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Insulin is made from proinsulin, but the extent to which fasting/feeding controls the homeostatically regulated proinsulin pool in pancreatic ß-cells remains largely unknown. Here, we first examined ß-cell lines (INS1E and Min6, which proliferate slowly and are routinely fed fresh medium every 2-3 days) and found that the proinsulin pool size responds to each feeding within 1 to 2 h, affected both by the quantity of fresh nutrients and the frequency with which they are provided. We observed no effect of nutrient feeding on the overall rate of proinsulin turnover as quantified from cycloheximide-chase experiments. We show that nutrient feeding is primarily linked to rapid dephosphorylation of translation initiation factor eIF2α, presaging increased proinsulin levels (and thereafter, insulin levels), followed by its rephosphorylation during the ensuing hours that correspond to a fall in proinsulin levels. The decline of proinsulin levels is blunted by the integrated stress response inhibitor, ISRIB, or by inhibition of eIF2α rephosphorylation with a general control nonderepressible 2 (not PERK) kinase inhibitor. In addition, we demonstrate that amino acids contribute importantly to the proinsulin pool; mass spectrometry shows that ß-cells avidly consume extracellular glutamine, serine, and cysteine. Finally, we show that in both rodent and human pancreatic islets, fresh nutrient availability dynamically increases preproinsulin, which can be quantified without pulse-labeling. Thus, the proinsulin available for insulin biosynthesis is rhythmically controlled by fasting/feeding cycles.
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Células Secretoras de Insulina , Nutrientes , Proinsulina , Humanos , Insulina/biosíntesis , Células Secretoras de Insulina/efectos de los fármacos , Células Secretoras de Insulina/metabolismo , Islotes Pancreáticos/metabolismo , Nutrientes/farmacología , Proinsulina/biosíntesis , Proinsulina/metabolismo , Estrés Fisiológico , Transducción de Señal , Línea Celular , Regulación hacia ArribaRESUMEN
PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic facilitated the rapid development of digital detection surveillance (DDS) for outbreaks. This qualitative study examined how DDS for infectious diseases (ID) was perceived and experienced by primary care physicians and patients in order to highlight ethical considerations for promoting patients' autonomy and health care rights. METHODS: In-depth interviews were conducted with a purposefully selected group of 16 primary care physicians and 24 of their patients. The group was reflective of a range of ages, educational attainment, and clinical experiences from urban areas in northern and southern China. Interviews were audio recorded, transcribed, and translated. Two researchers coded data and organized it into themes. A third researcher reviewed 15% of the data and discussed findings with the other researchers to assure accuracy. RESULTS: Five themes were identified: ambiguity around the need for informed consent with usage of DDS; importance of autonomous decision making; potential for discrimination against vulnerable users of DDS for ID; risk of social inequity and disparate care outcomes; and authoritarian institutions' responsibility for maintaining health data security. The adoption of DDS meant some patients would be reluctant to go to the hospital for fear of either being discriminated against or forced into quarantine. Certain groups (older people and children) were thought to be vulnerable to DDS misappropriation. CONCLUSIONS: These findings indicate the paramount importance of establishing national and international ethical frameworks for DDS implementation. Frameworks should guide all aspects of ID surveillance, addressing privacy protection and health security, and underscored by principles of social equity and accountability.Annals "Online First" article.
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COVID-19 , Enfermedades Transmisibles , Médicos de Atención Primaria , Niño , Humanos , Anciano , Consentimiento Informado , Investigación CualitativaRESUMEN
BACKGROUND AND OBJECTIVES: Age-related hearing loss (ARHL) is the third leading cause of years lived with disability. Connections among ARHL, depressive symptoms, social engagement and cognitive status are increasingly reported but the underlying mechanisms leading to these relationships are largely unknown. Exploring these mechanisms is a worthy goal, especially in older adults. This study aimed to examine the mediating effect of social engagement and depressive symptoms on the relationship between ARHL and cognitive status. METHODS: Structural equation modeling (SEM) with path analysis were performed with data from a cross-sectional study conducted in 11 community centers in 2021, which assessed older adults' intrinsic and sensory capacities using the WHO ICOPE framework. Demographic information, health profile, a binary measure of hearing capacity, depressive symptoms, social engagement, and cognitive status of participants were gathered. RESULTS: A total of 304 participants were included. ARHL was positively associated with depressive symptoms (ß = 0.18, p = 0.009) and negatively related to social engagement (ß = -0.13, p = 0.026). Social engagement was positively associated with cognitive status (ß = 0.17, p = 0.005) and negatively associated with depressive symptoms (ß = -0.23, p < 0.001). Greater depressive symptoms were negatively associated with the participants' cognition (ß = -0.13, p = 0.009). Both social engagement (ß = -0.02, p = 0.029) and depressive symptoms (ß = -0.02, p = 0.032) mediated the negative associations between ARHL and cognitive status. CONCLUSIONS: Addressing hearing loss, depressive symptoms, and enhancing social engagement should be investigated as a potential means of minimizing cognitive decline. Well-designed studies are needed to comprehensively inform the clinical practice development, particularly large prospective studies that will facilitate further elucidate possible causal mechanisms behind these observed associations.
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Depresión , Participación Social , Humanos , Anciano , Estudios Transversales , Estudios Prospectivos , CogniciónRESUMEN
BACKGROUND: World Health Organization (WHO) has defined healthy ageing by highlighting five functional ability domains to (meet basic needs, make decisions, be mobile, build and maintain relationships, and contribute to society), which also emphasized the importance of addressing loneliness as priorities within United Nations Decade of Healthy Ageing initiative. However, the level and determinants of healthy ageing and its association with loneliness are rarely examined. This study aimed to construct a healthy ageing index to verify the WHO healthy ageing framework, measure five domains of functional ability of older adults and examine the relationship between functional ability domains and loneliness. METHODS: A total of 10,746 older adults from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were included. A healthy ageing index ranging from 0 to 17 was constructed using 17 components related to functional ability domains. Univariate and multivariate logistic regression analyses were utilized to determine the association between loneliness and healthy ageing. The STROBE guidelines with the RECORD statement for observational studies using routinely collected health data were observed. RESULTS: The factor analysis verified the five functional ability domains for healthy ageing. After adjusting for confounders, being mobile, building and maintaining relationships, and learning, growing and making decisions were significantly associated with lesser loneliness among participants. CONCLUSIONS: The healthy ageing index of this study can be utilized and further modified with respect to large-scale research with relevant healthy ageing topics. Our findings will support healthcare professionals to provide patient-centered care when identifying their comprehensive abilities and needs.
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Envejecimiento Saludable , Soledad , Humanos , Anciano , Estudios Longitudinales , Envejecimiento , JubilaciónRESUMEN
BACKGROUND: Immersive virtual reality (IVR) applications are gaining popularity in health care education. They provide an uninterrupted, scaled environment capable of simulating the full magnitude of sensory stimuli present in busy health care settings and increase students' competence and confidence by providing them with accessible and repeatable learning opportunities in a fail-safe environment. OBJECTIVE: This systematic review aimed to evaluate the effects of IVR teaching on the learning outcomes and experiences of undergraduate health care students compared with other teaching methods. METHODS: MEDLINE, Embase, PubMed, and Scopus were searched (last search on May 2022) for randomized controlled trials (RCTs) or quasi-experimental studies published in English between January 2000 and March 2022. The inclusion criteria were studies involving undergraduate students majoring in health care, IVR teaching, and evaluations of students' learning outcomes and experiences. The methodological validity of the studies was examined using the Joanna Briggs Institute standard critical appraisal instruments for RCTs or quasi-experimental studies. The findings were synthesized without a meta-analysis using vote counting as the synthesis metric. A binomial test with P<.05 was used to test for statistical significance using SPSS (version 28; IBM Corp). The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation tool. RESULTS: A total of 17 articles from 16 studies totaling 1787 participants conducted between 2007 and 2021 were included. The undergraduate students in the studies majored in medicine, nursing, rehabilitation, pharmacy, biomedicine, radiography, audiology, or stomatology. The IVR teaching domains included procedural training (13/16, 81%), anatomical knowledge (2/16, 12%), and orientation to the operating room setting (1/16, 6%). The quality of the 75% (12/16) of RCT studies was poor, with unclear descriptions of randomization, allocation concealment, and outcome assessor blinding procedures. The overall risk of bias was relatively low in the 25% (4/16) of quasi-experimental studies. A vote count showed that 60% (9/15; 95% CI 16.3%-67.7%; P=.61) of the studies identified similar learning outcomes between IVR teaching and other teaching approaches regardless of teaching domains. The vote count showed that 62% (8/13) of the studies favored using IVR as a teaching medium. The results of the binomial test (95% CI 34.9%-90%; P=.59) did not show a statistically significant difference. Low-level evidence was identified based on the Grading of Recommendations Assessment, Development, and Evaluation tool. CONCLUSIONS: This review found that undergraduate students had positive learning outcomes and experiences after engaging with IVR teaching, although the effects may be similar to those of other forms of virtual reality or conventional teaching methods. Given the identification of risk of bias and low level of the overall evidence, more studies with a larger sample size and robust study design are required to evaluate the effects of IVR teaching. TRIAL REGISTRATION: International prospective register of systematic reviews (PROSPERO) CRD42022313706; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=313706.
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Aprendizaje , Farmacias , Humanos , Educación en Salud , EstudiantesRESUMEN
AIMS AND OBJECTIVE: To synthesise current international empirical evidence on loneliness and social isolation in Chinese late-life immigrants. BACKGROUND: Loneliness causes adverse health consequences in Chinese late-life immigrants leading to increased utilisation of often increasingly limited healthcare resources. However, little is known about how Chinese late-life immigrants perceive and experience loneliness and social isolation in their host countries. DESIGN: An integrative review methodology. METHODS: Using a systematic search strategy, Google scholar and databases, such as Scopus, Web of Science, PubMed, CHNAHL, Medline and open access Theses were searched. No limitation was placed on publication date. Peer-reviewed studies published from the database inception to May 6, 2021 in the English language were included. The review process is reported according to PRISMA. RESULTS: Eight articles met the criteria and were included in this review. Two themes resulting from the data synthesis process were identified. Firstly, 'disrupted social relations after late-life immigration' and secondly 'moving away from filial expectations'. CONCLUSION: Loneliness and social isolation are commonly experienced by Chinese late-life immigrants when residing in host countries. Understanding and identification of the sources of loneliness and social isolation among late-life immigrants are essential prompts for healthcare professionals, particularly nurses, to engage sensitively with Chinese late-life immigrants. Nurses culturally relevant care delivery in a variety of settings may best serve recipients' social and health related needs. RELEVANCE TO CLINICAL PRACTICE: This integrated review informs the planning of health and social services for addressing Chinese late-life immigrants' experiences of loneliness and social isolation. Focused attention on cultural responsiveness is an important component of providing quality and safe nursing care. This review of the recent evidence on socially-rooted health concerns affected by both immigration and ageing will help advance nursing practice in providing culturally responsive care interventions.
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Emigrantes e Inmigrantes , Soledad , Humanos , Pueblos del Este de Asia , Aislamiento Social , Pueblo AsiaticoRESUMEN
BACKGROUND: The World Health Organization (WHO) encourages healthy ageing strategies to help develop and maintain older people's functional abilities in five domains: their ability to meet basic needs; learn, grow, and make decisions; be mobile; build and maintain relationships, and contribute to society. This scoping review reports the available evidence-based interventions that have been undertaken with people ≥ 50 years of age in rural and remote areas and the outcomes of those interventions relevant to enhancing functional ability. METHODS: The scoping review was undertaken following the JBI methodology. A literature search was carried out to identify published intervention studies for enhancing functional ability in older people living in rural and remote settings. The databases searched included CINAHL, Scopus, ProQuest Central, PubMed, EBSCOHost, APA PsycInfo, Carin.info, and the European Network for Rural Development Projects and Practice database. Gray literature sources included government reports, websites, policy papers, online newsletters, and studies from a bibliographic hand search of included studies. RESULTS: Literature published from January 2010 to March 9, 2021 were included for review. A total of 67 studies were identified, including quasi-experimental studies (n = 44), randomized controlled trials (n = 22), and a descriptive study. Five main types of interventions were conducted in rural and remote areas with older people: Community Services, Education and Training, Exercise and Physical Activity, Health Promotion Programmes, and Telehealth. Health Promotion Programmes (n = 28, 41.8%) were the most frequently reported interventions. These focused primarily on improving the ability to meet basic needs. About half (n = 35, 52.2%) of the included studies were linked to the ability to learn, grow, and make decisions, and 40% of studies (n = 27) were relevant to the ability to be mobile. Only a very limited number of intervention studies were geared towards outcomes such as maintaining relationships (n = 6) and contributing to society (n = 3). CONCLUSION: Interventions for enhancing functional ability focused primarily on the ability to meet basic needs. We identified the need for health-related interventions in rural and remote areas to consider all five functional ability domains as outcomes, particularly to strengthen the psychosocial wellbeing of older people and enhance their sense of purpose through their contributions to society.
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Aprendizaje , Población Rural , Humanos , Anciano , Promoción de la Salud , Organización Mundial de la Salud , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
AIMS AND OBJECTIVES: The study aimed to explore the perspectives of adult children about late-life living and care arrangements for their ageing immigrant parents living in New Zealand. BACKGROUND: Older immigrants' well-being is closely associated with filial relations and is often reliant on families as a main source of social, financial and emotional support. Research among migrant Asian adults has reported mixed findings regarding intergenerational perspectives of filial practices. DESIGN: Qualitative design using focused ethnographic lens. METHODS: Semi-structured individual interviews were undertaken with 45 adult children of older immigrants living in New Zealand to explore their views about filial piety. The CoREQ checklist was used in reporting methods and findings. RESULTS: Two major themes were identified in this study of adult children's view of filial piety and late-life care for their ageing parents. The first theme, 'holding on-reconfiguring values', referred to a process described by the participants as upholding the core values and cultural familial expectations, looking after their ageing parents, yet modifying the ways in which they provide care. The second major theme 'letting go-reconfigured expectations', described participants' views of aged care for themselves, which meant they no longer held traditional values that needed to be enacted by their children. CONCLUSIONS: Adult children from immigrant families were positioned as intermediaries of these shifting values of their own and within younger generations. The adult children's shift of thinking and acceptance of reconfigured expression of filial duties impact care and living arrangements of older people from immigrant and culturally diverse backgrounds, which also influences health and well-being in later life. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals including nurses working in the ageing and aged care sector need to accommodate the changing generational perspectives about filial piety to cater to the unique late-life care requirements and health needs of older people and their families.
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Hijos Adultos , Emigrantes e Inmigrantes , Adulto , Anciano , Humanos , Hijos Adultos/psicología , Envejecimiento , Pueblo Asiatico , Nueva Zelanda , Relaciones Padres-HijoRESUMEN
OBJECTIVE: This study aimed to retrospectively examine the contribution of nurses to population health outcomes with reference to nurse visits and blood pressure measurement in primary health settings. DESIGN: A retrospective study was conducted using New Zealand Health Survey (NZHS) from 2012 to 2017. SAMPLE: Adult population who are 18 years old and over living in New Zealand. MEASUREMENTS: Age, gender, and ethnicity, the service utilization of primary health care nurse visit and blood pressure measurement were extracted from the NZHS (2012-2017) to compare with the service utilization of primary health care nurses by different demographic groups. RESULTS: Females who have treated hypertension shows higher utilization of nurse visit than males. From 2015 to 2017, the participants in this cohort have visited a primary health care nurse at least more than once within a year. With blood pressure control, the overall pooled results show the impact of visiting primary health nurses on systolic and diastolic blood pressure control. CONCLUSION: Our study at a national scale, demonstrated the impact of nurse's contribution to population health outcomes among people living with hypertension in New Zealand. Nurses are key to improving population health outcomes and to achieve universal health coverage.
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Hipertensión , Masculino , Adulto , Femenino , Humanos , Adolescente , Presión Sanguínea/fisiología , Estudios Retrospectivos , Estudios de Cohortes , Nueva Zelanda , Hipertensión/epidemiología , Rol de la EnfermeraRESUMEN
BACKGROUND: The COVID-19 pandemic has increased the importance of the deployment of digital detection surveillance systems to support early warning and monitoring of infectious diseases. These opportunities create a "double-edge sword," as the ethical governance of such approaches often lags behind technological achievements. OBJECTIVE: The aim was to investigate ethical issues identified from utilizing artificial intelligence-augmented surveillance or early warning systems to monitor and detect common or novel infectious disease outbreaks. METHODS: In a number of databases, we searched relevant articles that addressed ethical issues of using artificial intelligence, digital surveillance systems, early warning systems, and/or big data analytics technology for detecting, monitoring, or tracing infectious diseases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and further identified and analyzed them with a theoretical framework. RESULTS: This systematic review identified 29 articles presented in 6 major themes clustered under individual, organizational, and societal levels, including awareness of implementing digital surveillance, digital integrity, trust, privacy and confidentiality, civil rights, and governance. While these measures were understandable during a pandemic, the public had concerns about receiving inadequate information; unclear governance frameworks; and lack of privacy protection, data integrity, and autonomy when utilizing infectious disease digital surveillance. The barriers to engagement could widen existing health care disparities or digital divides by underrepresenting vulnerable and at-risk populations, and patients' highly sensitive data, such as their movements and contacts, could be exposed to outside sources, impinging significantly upon basic human and civil rights. CONCLUSIONS: Our findings inform ethical considerations for service delivery models for medical practitioners and policymakers involved in the use of digital surveillance for infectious disease spread, and provide a basis for a global governance structure. TRIAL REGISTRATION: PROSPERO CRD42021259180; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259180.
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COVID-19 , Enfermedades Transmisibles , Inteligencia Artificial , Enfermedades Transmisibles/diagnóstico , Enfermedades Transmisibles/epidemiología , Humanos , Pandemias , SARS-CoV-2RESUMEN
BACKGROUND AND OBJECTIVES: Social frailty is an emerging concept characterized by state of vulnerability due to the lack or absence of social resources that enable health and wellbeing, particularly among older people. However, there is no consensus on how to accurately measure and assess social frailty, given the broad coverage of social dimensions affecting older individuals. This scoping review aimed to identify existing tools and scales used to measure social frailty in older people. RESEARCH DESIGN AND METHODS: A scoping review methodology was employed. Articles published between January 2014 and April 2024 were searched in six electronic databases: PubMed, PsycINFO, ProQuest, Scopus, SocIndex, and CINAHL. The scoping review followed a five-stage process by Arksey and O'Malley and adhered to the guidelines provided by PRISMA-ScR. RESULTS: Nine social frailty tools were identified across the 58 papers included in this review. The individual question item commonly used in the scales were classified into main categories based on their conceptual characteristics and intentions. The most common individual questionnaire constructs used to measure social frailty included financial status, social resources, social behaviours and activities, and sense of purpose. The reviewed tools varied in terms of their robustness and the process of scale development. DISCUSSION AND IMPLICATIONS: Our review suggested the development of a standardized, psychometrically tested, and accurate screening tool to screen social frailty status. An accurate social frailty assessment can inform the development of useful interventions, which also has implications in preventing the development of physical frailty.
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Loneliness has become a significant public health issue among community-dwelling older adults particularly those with multimorbidity. Family caregivers are crucial care resources for dependent older adults living in the community before transitioning to institutional services. However, understanding of their perceptions in supporting older adults with multimorbidity to cope with loneliness is limited. This qualitative study aimed to elucidate on the experiences of caring and explore the experiences and perceptions of family caregivers in supporting older community-dwelling adults with multimorbidity to cope with loneliness. Eleven family caregivers, aged 51-93 years old, with at least 2 years of caregiving experience were purposively recruited and interviewed individually. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was utilised to report the study. Three key themes were generated from the inductive analysis: (1) recognising older adults' loneliness through the expression of unusual emotions, behaviour/s, social network alteration and speech; (2) variations in perceptions and responses to loneliness among different family caregiving relationships; and (3) challenges in addressing loneliness. Positive feedback from cared-for older adults was appreciated by their family caregivers which in turn motivated further actions to alleviate loneliness. The findings emphasised the importance of developing specific patients and family caregivers centred interventions, such as communication skills training to enhance effective communications. Cultural values and norms of individuals should be respected in those interventions, ensuring that emotional expression is facilitated in a comfortable way for both older patients and family caregivers.
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OBJECTIVES: To examine loneliness in old age and whether intergenerational reciprocity and WHO functional ability predicted loneliness. METHODS: Using the China Health and Retirement Longitudinal Study Wave 4 (2018) database (CHARLS), logistic regression models were adopted to investigate the relationships. RESULTS: The prevalence of loneliness was 28% in older people in China. Corresponding to the five domains of functional abilities, providing financial support to adult children (adj. OR 0.83, 95% CI 0.70-0.99), self-perceived health (adj. OR 1.30, 95% CI 1.19-1.41), having a retirement pension (adj. OR 0.73, 95% CI 0.57-0.93), the ability to decide on taking medications (adj. OR 1.32, 95% CI 1.10-1.58), as well as being able to get up from a chair (adj. OR 1.15, 95% CI 1.02-1.3), and having paid work (adj. OR 0.72, 95% CI 0.54-0.95) were associated with less loneliness. On the contrary, infrequent contact (once a month) with adult children (adj. OR 1.18, 95% CI 1.01-1.38), troubling body pain (adj. OR 1.16, 95% CI 1.10-1.23) and falling since the last interview (adj. OR .23, 95% CI 1.04-1.45) were positively associated with loneliness. CONCLUSIONS: In this study, functional abilities of meeting basic needs, making decisions, being mobile and contributing to the support of adult children and society were protective factors for experiencing loneliness in late life. We need to rethink interventions for addressing loneliness in the context of healthy ageing and specific cultural values, taking into account not only providing services to older adults but also supporting them to gain values by contributing to society.
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Soledad , Humanos , Persona de Mediana Edad , Anciano , Estudios Longitudinales , Modelos Logísticos , Organización Mundial de la Salud , ChinaRESUMEN
Dementia is a long-term and progressive syndrome that not only influences the person with dementia (PWD) but also the caregiver. However, informal caregivers are not always empathic and understand the symptoms of dementia, leading to destructive caregiving relationships and poor quality of caregiving. VR-based simulation interventions can provide a more realistic and memorable learning experience for caregivers to walk in PWDs' shoes. This review aimed to provide practitioners and researchers with insights on developing and/or adopting an effective VR-based simulation intervention for enhancing the empathy of informal caregivers of PWD. A mixed-methods systematic review was conducted. Quantitative, qualitative, and mixed-methods studies were searched from MEDLINE, PsycINFO, CINAHL, Scopus, Embase, and Cochrane Library updating. Standard JBI critical appraisal instruments were used for the quality appraisal. A convergent segregated approach was used to synthesize and integrate the data. A total of seven studies were included. Inconsistent quantitative results were reported on the effects of VR-based simulation on empathy enhancement. Significant effects were reported on knowledge of dementia and emotion-focused coping strategies. Two themes were generated from the qualitative studies, including "Informal caregivers gained better insight into problems encountered by older people with dementia" and "Thinking from the perspective of older people with dementia, leading to changes in attitudes and behaviours towards dementia". The qualitative synthesized evidence showed that informal caregivers gained better insight into problems encountered by PWD, but the quantitative synthesized results are inconsistent. Yet, informal caregivers experienced a change in attitude by thinking from the perspective of PWD.
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Demencia , Realidad Virtual , Humanos , Anciano , Cuidadores , Empatía , Demencia/terapia , Aprendizaje , Calidad de VidaRESUMEN
BACKGROUND: Caring for patients with advanced cancer is complex and challenging, requiring varied expertise, including symptom management, communication skills, care coordination and emotional resilience. Within existing literature, the lived experiences of oncology nurses are poorly articulated in countries with a lower income where formal palliative care (PC) is absent. AIM: To explore the lived experiences of Gazan oncology nurses who provide care to patients with advanced cancer in healthcare systems, without formal palliative care infrastructure. METHODS: A phenomenological approach was adopted. Semi-structured interviews were conducted between January and April 2022, in the Turkish Palestinian Friendship Hospital. Thematic analysis used the themes (corporeality, relationality, spatiality and temporality) to facilitate reflection on the meaning of participants' lived experiences. RESULTS: Interviews were undertaken with 16 oncology nurses. The experience of the 'erosion of nurses' work when coping with anxious attachments to patients and families' was the overarching theme in nurses' views, characterised by five sub-themes: (1) inadequacy of PC training and resources, (2) serving humanity, (3) pride in their profession, (4) existential distress and the coping strategies used by nurses, and (5) reported stress and anxiety when caring for seriously ill patients and their families. CONCLUSIONS: The study sheds light on the challenges and powerful emotions experienced by oncology nurses who care for patients with advanced cancer, yet lack the necessary PC training and institutional resources. The findings indicate an urgent need for PC training for nurses within the Gazan healthcare system and other lower-income settings. Assessing nurses' emotions and relationships with patients and family caregivers is imperative to enable optimum care for patients with cancer and to foster resilience among their nurses.
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Neoplasias , Enfermería Oncológica , Humanos , Neoplasias/enfermería , Adulto , Femenino , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Investigación Cualitativa , Adaptación Psicológica , Turquía , Entrevistas como AsuntoRESUMEN
Background: Older Chinese immigrants constitute the largest older Asian ethnic population in New Zealand. Aging in a foreign land can be complex, presenting increasing challenges for gerontology scholars, practitioners, and policy makers. Older Chinese immigrants are more susceptible to experiencing loneliness and social isolation compared to native older people, primarily due to language, transportation, and cultural barriers. These factors subsequently impact their physical and mental health. With advancements in robotic technology, aged care robots are being applied to support older people with their daily living needs. However, studies on using robots with older immigrants living in the community are sparse. Their preferences for the appearance and function of aged care robots are unclear, which impacts the acceptance and usability of robots, highlighting the need for a user-centered design approach. Objective: This study aims to explore older Chinese immigrants' needs and preferences toward the appearance and function of aged care robots and to examine their relationships with the demographic characteristics of participants. Methods: A cross-sectional design was used in this study, which was undertaken between March and May 2020. A total of 103 participants completed a web-based survey. Results: The average age of participants was 68.7 (SD 5.5) years. The results suggest that 41.7% (n=43) of the 103 participants preferred a humanlike adult appearance, while 32% (n=33) suggested an animallike appearance. These participants reported higher scores in both rigorousness and friendliness compared to others who preferred different robot appearances. Participants expressed a greater preference for the functions of housework assistance (n=86, 83.5%), language translation (n=79, 76.7%), health monitoring (n=78, 75.7%), facial expressions (n=77, 74.8%), news reading (n=66, 64.1%), and security monitoring (n=65, 63.1%). These preferences were found to be significantly associated with marital status, financial status, and duration of immigration. Conclusions: To support immigrant populations to age well in a foreign country and address the growing shortage of health and social professionals, it is important to develop reliable robotic technology services that are tailored based on the needs and preferences of individuals. We collected and compared the perspectives of immigrant and nonimmigrant participants on using robots to support aging in place. The results on users' needs and preferences inform robotic technology services, indicating a need to prioritize older Chinese immigrants' preference toward aged care robots that perform housework assistance, language translation, and health and safety monitoring, and robots with humanlike features.
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PROBLEM: COVID-19 guidance from professional and health organisations created uncertainty leading to professional and personal stress impacting on midwives providing continuity of care in New Zealand (NZ). The COVID-19 pandemic resulted in massive amounts of international and national information and guidance. This guidance was often conflicting and not suited to New Zealand midwifery. AIM: To examine and map the national and international guidance and information provided to midwifery regarding COVID-19 and foreground learnt lessons for future similar crises. METHODS: A systematic scoping review informed by Arksey and O'Malley's five-stage framework. A range of sources from grey and empirical literature was identified and 257 sources included. FINDINGS: Four categories were identified and discussed: (1) guidance for provision of maternity care in the community; (2) guidance for provision of primary labour and birth care; (3) Guidance for midwifery care to women/wahine with confirmed/suspected COVID-19 infection, including screening processes and management of neonates of infected women/wahine (4) Guidance for midwives on protecting self and own families and whanau (extended family) from COVID-19 exposure. CONCLUSION: Guidance was mainly targeted and tailored for hospital-based services. This was at odds with the NZ context, where primary continuity of care underpins practice. It is evident that those providing continuity of care constantly needed to navigate an evolving situation to mitigate interruptions and restrictions to midwifery care, often without fully knowing the personal risk to themselves and their own families. A key message is the need for a single source of evidence-based guidance, regularly updated and timestamped to show where advice changes over time.
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COVID-19 , Servicios de Salud Materna , Partería , Femenino , Humanos , Recién Nacido , Nueva Zelanda/epidemiología , Pandemias/prevención & control , EmbarazoRESUMEN
Objective: There is limited research exploring the experiences of people living with advanced cancer in the Gaza Strip (GS), Palestine. Thus, this study aimed to determine the level of psychological distress, anxiety, and depression among advanced cancer patients in the GS and identify factors associated with a high level of distress. Materials and methods: A secondary analysis was performed using primary data from a larger study focusing on supportive care needs in advanced cancer patients in GS. Three hundred sixty-one patients agreed to participate and filled out the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression was conducted to identify factors associated with high distress levels. Results: Over two-thirds of advanced cancer patients (70.6%) reported a high level of distress. They also reported a significantly higher distress level than patients with early cancer (96.5 vs. 3.5%; p = 0.001). About 92.8% of participants reported depression and anxiety symptoms. Physical, emotional, and practical problems were the primary sources of distress. Breast cancer patients were more likely to have psychological distress than colon and stomach cancer patients. Newly diagnosed patients had a higher level of anxiety, depression, and distress than those who had a cancer diagnosis for an extended period. Conclusion: Patients with advanced cancer in the GS exhibited a significantly higher level of psychological distress, depression and anxiety than patients with advanced cancer elsewhere. Efforts should be made to identify psychological distress as a routine part of oncology practice. Future research should further explore the causes of psychological distress in cancer patients in conflict zones and feasible mitigation strategies.
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OBJECTIVES: To examine loneliness experienced by middle-aged and older Chinese immigrants and its association with accepting technology as a companion (apps, Internet and robots) versus owning pets, when social distancing measures were implemented in New Zealand during the first COVID-19 outbreak. METHODS: This study conducted a community-based cross-sectional survey. Chinese immigrants who were 45-87 years old (n = 173) were invited to answer an online survey in the Chinese language, collecting demographic data, responses to the 6-item De Jong Gierveld Loneliness Scale and experiences in using technology and pet ownership. Descriptive analyses and inferential statistics tests were utilised in the data analysis. RESULTS: A moderate level of overall loneliness with a mean score of 3.68 (SD 1.84), ranging from 0 to 6, was reported by participants. Emotional and social loneliness ranged from 0 to 3 with mean scores of 1.69 (SD 0.98) and 1.99 (SD 1.24), respectively. Self-reported health, financial status, English language abilities, transportation and experiences of using the Internet and apps were significantly related to experiencing loneliness. Loneliness had a weak association with acceptance of robots and pets, but 67.8% and 58.3% of participants who felt lonely, accepted companionship of robots and pets, respectively. CONCLUSIONS: The level of loneliness among older and middle-aged immigrants increased during the COVID-19 pandemic. Further evidence of the specific dimensions of loneliness and the utility of technology to alleviate loneliness among immigrant groups is needed. Interventions tailored for older people with specific cultural requirements to address loneliness are needed.
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COVID-19 , Emigrantes e Inmigrantes , Robótica , Anciano , Anciano de 80 o más Años , China , Estudios Transversales , Amigos , Humanos , Lenguaje , Soledad/psicología , Persona de Mediana Edad , Pandemias , Apoyo SocialRESUMEN
BACKGROUND: Social robots have the potential to bring benefits to aged care. However, it is uncertain whether placing these robots in older people's home is acceptable and whether human-robot interactions would occur or not. METHODS: Four case studies were conducted to understand the experiences of older adults and family caregivers when humanoid social robot Ka Ka was placed in homes for two weeks. RESULTS: Four older adults and three family caregivers were involved. Older adults interacted with the social robot Ka Ka every day during the study period. 'Talking to Ka Ka', 'listening to music', 'using the calendar reminder', and 'listening to the weather report' were the most commonly used features. Qualitative data reported the strengths of Ka Ka, such as providing emotional support to older adults living alone, diversifying their daily activities, and enhancing family relationships. The voice from Ka Ka (female, soft, and pleasing to the ear) was considered as 'bringing a pleasant feeling' to older adults. CONCLUSIONS: In order to support aging-in-place and fill the gaps of the intensified shortage of health and social manpower, it is of prime importance to develop reliable and age-friendly AI-based robotic services that meet the needs and preferences of older adults and caregivers.