test the effects of different specific combinations of the above interventions on psychosocial functioning, especially in FEP patients.
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Objective: Predictive models for the occurrence of cancer symptoms by using machine learning (ML) algorithms could be used to aid clinical decision-making in order to enhance the quality of cancer care. This study aimed to develop and validate a selection of classification models that used ML algorithms to predict the occurrence of breast cancer-related lymphedema (BCRL) among Chinese women. Methods: This was a retrospective cohort study of consecutive cases that had been diagnosed with breast cancer, stages I-IV. Forty-eight variables were grouped into five feature sets. Five classification models with ML algorithms were developed, and the models' performance and the variables' relative importance were assessed accordingly. Results: Of 370 eligible female participants, 91 had BCRL (24.6%). The mean age of this study sample was 49.89 (SD â= â7.45). All participants had had breast cancer surgery, and more than half of them had had a modified radical mastectomy (n â= â206, 55.5%). The mean follow-up time after breast cancer surgery was 28.73 months (SD â= â11.71). Most of the tumors were either stage I (n â= â49, 31.2%) or stage II (n â= â252, 68.1%). More than half of the sample had had postoperative chemotherapy (n â= â227, 61.4%). Overall, the logistic regression model achieved the best performance in terms of accuracy (91.6%), precision (82.1%), and recall (91.4%) for BCRL. Although this study included 48 predicting variables, we found that the five models required only 22 variables to achieve predictive performance. The most important variable was the number of positive lymph nodes, followed in descending order by the BCRL occurring on the same side as the surgery, a history of sentinel lymph node biopsy, a dietary preference for meat and fried food, and an exercise frequency of less than three times per week. These factors were the most influential predictors for enhancing the ML models' performance. Conclusions: This study found that in the ML training dataset, the multilayer perceptron model and the logistic regression model were the best discrimination models for predicting the outcome of BCRL, and the k-nearest neighbors and support vector machine models demonstrated good calibration performance in the ML validation dataset. Future research will need to use large-sample datasets to establish a more robust ML model for predicting BCRL deeply and reliably.