Path model on decision-making ability of clinical nurses.

AIMS AND OBJECTIVES: To identify and examine the relationship between the factors influencing the decision-making ability of clinical nurses in hospitals, South Korea, and to establish a model, to verify the fit and the effect. BACKGROUND: Clinical nurses are exposed to environments and situations where they make continuous decisions according to the need of direct treatment and nursing. DESIGN: This study used a cross-sectional descriptive design, relation prediction modelling and adheres to the STROBE guidelines. METHODS: The model construction was based on the information processing theory by Hansen and Thomas (Nursing Research, 17, 436, 1968). The model consists of 5 exogenous variables (expertise, critical thinking disposition, knowledge-sharing behaviour, nursing work environment, and decision-making stress) and 3 endogenous variables (analytic-systematic decision-making type, intuitive-interpretive decision-making type and decision-making ability). Participants were 274 clinical nurses, who were working at two hospitals in Seoul, South Korea. The data was analysed using SPSS WIN 18.0 and AMOS 20.0 program. Path analysis to verify the hypothetical model was used, and the fit was evaluated by χ2 /df, GFI, AGFI, NFI, CFI and RMSEA. Data were collected from March to May 2017. RESULTS: The fit index of the modified path model was χ2 /df = 2.25, GFI = .972, AGFI = .929, NFI = .967, CFI = .981 and RMSEA = .068. The analytic-systematic decision-making type had the greatest direct effect on the clinical nurses' decision-making ability, which is the final outcome variable, followed by significant direct and indirect effects on critical thinking disposition. CONCLUSION: This study suggests that the clinical nurses' decision-making ability in hospitals were leadingly influenced by analytic-systematic decision-making type and critical thinking disposition. RELEVANCE TO CLINICAL PRACTICE: In the nursing practice, nurses need to pay attention the analytic-systematic decision-making type and critical thinking disposition for improving decision-making ability of clinical nurses in hospitals.

Assessing the causal effects of long-term exposure to PM2.5 during pregnancy on cognitive function in the adolescence: Evidence from a nationwide cohort in China.

The effects of air pollution on adolescents need further consideration. Although there is evidence that maternal exposure to air pollution may affect the cognitive function of offspring, relevant studies remain limited and inconsistent, with a lack of studies assessing the causal effects and evidence from developing countries. Using data from Chinese Family Panel Studies, a representative Chinese nationwide cohort study, OLS combined with instrumental variable + two-stage least square (IV+2SLS) was used to explore the causal effects of exposure to PM2.5 concentrations during pregnancy on the cognitive function of offspring when they become adolescents. After detailed argumentation and multiple testing, Planetary Boundary Layer Height (PBLH) and Surface Pressure (SP) were selected as the instrumental variables for this study. One thousand five hundred fifty-five adolescents participated in this study, with a mean age of 13.3 years (sd = 2.3). There were 706 females (45.4%), the mean maternal PM2.5 exposure concentration was 64.9 µg/m3, and recorded a mean cognitive function score of 38.1 (sd = 9.4). The OLS results found that maternal exposure to air pollution increased cognitive function in offspring adolescents, corroborating the presence of endogeneity. Multi-domain knowledge, the results of the weak instrumental variable assessments of F-tests (F = 237 > 10) and Stock-yogo tests (minimum eigenvalue statistic = 153.16 > 16.38), and the results of the Hansen J overidentification test (p > 0.05) verified the plausibility and validity of the instrumental variables. The IV+2SLS results, following causal modeling, showed that PM2.5 exposure during pregnancy impairs the cognitive ability of offspring adolescents (ß = -0.040, p < 0.05). Robustness tests also validated the results. This study provides important policy implications for developing countries on protecting their adolescents and reminds parents that the protection of adolescents from air pollution should begin from conception.

Activity limitations in leprosy and their association to cognition and neuropsychiatric symptoms.

OBJECTIVES: to analyze activity limitations in patients with leprosy and their association to cognition and neuropsychiatric symptoms. METHODS: this cross-sectional design study included sixty patients with multibacillary leprosy assisted at a reference center. Participants were divided according to their physical disability and submitted to instruments assessing daily activities (basic and instrumental), cognitive functions, and neuropsychiatric symptoms. The order of the instruments was random to avoid any interference of test sequence on the results. RESULTS: fifty-five percent of the participants presented physical disabilities. All patients were independent in performing basic activities but sixty-six percent presented difficulties in performing instrumental activities. Cognitive decline and neuropsychiatric symptoms were seen in advanced stages of the disease, but they were more associated to patient age than to leprosy. CONCLUSIONS: leprosy patients presented physical disabilities and difficulties in performing instrumental daily activities. Cognitive decline and neuropsychiatric symptoms were more associated to aging than to leprosy itself.

Activity limitations in leprosy and their association to cognition and neuropsychiatric symptoms / Limitaciones de tarea en la enfermedad de Hansen y su relación con cognición y síntomas neuropsiquiátricos / Limitações de tarefa na hanseníase e sua associação com cognição e sintomas neuropsiquiátricos

ABSTRACT Objectives: to analyze activity limitations in patients with leprosy and their association to cognition and neuropsychiatric symptoms. Methods: this cross-sectional design study included sixty patients with multibacillary leprosy assisted at a reference center. Participants were divided according to their physical disability and submitted to instruments assessing daily activities (basic and instrumental), cognitive functions, and neuropsychiatric symptoms. The order of the instruments was random to avoid any interference of test sequence on the results. Results: fifty-five percent of the participants presented physical disabilities. All patients were independent in performing basic activities but sixty-six percent presented difficulties in performing instrumental activities. Cognitive decline and neuropsychiatric symptoms were seen in advanced stages of the disease, but they were more associated to patient age than to leprosy. Conclusions: leprosy patients presented physical disabilities and difficulties in performing instrumental daily activities. Cognitive decline and neuropsychiatric symptoms were more associated to aging than to leprosy itself.

RESUMEN Objetivo: analizar limitaciones de tarea en pacientes con Lepra y su relación con cognición y síntomas neuropsiquiátricos. Métodos: este estudio transversal incluyó 60 pacientes con Lepra multibacilar atendidos en centro de referencia. Participantes fueron divididos segundo la disfunción física y evaluados cuanto a las actividades diarias (básicas y instrumentales), funciones cognitivas y síntomas neuropsiquiátricos. Orden de aplicación de los instrumentos aleatoria para evitar interferencia de la secuencia de tests sobre los resultados. Resultados: de los participantes, 55% presentaron disfunción física. Todos pacientes eran independientes en las actividades básicas, pero 66% mostraron dificultades en las actividades instrumentales. Declive cognitivo y síntomas neuropsiquiátricos fueron observados en etapas avanzadas de la enfermedad, pero estos estaban más relacionados a la edad del paciente que a la Lepra. Conclusiones: pacientes con Lepra evidenciaron disfunción física y dificultades en las actividades instrumentales. Declive cognitivo y síntomas neuropsiquiátricos están más relacionados al envejecimiento que a la Lepra.

RESUMO Objetivo: analisar as limitações de tarefa em pacientes com hanseníase e sua associação com cognição e sintomas neuropsiquiátricos. Métodos: este estudo transversal incluiu 60 pacientes com hanseníase multibacilar atendidos em um centro de referência. Os participantes foram divididos segundo a disfunção física e avaliados quanto às atividades diárias (básicas e instrumentais), às funções cognitivas e aos sintomas neuropsiquiátricos. A ordem de aplicação dos instrumentos foi aleatória para evitar interferência da sequência dos testes sobre os resultados. Resultados: dos participantes, 55% apresentaram disfunção física. Todos os pacientes eram independentes nas atividades básicas, mas 66% mostraram dificuldades nas atividades instrumentais. Declínio cognitivo e sintomas neuropsiquiátricos foram observados em estágios avançados da doença, porém estes estavam mais associados à idade do paciente do que à hanseníase. Conclusões: pacientes com hanseníase evidenciaram disfunção física e dificuldades nas atividades diárias instrumentais. Declínio cognitivo e sintomas neuropsiquiátricos estão mais associados ao envelhecimento do que à hanseníase.

2,4 Dinitrophenol as Medicine.

In the sanctity of pure drug discovery, objective reasoning can become clouded when pursuing ideas that appear unorthodox, but are spot on physiologically. To put this into historical perspective, it was an unorthodox idea in the 1950's to suggest that warfarin, a rat poison, could be repositioned into a breakthrough drug in humans to protect against strokes as a blood thinner. Yet it was approved in 1954 as Coumadin® and has been prescribed to billions of patients as a standard of care. Similarly, no one can forget the horrific effects of thalidomide, prescribed or available without a prescription, as both a sleeping pill and "morning sickness" anti-nausea medication targeting pregnant women in the 1950's. The "thalidomide babies" became the case-in-point for the need of strict guidelines by the U.S. Food & Drug Administration (FDA) or full multi-species teratogenicity testing before drug approval. More recently it was found that thalidomide is useful in graft versus host disease, leprosy and resistant tuberculosis treatment, and as an anti-angiogenesis agent as a breakthrough drug for multiple myeloma (except for pregnant female patients). Decades of diabetes drug discovery research has historically focused on every possible angle, except, the energy-out side of the equation, namely, raising mitochondrial energy expenditure with chemical uncouplers. The idea of "social responsibility" allowed energy-in agents to be explored and the portfolio is robust with medicines of insulin sensitizers, insulin analogues, secretagogues, SGLT2 inhibitors, etc., but not energy-out medicines. The primary reason? It appeared unorthodox, to return to exploring a drug platform used in the 1930s in over 100,000 obese patients used for weight loss. This is over 80-years ago and prior to Dr Peter Mitchell explaining the mechanism of how mitochondrial uncouplers, like 2,4-dinitrophenol (DNP) even worked by three decades later in 1961. Although there is a clear application for metabolic disease, it was not until recently that this platform was explored for its merit at very low, weight-neutral doses, for treating insidious human illnesses and completely unrelated to weight reduction. It is known that mitochondrial uncouplers specifically target the entire organelle's physiology non-genomically. It has been known for years that many neuromuscular and neurodegenerative diseases are associated with overt production of reactive oxygen species (ROSs), a rise in isoprostanes (biomarker of mitochondrial ROSs in urine or blood) and poor calcium (Ca2+) handing. It has also been known that mitochondrial uncouplers lower ROS production and Ca2+ overload. There is evidence that elevation of isoprostanes precedes disease onset, in Alzheimer's Disease (AD). It is also curious, why so many neurodegenerative diseases of known and unknown etiology start at mid-life or later, such as Multiple Sclerosis (MS), Huntington Disease (HD), AD, Parkinson Disease, and Amyotrophic Lateral Sclerosis (ALS). Is there a relationship to a buildup of mutations that are sequestered over time due to ROSs exceeding the rate of repair? If ROS production were managed, could disease onset due to aging be delayed or prevented? Is it possible that most, if not all neurodegenerative diseases are manifested through mitochondrial dysfunction? Although DNP, a historic mitochondrial uncoupler, was used in the 1930s at high doses for obesity in well over 100,000 humans, and so far, it has never been an FDA-approved drug. This review will focus on the application of using DNP, but now, repositioned as a potential disease-modifying drug for a legion of insidious diseases at much lower and paradoxically, weight neutral doses. DNP will be addressed as a treatment for "metabesity", an emerging term related to the global comorbidities associated with the over-nutritional phenotype; obesity, diabetes, nonalcoholic steatohepatitis (NASH), metabolic syndrome, cardiovascular disease, but including neurodegenerative disorders and accelerated aging. Some unexpected drug findings will be discussed, such as DNP's induction of neurotrophic growth factors involved in neuronal heath, learning and cognition. For the first time in 80's years, the FDA has granted (to Mitochon Pharmaceutical, Inc., Blue Bell, PA, USA) an open Investigational New Drug (IND) approval to begin rigorous clinical testing of DNP for safety and tolerability, including for the first ever, pharmacokinetic profiling in humans. Successful completion of Phase I clinical trial will open the door to explore the merits of DNP as a possible treatment of people with many truly unmet medical needs, including those suffering from HD, MS, PD, AD, ALS, Duchenne Muscular Dystrophy (DMD), and Traumatic Brain Injury (TBI).

Cognitive performance of long-term institutionalized elderly patients with schizophrenia: a case control study / Desempenho cognitivo em pacientes idosos com esquizofrenia: um estudo caso-controle

Cognitive impairment is inherent to the ageing process. Several studies suggest that patients with late-life schizophrenia have more marked cognitive impairment. Objective: The aim of this study was to compare the cognitive performance of elderly institutionalized patients with schizophrenia and institutionalized elderly control patients without neurological or psychiatric diseases, matched for age, educational level and institutionalization time. Methods: The Cambridge Examination for Mental Disorders of the Elderly (CAMCOG) was used to test 10 institutionalized elderly patients with schizophrenia. Results were compared with those of 10 institutionalized control patients with history of Hansens disease. Results: Patients with schizophrenia showed a worse performance in terms of total CAMCOG score and on its subtests of orientation, language, abstraction, and memory. Patients with schizophrenia also disclosed a non-significant trend toward lower scores on the MMSE and on calculus. Conclusion: Findings demonstrated that schizophrenia was associated to worse cognitive impairment in long-term institutionalized elderly patients compared with institutionalized patients without neurological or psychiatric diseases.

Prejuízo cognitivo é inerente ao processo de senescência. Estudos tem sugerido que pacientes idosos com esquizofrenia apresentam esse prejuízo de maneira mais acentuada. Objetivo: O objetivo deste estudo foi comparar o desempenho cognitivo de pacientes idosos com esquizofrenia, institucionalizados, com indivíduos idosos, institucionalizados, sem doenças neurológicas ou psiquiátricas, pareados pela idade, escolaridade e tempo de institucionalização. Métodos: Cambridge Examination for Mental Disorders of the Elderly (CAMCOG) foi aplicado em 10 pacientes, institucionalizados, com esquizofrenia, cujo desempenho cognitivo foi comparado ao de 10 indivíduos, institucionalizados, com história de doença de Hansen. Resultados: Pacientes com esquizofrenia apresentaram um pior desempenho na pontuação total do CAMCOG e em seus subitens orientação, linguagem, abstração e memória. Pacientes com esquizofrenia também apresentaram uma tendência, não significativa, para menor pontuação no MEEM e cálculo. Conclusão: Nossos achados demonstram que a esquizofrenia está associada a piora do comprometimento cognitivo em pacientes idosos com institucionalização de longa permanência comparados a pacientes institucionalizados sem doenças neurológicas ou psiquiátricas.

Functional neural correlates of fluid and crystallized analogizing.

The main aim of this study was to characterize neural correlates of analogizing as a cognitive contributor to fluid and crystallized intelligence. In a previous fMRI study which employed fluid analogy letter strings as criteria in a multiple plausibility design (Geake and Hansen, 2005), two frontal ROIs associated with working memory (WM) load (within BA 9 and BA 45/46) were identified as regions in which BOLD increase correlated positively with a crystallized measure of (verbal) IQ. In this fMRI study we used fluid letter, number and polygon strings to further investigate the role of analogizing in fluid (transformation string completion) and non fluid or crystallized (unique symbol counting) cognitive tasks. The multi stimulus type (letter, number, polygon) design of the analogy strings enabled investigation of a secondary research question concerning the generalizability of fluid analogizing at a neural level. A selective psychometric battery, including the Raven's Progressive Matrices (RPM), measured individual cognitive abilities. Neural activations for the effect of task-fluid analogizing (string transformation plausibility) vs. crystallized analogizing (unique symbol counting)-included bilateral frontal and parietal areas associated with WM load and fronto parietal models of general intelligence. Neural activations for stimulus type differences were mainly confined to visually specific posterior regions. ROI covariate analyses of the psychometric measures failed to find consistent co-relationships between fluid analogizing and the RPM and other subtests, except for the WAIS Digit Symbol subtest in a group of bilateral frontal cortical regions associated with the maintenance of WM load. Together, these results support claims for separate developmental trajectories for fluid cognition and general intelligence as assessed by these psychometric subtests.

Cognitive inhibition in individuals prone to homophobia.

Individuals scoring either High, Medium, or Low on the Homosexism Short-Form scale (Hansen, 1982) made speeded decisions to neutral (N), mildly provocative (MP), or very provocative (VP) statements regarding issues relating to homophobia. These three groups did not differ on age, education, reading rate, or vocabulary ability. It was predicted that individuals High in homophobia would produce faster reaction times to the VP sentences than those individuals scoring Medium or Low in homophobia. Results indicated the opposite pattern. Individuals scoring High in homophobia actually had slower reaction times to VP sentences than did either the Medium or Low homophobia individuals. Results are discussed within an inhibitory framework related to the High homophobia individuals' overall homophobia schema.

Knowledge about leprosy among leprosy patients.

A study on "Knowledge of Leprosy in Leprosy patients" was conducted in the Dermatology outpatient department of JIPMER. The study has shown that a good percentage of leprosy patients possess proper knowledge of leprosy in respect of its awareness, nature of treatment, consequences of lack of treatment and prevention of disease. Knowledge regarding the cause and mode of spread of disease and duration of treatment was lacking in majority of patients These areas should be given more concentration in educating the leprosy patients. It was found that literate patients possessed better knowledge than illiterate patients.

Knowledge about leprosy among leprosy patients

A study on Knowledge of Leprosy in Leprosy patients was conducted in the Dermatology outpatient department of JIPMER. The study has shown that a good percentage of leprosy patients possess proper knowledge of leprosy in respect of its awareness, nature of treatment, consequences of lack of treatment and prevention of disease. Knowledge regarding the cause and mode of spread of disease and duration of treatment was lacking in majority of patients These areas should be given more concentration in educating the leprosy patients. It was found that literate patients possessed better knowledge than illiterate patients.