Shift Work Sleep Disorder and Mental Health: An Integrative Review of Neurobiological, Sociological, and Psychological Perspectives With Public Policy Implications.

Shift workers support critical 24-hr operations; their health can be impaired by disrupted circadian rhythms and dysfunctional sleep. Shift work sleep disorder (SWSD) is a prevalent condition with significant psychological consequences. Nurse leaders have not yet implemented effective policies to prevent SWSD and optimize shift workers' mental health. The purpose of this integrative review was to examine research about SWSD within the context of neurobiological, sociological, and psychological perspectives that can inform policy changes. The Centers for Disease Control and Prevention Policy Analytic Framework was used to determine the priority recommendations. A search of three databases provided 19 research articles about SWSD and mental health, which illustrated how SWSD is common around the world in many occupations. Backward-rotating schedules and quick returns were risk factors for SWSD. In addition, SWSD was associated with circadian languidity, sleep reactivity, depressive symptoms, and anxiety. Collectively, the studies lacked objective measures of sleep and circadian rhythms, which has hindered the ability to devise interventions that will target the neurobiological causes of SWSD. The research also lacked attention to important sociological factors, such as workers' pay and benefits. Using these findings, nurse leaders can contribute to public policy reforms that increase funding for more rigorous SWSD research. Lawmakers should be advised by nurse leaders to enforce new regulations that provide incentives for employers to create healthier workplaces, such as prohibiting the overuse of schedules that make employees vulnerable to SWSD and providing funds for interventions to prevent SWSD and support mental health.

The Impact of Sex-Specific Survival on the Incidence of Dementia in Parkinson's Disease.

OBJECTIVE: The aim of our study is to analyze sex-specific patterns of Parkinson's disease dementia (PDD) incidence. We are investigating the extent to which sex differences in survival after initial Parkinson's disease (PD) diagnosis influence differences in PDD risk among PD patients. METHODS: We used a random sample of German longitudinal health claims data of persons ages 50+ (2004-2019; n = 250,000) and identified new PD cases ages 65+ who were followed-up for a PDD diagnosis or death between 2006 and 2017. We performed Cox and competing-risk regression models, with death as competing event, to calculate PDD hazard ratios (HR) adjusted for age at PD onset, PD severity as measured by the modified Hoehn and Yahr (HY) scale, comorbidities, and medications. RESULTS: Of 2195 new PD cases, 602 people died before PDD and 750 people developed PDD by the end of 2017. The adjusted risk of PDD differs by sex, with men having a higher PDD risk than women. When accounting for death, men and women do not differ in their PDD risk (HR = 1.02, P = 0.770). Sex-specific analyses showed significant age and severity effects in women (age: HR = 1.05, P < 0.001; HY 3-5 vs. 0-2.5: HR = 1.46, P = 0.011), but not in men. CONCLUSION: Older age at first PD diagnosis and higher disease severity increase PDD risk, but this association is attenuated for PD men when controlling for death. This implies that the most frail PD men die rapidly before receiving a dementia diagnosis, whereas women with PD survive at higher rates, regardless of their age at onset and disease severity. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

A concept analysis of nurses in conflicts after World War II.

AIM: We analysed nurses' experiences during military conflicts since World War II. BACKGROUND: Nurses have successfully reduced morbidity and mortality in populations affected by wars; despite centuries of nurses' global involvement in wars, there is limited knowledge about their experiences. METHOD: We used Rodger's evolutionary concept analysis methodology to understand the antecedents, attributes, consequences, context and implications of nurses' war-related experiences. We analysed data from quantitative and qualitative research, media reports, editorials, historical reviews and published accounts of nurses' experiences in many locations, including Afghanistan, Bosnia, Croatia, Korea, Kosovo, Iran, Iraq, Israel, Palestine, Russia, Somalia, Ukraine and Vietnam. FINDINGS: Two antecedent conditions preceded nurses' war involvement: actively responding to human suffering and having resources for readiness. Nurses were defined by five attributes: sacrifice, resourcefulness, tunnel-vision, survival mindset and comradery. We also found evidence for seven consequences; nurses saved lives (reduced morbidity and mortality), however, some nurses faced professional burnout/disillusionment, restricted practice authority, isolation and post-traumatic stress after war. In addition, growth and pacifism were consequences for some nurses who were exposed to war. CONCLUSION: The findings of our concept analysis illustrate how nurses have fulfilled critical life-saving roles, but some nurses' post-war experiences were debilitating, stigmatized and unsupported. We conclude that research about the resourcefulness, innovations and resiliency nurses have developed during wars is essential, and professional support mechanisms must be developed to prevent post-traumatic stress, burnout and attrition from the profession. Governments can use utilize the knowledge nurses developed during wars to expand emergency preparedness skillsets and promote nurses as the leaders of international efforts to promote peace. NO PATIENT OR PUBLIC CONTRIBUTION: Patients, service users, caregivers and members of the public were not involved in conducting this concept analysis or preparing the manuscript. IMPACT STATEMENT: By understanding nurses' involvement with post-WWII conflicts, we have demonstrated the significant public health contributions, challenges and personal and professional growth experienced by nurses. Nurses' war-related knowledge should be utilized to innovate healthcare practices during disasters and to advise policymakers in developing, implementing and evaluating peace-promoting operations.

Amisulpride as a potential disease-modifying drug in the treatment of tauopathies.

INTRODUCTION: Hyperphosphorylation and aggregation of the microtubule-associated protein tau cause the development of tauopathies, such as Alzheimer's disease and frontotemporal dementia (FTD). We recently uncovered a causal link between constitutive serotonin receptor 7 (5-HT7R) activity and pathological tau aggregation. Here, we evaluated 5-HT7R inverse agonists as novel drugs in the treatment of tauopathies. METHODS: Based on structural homology, we screened multiple approved drugs for their inverse agonism toward 5-HT7R. Therapeutic potential was validated using biochemical, pharmacological, microscopic, and behavioral approaches in different cellular models including tau aggregation cell line HEK293 tau bimolecular fluorescence complementation, primary mouse neurons, and human induced pluripotent stem cell-derived neurons carrying an FTD-associated tau mutation as well as in two mouse models of tauopathy. RESULTS: Antipsychotic drug amisulpride is a potent 5-HT7R inverse agonist. Amisulpride ameliorated tau hyperphosphorylation and aggregation in vitro. It further reduced tau pathology and abrogated memory impairment in mice. DISCUSSION: Amisulpride may be a disease-modifying drug for tauopathies.

Sleep Disturbances in Older Adults Receiving Dialysis.

Sleep disturbances are serious issues in individuals with end stage kidney disease because they are associated with worsening kidney function and other negative health outcomes, especially in older adults. Our analysis aimed to provide clinicians with the conceptual clarity required for managing sleep disturbances in older patients who are receiving dialysis. A literature review revealed three attributes that define this population's sleep disturbances: sleep initiation and maintenance difficulties, restless sleep and short sleep, and abnormal breathing during sleep. Con sidering the serious consequences and correlates of sleep disturbances in older patients who are receiving dialysis, tailored interventions are needed to improve their sleep. Our literature review, concept analysis, and case studies provide key information for designing future mechanistic, clinical-translational, and interventional research.

Potential of prevention strategies for the modifiable risk factor type 2 diabetes with relation to the future number of dementia patients in Germany- a multi-state projection through 2040.

BACKGROUND: We assess the impact of prevention strategies regarding type 2 diabetes as a modifiable risk factor for dementia and its consequences for the future number of dementia patients in Germany. METHODS: We used a random sample of health claims data (N = 250,000) of insured persons aged 50+ drawn in 2014, and data on population size and death rates in 2015 from the Human Mortality Database. Using exponential hazard models, we calculated age- and sex-specific transition probabilities and death rates between the states (no diabetes/no dementia, diabetes/no dementia, no diabetes/dementia, diabetes/dementia). In multi-state projections, we estimated the future number of dementia cases aged 75+ through 2040 depending on the development of the incidence of diabetes among persons without diabetes and without dementia, and the dementia incidence among persons with and without diabetes. RESULTS: In 2015 there were 1.53 million people with dementia aged 75+ in Germany. A relative annual reduction in death rates of 2.5% and in dementia incidence in persons without diabetes of 1% will increase this number to 3.38 million by 2040. A relative reduction of diabetes incidence by 1% annually would decrease dementia cases by around 30,000, while a reduction of dementia incidence among people with diabetes by 1% would result in 220,000 fewer dementia cases. Both prevention strategies combined would prevent 240,000 dementia cases in 2040. CONCLUSIONS: The increase in life expectancy is decisive for the future number of people with dementia. Strategies of better diabetes treatment have the potential to lower the increase in the number of dementia patients in the coming decades.

Diabetes duration and the risk of dementia: a cohort study based on German health claims data.

OBJECTIVE: Diabetes is a risk factor for dementia but little is known about the impact of diabetes duration on the risk of dementia. We investigated the effect of type 2 diabetes duration on the risk of dementia. DESIGN: Prospective cohort study using health claims data representative for the older German population. The data contain information about diagnoses and medical prescriptions from the in- and outpatient sector. METHODS: We performed piecewise exponential models with a linear and a quadratic term for time since first type 2 diabetes diagnosis to predict the dementia risk in a sample of 13,761 subjects (2,558 dementia cases) older than 65 years. We controlled for severity of diabetes using the Adopted Diabetes Complications Severity Index. RESULTS: We found a U-shaped dementia risk over time. After type 2 diabetes diagnosis the dementia risk decreased (26% after 1 year) and reached a minimum at 4.75 years, followed by an increase through the end of follow-up. The pattern was consistent over different treatment groups, with the strongest U-shape for insulin treatment and for those with diabetes complications at the time of diabetes diagnosis. CONCLUSIONS: We identified a non-linear association of type 2 diabetes duration and the risk of dementia. Physicians should closely monitor cognitive function in diabetic patients beyond the first few years after diagnosis, because the later increase in dementia occurred in all treatment groups.

Left-censored dementia incidences in estimating cohort effects.

We estimate the dementia incidence hazard in Germany for the birth cohorts 1900 until 1954 from a simple sample of Germany's largest health insurance company. Followed from 2004 to 2012, 36,000 uncensored dementia incidences are observed and further 200,000 right-censored insurants included. From a multiplicative hazard model we find a positive and linear trend in the dementia hazard over the cohorts. The main focus of the study is on 11,000 left-censored persons who have already suffered from the disease in 2004. After including the left-censored observations, the slope of the trend declines markedly due to Simpson's paradox, left-censored persons are imbalanced between the cohorts. When including left-censoring, the dementia hazard increases differently for different ages, we consider omitted covariates to be the reason. For the standard errors from large sample theory, left-censoring requires an adjustment to the conditional information matrix equality.

Sleep fragmentation increases blood pressure and is associated with alterations in the gut microbiome and fecal metabolome in rats.

The gut microbiota, via the production of metabolites entering the circulation, plays a role in blood pressure regulation. Blood pressure is also affected by the characteristics of sleep. To date, no studies have examined relationships among the gut microbiota/metabolites, blood pressure, and sleep. We hypothesized that fragmented sleep is associated with elevated mean arterial pressure, an altered and dysbiotic gut microbial community, and changes in fecal metabolites. In our model system, rats were randomized to 8 h of sleep fragmentation during the rest phase (light phase) or were undisturbed (controls) for 28 consecutive days. Rats underwent sleep and blood pressure recordings, and fecal samples were analyzed during: baseline (days -4 to -1), early sleep fragmentation (days 0-3), midsleep fragmentation (days 6-13), late sleep fragmentation (days 20-27), and recovery/rest (days 28-34). Less sleep per hour during the sleep fragmentation period was associated with increased mean arterial pressure. Analyses of gut microbial communities and metabolites revealed that putative short chain fatty acid-producing bacteria were differentially abundant between control and intervention animals during mid-/late sleep fragmentation and recovery. Midsleep fragmentation was also characterized by lower alpha diversity, lower Firmicutes:Bacteroidetes ratio, and higher Proteobacteria in intervention rats. Elevated putative succinate-producing bacteria and acetate-producing bacteria were associated with lower and higher mean arterial pressure, respectively, and untargeted metabolomics analysis demonstrates that certain fecal metabolites are significantly correlated with blood pressure. These data reveal associations between sleep fragmentation, mean arterial pressure, and the gut microbiome/fecal metabolome and provide insight to links between disrupted sleep and cardiovascular pathology.

Multimorbidity in Patients With Acute Coronary Syndrome Is Associated With Greater Mortality, Higher Readmission Rates, and Increased Length of Stay: A Systematic Review.

OBJECTIVE: The aims of this systematic review were to determine the magnitude and impact of multimorbidity (≥2 chronic conditions) on mortality, length of stay, and rates of coronary intervention in patients with acute coronary syndrome (ACS) and to compare the prevalence of cardiovascular versus noncardiovascular multimorbidities. METHODS: MEDLINE, PubMed, MedlinePlus, EMBASE, OVID, and CINAHL databases were searched for studies published between 2009 and 2019. Eight original studies enrolling patients with ACS and assessing cardiovascular and noncardiovascular comorbid conditions met the inclusion criteria. Study quality was evaluated using the Crowe Critical Appraisal Tool. RESULTS: The most frequently examined cardiovascular multimorbidities included hypertension, diabetes, heart failure, atrial fibrillation, stroke/transient ischemic attack, coronary heart disease, and peripheral vascular disease; the most frequently examined noncardiovascular multimorbidities included cancer, anemia, chronic obstructive pulmonary disease, renal disease, liver disease, and depression. The prevalence of multimorbidity in the population with ACS is high (25%-95%). Patients with multimorbidities receive fewer evidence-based treatments, including coronary intervention and high-dose statins. Patients with multimorbidities experience higher in-hospital mortality (5%-13.9% vs 2.6%-6.1%), greater average length of stay (5-9 vs 3-4 days), and lower rates of revascularization (9%-14% vs 39%-42%) than nonmultimorbid patients. Women, despite being the minority in all sample populations, exhibited greater levels of multimorbidity than men. CONCLUSIONS: Multimorbid patients with ACS are at a greater risk for worse outcomes than their nonmultimorbid counterparts. Lack of consistent measurement makes interpretation of the impact of multimorbidity challenging and emphasizes the need for more research on multimorbidity's effects on postdischarge healthcare utilization.

[Trends in the Prevalence of Dementia and Parkinson's Disease: An Analysis Based on Health Claims Data from all German Statutory Health Insurance Funds for Persons aged 65+in Germany 2009-2012]. / Trends in der Prävalenz von Demenz und Parkinson ­ Eine Analyse auf Basis aller gesetzlich versicherten Personen im Alter 65+in Deutschland zwischen 2009 und 2012.

OBJECTIVES: There will be an increase in the number of people with dementia (DEM) and Parkinson's disease (PD) with the ageing of the population. The aim of the study was to calculate prevalences and trends of prevalences for DEM and PD in Germany to enable reliable public health planning. METHODS: For the years 2009-2012, sex-specific period prevalences of DEM and PD for 5-year age-groups based on health claims data from all German statutory health insurance funds were calculated. Time trends were estimated using a negative binomial regression. RESULTS: In 2012 and for persons aged 65 or older, the crude prevalence was 7.9% for DEM and 2.2% for PD. Between 2009 and 2012, a mean decrease of the DEM prevalence by 1.2% per year was found for women and men above age 65. For PD we found constant rates between 2009-2012 among men and an annual mean decrease of PD prevalence of 0.5% among women. CONCLUSION: A reduction of the DEM prevalence by 1.2% per year could partially counterbalance the increase of people with dementia resulting from ageing population. For PD we found decreasing prevalences only among women.

Autonomic regulation during sleep and wakefulness: a review with implications for defining the pathophysiology of neurological disorders.

Cardiovascular and respiratory parameters change during sleep and wakefulness. This observation underscores an important, albeit incompletely understood, role for the central nervous system in the differential regulation of autonomic functions. Understanding sleep/wake-dependent sympathetic modulations provides insights into diseases involving autonomic dysfunction. The purpose of this review was to define the central nervous system nuclei regulating sleep and cardiovascular function and to identify reciprocal networks that may underlie autonomic symptoms of disorders such as insomnia, sleep apnea, restless leg syndrome, rapid eye movement sleep behavior disorder, and narcolepsy/cataplexy. In this review, we examine the functional and anatomical significance of hypothalamic, pontine, and medullary networks on sleep, cardiovascular function, and breathing.

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association.

BACKGROUND: Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today's myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. METHODS AND RESULTS: This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. CONCLUSIONS: Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.

Effect of pioglitazone medication on the incidence of dementia.

OBJECTIVE: Peroxisome proliferator activated receptor γ-activating drugs show various salutary effects in preclinical models of neurodegenerative disease. The decade-long clinical usage of these drugs as antidiabetics now allows for evaluation of patient-oriented data sources. METHODS: Using observational data from 2004-2010, we analyzed the association of pioglitazone and incidence of dementia in a prospective cohort study of 145,928 subjects aged ≥60 years who, at baseline, were free of dementia and insulin-dependent diabetes mellitus. We distinguished between nondiabetics, diabetics without pioglitazone, diabetics with prescriptions of <8 calendar quarters of pioglitazone, and diabetics with ≥8 quarters. Cox proportional hazard models explored the relative risk (RR) of dementia incidence dependent on pioglitazone use adjusted for sex, age, use of rosiglitazone or metformin, and cardiovascular comorbidities. RESULTS: Long-term use of pioglitazone was associated with a lower dementia incidence. Relative to nondiabetics, the cumulative long-term use of pioglitazone reduced the dementia risk by 47% (RR = 0.53, p = 0.029). If diabetes patients used pioglitazone <8 quarters, the dementia risk was comparable to those of nondiabetics (RR = 1.16, p = 0.317), and diabetes patients without a pioglitazone treatment had a 23% increase in dementia risk (RR = 1.23, p < 0.001). We did not find evidence for age effects, nor for selection into pioglitazone treatment due to obesity. INTERPRETATION: These findings indicate that pioglitazone treatment is associated with a reduced dementia risk in initially non-insulin-dependent diabetes mellitus patients. Prospective clinical trials are needed to evaluate a possible neuroprotective effect in these patients in an ageing population.

Short-term trends in dementia prevalence in Germany between the years 2007 and 2009.

Recent studies have been cautiously optimistic about declining trends in dementia prevalence and incidence. Newly available claims data from a German public health insurance company covering 30% of the total population permitted us to explore short-term trends based on millions of observations up to the highest ages. Diagnoses stemmed from the inpatient and outpatient services and covered both the community-dwelling population and those living in nursing homes. Data spanning more than 3 years were examined, and the examination revealed a significant yearly reduction between 1% and 2% in the prevalence of dementia among women aged 75 to 84 years. The extent of the reduction was comparable with reports from earlier studies. A similar tendency existed among men, however, statistically not significant. Trends in medical, lifestyle, and societal risk factors of dementia may have contributed to this decline.