Financial strain and social support as moderators of the relationship between living alone and depressive symptoms in older people.

This study investigated the moderating effect of financial strain or social support on depressive symptoms among older people living alone in Taiwan. Data were collected from the "Taiwan Longitudinal Study on Aging (TLSA)," which included 1513 participants aged 65 and over, among them, 153 (10.1%) were living alone, while 1360 (89.9%) were living with others. Measurement tools included the Depression scale (CES-D), financial stress scale, social support scale, ADL scale, IADL scale, and stress scale, with Cronbach's α coefficients were 0.85, 0.78, 0.67, 0.91, 0.90, and 0.70 respectively. Hierarchical multiple regression was used to examine the moderator effect. The findings revealed that (1) Financial strain was found to moderate the relationship between living alone and depressive symptoms, acting as a promotive moderator among older men living alone. For older women, financial stress does not moderate the relationship between living alone and depressive symptoms. However, financial strain was also identified as a significant factor associated with depressive symptoms among older women living alone. (2) Social support does not moderate effect on the relationship between living alone and depressive symptoms in older men or older women. These results underscore the importance of considering financial stress in mental health policy development by government agencies. It is imperative to address the unique challenges faced by older individuals living alone, particularly in relation to financial strain, in order to promote their mental well-being.

Dual Caregiving and Mental Health Among Long-Term Care Nursing Assistants: The Moderating Role of Social Support.

AIM: To investigate the association of long-term care nursing assistants' dual caregiving roles with mental health and to determine whether social support moderates this relationship. DESIGN: A cross-sectional survey. METHODS: We surveyed 962 certified long-term care nursing assistants working in long-term care and medical facilities across Taiwan from October 2022 to July 2023. 'Dual caregiving roles' denote the fulfilment of caregiving duties both at work and within families. Mental health was evaluated using the 5-item Brief Symptom Rating Scale. Logistic regression analysis was utilized to investigate the association of dual caregiving roles and psychological job demands with poor mental health. Moreover, we explored whether family, colleague, and supervisor support moderated the association between dual caregiving roles and poor mental health. RESULTS: Among long-term care nursing assistants, 15% had dual caregiving responsibilities. Individuals with both dual caregiving roles and high psychological job demands faced the highest risk of poor mental health compared to those without dual caregiving roles and low psychological job demands. Having dual caregiving roles was associated with poor mental health compared to workers without such roles. Additionally, support from family, colleagues, and supervisors mitigates the association between caregivers' dual caregiving roles and poor mental health. CONCLUSION: A substantial proportion of long-term care nursing assistants had dual caregiving roles, leading to an additional mental health burden when combined with high psychological job demands. High social support attenuated this association. IMPLICATIONS FOR THE PROFESSION: Long-term care nursing assistants with dual caregiving roles had poorer mental health outcomes. Yet, support from family, colleagues, and supervisors mitigated these effects. These results emphasize the importance of enhancing social support to protect the mental well-being of long-term care nursing assistants managing both formal and informal caregiving duties. REPORTING METHOD: This study adheres to the STROBE guideline of reporting. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

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

BACKGROUND: Stroke may cause debilitating neurological deficiencies that result in motor, sensory, and cognitive deficits and poorer psychosocial functioning. Prior studies have provided some initial evidence for the significant roles of health literacy and poor oral health for old people. However, few studies have focused on the health literacy of individuals who had a stroke; therefore, the relationships between the health literacy and oral health-related quality of life (OHRQoL) among middle-aged and older adults who had a stroke are unknown. We aimed to assess the relationships between stroke prevalence, health literacy status, and OHRQoL in middle-aged and older adults. METHODS: We retrieved the data from The Taiwan Longitudinal Study on Aging, a population-based survey. For each eligible subject, we gathered data in 2015 on age, sex, level of education, marital status, health literacy, the activity daily living (ADL), stroke history and OHRQoL. We evaluated the respondents' health literacy by using a nine-item health literacy scale and categorized their health literacy level as low, medium, or high. OHRQoL was identified based on the Taiwan version of the Oral Health Impact Profile (OHIP-7T). RESULTS: The final study contained 7702 community-based dwelling elderly people (3630 male and 4072 female) were analysis in our study. Stroke history was reported in 4.3% of participants, 25.3% reported low health literacy, and 41.9% had at least one ADL disability. Furthermore, 11.3% of participants had depression, 8.3% had cognitive impairment, and 3.4% had poor OHRQoL. Age, health literacy, ADL disability, stroke history, and depression status were significantly associated with poor OHRQoL after sex and marital status was adjusted. Medium (odds ratio [OR] = 1.784, 95% confidence interval [CI] = 1.177, 2.702) to low health literacy (OR = 2.496, 95% CI = 1.628, 3.828) was significantly associated with poor OHRQoL. CONCLUSIONS: Base our study results, people with stroke history had poor OHRQoL. Lower health literacy and ADL disability were associated with worse QHRQoL. Further studies are necessary to define practical strategies for reducing the risk of stroke and oral health with constantly lower health literacy, thereby improving the quality of life and providing health care of older people.

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

AIM: Examine effectiveness of respiratory rehabilitation and moderating factors on lung function and exercise capacity in post-COVID-19 patients. DESIGN: Meta-analysis. METHODS: R software 4.0.2 assessed the effectiveness of respiratory rehabilitation adopting the random-effects model and presenting standardised mean differences (SMDs). Heterogeneity was determined by Cochran's Q and I2 . The Cochrane Risk of Bias 2.0 and MINORS evaluated quality of the included studies. DATA SOURCES: A comprehensive search was undertaken in Cochrane, Embase, Ovid-MEDLINE, Scopus, NCBI SARS-CoV-2 Resources, ProQuest, Web of Science and CINAHL until March 2022. RESULTS: Of the 5703 identified studies, 12 articles with 596 post-COVID-19 patients were included. Eleven of our twelve studies had moderate to high quality and one study had high risk of bias assessed with MINORS and RoB 2 tool. Overall, respiratory rehabilitation was effective in improving forced expiratory volume in 1 s (1.14; 95%CI 0.39-1.18), forced vital capacity (0.98; 95%CI 0.39-1.56), total lung capacity (0.83; 95%CI 0.22-1.44), 6-minute walk distance (1.56; 95%CI 1.10-2.02) and quality of life (0.99; 95%CI 0.38-1.60). However, no significant differences were observed for ratio of the forced expiratory volume in 1 s to the forced vital capacity of the lungs, anxiety and depression. Respiratory rehabilitation for post-COVID-19 patients was effective in those without comorbidities, performed four types of exercise programs, frequency ≥3 times/week and rehabilitation time 6 weeks. CONCLUSIONS: Respiratory rehabilitation improved lung function, exercise capacity and quality of life in post-COVID-19 patients. The findings suggest rehabilitation programs for post-COVID-19 patients should use multiple respiratory exercise programs with frequency of ≥3 times per week for longer than 6 weeks. IMPACT: These findings will help improve the implementation of respiratory rehabilitation programs for post-COVID-19 patients. IMPLICATIONS FOR THE PROFESSION: Our findings can be used to develop patient-centred respiratory rehabilitation interventions by nurses and clinicians for post-COVID-19 patients. REPORTING METHOD: PRISMA guideline was followed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

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

BACKGROUND: Post-stroke dysphagia (PSD) has been associated with high risk of aspiration pneumonia and mortality. However, limited evidence on pooled prevalence of post-stroke dysphagia and influence of individual, disease and methodological factors reveals knowledge gap. Therefore, to extend previous evidence from systematic reviews, we performed the first meta-analysis to examine the pooled prevalence, risk of pneumonia and mortality and influence of prognostic factors for PSD in acute stroke. METHODS: Our search was conducted in CINAHL, Cochrane Library, EMBASE, Ovid-Medline, PubMed, and Web of Science an initial search in October 2020 and a follow-up search in May 2021. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and the DerSimonian-Lard random-effects model for prognostic factors and outcomes of PSD. RESULTS: The pooled prevalence of PSD was 42% in 42 studies with 26,366 participants. PSD was associated with higher pooled odds ratio (OR) for risk of pneumonia 4.08 (95% CI, 2.13-7.79) and mortality 4.07 (95% CI, 2.17-7.63). Haemorrhagic stroke 1.52 (95% CI, 1.13-2.07), previous stroke 1.40 (95% CI, 1.18-1.67), severe stroke 1.38 (95% CI, 1.17-1.61), females 1.25 (95% CI, 1.09-1.43), and diabetes mellitus 1.24 (95% CI, 1.02-1.51) were associated with higher risk of PSD. Males 0.82 (95% CI, 0.70-0.95) and ischaemic stroke 0.54 (95% CI, 0.46-0.65) were associated with lower risk of PSD. Haemorrhagic stroke, use of instrumental assessment method, and high quality studies demonstrated to have higher prevalence of PSD in the moderator analysis. CONCLUSIONS: Assessment of PSD in acute stroke with standardized valid and reliable instruments should take into account stroke type, previous stroke, severe stroke, diabetes mellitus and gender to aid in prevention and management of pneumonia and thereby, reduce the mortality rate. TRIAL REGISTRATION: https://osf.io/58bjk/?view_only=26c7c8df8b55418d9a414f6d6df68bdb .

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

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

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

AIMS: This study aims to examine coronavirus disease 2019 (COVID-19) pandemic-related work factors for adverse effects on the mental health and whether organisational strategies attenuate these effects. BACKGROUND: COVID-19 pandemic has led to increased work burden and mental health risks for nurses. METHODS: A total of 1499 Taiwanese full-time nurses completed a web-based questionnaire between July and December 2020. Pandemic-related work conditions, namely, increased working hours, caring for COVID-19 patients, occupational stigma and redeployment, were assessed. Organisational strategies to combat pandemic-related work stressors including compensation to workers and adequate protection equipment were surveyed. Outcome measures were intention to leave, burnout and depression assessed using validated questionnaires. RESULTS: Redeployment, increased working hours and occupational stigma were associated with adverse mental health and intention to leave in logistic regression analysis. Caring for COVID-19 patients was negatively associated with depression. Adequate compensation for workers modified the association between redeployment and burnout. CONCLUSIONS: Pandemic-related work conditions were associated with adverse mental health and intention to leave. Organisational strategies attenuated the adverse impact of the pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Efforts to decrease stigma and organisational strategies including compensation for workers and adequate protection equipment provision should be adopted to improve nurses' health during a pandemic.

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

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

Occupation-level automation probability is associated with psychosocial work conditions and workers' health: A multilevel study.

OBJECTIVE: Work automation is increasing worldwide, and the probability of job automation has been associated with workers' adverse health outcomes. This study aimed to examine the association of occupation-level automation probability with work stress and workers' health. METHODS: We used data from a national survey of 14,948 randomly selected general workers conducted in 2016. Job control and job demand were assessed by the Job Content Questionnaire, and working hours and job insecurity were self-reported. Health outcomes were measured according to burnout and work-related injury or disease. We derived automation probabilities for 38 occupational groups and conducted multilevel analyses to examine the associations between occupation-level automation probability and workers' safety and health after adjusting for psychosocial work conditions. RESULTS: Participants working in jobs with a high probability of automation were more likely to have low job control, higher job insecurity, and work-related injury and disease prevalence; whereas workers in jobs with a low automation probability had higher psychological and physical demands and burnout prevalence. Furthermore, automation probability significantly predicted workers' health after adjustment for demographic characteristics and psychosocial work conditions. CONCLUSIONS: Workers with low automation probability jobs may experience work stress other than that captured by traditional measures of job strain. Organizational approaches to improve employment security and psychosocial conditions are essential for workers' safety and health in the context of increasing job automation.

Differential effects of employment grade on the association between long working hours and problem drinking.

OBJECTIVE: To examine the association between working hours and problem drinking in employees from different employment grades. METHODS: We used data from a national survey of randomly sampled Taiwanese workers. A total score of 2 or more on the Cut down, Annoyed, Guilty, and Eye-Opener (CAGE) questionnaire was used to identify problem drinkers. Weekly working hours were categorized into five groups: <40, 40, 41-48, 49-59, and ≥60. Employees were classified into three employment grades: managers and professionals, skilled workers, and low-skilled workers. The associations between working hours and problem drinking in employees from different employment grades were examined by logistic regression models. RESULTS: In skilled workers, problem drinking was associated with <40 and 41-48 working hours, but not with >48 working hours. In low-skilled workers, problem drinking was most strongly associated with 49-59 working hours. CONCLUSION: The association between working hours and problem drinking was not linear and differed with employment grades.

Internal workplace violence from colleagues is more strongly associated with poor health outcomes in nurses than violence from patients and families.

AIMS: To examine the associations between different workplace violence sources and health outcome in nurses. BACKGROUND: Workplace violence is a major threat to nurses' physical and mental health. Other workers in the health sector, patients and visitors can cause workplace violence. To effectively prevent workplace violence-related health problems, the differential impact of internal and external violence needs to be explored. DESIGNS: A cross-sectional survey of 1,690 fully employed female nurses. METHODS: A self-administered questionnaire was used to record the nurses' experiences of workplace violence, including types (physical, psychological, verbal and sexual) and sources (internal and external) of violence. Data on psychosocial work conditions including work shift, psychological job demands, job control and workplace justice, were also collected. The nurses' health condition was measured using the 5-item Brief Symptom Rating Scale and Self-Rated Health Scale and multivariable logistic regression was used to examine the associations between workplace violence and health. The study was carried out in 2015-2016. RESULTS: Sixty percent of the internal workplace violence was psychological and verbal and adverse psychosocial work conditions were associated with workplace violence. After adjustment for demographic characteristics and psychosocial work conditions, internal workplace violence resulted in higher risks of poor self-rated health and mental health than did external workplace violence, particularly in nurses who had experienced psychological and verbal violence. CONCLUSION: Internal workplace violence in the form of psychological and verbal violence had a stronger effect on nurses' health than did external workplace violence. Organization-level measures should be implemented to prevent internal violence.

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

AIMS: To validate the Chinese version Psychosocial Safety Climate scale (PSC-12), and examine the associations between PSC, workplace violence and self-rated health (SRH). BACKGROUND: Psychosocial safety climate moderates the negative effect of workplace violence on health. To address workplace violence experienced by nurses across the Asia-Pacific region, it is important to develop and apply a Chinese language version of the tool. METHODS: We conducted a two-part study. In the first part, the Chinese version PSC-12 was developed and tested for its validity in 405 nurses. In the second part, a total of 1690 nurses from 73 hospitals filled a questionnaire concerning their work and health conditions. Multi-level modelling was used to examine the association between PSC, workplace violence and SRH. RESULTS: A comparable validity and reliability of the Chinese version PSC-12 with the original PSC was found. PSC scores were negatively associated with workplace violence. In the hierarchical linear model, participants from hospitals with the lowest PSC score had twofold risks of having poor SRH. CONCLUSIONS: The Chinese version PSC-12 is a valid tool. Hospital-level PSC was associated with poor health status in female nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Psychosocial safety climate should be evaluated and promoted to prevent workplace violence in nurses.

The effect of multiple types of workplace violence on burnout risk, sleep quality, and leaving intention among nurses.

OBJECTIVE: The aim of our study is to explore the associations between multiple types of workplace violence (WPV) and burnout risk, sleep problems, and leaving intention among nurses. METHODS: This cross-sectional survey recruited 1,742 nurses, and data on WPV experiences were collected through self-administered questionnaires. Work conditions, burnout risk scales, sleep quality, and leaving intentions were also evaluated. Multivariate logistic regression analyses were performed to examine the associations of WPV with burnout risk, sleep quality, and leaving intentions, adjusting for demographic characteristics and work conditions. RESULTS: The study found that 66.7% of nurses reported experience of WPV, with 26.9% experiencing both physical and nonphysical forms. Those who experienced multiple types of WPV reported worse work conditions, higher burnout risk, poorer sleep quality, and a stronger leaving intention compared to those without such experiences. Adjusting for working conditions, logistic regression analysis showed that nurses who experienced multiple types of WPV had 2.12-fold higher odds of high personal burnout risk, 2.36-fold higher odds of high client-related burnout risk, 1.95-fold higher odds of poor sleep quality, and 1.80-fold higher odds of high leaving intention, compared to those without WPV experiences. CONCLUSIONS: Strategies by hospital managers and policymakers to monitor and reduce workplace violence are vital for sustaining nurses' mental health, well-being, and preventing early attrition from the profession.

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

OBJECTIVE: Sleep-related breathing disorders (SRBD) have shown to cause worsened cognitive impairment among people with dementia. Therefore, we conducted the first meta-analysis to estimate the prevalence of SRBD among people with dementia. METHODS: Comprehensive searches were conducted in Embase, Ovid-MEDLINE, PubMed, PsycINFO, Scopus, Web of Science, and CINAHL. The generalized linear mixed model (GLMM) was used for the pooled prevalence analysis and heterogeneity using I2 test and Cochran's Q-statistic in R-software. Study quality was assessed by Hoy's risk of bias assessment tool. Overall, 20 studies from 1282 studies were included with 1461 participants. RESULTS: The pooled prevalence of SRBD among dementia was 59% (95%CI: 44%-73%) with 55% (95%CI: 34%-74%) for obstructive sleep apnea (OSA), 49% (95%CI: 25%-73%) for unspecified SRBD, and 11% (95%CI: 5%-21%) for central sleep apnea (CSA). Regarding dementia subtypes, the prevalence of SRBD was 89% (95%CI: 61%-97%) for Alzheimer's dementia, 56% (95%CI: 48%-63%) for Parkinson's and Idiopathic Parkinson's dementia, and 16% (95%CI: 8%-30%) for Huntington's dementia. Significant moderator variables were male, body mass index, larger waist and hip circumference, waist-hip ratio, and comorbidities including hypertension, dyslipidemia, renal disease, diabetes, heart disease, and stroke. CONCLUSIONS: There is considerable high prevalence of SRBD among dementia people, with OSA and unspecified SRBD being fivefold higher than CSA. Regarding dementia subtypes, Parkinson's and Idiopathic Parkinson's, and Alzheimer's dementia had four to sixfold increased risk of presenting with SRBD than Huntington's dementia. Therefore, assessment and management of SRBD in Alzheimer's, and Parkinson's and Idiopathic Parkinson's dementia deserves more attention in future research.

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

Background: Cognitive function, working memory, attention, and coordination are higher-level functions sharing a complex relationship. Limited evidence exists on the effectiveness of multi-domain cognitive function interventions to improve cognitive outcomes. We evaluated the effectiveness of such interventions on cognitive function, working memory, attention, and coordination in older adults with mild cognitive impairment and mild dementia. Methods: We conducted a double-blind, two-arm, parallel-group randomised controlled trial in community care centres of Northern Taiwan. We recruited 72 participants aged≥65 years and randomly allocated them using 1:1 block randomization (block size = 4) into experimental (multi-domain cognitive function training) (MCFT) and control groups (passive information activities) (PIA) (n = 36/group). We administered the interventions in both groups for 30 minutes per session, three sessions per week for eight weeks, for a total of 24 sessions. The outcome indicators were cognitive function assessed (mini-mental status examination), working memory (digit span), selective attention (Stroop test), visual-spatial attention (trail making test-A (TMT-A)), divided attention (trail making test-B (TMT-B)), and coordination (Berry visual-motor integration (Berry-VMI)). We evaluated the study outcomes at baseline, immediate post-test, one-month follow-up, and one-year follow-up. Results: We found no significant differences between the groups at baseline except for education. The average age of participants was 82.3 years, and most (76.4%) were female. We analysed the results by generalised estimating equations (GEE) based on the intention-to-treat (ITT) principle. The multi-domain cognitive function training was effective in improving cognitive function (ß = 1.7; 95% confidence interval (CI) = 0.63-2.31; P = 0.001), working memory (ß = -1.45; 95% CI = -2.62, -0.27; P = 0.016), and selective attention (ß = -23.3; 95% = CI -43.9, -2.76; P = 0.026) compared to passive information activities at 1-month follow-up. The effects of multi-domain cognitive function training on cognitive function (ß = 1.51; 95% CI = 0.40-2.63; P = 0.008), working memory (ß = -1.93; 95% CI -3.33, -0.54; P = 0.007), selective attention (ß = -27.8; 95% CI = -47.1, -8.48; P = 0.005), and coordination (ß = 1.61; 95% CI = 0.25, 2.96; P = 0.020) were maintained for one year. There were no significant improvements in attention outcomes (visual-spatial and divided attention) after training. Conclusions: MCFT intervention demonstrated favourable effects in improving global cognitive function, working memory, selective attention, and coordination among older adults with mild cognitive impairment and mild dementia. Thus, applying multi-domain cognitive training in older adults with mild cognitive impairment and mild dementia could help to delay the cognitive decline. Registration: Chinese Clinical Trial Registry (ChiCTR2000039306).

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

BACKGROUND: Comparative therapeutic benefits of combined and single neurostimulation therapies including neuromuscular electrical stimulation (NMES), pharyngeal electrical stimulation (PES), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and traditional dysphagia therapy (TDT) remain unknown in post-stroke dysphagia (PSD) rehabilitation. Therefore, we performed the first network meta-analysis (NMA) to determine comparative effectiveness of combined and single neurostimulation and traditional dysphagia therapies for PSD. METHODS: A frequentist NMA model was performed with therapy effect sizes presented as standardized mean differences (SMD) and corresponding 95% confidence interval (95% CI) for therapy comparisons while netrank function ranked the therapies in R-Software. Meta-regression models for study characteristics were analyzed using Bayesian NMA Model. RESULTS: Overall, 50 randomized controlled studies with 2250 participants were included. NMES + TDT 3.82 (95% CI, 1.62-6.01), tDCS + TDT 3.34 (95% CI, 1.09-5.59), rTMS + TDT 3.32 (95% CI, 1.18-5.47), NMES 2.69 (95% CI, 0.44-4.93), and TDT 2.27 (95% CI, 0.12-4.41) demonstrated very large effect in improving swallowing function. NMES + TDT -0.50 (95% CI, -0.68 to -0.32, rTMS + TDT -0.44 (95% CI, -0.67 to -0.21), TDT -0.28 (95% CI, -0.46 to -0.10), and NMES -0.19 (95% CI, -0.34 to -0.04) demonstrated medium to small effect in reducing pharyngeal transit time (PTT). rTMS -0.51 (95% CI, -0.93 to -0.08) demonstrated medium effect in reducing oral transit time (OTT). No significant therapy comparison differences were found for reducing aspiration/penetration. The highest ranked therapy was NMES + TDT for better swallowing function and reduction of PTT, rTMS for reduction of OTT, and tDCS + TDT for reduction of aspiration/penetration. Therapeutic effects of the therapies were moderated by frequency, sessions, and duration. CONCLUSION: Combined therapies including NMES + TDT, tDCS + TDT, and rTMS + TDT demonstrate better therapeutic effect for improved swallowing function and reduction of PTT, OTT, and aspiration/penetration for PSD.

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

OBJECTIVE: To estimate the global prevalence of low resilience among the general population and health professionals during the COVID-19 pandemic. METHODS: Embase, Ovid-MEDLINE, PubMed, Scopus, Web of Science, CINAHL, WHO COVID-19 databases, and grey literature were searched for studies from January 1, 2020, to August 22, 2022. Hoy's assessment tool was used to assess for risk of bias. Meta-analysis and moderator analysis was performed using the Generalized Linear Mixed Model with a corresponding 95 % confidence interval (95 % CI) adopting the random-effect model in R software. Between-study heterogeneity was measured using I2 and τ2 statistics. RESULTS: Overall, 44 studies involving 51,119 participants were identified. The pooled prevalence of low resilience was 27.0 % (95 % CI: 21.0 %-33.0 %) with prevalence among the general population being 35.0 % (95 % CI: 28.0 %-42.0 %) followed by 23.0 % (95 % CI: 16.0 %-30.9 %) for health professionals. The 3-month trend analysis of the prevalence of low resilience beginning January 2020 to June 2021 revealed upward then downward patterns among overall populations. The prevalence of low resilience was higher in females, studied during the delta variant dominant period, frontline health professionals, and undergraduate degree education. LIMITATIONS: Study outcomes showed high heterogeneity; however, sub-group and meta-regression analyses were conducted to identify potential moderating factors. CONCLUSIONS: Globally, 1 out of 4 people among the general population and health professionals experienced low resilience due to COVID-19 adversity. The prevalence of low resilience was twice as much among the general population compared to health professionals. These findings provide information for policymakers and clinicians in the development and implementation of resilience-enhancing programs.

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

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

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

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