Preoperative NUn score serves as a robust predictor of overall and disease-specific survivals following radical surgery for gastric cancer.

PURPOSE: Methods to preoperatively stratify oncological risks associated with gastric cancer (GC) are limited. Host inflammatory parameters, i.e., serum C-reactive protein (CRP) and albumin levels, are known to be associated with outcomes. We examined the relationships between disease-specific mortality and four CRP-albumin-based indices (CRP-albumin ratio [CAR], modified Glasgow prognostic score [mGPS], Osaka prognostic score [OPS], and NUn score) preoperatively measured in cases with resectable GC. METHODS: Survival outcomes of 1290 consecutive GC patients with oncological gastrectomy were reviewed. Predictive significances of preoperative CAR, mGPS, OPS, and NUn scores were assessed with time-dependent receiver operating characteristic curves and Cox regression analyses. RESULTS: Median follow-up was 107 months. Area under the curve for predicting overall and disease-specific survivals (OS/DSS) for the preoperative NUn score was clearly superior to those of the other parameters. On univariate Cox regression analysis, preoperative CAR, mGPS, OPS, and the NUn score all correlated significantly with OS/DSS. On multivariate Cox regression analysis, the preoperative NUn score, as a continuous variable, showed an independent relationship with OS (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.16-1.50, per 1-unit increase, P < 0.001) and even DSS (HR 1.23, 95% CI 1.02-1.49, P = 0.032). The other three markers failed to maintain independence for DSS. CONCLUSIONS: Preoperative NUn scores are stably associated with outcomes, including disease-specific mortality, possibly serving as a simple measure to define the likelihood of progression to systemic disease after meticulous surgery for GC, which may contribute to identifying patients who would benefit from additional modalities.

Prevalence and associated factors of breast cancer screening among nuns in the Catholic Archdiocese of Nairobi.

Introduction: breast cancer is a significant global challenge. The risk of breast cancer among nuns is high mainly due to the basis of nulliparity. Among the effective approaches to addressing breast cancer is early screening. However, there are concerns over the uptake of screening across all populations, including nuns. The objective of the study is to determine the prevalence and the associated factors of breast cancer screening among nuns in the Catholic Archdiocese of Nairobi. Methods: this research used the analytical cross-sectional design. A total of 384 nuns in the Catholic Archdiocese of Nairobi were recruited using a stratified sampling. Structured questionnaires were used to collect data. Chi-square and binary logistic regression were used to determine association between social-demographic factors and breast cancer screening. Statistical package for social sciences (SPSS version 26) was used for analysis. The level of significance was investigated at p<0.05. Results: our findings revealed that the prevalence of breast cancer screening among nuns was 30.7%. The findings established that those who had knowledge on breast cancer screening (AOR=25.52, 95%CI: 8.87 - 73.45, p<0.001) and those who had congregational financial support (AOR=1.97, 95%CI: 1.68 - 5.74, p=0.021) were more likely to undergo breast cancer screening. Those who had hospital check-up for in more than six months prior to the study (AOR=0.001, 95%CI: 0.000 - 0.008, p<0.001) and those who never had a hospital check-up, (AOR=0.001, 95%CI: 0.000 - 0.006, p<0.001) were less likely to undergo breast cancer screening. Conclusion: the findings have shown low uptake of breast cancer screening amongst nuns in the Catholic Archdiocese in Nairobi. Knowledge on breast cancer screening access to congregational support and hospital check-up have been identified as key factors associated with breast cancer screening. Therefore, there is a need to create adequate awareness be created and the Catholic reverend sisters educated through aggressive education campaign programs so as to eliminate misconceptions relating to the topic. Also, to integrate free access to screening services in the government health institutions for nuns.

Evaluation of the natural history of disease by combining incident and prevalent cohorts: application to the Nun Study.

The Nun study is a well-known longitudinal epidemiology study of aging and dementia that recruited elderly nuns who were not yet diagnosed with dementia (i.e., incident cohort) and who had dementia prior to entry (i.e., prevalent cohort). In such a natural history of disease study, multistate modeling of the combined data from both incident and prevalent cohorts is desirable to improve the efficiency of inference. While important, the multistate modeling approaches for the combined data have been scarcely used in practice because prevalent samples do not provide the exact date of disease onset and do not represent the target population due to left-truncation. In this paper, we demonstrate how to adequately combine both incident and prevalent cohorts to examine risk factors for every possible transition in studying the natural history of dementia. We adapt a four-state nonhomogeneous Markov model to characterize all transitions between different clinical stages, including plausible reversible transitions. The estimating procedure using the combined data leads to efficiency gains for every transition compared to those from the incident cohort data only.

Religious Sisters in Healthcare: The Conspicuous Love of Jesus.

ABSTRACT: To better understand the impact Roman Catholic religious sisters have had on healthcare in the United States, the authors initiated the Religious Sisters in Health Care: The Conspicuous Love of Jesus project, recording sisters' stories of service, obedience, and leadership that point to their foundational work of making the healing presence of Jesus central to Catholic healthcare identity. The sisters' counsel for nurses and all staff in Catholic healthcare was to focus on Jesus' love in all work and to keep each person's healing ministry alive through regular rejuvenating opportunities.

Assessing retinal vein occlusion based on color fundus photographs using neural understanding network (NUN).

OBJECTIVE: To develop and validate a novel deep learning architecture to classify retinal vein occlusion (RVO) on color fundus photographs (CFPs) and reveal the image features contributing to the classification. METHODS: The neural understanding network (NUN) is formed by two components: (1) convolutional neural network (CNN)-based feature extraction and (2) graph neural networks (GNN)-based feature understanding. The CNN-based image features were transformed into a graph representation to encode and visualize long-range feature interactions to identify the image regions that significantly contributed to the classification decision. A total of 7062 CFPs were classified into three categories: (1) no vein occlusion ("normal"), (2) central RVO, and (3) branch RVO. The area under the receiver operative characteristic (ROC) curve (AUC) was used as the metric to assess the performance of the trained classification models. RESULTS: The AUC, accuracy, sensitivity, and specificity for NUN to classify CFPs as normal, central occlusion, or branch occlusion were 0.975 (± 0.003), 0.911 (± 0.007), 0.983 (± 0.010), and 0.803 (± 0.005), respectively, which outperformed available classical CNN models. CONCLUSION: The NUN architecture can provide a better classification performance and a straightforward visualization of the results compared to CNNs.

[Cross-Sectional Study on Adverse Effects of Metformin Hydrochloride on 130 Patients Type 2 Diabetic Admitted to Medical Center and Diabetes Home of Sidi Bel-Abbès]. / Étude Transversale sur les Effets Indésirables de la Chlorhydrate de Métformine chez 130 Patients Diabétiques Type 2 Admis au Centre Médical et à la Maison du Diabète de Sidi Bel-Abbès.

INTRODUCTION: MetforminHydrochloride is an antidiabetic used for many years, currently; it considered the first choice in treatment of type 2 diabetes (T2D). It decreases insulin resistance, does not induce hypoglycaemia, increases glucose utilization in the liver and skeletal muscle, and decreases hepatic glucose production. Its adverse effects (AE) are gastrointestinal, decrease in vitamin B12 absorption, abnormalities of hemogram and rarely skin reactions. The objective of this study was to report the type and frequency of AEs of Metformin Hydrochloride used in the therapeutic management of T2D patients admitted to the medical center and the diabetes home of Sidi Bel-Abbès in Algeria. MATERIALS AND METHODS: A cross-sectional descriptive study was carried out over a period of four months, from January 1st, 2017 to April 30th, 2017, involving 130 patients treated with Metformin Hydrochloride consulting at Mimoun City Diabetes Home and Gambetta Diabetes Center in the town of Sidi Bel-Abbès. The primary outcome measure was the determination of the type and frequency of AEs related to normal dosages or overdose use of Metformin Hydrochloride in T2D. Data were collected from patient records, using a questionnaire, and analyzed using Statistical Package for the Social Sciences, version 20 software. RESULTS: 130 patients were included, including 82 women, with a mean age of 51.08±8.85 years (30-66). One hundred and ninety-eight (198) AEs were reported, an average of 1.52 AEs per patient. Among them, 95 (47.98%) AEs are digestive disorders (30.77% of patients suffered from diarrhea, 10.77% had nausea and vomiting, 8.46% suffered from abdominal pain and bloating, 3.85% lost their taste, 7.69% complained of epigastric cramps and 11.54% of anorexia), 29 (14.65%) AEs are hypoglycaemia, 73 (36.87%) AEs are other symptoms and 1 (0.50%) EI is vitamin B12 deficiency and no cases of lactic acidosis or allergic reaction were reported. Five (3.85%) patients had a total and lasting intolerance to Metformin Hydrochloride leading to its discontinuation following persistent diarrhoea. CONCLUSION: AEs of Metformin Hydrochloride used in the management of T2D patients consulting at the medical center and the Diabetes home of Sidi Bel-Abbès are frequent. Digestive disorders were the most frequent, diarrhea was very frequent and led to discontinuation of treatment in 3.85% of T2D patients, followed by nausea and vomiting, then abdominal pain, bloating and epigastric cramps, and rarely taste metallic. Hypoglycaemia was frequent following its association with insulin, the onset of headaches and fatigue were frequent, but no case of lactic acidosis or allergic reaction was reported. Due to a lack of means, the dosage of homocysteine and methylmalonic acid had not been carried out to confirm the vitamin B12 deficiency in the patient whose level was less than 200ng/mL. A precise assessment of the imputability of reported AEs is necessary.

Generalized dermatitis in the natural mummy of the Roman Catholic nun Marie-Léonie Martin (France, 1863-1941).

OBJECTIVE: To document skin lesions on a mummified individual from the XIX century and to diagnose the pathology based historical documentation and physical examination. MATERIALS: Marie Leonie Martin (1863-1941) was a Roman Catholic nun. Her naturally mummified body is currently preserved in the Monastery of the Visitation in Caen (France). On the occasion of her beatification, the body was exhumed, studied and restored for conservation purposes. METHODS: The mummy was analyzed histologically and with CT imaging. RESULTS: The examination of the body noted areas of skin discoloration of reddish color; the paleopathological investigations revealed the presence of skin lesions (pustules) distributed throughout the body, with the exception of the face, abdomen and palms. The histological analyses of the pustules showed the presence of a central duct for the leakage of exudate, hyperkeratosis of the stratum corneum and a proliferation of cells in the spinous layer (acanthosis) of the epidermis. CONCLUSIONS: The red discoloration of the skin is typical of extensive erythema. SIGNIFICANCE: Our understanding of skin conditions in the past is extremely limited. This study provides the first paleopathological case of diagnosed unclassified endogenous eczema and provides insight into the antiquity and effects of the disease. LIMITATIONS: It was not possible to carry out a genetic analysis due to DNA contamination of the mummy.

Las epidemias de cólera en Estambul Otomano tardío, la atención médica y las Hermanas de la Caridad Católicas / Cholera epidemics in the late ottoman Istanbul, healthcare and the french catholic sisters of charity

This article is about the healthcare services provided by the Sisters of Charity (Filles de la Charité) during cholera epidemics in institutions opened and managed in nineteenth century Istanbul as part of their Eastern missions. The annuals in which reports and letters were collected and addressed to the center of the congregation in Paris, Annales de la Congrégation de la Mission et des Filles de la Charité (ACM), are used as primary sources. This study aims to evaluate the pandemies of cholera within the framework of world history and Ottoman context by contributing to the existing historical geographies of cholera, in addition to the literature, which accentuates the importance of agency of women in the Ottoman context, based on original findings. The article assesses how cholera affected Istanbul and how the disease was dealth with, through the connections between the sisters and local actors. The study also shows that the Ottoman example was not only a result of Western experiences, but although it was part of a wide history of pandemics, its actors had their own unique developments shaped by imperial and local settings and events.

Este artículo trata sobre los servicios de salud brindados por las Hermanas de la Caridad (Filles de la Charité) durante las epidemias de cólera en instituciones abiertas y administradas en el siglo XIX en Estambul como parte de sus misiones orientales. Los anuarios en los que se recopilaron informes y cartas y se dirigieron al centro de la congregación en París, Annales de la Congrégation de la Mission et des Filles de la Charité (ACM), se utilizan como fuentes primarias. Este estudio tiene como objetivo evaluar las pandemias de cólera en el marco de la historia mundial y el contexto otomano haciendo una contribución a las geografías históricas existentes del cólera, además de la literatura que acentúa la importancia de la agencia de las mujeres en el contexto otomano, con base en hallazgos originales. El artículo evalúa cómo afectó el cólera a Estambul y cómo se enfrentó la enfermedad, a través de las conexiones entre las hermanas y los actores locales. El estudio también muestra que el ejemplo otomano no fue solo el resultado de las experiencias occidentales, sino que, aunque fue parte de una amplia historia de pandemias, sus actores tuvieron sus propios desarrollos únicos moldeados por escenarios y eventos imperiales y locales.

Female Vanity in the Early Modern Period: Evidence from the Science Based Reassessment of a Supposed Merovingian Dental Appliance.

Musée de la Cour d'Or, Metz, France, possesses a female skull bearing a gold wire dental appliance claimed in a 1934 Dental Cosmos article on the history of dental prosthetics to be 'probably' Merovingian in origin. Inquiries in 2017 revealed current museum curators were unaware of this claim but were skeptical of such dating suggesting scientific analysis might provide clarity. Carbon dating of a tooth from the skull was carried out placing the artifact in the mid seventeenth-late eighteenth centuries while Metz historical records reveal the find site was occupied by a convent of nuns for most of C14 dated period. Strontium isotopic analysis indicates the woman was a local of the Metz region while fluorine analysis indicates exposure to fluoride early in life. Oral health status and the dentistry indicate the woman was of high social status.

Outcomes of a Decision-Making Capacity Assessment Model at the Grey Nuns Community Hospital.

BACKGROUND: With an increasing elderly population, the number of persons with dementia is expected to increase and, consequently, the number of persons needing decision-making capacity assessments (DMCA) is too. However, many healthcare professionals do not feel ready to provide DMCAs. Since 2006, we implemented a DMCA Model that includes a care pathway, worksheets, education, and mentoring. The objective of this study was to assess the impact of the utilization of this patient-centered DMCA model on the need for Capacity Interviews. METHODS: This was a retrospective quality assurance chart review of patients referred for DMCA to the Geriatric Service at the Grey Nuns Community Hospital from 2006-2020. The Geriatric Service is run by Family Physicians with extra training in Care of the Elderly. We extracted patient demographics, elements of the DMCA process, and whether Capacity Interviews were performed. We used descriptive statistics to summarize the data. RESULTS: Eighty-eight patients were referred for DMCAs, with a mean age of 76 years (SD = 10.5). Dementia affected 43.2% (38/88) of patients. Valid reasons for conducting a DMCA were evident in 93% (80/86) of referrals, and DMCAs were performed in 72.6% (61/84). 85.3% (58/68) of referrals identified the need for DMCA in two to four domains, most commonly accommodation, healthcare, and finances. Two to three disciplines, frequently social workers and occupational therapists, were involved in conducting the DMCAs for 67.2% (39/58) of patients. The Capacity Assessment Process Worksheet was used 63.2% of the time. Capacity Interviews were conducted in only 20.7% of referrals. Following the DMCAs, 48.2% (41/85) of those assessed were deemed to lack capacity. CONCLUSION: This study suggests that the DMCA Model implemented has decreased the need for Capacity Interviews while simultaneously respecting patient autonomy. This is an important finding as DMCAs carried out following this process reduced the need for both a Capacity Interview and declarations of incapacity while simultaneously respecting patient autonomy and supporting patients in their decisions in accordance with the legislation.

From doctor to incendiary nun: the importance of analysing the pathways of trauma.

ABSTRACT: Childhood traumatic experiences have often been associated with the development of severe psychiatric disorders or, at least, with serious impairment in the victims' developing personality. Emotional abuse and neglect can cause gradual damage to Self-image and to models of self-in-relation to Others. We report a case of a woman who underwent psychiatric evaluations for marriage annulment. The issues were the as-sessment of the outcomes of early psychic trauma and the examination of the remaining individual capacities from a judicial standpoint. The examiners found that the memories of the woman's history of childhood abuse had become integrated into her personality organization. The spheres most strongly influenced were those of psycho-sexual/affective maturation and a dysfunctional bond with religion. Psychodiagnostic evaluation diagnosed a Borderline Personality Disorder. The complexity of the case suggests the need of a multi-dimen-sional analysis by an interdisciplinary team including experts in legal medicine, forensic psychiatry and psychology as well as clinical crimi-nology.

Female Vanity in the Early Modern Period: Evidence from the Science Based Reassessment of a Supposed Merovingian Dental Appliance.

Musée de la Cour d'Or, Metz, France, possesses a female skull bearing a gold wire dental appliance claimed in a 1934 Dental Cosmos article on the history of dental prosthetics to be 'probably' Merovingian in origin. Inquiries in 2017 revealed current museum curators were unaware of this claim but were skeptical of such dating, suggesting scientific analysis might provide clarity. Carbon dating of a tooth from the skull was performed placing the artifact in the mid seventeenth-late eighteenth centuries, while Metz historical records reveal the find site was occupied by a convent of nuns for most of C14 dated period. Strontium isotopic analysis indicated that the woman was a local of the Metz region while fluorine analysis indicated exposure to fluoride early in life. Oral health status and the dentistry indicate the woman was of high social status.

"The bent nuns convent". Antipsycotic-induced Pisa Syndrome and Camptocormia. / «El convento de las monjas torcidas¼. Síndrome de Pisa y camptocormia inducido por antipsicóticos.

Camptocormia is an involuntary flexion between 15-45° of the thoracolumbar spine when standing, walking or sitting, which disappears completely in the supine position. Is associated to Parkinson's disease and other neurodegenerative conditions, being its physiopatology unknown. We report three cases of atypical anti-psychotic induced camptocormia.

Self-care by discalced carmelite nuns in the light of Orem's Theory. / Autocuidado em freiras carmelitas descalças à luz da Teoria de Orem.

OBJECTIVE: To understand the perception of self-care by contemplative nuns residing in a Discalced Carmelite Monastery. METHOD: Descriptive, exploratory study, with a qualitative approach, conducted in a Discalced Carmelite Monastery in Minas Gerais state. Data collection from nuns was performed in January 2018 through a questionnaire on their sociodemographic profile and a semi-structured interview script. The interviews were transcribed, reviewed, and submitted to content analysis. RESULTS: Twenty nuns took part in this study. Three categories emerged: self-care comprehension, how self-care is practiced and what should be done to improve self-care. One subcategory was selected from each thematic category. Subcategories were, respectively, care of others, nutrition, and exercise. Nuns were seen to understand self-care as care of others, practicing it mostly through nutrition while considering exercise a point to be improved. CONCLUSION: Nuns were found to understand what self-care is in its essence and to perform it. However, their priority is to provide care of others as a form of mutual care, which impacts on self-care.

A Phenomenological Study of the Lived Experience of Roman Catholic Sisters and Successful Aging.

Purpose: To gain an understanding of how religious and spiritual practices might enable Catholic Sisters to age successfully. Design: A purposive sample of 12 retired Roman Catholic Sisters aged 75 years and older from two convent settings were interviewed. Method: Using a semistructured recorded interview, the Roman Catholic Sisters shared their lived experiences of aging, and practices of religion, spirituality, and meditation. Data analysis utilized thematic analysis of the interview texts. Findings: Thematic analysis identified the following themes: daily engagement in religious and spiritual practice and meditation; self-contentment and positivity regarding the meaning of successful aging; life acceptance; sense of faith and positivity regarding the afterlife; and intersection of meditation, prayer, spirituality, and cognitive engagement. Conclusion: This research contributes to the body of aging research and presents successful aging as understood and more specifically as experientially influenced. The findings of the study provided insight regarding the meaning and experience of successful aging, and the role of everyday religious and spiritual practices in the lives of the Catholic Sisters which influenced their individual life experiences as they age.

Autocuidado em freiras carmelitas descalças à luz da Teoria de Orem / Autocuidado de las carmelitas descalzas a la luz de la Teoría de Orem / Self-care by discalced carmelite nuns in the light of Orems Theory

RESUMO Objetivo: Compreender a percepção do autocuidado por parte de freiras de vida contemplativa que residem em um Mosteiro da Ordem Carmelita Descalça. Método: Trata-se de um estudo descritivo e exploratório de abordagem qualitativa, realizado em um Mosteiro da Ordem Carmelita Descalça do Estado de Minas Gerais. A coleta de dados foi realizada em janeiro de 2018 junto às freiras por meio de um questionário sobre seu perfil sociodemográfico e um roteiro semi-estruturado para entrevista. As entrevistas foram transcritas e revisadas, sendo submetidas a análise de conteúdo. Resultados: Participaram 20 freiras. Emergiram três categorias: compreensão do autocuidado, como pratica o autocuidado e o que fazer para melhorar o autocuidado. De cada uma das três categorias temáticas, foi selecionada uma subcategoria. Estas foram, respectivamente, o cuidado com o outro, a alimentação e o exercício. Entendeu-se que as freiras compreendem o autocuidado como o cuidado com o outro. Praticam majoritariamente através da alimentação e consideram ainda o exercício como algo a ser melhorado no autocuidado. Conclusão: Constatou-se que as freiras compreendem o que é autocuidado em sua essência e o realizam. Contudo, dão prioridade ao cuidado do outro como forma de cuidado mútuo, que repercute no autocuidado.

RESUMEN Objetivo: Entender la percepción del autocuidado de las monjas de vida contemplativa que residen en un monasterio de la Orden de las Carmelitas Descalzas. Método: Se trata de un estudio descriptivo y exploratorio con un abordaje cualitativo, realizado en un monasterio de la Orden de las Carmelitas Descalzas en el estado de Minas Gerais. La recopilación de datos de las monjas se llevó a cabo en enero del año 2018 mediante un cuestionario sobre su perfil sociodemográfico y un guión semiestructurado para la entrevista. Las entrevistas se transcribieron y revisaron y se sometieron a un análisis de contenido. Resultados: Participaron 20 monjas. Surgieron tres categorías: comprensión del autocuidado, cómo practica el autocuidado y qué pueden hacer para mejorar su autocuidado. De cada una de las tres categorías temáticas, se seleccionó una subcategoría. Estas fueron respectivamente el cuidado del otro, la comida y el ejercicio. Se entendió que las monjas comprenden el autocuidado como el cuidado del otro. Practican el autocuidado principalmente a través de la alimentación y consideran el ejercicio como algo que pueden mejorar en el cuidado de sí mismas. Conclusión: Se constató que las monjas entienden lo que es el autocuidado y lo hacen. Sin embargo, dan prioridad al cuidado del otro como una forma de cuidado mutuo, que tiene un impacto en el autocuidado.

ABSTRACT Objective: To understand the perception of self-care by contemplative nuns residing in a Discalced Carmelite Monastery. Method: Descriptive, exploratory study, with a qualitative approach, conducted in a Discalced Carmelite Monastery in Minas Gerais state. Data collection from nuns was performed in January 2018 through a questionnaire on their sociodemographic profile and a semi-structured interview script. The interviews were transcribed, reviewed, and submitted to content analysis. Results: Twenty nuns took part in this study. Three categories emerged: self-care comprehension, how self-care is practiced and what should be done to improve self-care. One subcategory was selected from each thematic category. Subcategories were, respectively, care of others, nutrition, and exercise. Nuns were seen to understand self-care as care of others, practicing it mostly through nutrition while considering exercise a point to be improved. Conclusion: Nuns were found to understand what self-care is in its essence and to perform it. However, their priority is to provide care of others as a form of mutual care, which impacts on self-care.

Safeguarding Health at the Workplace: A Study of Work Engagement, Authenticity and Subjective Wellbeing among Religious Workers.

Research in work and organizational psychology has paid little attention to religious workers, something certainly surprising as faith-based organizations play a key role in the welfare state of many countries. This research shows that religious workers in a Catholic order present a high degree of subjective wellbeing, both in terms of flourishing and satisfaction with life in general, and a positive balance of positive and negative feelings. More specifically, this study examines the relationship between authenticity and wellbeing amongst religious workers. Survey responses from 142 religious workers in Spain were analyzed using partial least squares path modelling. The results reveal that subjective wellbeing at work is positively related to authenticity. In addition, this relationship is mediated by their level of work engagement.