La teoría de las transiciones como paradigma de apoyo al automanejo en personas con condiciones crónicas / Transitions theory as a paradigm for supporting self-management in people with chronic conditions / A teoria das transições como paradigma para apoiar a autogestão em pessoas com condições crónicas

Resumen Introducción: La experiencia de vivir con una enfermedad crónica no es una tarea sencilla, se requiere de herramientas que permitan aumentar el grado de conciencia para enfrentar las necesidades y superar desafíos sobre el estado de salud y enfermedad. En los últimos años, se ha instaurado el apoyo al automanejo, con la finalidad de potenciar las habilidades en personas con este tipo de afecciones. Resulta trascendental considerar como desde enfermería se puede contribuir al logro de aquello. El objetivo del presente ensayo es reflexionar acerca de la teoría de las transiciones de Meléis como paradigma de apoyo al automanejo en personas con condiciones crónicas. Desarrollo: La teoría de las transiciones de Meléis establece que las personas están en constante cambio, tal como ocurre en el proceso de transición de salud-enfermedad. Recibir el diagnóstico de una enfermedad crónica, conlleva una serie de procesos complejos para la persona, debido a la multiplicidad de variables que ello implica. La teoría de Meléis entrega lineamientos para orientar a la persona profesional de enfermería sobre elementos claves e interrelacionados, como la concepción previa de la naturaleza de la transición y sus condiciones, lo que servirá para la planificación de modalidades de intervención congruentes con las experiencias de la persona y su evaluación en el transcurso del proceso de salud y enfermedad. Conclusión: El paradigma ofrecido por Meléis puede ser considerado un enfoque clave para emprender el proceso de cuidado de enfermería tendiente a apoyar a las personas con enfermedad crónica en el logro del automanejo.

Abstract Introduction: The experience of living with a chronic disease is not a simple task, since it requires tools that allow increasing the degree of awareness to face the needs and overcome challenges about the state of health and disease. In recent years, support for self-management has been established, with the aim of enhancing the skills of people with this type of condition. It is important to consider how the nursing discipline can contribute to achieve this. The aim of this paper is to reflect on Meléis' theory of transitions as a paradigm to support self-management in people with chronic conditions. Development: Meléis' theory of transitions establishes that people are in constant change, as occurs in the health-illness transition process. Receiving the diagnosis of a chronic disease involves a series of complex processes for the person, due to the multiplicity of variables involved. Meléis' theory provides guidelines to orient the nursing professional on key and interrelated elements, such as the previous conception of the nature of the transition and its conditions, which will serve for the planning of intervention modalities congruent with the person's experiences and their evaluation in the course of the health and disease process. Conclusion: The paradigm offered by Meléis can be considered a key approach to undertake the nursing care process aimed at supporting people with chronic illness in achieving self-management.

Resumo Introdução: A experiênca de viver com uma doença crônica não é uma tarefa simple, pois requer ferramentas que permitam aumentar o nível de consciência para enfrentar as necessidades e superar desafios relativos ao estado de saúde e doença. Nos últimos anos, foi estabelecido o apoio à autogestão, com o objetivo de melhorar as habilidades das pessoas com este tipo de condições. É transcendental considerar como a disciplina de Enfermagem pode contribuir para isso. O objetivo deste ensaio é refletir sobre a teoria das transições de Meleis como paradigma de apoio à autogestão em pessoas com condições crônicas. Desenvolvimento: A teoria das transições de Meléis estabelece que as pessoas estão em constante mudança, como acontece no processo de transição saúde-doença. Receber o diagnóstico de uma doença crónica implica uma série de processos complexos para a pessoa, devido à multiplicidade de variáveis envolvidas. A teoria de Meléis fornece directrizes para orientar o profissional de enfermagem sobre elementos-chave e inter-relacionados, como a conceção prévia da natureza da transição e das suas condições, que servirão para o planeamento de modalidades de intervenção congruentes com as experiências da pessoa e a sua avaliação no decurso do processo saúde-doença. Conclusão: O paradigma oferecido por Meleis pode ser considerado uma abordagem chave para empreender o processo de cuidado de enfermagem que visa apoiar as pessoas com doenças crônicas no alcance do autogerenciamento.

Strategies that enabled access to chronic care during the COVID-19 pandemic and beyond in South Africa.

Background: The COVID-19 epidemic has revealed disturbing information about how chronic diseases are treated globally. Healthcare providers and coronavirus response teams have primarily reported on how individuals with chronic conditions sought care and treatment. However, individuals' experiences of patients are yet unknown. Aim: This study aimed to explore those strategies that enabled patients with chronic diseases access to chronic care and treatment during and beyond the COVID-19 pandemic. Setting: The study was conducted in the predominantly rural district of the Northwest Province, South Africa. Methods: An explorative qualitative research design was followed. Information-rich participants were chosen using a purposive sampling technique. Individual face-to-face interviews were used to gather data. Data saturation was achieved after interviewing n = 28 people in total. The six steps of Braun and Clarke thematic data analysis were used to analyse the data. Results: The study revealed three themes, which includes improved healthcare structural systems, shift from traditional chronic care to digital care services and medication refill and buddy system. Conclusion: The findings of this study revealed a range of effective and noteworthy approaches that facilitated access to treatment and continuity of care. As a result, enhancing telemedicine as well as structural systems such as appointment scheduling, decanting choices, mobile and medication home delivery can improve access to care and treatment. Contribution: The burden of disease and avoidable death will be eventually addressed by maximising the use of telemedicine and sustaining the new norm of ongoing care through digital and remote care and decanting strategies.

Chronic diseases and illness in schools: Teachers' confidence in helping students with intellectual disabilities.

Background: With movement to educate students with intellectual disabilities in special and mainstream schools, a considerable number of students with intellectual disabilities have common chronic diseases such as epilepsy and diabetes. In addition, these students may also face common illnesses, which occur in all students, such as fevers and headaches. Teachers are responsible for their students and provide first aid when needed. Therefore, this study aimed to determine whether teachers are confident in their ability to provide help when symptoms related to chronic diseases and illnesses occur. Methods: In this cross-sectional study, questionnaires were sent to 300 male and female teachers of students with intellectual disabilities in Riyadh, Saudi Arabia. Results: The findings illustrate that, in general, teachers have little confidence in helping students with chronic diseases and illnesses. Although the teachers felt that they were less confident in dealing with some symptoms of illnesses and chronic diseases, there were some symptoms that they showed either strong or low confidence in dealing with. Conclusion: The recommendations include increasing teachers' confidence in providing first aid.

The cost-effectiveness of school-based interventions for chronic diseases: a systematic review.

BACKGROUND: Chronic diseases, or non-communicable diseases (NCD), are conditions of long duration and often influenced and contributed by complex interactions of several variables, including genetic, physiological, environmental, and behavioral factors. These conditions contribute to death, disability, and subsequent health care costs. Primary and secondary school settings provide an opportunity to deliver relatively low cost and effective interventions to improve public health outcomes. However, there lacks systematic evidence on the cost-effectiveness of these interventions. METHODS: We systematically searched four databases (PubMed/Medline, Cochrane, Embase, and Web of Science) for published studies on the cost-effectiveness of chronic-disease interventions in school settings. Studies were eligible for inclusion if they assessed interventions of any chronic or non-communicable disease, were conducted in a school setting, undertook a full cost-effectiveness analysis and were available in English, Spanish, or French. RESULTS: Our review identified 1029 articles during our initial search of the databases, and after screening, 33 studies were included in our final analysis. The most used effectiveness outcome measures were summary effectiveness units such as quality-adjusted life years (QALYs) (22 articles; 67%) or disability-adjusted life years (DALYs) (4 articles; 12%). The most common health condition for which an intervention targets is overweight and obesity. Almost all school-based interventions were found to be cost-effective (30 articles; 81%). CONCLUSION: Our review found evidence to support a number of cost-effective school-based interventions targeting NCDs focused on vaccination, routine physical activity, and supplement delivery interventions. Conversely, many classroom-based cognitive behavioral therapy for mental health and certain multi-component interventions for obesity were not found to be cost-effective.

Deciphering Ferroptosis: From Molecular Pathways to Machine Learning-Guided Therapeutic Innovation.

Ferroptosis is a unique form of cell death reliant on iron and lipid peroxidation. It disrupts redox balance, causing cell death by damaging the plasma membrane, with inducers acting through enzymatic pathways or transport systems. In cancer treatment, suppressing ferroptosis or circumventing it holds significant promise. Beyond cancer, ferroptosis affects aging, organs, metabolism, and nervous system. Understanding ferroptosis mechanisms holds promise for uncovering novel therapeutic strategies across a spectrum of diseases. However, detection and regulation of this regulated cell death are still mired with challenges. The dearth of cell, tissue, or organ-specific biomarkers muted the pharmacological use of ferroptosis. This review covers recent studies on ferroptosis, detailing its properties, key genes, metabolic pathways, and regulatory networks, emphasizing the interaction between cellular signaling and ferroptotic cell death. It also summarizes recent findings on ferroptosis inducers, inhibitors, and regulators, highlighting their potential therapeutic applications across diseases. The review addresses challenges in utilizing ferroptosis therapeutically and explores the use of machine learning to uncover complex patterns in ferroptosis-related data, aiding in the discovery of biomarkers, predictive models, and therapeutic targets. Finally, it discusses emerging research areas and the importance of continued investigation to harness the full therapeutic potential of targeting ferroptosis.

Dietary Behavior and Determinants of Diet Quality among Primary Health Care Patients in Poland.

BACKGROUND: The aim of the present research was to determine the factors influencing the prevalence of eating behaviors, diet quality, and unhealthy eating among primary healthcare patients in Poland. METHODS: The cross-sectional study included 896 adult primary care patients in Lódz. The study was conducted from January 2020 to December 2021 among thirty-four primary healthcare facilities. A survey recorded the sociodemographic data of the respondents as well as data regarding their health condition and diet. RESULTS: The majority of the respondents (57.6%) had average dietary habits, while 40% had unhealthy eating habits. The univariable logistic regression found that primary care patients with medium/secondary education had a 1.5 times greater risk of unhealthy eating habits, and those with post-secondary vocational education had a 1.75 times greater risk of unhealthy eating habits than those with higher education (OR = 1.46; 95% CI: 1.08-1.97, p ≤ 0.01, and OR = 1.75; 95% CI: 1.04-2.94, p ≤ 0.05). The multivariable logistic regression confirmed that the level of education had a significant impact on dietary habits: for medium/secondary education, OR = 1.40; 95% CI: 1.03-1.91 (p ≤ 0.01); for post-secondary vocational education, OR = 1.69; 95% CI: 1.0-2.85 (p ≤ 0.05). CONCLUSIONS: The education level was significantly correlated with the prevalence of unhealthy eating behaviors in the studied population. This factor should be considered in the promotion of healthy eating behaviors and nutritional counseling interventions conducted by family physicians in primary health care.

Gestational diabetes mellitus is associated with greater incidence of dementia during long-term post-partum follow-up.

BACKGROUND: The impact of gestational diabetes mellitus (GDM) on incident dementia is unknown. Our aim was to evaluate the relationship between GDM and all-cause dementia and the mediating effects of chronic diseases on this relationship. METHODS: This prospective cohort study included women from the UK Biobank who were grouped based on GDM history. Multivariate Cox proportional hazard models were used to explore the associations between GDM and dementia. We further analysed the mediating effects of chronic diseases on this relationship and the interactions of covariates. RESULTS: A total of 1292 women with and 204,171 women without a history of GDM were included. During a median follow-up period of 45 years after first birth, 2921 women were diagnosed with dementia. Women with a GDM history had a 67% increased risk of incident dementia (hazard ratio 1.67, 95% confidence interval: 1.03-2.69) compared with those without a GDM history. According to mediation analyses, type 2 diabetes, coronary heart disease, chronic kidney disease and comorbidities (diagnosed with any two of the three diseases) explained 34.5%, 8.4%, 5.2% and 18.8% of the mediating effect on the relationship. Subgroup analyses revealed that physical activity modified the association between GDM history and dementia (p for interaction = 0.030). Among physically inactive women, GDM was significantly associated with incident dementia; however, this association was not observed among physically active women. CONCLUSIONS: A history of GDM was associated with a greater risk of incident dementia. Type 2 diabetes partially mediated this relationship. Strategies for dementia prevention might be considered for women with a history of GDM.

Examination of Primary and Secondary Metabolites Associated with a Plant-Based Diet and Their Impact on Human Health.

The consumption of plant-based diets has become a burgeoning trend, and they are increasingly consumed globally owing to their substantial energy intensity and dietetic advantages. Plants possess numerous bioactive components that have been recognized to exhibit manifold health-promoting assets. Comprehension of the synthesis of these primary and secondary metabolites by plants and their method of action against several chronic illnesses is a significant requirement for understanding their benefits to human health and disease prevention. Furthermore, the association of biologically active complexes with plants, humans, disease, medicine, and the underlying mechanisms is unexplored. Therefore, this review portrays various bioactive components derived from plant sources associated with health-promoting traits and their action mechanisms. This review paper predominantly assembles proposed plant-derived bioactive compounds, postulating valuable evidence aimed at perceiving forthcoming approaches, including the selection of potent bioactive components for formulating functional diets that are effective against several human disorders. This meticulous evidence could perhaps provide the basis for the advanced preemptive and therapeutic potential promoting human health. Hence, delivery opens possibilities for purchasers to approach the lucrative practice of plants as a remedy, produce novel products, and access new marketplaces.

Four modeling approaches to study restrictions on everyday life and social activities due to chronic diseases with consequences of suicidal behavior.

The purpose of this study was to discover the association between disability in everyday life and social activities due to chronic diseases and suicidal ideation (SI), suicidal plan (SP), and suicidal attempt (SA) from the Korea National Health and Nutrition Examination Survey (KNHANES), considering the cross-sectional design of this study, 2016-2018 dataset. Variables for finding the associated factors of SI, SP, and SA were confirmed through random forest (RF), decision tree, generalized linear model (GLM), and support vector machine (SVM), and the performance of each model is listed. A total of 17,323 (males: 7,530, females: 9793) responders from the KNHANES from 2016 to 2018 were employed for the study. The relationship between restrictions on daily life, social activities, and three stages of suicidal behaviors due to diseases were analyzed using the R function (R version 4.2.0), randomForest, ctree, glm, and ksvm. The F1-score is a measure used to evaluate the accuracy of the performance of a model, in the binary classification. The score of 1 indicates good performance, whereas a score of 0 signifies poor performance. Due to chronic diseases, disability in everyday life and social activities lead to suicide behaviors. In our study, we examined the impact of limitations in daily living and social activities on suicidal behaviors among participants. Our findings revealed that for those experiencing such limitations, the odds ratios (ORs) for SIs were 6.10 (95% CI: 3.99-9.34) for males and 2.61 (1.79-3.81) for females. SPs were 3.69 (2.36-5.78) for males and 3.94 (2.70-5.75) for females. Similarly, the odds ratios for SAs were 5.04 (2.51-10.13) for males and 2.71 (1.48-4.98) for females, indicating a significant association between these limitations and increased suicidal behaviors, with variances observed between genders. These results underscore the necessity of addressing daily living and social activity restrictions when considering mental health interventions and suicide prevention strategies. In RF, GLM, and SVM, F1-score were 0.8192, 0.6887, and 0.9687 in SA, respectively. Among the patients with chronic disease, those with sequelae, low incomes, and low levels of education had limitations in daily activities and social activities, which increased the likelihood of suicidal thoughts, planning, and attempts.

Nimbolide: promising agent for prevention and treatment of chronic diseases (recent update).

Background: Nimbolide, a bioactive compound derived from the neem tree, has garnered attention as a potential breakthrough in the prevention and treatment of chronic diseases. Recent updates in research highlight its multifaceted pharmacological properties, demonstrating anti-inflammatory, antioxidant, and anticancer effects. With a rich history in traditional medicine, nimbolide efficacy in addressing the molecular complexities of conditions such as cardiovascular diseases, diabetes, and cancer positions it as a promising candidate for further exploration. As studies progress, the recent update underscores the growing optimism surrounding nimbolide as a valuable tool in the ongoing pursuit of innovative therapeutic strategies for chronic diseases. Methods: The comprehensive search of the literature was done until September 2020 on the MEDLINE, Embase, Scopus and Web of Knowledge databases. Results: Most studies have shown the Nimbolide is one of the most potent limonoids derived from the flowers and leaves of neem (Azadirachta indica), which is widely used to treat a variety of human diseases. In chronic diseases, nimbolide reported to modulate the key signaling pathways, such as Mitogen-activated protein kinases (MAPKs), Wingless-related integration site-ß (Wnt-ß)/catenin, NF-κB, PI3K/AKT, and signaling molecules, such as transforming growth factor (TGF-ß), Matrix metalloproteinases (MMPs), Vascular Endothelial Growth Factor (VEGF), inflammatory cytokines, and epithelial-mesenchymal transition (EMT) proteins. Nimbolide has anti-inflammatory, anti-microbial, and anti-cancer properties, which make it an intriguing compound for research. Nimbolide demonstrated therapeutic potential for osteoarthritis, rheumatoid arthritis, cardiovascular, inflammation and cancer. Conclusion: The current review mainly focused on understanding the molecular mechanisms underlying the therapecutic effects of nimbolide in chronic diseases.

Association between the decrease in medical visit frequency and chronic disease worsening in the early stages of COVID-19-A longitudinal study.

BACKGROUND: This longitudinal study aimed to clarify the changes in the medical treatment behavior of Japanese patients with chronic diseases during the early phase of the COVID-19 pandemic and examine the factors associated with disease worsening. METHODS: Subjects with chronic diseases were selected from a panel survey that started at the beginning of the COVID-19 pandemic consists of 2,400 participants recruited via the Internet. Medical treatment behaviors (decrease in medical visit frequency, inability to take regular medications, and utilization of telephone/online medical care), psychological distress, and sociodemographic factors were evaluated at baseline (May 2020) and at the follow-up survey (February 2021). A worsening of chronic diseases was defined as those who answered yes to the question, "Has-the-condition-of-the-chronic-disease-worsened?". The factors related to the worsening of chronic diseases at follow-up were examined. RESULTS: A total of 514 participants (mean age 61.6±12.9 years) were analyzed. The percentage of participants who reported decreasing medical visit frequency was 34% at the baseline and 16.5% at follow-up, and those who reported a worsening of chronic diseases was 5.1% and 5.1%, respectively. A worsening of chronic diseases at follow-up was significantly associated with a younger age, a decreased frequency of medical visits, unemployment, a history of smoking, and psychological distress. CONCLUSIONS: A decreased frequency of medical visits was observed among one-third of the participants with chronic disease in the early stage of the pandemic, and it reduced by half at follow-up. In the early stages of an emerging infectious disease pandemic, decreased regular hospital/clinic visits can lead to a worsening of chronic diseases. Those who had psychological distress, unemployment, and a history of smoking were vulnerable to a worsening chronic disease.

The awareness rate of knowledge of chronic diseases and influencing factors among 4790 adults in anhui province: An online survey using WeChat.

Objective: To investigate public awareness about core information regarding chronic diseases and identify factors influencing that awareness among Anhui Province residents, provide a scientific basis for policy-making, and formulate corresponding intervention measures. Methods: From March to April 2021, 12 provincial-level representative counties and districts of Anhui province in the China Adult Chronic Disease and Nutrition Surveillance were selected as survey sites, and 4790 residents were recruited for the survey using stratified multi-stage cluster random sampling. Basic details about the study participants were collected and their awareness of core information about major chronic diseases was measured through an online survey using WeChat. Results: In 2021, the awareness rate of core information about chronic diseases among residents of Anhui Province was 54.93%. Multivariate logistic regression analysis showed that a higher awareness rate was associated with the following factors: non-housework occupations (agriculture, forestry, animal husbandry, and fishery: OR = 1.309, commercial services and production and transportation: OR = 1.450, institutions, and professional and technical personnel: OR = 1.461), a high education level (high school/junior high school/technical school OR = 1.357, college and above OR = 2.133), and residence in the southern and northern Anhui areas (southern Anhui OR = 1.282, northern Anhui OR = 1.431); whereas in rural areas (by district and country) (OR = 0.863), the awareness rate was low (all P < 0.05). Conclusions: The awareness rate of core information about chronic diseases among residents of Anhui, China, is low. It is necessary to strengthen awareness about chronic disease prevention and management by targeting specific groups of people in this region.

The association between intensity-specific physical activity and the number of multiple chronic diseases among Chinese elderly: A study based on the China Health and Retirement Longitudinal study (CHARLS).

Background: With ageing, the elderly are facing a complex situation where multiple chronic diseases coexist. This paper aims to investigate the effect of intensity-specific physical activity on the number of multiple chronic diseases in the elderly. Methods: Our data came from wave 4 of the China Health and Retirement Longitudinal Survey (CHARLS), which involved 10,341 residents aged ≥ 60 years. The intensity-specific physical activity was divided into two categories: moderate-intensity physical activity (MPA) lasting ≥ 150 min/week and vigorous-intensity physical activity (VPA) lasting ≥ 75 min/week. Data on 14 types of chronic diseases were collected. Propensity score matching (PSM) with controlling nine confounding factors were used to analyse the effects of intensity-specific physical activity. Results: Among 10,341 samples, 40.12% of the elderly often participated in MPA and 25.72% participated in VPA. The PSM results showed that performing 150 min/week of MPA leads to 0.0675(P<0.05) fewer multiple chronic diseases than not achieving this standard, and VPA up to 75 min/week leads to 0.0785(P<0.05) fewer multiple chronic disease than that does not meet this criterion. Additionally, VPA is more effective than MPA. Conclusion: Both MPA of at least 150 min/week and VPA of at least 75 min/week can significantly reduce the number of multiple chronic diseases in elderly. Elderly people should increase their exercise intensity as much as possible while ensuring safety.

[Chronic communicable and non-communicable pathology and skin pathology of the migrant patient]. / Enfermedad crónica transmisible y no transmisible, y enfermedad cutánea del paciente migrante.

The care of migrant patients includes initial screening and lifelong monitoring, highlighting the importance of preventing and tracking chronic, communicable and non-communicable diseases. The prevalence of hypertension, diabetes mellitus, dyslipidemia, and obesity varies by ethnicity, influenced by genetic factors, lifestyle, and socio-economic status. Preventive measures, health promotion, and risk factor identification are crucial. Chronic communicable diseases may manifest years after transmission, underscoring the necessity of primary care screening, especially for populations from endemic or high-risk areas. Imported skin lesions are a common reason for consultation among migrant and traveller patients. Their ethiology is varied, ranging from common conditions such as scabies, mycoses, and urticaria to tropical dermatoses like filariasis and leprosy.

Harmful Free Radicals in Aging: A Narrative Review of Their Detrimental Effects on Health.

The production of harmful free radicals (H-FRs), especially those with oxygen or nitrogen atoms, depends on both internal and environmental causes. The negative effects of H-FRs are greatly alleviated by antioxidant protection. The harmful impact of oxidative stress, or OS, is brought on by a disparity between the defense mechanisms of the body and the creation of H-FRs. Aging is characterized by a slow decline in tissue and organ competence. Age-mediated pathologies start as an aberrant accumulation of H-FRs, which inhibit cells' capacity to divide, repair, and operate, based on the OS theorem of aging. The natural outcome of this situation is apoptosis. These conditions may include skeletal muscle dysfunction, cancer, cardiovascular, chronic hepatitis, chronic renal, and chronic pulmonary disorders. Given the substantial role that OS plays in the progression of many of these illnesses, antioxidant-based therapy may have a favorable impact on how these diseases progress. To ascertain the true efficacy of this therapy strategy, more research is necessary. The aim of this study is to provide an overview of the literature on this challenging issue that is attracting interest.

Machine Learning-Based Prediction of Changes in the Clinical Condition of Patients With Complex Chronic Diseases: 2-Phase Pilot Prospective Single-Center Observational Study.

BACKGROUND: Functional impairment is one of the most decisive prognostic factors in patients with complex chronic diseases. A more significant functional impairment indicates that the disease is progressing, which requires implementing diagnostic and therapeutic actions that stop the exacerbation of the disease. OBJECTIVE: This study aimed to predict alterations in the clinical condition of patients with complex chronic diseases by predicting the Barthel Index (BI), to assess their clinical and functional status using an artificial intelligence model and data collected through an internet of things mobility device. METHODS: A 2-phase pilot prospective single-center observational study was designed. During both phases, patients were recruited, and a wearable activity tracker was allocated to gather physical activity data. Patients were categorized into class A (BI≤20; total dependence), class B (2060; moderate or mild dependence, or independent). Data preprocessing and machine learning techniques were used to analyze mobility data. A decision tree was used to achieve a robust and interpretable model. To assess the quality of the predictions, several metrics including the mean absolute error, median absolute error, and root mean squared error were considered. Statistical analysis was performed using SPSS and Python for the machine learning modeling. RESULTS: Overall, 90 patients with complex chronic diseases were included: 50 during phase 1 (class A: n=10; class B: n=20; and class C: n=20) and 40 during phase 2 (class B: n=20 and class C: n=20). Most patients (n=85, 94%) had a caregiver. The mean value of the BI was 58.31 (SD 24.5). Concerning mobility aids, 60% (n=52) of patients required no aids, whereas the others required walkers (n=18, 20%), wheelchairs (n=15, 17%), canes (n=4, 7%), and crutches (n=1, 1%). Regarding clinical complexity, 85% (n=76) met patient with polypathology criteria with a mean of 2.7 (SD 1.25) categories, 69% (n=61) met the frailty criteria, and 21% (n=19) met the patients with complex chronic diseases criteria. The most characteristic symptoms were dyspnea (n=73, 82%), chronic pain (n=63, 70%), asthenia (n=62, 68%), and anxiety (n=41, 46%). Polypharmacy was presented in 87% (n=78) of patients. The most important variables for predicting the BI were identified as the maximum step count during evening and morning periods and the absence of a mobility device. The model exhibited consistency in the median prediction error with a median absolute error close to 5 in the training, validation, and production-like test sets. The model accuracy for identifying the BI class was 91%, 88%, and 90% in the training, validation, and test sets, respectively. CONCLUSIONS: Using commercially available mobility recording devices makes it possible to identify different mobility patterns and relate them to functional capacity in patients with polypathology according to the BI without using clinical parameters.

Development of a person-centred care approach for persons with chronic multimorbidity in general practice by means of participatory action research.

BACKGROUND: The management of persons with multimorbidity challenges healthcare systems tailored to individual diseases. A person-centred care approach is advocated, in particular for persons with multimorbidity. The aim of this study was to describe the co-creation and piloting of a proactive, person-centred chronic care approach for persons with multimorbidity in general practice, including facilitators and challenges for successful implementation. METHODS: A participatory action research (PAR) approach was applied in 13 general practices employing four subsequent co-creation cycles between 2019 and 2021. The target population included adults with ≥3 chronic conditions. Participating actors were general practitioners (GPs), practice nurses (PNs), patients (target group), the affiliated care cooperation, representatives of a health insurer and researchers. Each cycle consisted of a try-out period in practice and a reflective evaluation through focus groups with healthcare providers, interviews with patients and analyses of routine care data. In each cycle, facilitators, challenges and follow-up actions for the next cycle were identified. Work satisfaction among GPs and PNs was measured pre and at the end of the final co-creation cycle. RESULTS: Identified essential steps in the person-centred chronic care approach include (1) appropriate patient selection for (2) an extended person-centred consultation, and (3) personalised goalsetting and follow-up. Key facilitators included improved therapeutic relationships, enhanced work satisfaction for care providers, and patient appreciation of extended time with their GP. Deliberate task division and collaboration between GPs and PNs based on patient, local setting, and care personnel is required. Challenges and facilitators for implementation encompassed a prioritisation tool to support GPs appropriately who to invite first for extended consultations, appropriate remuneration and time to conduct extended consultations, training in delivering person-centred chronic care available for all general practice care providers and an electronic medical record system accommodating comprehensive information registration. CONCLUSIONS: A person-centred chronic care approach targeting patients with multimorbidity in general practice was developed and piloted in co-creation with stakeholders. More consultation time facilitated better understanding of persons' situations, their functioning, priorities and dilemma's, and positively impacted work satisfaction of care providers. Challenges need to be tackled before widespread implementation. Future evaluation on the quadruple aims is recommended.

Humor and Quality of Life in Adults With Chronic Diseases: A Systematic Review.

Individuals grappling with chronic ailments often undergo a deterioration in their overall quality of life (QoL), encompassing psychological, social, and physical dimensions of well-being. Acknowledging that humor has demonstrated the potential to engender favorable effects on QoL, this systematic review endeavors to investigate the correlation between humor and QoL among adults contending with chronic health conditions. A comprehensive review of quantitative data was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed/MEDLINE, PsycINFO, and Cumulative Index to Nursing & Allied Health (CINAHL) were comprehensively searched from the establishment of each database up to June 22, 2023. Furthermore, reference lists of the included datasets and pertinent review articles were scrutinized exhaustively. The Newcastle-Ottawa Scale (NOS) was employed to assess the quality of eligible studies. A total of 18 studies satisfied the inclusion criteria. These studies encompassed a diverse spectrum of chronic disease categories (including cardiovascular diseases, various types of cancer, etc.) and collectively involved a participant cohort comprising 4,325 individuals. Remarkable findings surfaced, indicating a noteworthy association between distinct facets of humor-such as one's sense of humor, coping humor, humor styles, and laughter-and psychological QoL. Nonetheless, the relationship between humor and physical QoL exhibited a more intricate pattern, characterized by mixed outcomes. Despite the limited and inconsistent evidence across studies, humor appears to exhibit a positive association with QoL.

Interaction between Dietary Lactoferrin and Gut Microbiota in Host Health.

The gut microbiota are known to play an important role in host health and disease. Alterations in the gut microbiota composition can disrupt the stability of the gut ecosystem, which may result in noncommunicable chronic diseases (NCCDs). Remodeling the gut microbiota through personalized nutrition is a novel therapeutic avenue for both disease control and prevention. However, whether there are commonly used gut microbiota-targeted diets and how gut microbiota-diet interactions combat NCCDs and improve health remain questions to be addressed. Lactoferrin (LF), which is broadly used in dietary supplements, acts not only as an antimicrobial in the defense against enteropathogenic bacteria but also as a prebiotic to propagate certain probiotics. Thus, LF-induced gut microbiota alterations can be harnessed to induce changes in host physiology, and the underpinnings of their relationships and mechanisms are beginning to unravel in studies involving humans and animal models.