The effects of lockdown during the COVID-19 pandemic on fetal movement profiles.

PURPOSE: The current study investigated the direct impact of the COVID-19 lockdown on fetal movements, addressing a critical research gap. While previous research has predominantly examined the effects of lockdown on maternal health and postnatal outcomes, little attention has been paid to the direct consequences on fetal well-being as indicated by their movement profile. METHODS: We conducted analysis of movement profiles in 20 healthy fetuses during the COVID-19 pandemic lockdown (third national UK lockdown period between January and March 2021) and compared them with 20 healthy fetuses from pre-covid pregnancies, all at 32 weeks gestation. We controlled for maternal stress, depression, and anxiety. RESULTS: Pregnant mothers during pre-covid compared with those during the COVID-19 lockdown reported similar levels of stress (p = 0.47), depression (p = 0.15), and anxiety (p = 0.07). Their fetuses, however, differed in their movement profiles with mouth movement frequencies significantly higher during COVID-19 lockdown (COVID-19 lockdown: mean of 5.909) compared to pre-Covid pregnancies (mean of 3.308; p = 0.029). Furthermore, controlling for maternal anxiety a regression analysis indicated that frequency of fetal mouth movements (p = 0.017), upper face movements (p = 0.008), and touch movements (p = 0.031) were all significantly higher in fetuses observed during lockdown compared to fetuses before the Covid period. CONCLUSION: Fetuses show an effect of lockdown independent of maternal anxiety, stress, or depression. These findings contribute to our understanding of fetal development during extraordinary circumstances, raising questions about the potential effects of having to stay indoors during lockdowns.

Tailoring the phase composition of carbon-coated nickel sulfides to achieve a high specific capacitance.

As significant transition metal sulfides, nickel sulfides integrated with carbon were successfully synthesized in the presence of polyethylenimine and glutaraldehyde with a solvothermal route at 180 °C followed by carbonization. Glutaraldehyde prevented complete sulfur loss and allowed the formation of a mixed phase of nickel sulfide. The electrochemical performances of pure NiS2, NiS@C0, NiS2/NiS@C1, and NiS2/NiS@C2 electrodes were tested by a series of measurements. The specific capacitances obtained from GCD analysis were 698, 1160, 1484, and 908 F g-1 at 1 A g-1 for NiS2, NiS@C0, NiS2/NiS@C1, and NiS2/NiS@C2 electrodes, respectively. The results implied that the NiS2/NiS@C1 electrode possessed the highest specific capacitances and this study can be a good reference for the preparation of other hybrid metal sulfides as pseudocapacitive electrode materials.

Prenatal effects of maternal nutritional stress and mental health on the fetal movement profile.

PURPOSE: Prenatal sub-optimal nutrition and exposure to maternal stress, anxiety and depression in pregnancy have been linked to increased postnatal morbidity and mortality. Fetal growth is most vulnerable to maternal dietary deficiencies, such as those evident in hyperemesis gravidarum (HG), early in pregnancy. The purpose of this pilot study was to examine the effects of HG on fetal movement profiles as a measure of fetal healthy development in the 3rd trimester of pregnancy, and to assess whether nutritional stress on the mother can be evaluated using isotopic analysis of hair. METHOD: We analyzed fetal movement profiles using 4D ultrasound scans at 32- and 36-weeks' gestation. Fetuses of women (N = 6) diagnosed with HG, having lost more than 10% of their body weight in the first trimester of pregnancy were compared to a healthy group (N = 6), controlling for stress, depression and anxiety. We tested carbon and nitrogen isotope ratios in maternal hair as a measure of both diet and nutritional changes due to catabolism of body proteins and fats. RESULTS: HG and catabolism were significantly correlated (p = 0.02). Furthermore, at 32-weeks' gestation movement profiles of fetuses of mothers with HG differed significantly from the movement profiles of fetuses of healthy mothers. Fetuses of mothers suffering from HG showed a significantly increased ratio of fine-grained movements at 32 weeks (p = 0.008); however, there were no significant differences detectable at 36-weeks' gestation. CONCLUSION: The effect of HG on fetal development as expressed by variations in fetal movement profiles in this pilot study suggest that prenatal effects of HG can be measured using movement profiles. Isotope analysis of hair can supplement this with information on nutritional imbalances early in pregnancy.

Sedative-analgesic activity of remifentanil and effects of preoperative anxiety on perceived pain in outpatient mandibular third molar surgery.

The aim of this study was to assess the sedative-analgesic activity of different doses of remifentanil and effects of preoperative anxiety on intraoperative pain levels in patients attending a dental clinic. The patients (n=60) were divided into two groups according to the remifentanil infusion dose given: group R1: 0.05µg/kg/min; group R2: 0.1µg/kg/min. The following were evaluated: haemodynamic parameters, State-Trait Anxiety Inventory (STAI) TX-I score, pain level due to local anaesthesia injection, time to reach a Ramsay Sedation Scale (RSS) score of 3, amount of bolus dose, total drug consumption, recovery period, patient and surgeon satisfaction, and complications. The patient satisfaction score on a visual analogue scale (VAS) was 90 in group R1 and 100 in group R2 (P=0.008); the surgeon satisfaction score was 80 in group R1 and 90 in group R2 (P=0.004). The time to reach an RSS score of 3 and the amount of bolus dose were significantly lower in group R2 than in group R1. High levels of anxiety did not affect intraoperative pain levels. In conclusion, high doses of remifentanil can safely be used for various same-day dental surgery interventions.

A guide on how to develop an International Classification of Functioning, Disability and Health Core Set.

International Classification of Functioning, Disability and Health (ICF) Core Sets are purpose-tailored shortlists of ICF categories from the whole ICF classification for describing functioning and disability. Although the 34 ICF Core Sets developed up to now already cover many health conditions, there may still be a need to develop additional ICF Core Sets that tackle other health conditions and address other purposes. This paper provides a detailed description of the standard process for developing ICF Core Sets that will serve as a guide for future ICF Core Set development projects. ICF Core Sets are developed by means of a three-phase, multi-method scientific process. The process involves four preparatory studies - an empirical multicentre study, a systematic literature review, a qualitative study and an expert survey. The results of the preparatory studies serve as the starting point for a structured decision-making and consensus process at an international conference, during which participating experts decide on the ICF categories to be included in the Comprehensive and Brief ICF Core Sets. The first version of the ICF Core Set may necessitate modifications for specific applications and implementation in specific settings.

An analysis of two evidence-based parent training programmes and determination of the characteristics for a new programme model.

The Triple P and Incredible Years are the two best (well-known) parent programmes which cooperate with families and the society, reduce the risk factors and support the protective factors. The programmes also offer a multidisciplinary approach with high evidence standards, use randomized controlled studies and yield long-term results. Accordingly, this literature review was conducted in order to evaluate the efficacy of these two programmes, to determine the (similarities) and differences. 'MEDLINE, PUBMED, COCHRANE' databases, online and published journals and dissertations in Turkey were reviewed for the study. Consequently, results of 49 studies were presented, which were evaluated according to certain criteria such as samples, methods and results. The studies on the Triple P and the Incredible Years Parent Program illustrated a decrease in problematic behaviours of the children and negative parenting practices of parents following the implementation of programmes. However, the studies also pointed out the differences between the Triple P and the Incredible Years Parent Program. It is recommended that a new parent education programme be prepared and tested for our country in accordance with the results of the study.

Quantification of chondroitin sulfate and dermatan sulfate in danaparoid sodium by (1)H NMR spectroscopy and PLS regression.

Danaparoid sodium (the active pharmaceutical ingredient in Orgaran; Merck Sharp and Dohme) is a biopolymeric non-heparin drug used as anticoagulant and antithrombotic agent approved for the prophylaxis of post-operative deep-vein thrombosis, which may lead to pulmonary embolism in patients undergoing, e.g., elective hip replacement surgery. It consists of a mixture of three glycosaminoglycans (GAGs): heparan sulfate (HS), dermatan sulfate (DS), and chondroitin sulfate (CS). Currently, the CS and DS content are quantified by means of a time-consuming enzymatic method. In this paper the use of (1)H NMR in combination with multivariate regression (partial least-squares, PLS) is proposed as a new method. In order to evaluate the proposed method, a series of danaparoid sodium samples were analyzed and the results were compared with those obtained by the enzymatic method (reference method). The results showed that the proposed (1)H NMR method is a good alternative for analysis of CS and DS in danaparoid sodium. Accuracy of ±0.7% (w/w) and ±1.1% (w/w) for CS and DS was obtained by the (1)H NMR method and accuracy of ±1.0% (w/w) and ±1.3% (w/w) by the enzymatic method. Furthermore, the use of (1)H NMR in combination with PLS results in a fast quantification. The analysis time is reduced to 35 min per sample instead of 60 h for a maximum of 16 samples.

An RCT of coping and support groups to reduce burnout among nurses.

BACKGROUND: Burnout is a fundamental problem among nurses. Nurses need to be trained to reduce burnout. AIM: The aim of this study was to evaluate the effects of coping and support group interventions to reduce burnout among nurses. METHODS: A randomized controlled trial (RCT) was conducted at a University Hospital in Izmir, Turkey. Level of burnout was measured with Maslach Burnout Inventory before and after the intervention as well as in the following 6 months. A total of 108 nurses met the selection criteria and agreed to participate. To determine the effectiveness of the intervention, two-factor repeated-measures analysis of variance and paired t-test with Bonferroni correction were used when appropriate. All analyses were conducted on an intention-to-treat basis. RESULTS: Right after the intervention, there was an immediate reduction in emotional exhaustion dimension of burnout with respect to time. However, in 6 months, scores were increased again. No significant difference was noted between groups and from the point of group × time interaction. There was not any change in depersonalization and personal accomplishment dimensions of burnout after the intervention. CONCLUSION: By means of person-directed interventions, emotional exhaustion level can be decreased. The fact that burnout reduces after the intervention and an increase is observed in 6 months is an important result. Repetitive interventions can render the effect to be long lasting. It is recommended that the number of intervention studies to reduce burnout be increased and that long-term outcomes be observed.

Turkish nurses' perspectives on a programme to reduce burnout.

BACKGROUND: Burnout is a serious problem among nurses. Programmes to prevent and reduce burnout have been described, but nurses report that they have difficulty attending such programmes and the dropout rate is substantial. AIM: To investigate the perspectives of nurses on burnout and the barriers and facilitators affecting attendance at a burnout reduction programme offered in their institution. METHODS: A qualitative study using semi-structured interviews was conducted with 18 nurses who had volunteered to attend a burnout intervention programme at a University Hospital in Izmir, Turkey. Six of the nurses had not attended any sessions, six attended four or less of the seven and six attended all sessions. Data were analysed using thematic analysis. RESULTS: Nurses attributed burnout to their heavy workload and a lack of recognition for their work. Most stated that they need work-directed rather than person-directed interventions to reduce stress and burnout. Attendance at the intervention programme was impeded by such issues as a perceived lack of institution support and the possibility of being seen by other nurses as unable to cope with stress. CONCLUSION: Researchers planning burnout intervention programmes should consider ways of increasing cooperation between the administration and the staff that facilitate attendance at such programmes. A holistic approach involving work-directed and person-directed interventions is recommended.

ICF-based classification and measurement of functioning.

If we aim towards a comprehensive understanding of human functioning and the development of comprehensive programs to optimize functioning of individuals and populations we need to develop suitable measures. The approval of the International Classification, Disability and Health (ICF) in 2001 by the 54th World Health Assembly as the first universally shared model and classification of functioning, disability and health marks, therefore an important step in the development of measurement instruments and ultimately for our understanding of functioning, disability and health. The acceptance and use of the ICF as a reference framework and classification has been facilitated by its development in a worldwide, comprehensive consensus process and the increasing evidence regarding its validity. However, the broad acceptance and use of the ICF as a reference framework and classification will also depend on the resolution of conceptual and methodological challenges relevant for the classification and measurement of functioning. This paper therefore describes first how the ICF categories can serve as building blocks for the measurement of functioning and then the current state of the development of ICF based practical tools and international standards such as the ICF Core Sets. Finally it illustrates how to map the world of measures to the ICF and vice versa and the methodological principles relevant for the transformation of information obtained with a clinical test or a patient-oriented instrument to the ICF as well as the development of ICF-based clinical and self-reported measurement instruments.

Developing ICF Core Sets for persons with sleep disorders based on the International Classification of Functioning, Disability and Health.

BACKGROUND: With the International Classification of Functioning, Disability and Health (ICF), we can now rely on a globally agreed-upon framework and system for classifying the typical spectrum of problems in the functioning of persons given the environmental context in which they live. ICF Core Sets are subgroups of ICF items selected to capture those aspects of functioning that are most likely to be affected by sleep disorders. OBJECTIVE: The objective of this paper is to outline the developmental process for the ICF Core Sets for Sleep. METHODS: The ICF Core Sets for Sleep will be defined at an ICF Core Sets Consensus Conference, which will integrate evidence from preliminary studies, namely (a) a systematic literature review regarding the outcomes used in clinical trials and observational studies, (b) focus groups with people in different regions of the world who have sleep disorders, (c) an expert survey with the involvement of international clinical experts, and (d) a cross-sectional study of people with sleep disorders in different regions of the world. CONCLUSION: The ICF Core Sets for Sleep are being designed with the goal of providing useful standards for research, clinical practice and teaching. It is hypothesized that the ICF Core Sets for Sleep will stimulate research that leads to an improved understanding of functioning, disability, and health in sleep medicine. It is of further hope that such research will lead to interventions and accommodations that improve the restoration and maintenance of functioning and minimize disability among people with sleep disorders throughout the world.

Visualisation and interpretation of Support Vector Regression models.

This paper introduces a technique to visualise the information content of the kernel matrix and a way to interpret the ingredients of the Support Vector Regression (SVR) model. Recently, the use of Support Vector Machines (SVM) for solving classification (SVC) and regression (SVR) problems has increased substantially in the field of chemistry and chemometrics. This is mainly due to its high generalisation performance and its ability to model non-linear relationships in a unique and global manner. Modeling of non-linear relationships will be enabled by applying a kernel function. The kernel function transforms the input data, usually non-linearly related to the associated output property, into a high dimensional feature space where the non-linear relationship can be represented in a linear form. Usually, SVMs are applied as a black box technique. Hence, the model cannot be interpreted like, e.g., Partial Least Squares (PLS). For example, the PLS scores and loadings make it possible to visualise and understand the driving force behind the optimal PLS machinery. In this study, we have investigated the possibilities to visualise and interpret the SVM model. Here, we exclusively have focused on Support Vector Regression to demonstrate these visualisation and interpretation techniques. Our observations show that we are now able to turn a SVR black box model into a transparent and interpretable regression modeling technique.

The WHO Family of International Classifications.

The concept of the Family of International Classifications has been created to have a common framework and language to report, compile, use, and compare health information at the national and international level. The family brings together different health classifications dealing with various dimensions of health and health care so as to present a more comprehensive picture of health care. The family of classifications in health consists of reference classifications, derived ones and related ones. The reference classifications cover the areas of death and disease, disability and health interventions. Other members cover fields like drugs, causes of injury and reasons for encounter. These classifications represent the building blocks of health information in order to be able to provide the best possible health to all people.

Combinative dyebath treatment with activated carbon and UV/H2O2: a case study on Everzol Black-GSP.

Treatability of textile dyebath effluents by two simultaneously operated processes comprising adsorption and advanced oxidation was investigated using a reactive dyestuff, Everzol Black-GSP (EBG). The method was comprised of contacting aqueous solutions of the dye with hydrogen peroxide and granules of activated carbon (GAC) during irradiation of the reactor with ultraviolet light (UV). Control experiments were run separately with each individual process (advanced oxidation with UV/H2O2 and adsorption on GAC) to select the operating parameters on the basis of maximum color removal. The effectiveness of the combined scheme was tested by monitoring the rate of decolorization and the degree of carbon mineralization in effluent samples. It was found that in a combined medium of advanced oxidation and adsorption, color was principally removed by oxidative degradation, while adsorption contributed to the longer process of dye mineralization. Economic evaluation of the system based on total color removal and 50% mineralization showed that in the case of Everzol Black-GSP, which adsorbs relatively poorly on GAC, the proposed combination provides 25% and 35% reduction in hydrogen peroxide and energy consumption relative to the UV/H2O2 system. Higher cost reductions are expected in cases with well adsorbing dyes and/or with less costly adsorbents.

The stability of the factor structure of the General Health Questionnaire.

BACKGROUND: Different versions of the General Health Questionnaire (GHQ), including the GHQ-12 and GHQ-28 have been subjected to factor analysis in a variety of countries. The World Health Organization study of psychological disorders in general health care offered the opportunity to investigate the factor structure of both GHQ versions in 15 different centres. METHODS: The factor structures of the GHQ-12 and GHQ-28 extracted by principal component analysis were compared in participating centres. The GHQ-12 was completed by 26,120 patients and 5,273 patients completed the GHQ-28. The factor structure of the GHQ-28 found in Manchester in this study was compared with that found in the earlier study in 1979. RESULTS: For the GHQ-12, substantial factor variation between centres was found. After rotation, two factors expressing depression and social dysfunction could be identified. For the GHQ-28, factor variance was less. In general, the original C (social dysfunction) and D (depression) scales of the GHQ-28 were more stable than the A (somatic symptoms) and B (anxiety) scales. Multiple cross-loadings occurred in both versions of the GHQ suggesting correlation of the extracted factors. In Manchester, the factor structure of the GHQ had changed since its development. Validity as a case detector was not affected by factor variance. CONCLUSIONS: These findings confirm that despite factor variation for the GHQ-12, two domains, depression and social dysfunction, appear across the 15 centres. In the scaled GHQ-28, two of the scales were remarkably robust between the centres. The cross-correlation between the other two subscales, probably reflects the strength of the relationship between anxiety and somatic symptoms existing in different locations.

Lifetime panic-depression comorbidity in the National Comorbidity Survey. Association with symptoms, impairment, course and help-seeking.

BACKGROUND: Most prior studies of panic-depression comorbidity have been limited methodologically by use of small clinical samples and incomplete analyses. AIMS: General population data were used to study the association of lifetime and recent (12 months) panic-depression comorbidity with symptom severity, impairment, course and help-seeking in the National Comorbidity Survey (NCS). METHOD: The NCS is a nationally representative survey of the prevalences and correlates of major DSM-III-R disorders in the US household population. RESULTS: Strong lifetime and current comorbidity were found between panic and depression. Comorbidity was associated with greater symptom severity, persistence, role impairment, suicidality and help-seeking, with many findings persisting after controlling for additional comorbid diagnoses. Findings did not differ according to which disorder was chronologically primary. CONCLUSIONS: Both lifetime and current panic-depression comorbidity are markers for more severe, persistent and disabling illness. Neither additional comorbid diagnoses nor the primary-secondary distinction were important moderators of these associations.

Mental, physical and functional status in primary care attenders.

OBJECTIVE: The purpose of the present study was to analyze the association, in primary care attenders, between psychiatric disorders, medical comorbidity, and impairment in mental and physical function status. METHODS: The study had a two-stage design. The GHQ-12 was used to screen 1647 patients, and 323 of them were then interviewed using the CIDI-PHC to obtain ICD-10 diagnoses. Severity of mental illness was assessed using the Hamilton scales for anxiety and depression. The DUSOI was used to evaluate the severity of physical illness. The MOS SF-36 was used to assess health related quality of life. RESULTS: The estimated prevalence of ICD-10 psychiatric disorders and subthreshold disorders was 12.4 percent and 18 percent respectively. The most common psychiatric disorders were generalized anxiety, major depression, and neurasthenia. The severity of physical illness did not vary across diagnostic status categories. Significant impairment, both in physical and mental functioning was seen in patients suffering from ICD-10 full-fledged and subthreshold disorders. Severity of impairment increased from sub-threshold cases to full-fledged cases, and among the latter according to the severity of depressive and anxious symptoms, assessed using Hamilton scales. The most frequent psychiatric disorders were associated with significant worsening in health related quality of life, with relevant differences between psychiatric diagnoses regarding the domains affected. Impairment associated with mental disorders was greater than that associated with physical illness. CONCLUSIONS: The results of the present study confirm that ICD-10 psychiatric disorders are common in general practice and are associated with relevant impairment in physical and mental functional status. Psychiatric morbidity is not related to severity of physical illness rated by general practitioner.

Typologies of anxiety, depression and somatization symptoms among primary care attenders with no formal mental disorder.

BACKGROUND: Typologies of anxiety, depression and somatization symptoms were investigated in individuals with no formal mental disorders, making no a priori assumptions about symptom distribution and inter-relationship. METHOD: The subjects were 1617 adult primary care attenders from the WHO Collaborative Project on Psychological Problems in General Health Care, with at least three symptoms of anxiety, depression and/or somatization, but with no formal ICD-10 disorders. Analyses were based on the grade of membership model, a multivariate statistical procedure exploring indistinct boundaries between disease categories and preserving the heterogeneity of clinical picture within each category. RESULTS: Six prototype categories (or pure types) best described the structure of symptoms included in analyses. Pure type I included the full set of somatization symptoms. Pure type II was characterized by most anxiety and depression symptoms. Pure type III resembled generalized anxiety disorder. Pure type IV consisted of individuals reporting sporadic symptoms of anxiety, depression or somatization. Pure type V defined individuals with sleep problems. Finally, pure type VI was characterized by anxiety symptoms, including panic-like symptoms. CONCLUSIONS: These findings provide support to the existence of a mixed anxiety-depression category crossing the diagnostic boundaries of current anxiety and depression disorders. Moreover, criteria of anxiety and somatization disorders may be re-examined to assess whether lower diagnostic thresholds can be identified that both preserve the symptom profile and clinical features of current diagnostic categories and allow for a better characterization of individuals with substantial psychopathology though not meeting the high symptom thresholds required for a diagnosis of formal mental disorders.