Comparing participation in sports discussion and art therapy groups in ABI

Background: Social connection is often impacted by acquired brain injury (ABI), contributing to isolation and compromised mental health. Group therapy is thought useful in this context. For those experiencing cognitive communication challenges, finding alternative ways to engage is also valuable. Art therapy may offer pro-social support through shared activity, self-expression, organic subject matter and enduring visual prompts. Method: A multiple A-B-A single case experimental design compared participation in sports discussion and art therapy groups on a long-stay secure unit. Nine individuals with ABI and complex combinations of communication, cognitive and mental health needs were studied. It was hypothesised that for some individuals, participation would be greater in art therapy than sports discussion groups. Results: Results from six individuals with at least five measurement points per phase are reported. Tau statistics revealed significant interphase differences for three individuals. Significantly less participation was recorded for two individuals in art than sports discussion, however they still appeared invested in the art groups. The remaining participant, with the most severe communication difficulties, avoided all baseline sports discussion groups, but participated in almost all art groups, with significant increase between initial sports discussion and art phases. Conclusion: Further research is warranted regarding the potential art therapy offers for group engagement, particularly where complex challenges render traditional talking-style groups less appropriate. Furthermore, disparate and complex needs in severe ABI require diverse, well-designed groups offering different opportunities and responding to individual strengths and motivations. More research into such approaches may increase group participation in this challenging cohort.

Pengetahuan Kader Kesehatan Dalam Pendampingan Ibu Hamil Untuk Persiapan Persalinan

ABSTRAK Puskesmas yang cakupan K4 masih rendah yaitu Puskesmas Hajimena yaitu 89,1%. Hasil wawancara pengabdi dengan kader Kesehatan di desa Hajimena dari 45 kader Kesehatan tugas mereka adalah membantu penimbangan bayi dan balita diposyandu, belum terpapar peran yang lain yaitu membantu ibu hamil dengan mendeteksi kehamilan normal, berisiko dan persiapan pendampingan ibu saat akan bersalin. Kegiatan ini dilaksanakan di Masjid Ulul Albab Desa Hajimena. Tujuan Kegiatan ini untuk memberikan Pengetahuan ibu kader Kesehatan dalam pemahaman kehamilan normal dan risiko, persalinan normal dan risiko serta pendampingan kader pada ibu hamil mempersiapkan persalinannya, sangat membantu ibu ibu hamil yang berada dilingkungan sekitarnya. Kegiatan pengabmas ini dilaksanakan oleh 3 Tim yang merupakan dosen kelompok keilmuan keperawatan maternitas dan anak dan kelompok Kesehatan masyarakat, dan tim juga telah berpengalaman menjadi ketua atau anggota tim dalam penelitian-penelitian sebelumnya dijurusan keperawatan poltekkes tanjungkarang. pada Jurusan Keperawatan Poltekkes Tanjungkarang dengan melibatkan 4 orang mahasiswa, Setekah dilakukan penyampaian materi dan implementasi peran kader,menunjukkan peningkatan dari sebelum diberikan materi oleh tim pengabmas dan sesudah diberikan materi oleh tim, dan hal ini menunjukkan peran kader dalam persiapan persalinan sangat mendukung tercapainya perawatan antenatal terhadap ibu hamil dalam mempersiapkan persalinannya untuk mencegah terjadinya resiko pada ibu hamil sebelum dan sesudah persalinan.Kata kunci : pengetahuan kader, ibu hamil, Persalinan ABSTRACTPuskesmas with low K4 coverage is Hajimena Health Center, which is 89.1%. The results of interviews with health cadres in Hajimena village from 45 health cadres, their job is to help weigh babies and toddlers at the posyandu, not yet exposed to other roles, namely helping pregnant women by detecting normal, risky pregnancies and preparing for maternal assistance when giving birth. This activity was carried out at the Ulul Albab Mosque, Hajimena Village. This community service activity was carried out by 3 teams who were lecturers of the maternity and child nursing scientific group and the public health group, and the team also had experience as chairpersons or team members in previous studies in the nursing department of the Tanjungkarang Health Polytechnic. at the Department of Nursing at the Tanjungkarang Health Polytechnic involving 4 students. After the delivery of material and implementation of the role of cadres, it showed an increase from before being given material by the community service team and after being given material by the team, and this shows the role of cadres in preparation for childbirth is very supportive of achieving antenatal care to pregnant women in preparing for childbirth to prevent risks to pregnant women before and after delivery.Keywords: Public health assistant, Role, Preparation, Childbirth

Trauma in Rapes and Assaults

Psychological trauma primarily affects children and adolescents; it mostly results from physical and sexual maltreatment. In the Medico-Judicial Unit Center for Sexual Violence Victims in Tours, France, which I joined in 1992 for research and to give treatment, underage patients represented about three-quarters of patients. At the same time, a national survey was conducted in collaboration with Marie Choquet’s “Adolescent Health” group (INSERM), which targeted several thousand adolescents representing the general population. It revealed that almost one out of five adolescents had experienced physical or sexual assault, and that although the number of sexual assaults probably does not exceed that of physical assaults, most of the time their psychological consequences do considerably exceed those of physical assaults. Several symptoms appear after experiencing rapes or assaults. They have a distinct semiology and independent evolutions. We isolated three of them: dissociative and phobic traumatic syndrome, re-experiencing traumatic syndrome, and borderline-like traumatic syndrome. They are generally triggered all at the same time or in close succession. Re-experiencing traumatic syndrome is profound, but the other two are often more worrying, particularly in relation to children and adolescents, because they generate disorders in their psychological development.

COVID-19 Vaccination in Home Health and Hospice: Barriers to Vaccination and Results From a Home Vaccination Program

Little is known about vaccination rates in home health and hospice populations. Results draw upon two separate data sources from The Visiting Nurse Association Health Group (VNAHG). Among VNAHG patients surveyed between February 2 and March 1, 202, 24% had received at least one COVID-19 vaccine. Among vaccinated patients, roughly one quarter did not travel to get the vaccine (received inpatient vaccination). They mostly traveled by car (88%), and 70% received help from a family member. Of patients who had not received a vaccine (76%), 81% were pursuing or planning to pursue obtaining a vaccine. Additionally, of those not pursuing a vaccine, 30% indicated it was because they could not get to a vaccine site. 44% of patients in the VNAHG “in home” vaccination pilot were bedbound, and 100% of patients had ambulation difficulties that make it impossible for them to leave home. All (100%) had a health care provider(s) recommended they get the vaccine. Only 38% have internet access. A quarter tried to call to schedule a vaccine, but only one was able to speak to someone. 40% of the patients attempted to get a COVID-19 vaccine prior to enrollment in the program. Most patients (81%) did not have someone available to assist with their transportation to get vaccinated, and most indicated difficulty securing an appointment. Many indicated severe traveling difficulties (requiring oxygen, needing ambulance transport). These findings highlight the high barriers for homebound patients, and the need and value of clinicians traveling to provide in-home vaccines.

Establishment of PIVKA-Ⅱ Reference Intervals From Hospital-stored Data: A Comparison Analysis

Objective The authors aimed to explore methods to establish indirect reference intervals for PIVKA-II from hospital-stored data.Method 7623 patient specimens of the Renmin Hospital of Wuhan University were collected. Indirect reference intervals were established based on the hospital-stored data with four different methods, including the Hoffmann method (HM), revised Hoffmann method (HMCDF), E-M algorithm-based method (EMBCT), and a recent estimator (KOSMIC). According to CLSI C28-A3 guidelines, 369 healthy specimens were collected. The authors tested the difference between reference intervals of gender-specific and age-specific subgroups using Harris and Boyd's test. Finally, the averaging result of estimates was calculated according to how likely each model was.Results The indirect reference intervals of PIVKA-II based on LIS data were 0 to 35.30 mAU/mL (HM), 0 to 31.48 mAU/mL (HMCDF), 0 to 30.78 mAU/mL (EMBCT), 0 to 36.17 mAU/mL (KOSMIC) and 0 to 31.48 mAU/mL (averaging) respectively, and the reference intervals based on healthy group were 0 to 32 mAU/mL. Compared with HM, EMBCT and KOSMIC, HMCDF and the averaging result was closer to those of the health group. Significant difference was detected between gender-partitioned subgroups, and the reference upper limit in the female group was smaller than the male group.Conclusions The authors established the indirect reference intervals of PIVKA-II for the Wuhan population, which could be used to the clinical reference intervals. The framework proposed could help clinical laboratory set their reference intervals of test items.

An Evidence Review of the Long-Term Consequences Associated with Components of the CHOP Chemotherapy Regimen in Transplant Recipients

Introduction: Epstein-Barr virus-driven post-transplant lymphoproliferative disease (EBV + PTLD) can be an aggressive, often deadly disease without any approved treatments. Current available treatments for EBV + PTLD may include cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). However, the long-term consequences of CHOP are poorly understood in immunocompromised transplant patients with cancer who may have different outcomes than immunocompetent cancer patients. This study reviewed and described the evidence for the long-term consequences associated with components of CHOP in transplant recipients. Methods: Potential long-term consequences of the components of CHOP were identified from the Children's Oncology Group Long-Term Follow-Up (COG LTFU) Guidelines. Abstracts were screened and eligibility was based on reporting data for the identified COG LTFU long-term consequences along with pre-specified criteria (English, systematic review, randomized controlled trial n>100, observation study n>100, case series n>20). Relevant studies that met the criteria were extracted and synthesized; of these, studies were selected if they evaluated patients who received any type of transplantation as part of their primary cancer treatment. Results: A total of 7 studies met the pre-specified selection criteria, all of which evaluated patients with hematopoietic stem cell transplantation (HCT) and none assessed solid organ transplant (SOT). None of the studies focused specifically on the CHOP regimen or EBV + PTLD. Long-term consequences of alkylating agents (eg, cyclophosphamide) and corticosteroids as primary treatment reported in these HCT studies included: hormone deficiencies and infertility (n=4 studies), osteonecrosis (n=2), and health status and quality of life (QoL; n=1). Results from three studies suggested that cancer survivors who received alkylating agents experienced hormone deficiencies and those with a HCT had a high risk. One quantified this by showing that, compared with cancer survivors without a history of HCT (CS), cancer survivors with a history of HCT (CS-HCT) and a history of total body irradiation had significantly impaired follicle stimulating hormone (40.42 vs 9.39 mIU/ml, P<0.001), Estradiol (15.09 vs 25.13 pg/ml, P=0.04), Inhibin B (10.61 vs 32.92 pg/ml, P=0.003), anti-Müllerian hormone (0.01 vs 1.28 ng/ml, P<0.001), antral follicle count (0.71 vs 17.78, P<0.001) and ovarian volume (1.82 vs 8.21 ml, P<0.001). In one study on the risk of osteonecrosis, the CS-HCT group had a significantly increased risk of developing osteonecrosis compared to the CS group treated with chemotherapy (6.8% vs 1.4%, respectively); cumulative incidence of osteonecrosis was 3.8% in the CS group for a steroid dose >5,835 mg/m 2 and 23.8% in the CS-HCT group for a post-transplant steroid dose >2,055 mg/m 2; and patients developed symptomatic osteonecrosis within a median of 2.4 years in the CS group with chemotherapy and 0.9 years after the first transplant in the CS-HCT group. A second study showed the rate ratio (RR) of osteonecrosis compared with a sibling comparison group was highest among the CS-HCT for acute lymphoblastic leukemia, acute myelogenous leukemia, and chronic myelogenous leukemia (RR = 26.9, 66.5, and 93.1, respectively; P<0.001 for all). One study reported that childhood acute leukemia survivors treated with HCT with preparative regimen with either busulfan-cyclophosphamide or total body irradiation/cyclophosphamide had a significantly lower QoL short-form (SF)-36 mental and physical composite scores in both treatment groups compared with norms. Conclusions: Since only a small number of studies (7) of long-term consequences in transplant recipients were identified and none were seen in patients with EBV + PTLD or in SOT recipients, more research is needed to evaluate adverse consequences of CHOP or its components in EBV + PTLD, especially in SOT patients where no studies were found. Results from this review suggest that immunocompromised HCT recipients who were cancer survivors are significantly more impaired by long-term consequences (hormone deficiencies and infertility, osteonecrosis, and QoL) of alkylating agents (eg, cyclophosphamide) and corticosteroids as primary treatment compared with other cancer survivors without HCT. Disclosures Watson: Atara Biotherapeutics: Current Employment, Current holder of individual stocks in a privately-held company. Gadikota: Maple Health Group: Current Employment. Barlev: Atara Biotherapeutics: Current Employment. Beckerman: Maple Health Group: Current Employment.

Quantification of Long-Term Consequences Associated with Components of the CHOP Chemotherapy Regimen

Introduction: A common chemotherapy regimen for Epstein-Barr virus-driven post-transplant lymphoproliferative disease (EBV + PTLD) following solid organ transplants is cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Long-term adverse consequences of CHOP, particularly the incidence, timing, and risk factors associated with these events, in any cancer survivor remain poorly understood. In this study, we review the evidence to determine how often long-term consequences associated with the components of CHOP occur. Methods: Potential long-term consequences of CHOP components were identified from the Children's Oncology Group Long-Term Follow-Up (COG LTFU) Guidelines. Abstracts were screened and eligibility was based on reporting data for the identified COG LTFU long-term consequences along with pre-specified criteria (English, systematic review, randomized controlled trial n>100, observation study n>100, case series n>20). Studies that met the inclusion criteria were extracted and synthesized. Quantification of late effects evaluated in >3 studies were reported. Results: Long-term consequences in the 45 studies that met the pre-specified criteria included cardiac toxicity, hormone deficiencies/infertility, secondary leukemia, osteonecrosis (ON), and urotoxicity/bladder cancer. Although none of the studies focused specifically on the CHOP regimen, 30%, 23%, and 15% evaluated alkylating agents (eg, cyclophosphamide), anthracyclines (eg, doxorubicin), and corticosteroids (eg, prednisone), respectively. Time to onset from treatment was as early as 1 year for cardiac toxicity, <5 for infertility, 2 for ON, 3 for secondary leukemia, and 5 for bladder cancer. Longer follow-up times were associated with higher percentages of long-term consequences. For example, cardiac toxicity and hormone deficiencies/infertility affected >20% of patients, and secondary leukemia, ON, urotoxicity/bladder malignancy affected 10-20% of patients (Table 1). A wide range in the incidence and timing of these late effects was observed, likely due to variation in the treatment regimens, follow-up time, and event definition. The synthesized evidence supports that CHOP components increased the risk of long-term consequences in a dose-dependent manner. Cardiac toxicity risk was elevated even at anthracycline doses of <150 mg/m 2 (traditionally considered a 'safe' dose range). Hazard ratios (HRs) for heart failure at doses of ≤300 to <400 mg/m 2 were 4.33 and 13.19 for daunorubicin and doxorubicin, respectively. Studies also reported significantly elevated risk of cardiac toxicity in patients with lymphoma treated with anthracyclines (eg, HR of up to 12.2) compared with the sibling cohort. Patients <5 years of age vs ≥5 years of age at exposure had a significantly higher risk of cardiac toxicity (HR of 1.89). Patients exposed to cumulative doses of cyclophosphamide ≥6 g/m 2 had significant reproductive risks. The risk of early menopause was shown to be dose dependent and as much as 27-fold higher in patients treated with both radiation below the diaphragm and alkylating agent chemotherapy. Patients exposed to high-dose cyclophosphamide (>7.5 g/m 2) were at statistically significantly higher risk (odds ratio of 12.0) for diminished ovarian reserve as measured by their Anti-Müllerian hormone level. One study reported 3.8- and 3.2-fold increases in risk of ovarian failure in patients who had been diagnosed with Hodgkin's lymphoma and Non-Hodgkin's lymphoma, respectively. High-doses of anthracyclines and alkylating agents were associated with up to 16-fold increases in risk of secondary leukemia. The risk of bladder cancer significantly increased with increasing dose of cyclophosphamide, with a 6- and 14.5-fold increased risk at cumulative doses of 20‒49 g and ≥50 g, respectively. Intensive corticosteroid therapy was associated with significant risk of ON, with one study showing cancer survivors had a 6.2 times higher likelihood of ON as compared to their sibling comparison group. Conclusions: Patients exposed to components of CHOP have a dose-dependent risk of cardiac toxicity, infertility, secondary leukemia, ON, and bladder cancer that are often significant, impacted a high percentage of patients, and occurred as early as 1 year after treatment. Safe and effective PTLD treatments that potentially avoid these long-term consequences are urgently needed. Figure 1 Figure 1. Disclosures Watson: Atara Biotherapeutics: Current Employment, Current holder of individual stocks in a privately-held company. Gadikota: Maple Health Group: Current Employment. Barlev: Atara Biotherapeutics: Current Employment. Beckerman: Maple Health Group: Current Employment.

Determination of Uranium Concentration in Blood Samples for Patients with Kidney Failure in Salah din Governorate

Analysis of human biological samples, such as blood, is generally used to verify human exposure to uranium. The uranium content in the blood of patients with kidney disease in Salah al-din governorate was determined using the Fission Track Analysis (FTA) of the detector CR39. Uranium concentrations of blood samples taken from kidney failure patients ranged between 1.636 ppb to7.477 ppb, with a mean value of 5.496 ppb. And the health group values ranged between 0.301 ppb to 2.332 ppb with a mean value 1.089 ppb.

Latent class analysis of depression and anxiety among medical students during COVID-19 epidemic

Objective The novel coronavirus disease 2019 (COVID-19) is a global public health emergency that has caused worldwide concern. The mental health of medical students under the COVID-19 epidemic has attracted much attention. This study aims to identify subgroups of medical students based on depression and anxiety and explore the influencing factors during the COVID-19 epidemic in China. Methods A total of 29,663 medical students were recruited during the epidemic of COVID-19 in China. Depression and anxiety symptoms were assessed using Patient Health Questionnaire 9 (PHQ9) and Generalized Anxiety Disorder 7 (GAD7) respectively. Latent class analysis was performed based on depression and anxiety symptoms in medical students. The latent class subtypes were compared using the chi-square test. Multinomial logistic regression was used to examine associations between identified classes and related factors. Results In this study, three distinct subgroups were identified, namely, the poor mental health group, the mild mental health group and the low symptoms group. The number of medical students in each class is 4325, 9321 and 16,017 respectively. The multinomial logistic regression results showed that compared with the low symptoms group, the factors influencing depression and anxiety in the poor mental health group and mild mental health group were sex, educational level, drinking, individual psychiatric disorders, family psychiatric disorders, knowledge of COVID-19, fear of being infected, and participate in mental health education on COVID-19. Conclusions Our findings suggested that latent class analysis can be used to categorize different medical students according to their depression and anxiety symptoms during the outbreak of COVID-19. The main factors influencing the poor mental health group and the mild mental health group are basic demographic characteristics, disease history, COVID-19 related factors and behavioural lifestyle. School administrative departments can carry out targeted psychological counseling according to different subgroups to promote the physical and mental health of medical students.