首页 > 最新文献

Lifestyle medicine (Hoboken, N.J.)最新文献

英文 中文
How do caregivers of children living with HIV/AIDS cope, and where do they get support?: A qualitative study in Ghana 感染艾滋病毒/艾滋病儿童的照料者如何应对,他们从哪里获得支持?在加纳进行的定性研究
Q3 Medicine Pub Date : 2023-04-17 DOI: 10.1002/lim2.79
Gideon Awenabisa Atanuriba, Felix Apiribu, Timothy Tienbia Laari, Adwoa Bemah Boamah Bonsu, Veronica Millicent Dzomeku, Richard Adongo Afaya, Yakubu Salifu, Philemon Adoliwine Amooba

Background

Caring for children living with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) is challenging and has a tremendous impact on the physical and psychological health of caregivers. Caregivers of children with HIV/AIDS need to adopt coping mechanisms to navigate these complexities as it influences the quality of care provided. The literature on coping strategies and support (formal and informal) available to caregivers of children living with HIV/AIDS is scant. This study aimed to explore the coping strategies and support systems for caregivers of children living with HIV/AIDS.

Methods

A phenomenological study design was adopted. A total of nine participants across three hospitals in the Tamale metropolis were interviewed using purposive sampling. The interviews were audio recorded, transcribed verbatim and analysed using Colaizzi's approach.

Results

Four main themes emerged from the analyses: (1) coping strategies, (2) types of support activities, (3) support from informal institutions and (4) support from formal institutions. The caregivers navigated the caring process with much spiritual coping. The caregivers had little or no support from informal institutions such as immediate family, faith and community leaders. Non-governmental organizations were not visible in support, and there were no support groups for caregivers.

Conclusion

Support for caregivers and the active involvement of the immediate family in paediatric HIV care is imperative.

背景:照顾感染人类免疫缺陷病毒和获得性免疫缺陷综合症(艾滋病毒/艾滋病)的儿童是一项具有挑战性的工作,对照顾者的身心健康产生巨大影响。感染艾滋病毒/艾滋病儿童的照料者需要采取应对机制来应对这些复杂性,因为它影响到所提供照料的质量。关于艾滋病毒/艾滋病儿童照料者可获得的应对策略和支持(正式和非正式)的文献很少。本研究旨在探讨HIV/AIDS儿童照顾者的应对策略及支持系统。方法采用现象学研究设计。采用有目的抽样对塔马莱市三家医院共九名参与者进行了访谈。访谈录音,逐字记录,并使用Colaizzi的方法进行分析。结果分析得出四个主题:(1)应对策略;(2)支持活动类型;(3)非正式机构的支持;(4)正式机构的支持。照顾者在照顾过程中有很多精神上的应对。照顾者很少或根本没有来自直系亲属、信仰和社区领袖等非正式机构的支持。非政府组织没有提供支持,也没有照料者支助小组。结论对护理人员的支持和直系亲属的积极参与是儿科HIV护理必不可少的。
{"title":"How do caregivers of children living with HIV/AIDS cope, and where do they get support?: A qualitative study in Ghana","authors":"Gideon Awenabisa Atanuriba,&nbsp;Felix Apiribu,&nbsp;Timothy Tienbia Laari,&nbsp;Adwoa Bemah Boamah Bonsu,&nbsp;Veronica Millicent Dzomeku,&nbsp;Richard Adongo Afaya,&nbsp;Yakubu Salifu,&nbsp;Philemon Adoliwine Amooba","doi":"10.1002/lim2.79","DOIUrl":"10.1002/lim2.79","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Caring for children living with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) is challenging and has a tremendous impact on the physical and psychological health of caregivers. Caregivers of children with HIV/AIDS need to adopt coping mechanisms to navigate these complexities as it influences the quality of care provided. The literature on coping strategies and support (formal and informal) available to caregivers of children living with HIV/AIDS is scant. This study aimed to explore the coping strategies and support systems for caregivers of children living with HIV/AIDS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A phenomenological study design was adopted. A total of nine participants across three hospitals in the Tamale metropolis were interviewed using purposive sampling. The interviews were audio recorded, transcribed verbatim and analysed using Colaizzi's approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four main themes emerged from the analyses: (1) coping strategies, (2) types of support activities, (3) support from informal institutions and (4) support from formal institutions. The caregivers navigated the caring process with much spiritual coping. The caregivers had little or no support from informal institutions such as immediate family, faith and community leaders. Non-governmental organizations were not visible in support, and there were no support groups for caregivers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Support for caregivers and the active involvement of the immediate family in paediatric HIV care is imperative.</p>\u0000 </section>\u0000 </div>","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lim2.79","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48752708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Lifestyle Medicine list of reviewers 《生活方式医学》审稿人名单
Q3 Medicine Pub Date : 2023-04-06 DOI: 10.1002/lim2.78

Lifestyle Medicine would like to thank the following people for their invaluable contribution to the peer-review process during 2022.

Abel, Julian United Kingdom

Bakhat, Zain United Kingdom

Donnelly, Cain United Kingdom

Eastland, Katie-May United Kingdom

El-Osta, Austen United Kingdom

Fama, Marcela Colombia

Fasanmade, Olufemi A. Nigeria

Findlater, Hannah United Kingdom

Fuchs, Julia United Kingdom

Hendrixson, Taylor United States

Irvine, Alison United Kingdom

Johnson, Peter United Kingdom

Jóhannsson, Guðmundur Iceland

Keenan, Riley United Kingdom

Lawson, Rob United Kingdom

Massahikhaleghi, Parissa Iran (the Islamic Republic of)

Menon, Sangeetha India

Mineviciene, Egle Lithuania

Penlington, Chris United Kingdom

Pipe, Teri United States

Qocha, Bontu United Kingdom

Roper, Megan United Kingdom

Samandika Saparamadu, Amarasinghe Arachchige Don Nalin Singapore

Schmitt-Egenolf, Marcus Sweden

Sliz, Daniel Poland

Tokell, Marisa United Kingdom

Valentine, Gregory United States

Woolley, Kate United Kingdom

{"title":"Lifestyle Medicine list of reviewers","authors":"","doi":"10.1002/lim2.78","DOIUrl":"10.1002/lim2.78","url":null,"abstract":"<p><i>Lifestyle Medicine</i> would like to thank the following people for their invaluable contribution to the peer-review process during 2022.</p><p>Abel, Julian <i>United Kingdom</i></p><p>Bakhat, Zain <i>United Kingdom</i></p><p>Donnelly, Cain <i>United Kingdom</i></p><p>Eastland, Katie-May <i>United Kingdom</i></p><p>El-Osta, Austen <i>United Kingdom</i></p><p>Fama, Marcela <i>Colombia</i></p><p>Fasanmade, Olufemi A. <i>Nigeria</i></p><p>Findlater, Hannah <i>United Kingdom</i></p><p>Fuchs, Julia <i>United Kingdom</i></p><p>Hendrixson, Taylor <i>United States</i></p><p>Irvine, Alison <i>United Kingdom</i></p><p>Johnson, Peter <i>United Kingdom</i></p><p>Jóhannsson, Guðmundur <i>Iceland</i></p><p>Keenan, Riley <i>United Kingdom</i></p><p>Lawson, Rob <i>United Kingdom</i></p><p>Massahikhaleghi, Parissa <i>Iran (the Islamic Republic of)</i></p><p>Menon, Sangeetha <i>India</i></p><p>Mineviciene, Egle <i>Lithuania</i></p><p>Penlington, Chris <i>United Kingdom</i></p><p>Pipe, Teri <i>United States</i></p><p>Qocha, Bontu <i>United Kingdom</i></p><p>Roper, Megan <i>United Kingdom</i></p><p>Samandika Saparamadu, Amarasinghe Arachchige Don Nalin <i>Singapore</i></p><p>Schmitt-Egenolf, Marcus <i>Sweden</i></p><p>Sliz, Daniel <i>Poland</i></p><p>Tokell, Marisa <i>United Kingdom</i></p><p>Valentine, Gregory <i>United States</i></p><p>Woolley, Kate <i>United Kingdom</i></p>","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lim2.78","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42832362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Maternal feeding styles and the risk of overweight in a cohort of Caribbean infants 加勒比海婴儿的母亲喂养方式与超重风险
Q3 Medicine Pub Date : 2023-02-28 DOI: 10.1002/lim2.77
Amika S. Wright, Marshall K. Tulloch-Reid, Susan M. Chang, Susan P. Walker

Introduction

Parental feeding styles in the first years of life may increase childhood overweight risk. There are few studies on this association in children under 2 years. The current study aimed to investigate the association between maternal feeding styles and Caribbean infants’ risk of overweight at 18 months and determine whether maternal depression is an important confounder in the association.

Methods

It is a prospective study of mother–child dyads that participated in a three-island parenting trial. Maternal and infant characteristics were collected at infant age 6–10 weeks with maternal depression assessed using the Center for Epidemiologic Studies Depression (CES-D) scale questionnaire. Feeding styles were measured using items from the Toddler Feeding Behaviour Questionnaire at 12 months. Infant weight and length were measured at 18 months, and infants at risk of overweight were defined as weight-for-length z-scores (WLZ) > 1. Factor analysis was used to identify feeding styles and associations with overweight risk assessed using multilevel logistic regression accounting for country and health clinic. Logistic regression models were adjusted for infant and maternal covariates, with a final model including depressive symptom scores.

Results

Of 366 infants assessed, 18.9% were affected by the risk of overweight. Five feeding styles were identified—uninvolved, indulgent, forceful, restrictive and responsive. Only restrictive feeding was associated with an increased risk of overweight (OR [95% CI], 1.61 [1.22, 2.13]). The association strengthened after adjusting for maternal depressive symptoms (OR [95% CI], 1.79 [1.30, 2.30]), representing an 11.18% increase in the risk of overweight odds.

Conclusion

Interventions that address restrictive feeding may be one strategy to reduce overweight risk among Caribbean maternal–infant dyads.

父母在生命最初几年的喂养方式可能增加儿童超重的风险。关于2岁以下儿童这种关联的研究很少。目前的研究旨在调查母亲喂养方式与加勒比地区婴儿18个月时超重风险之间的关系,并确定母亲抑郁是否是该关系中的一个重要混杂因素。方法采用前瞻性研究方法,对参与三岛育儿试验的母子二人组进行研究。在婴儿6-10周时收集母亲和婴儿的特征,并使用流行病学研究中心抑郁量表(CES-D)问卷对母亲抑郁进行评估。喂养方式在12个月时使用幼儿喂养行为问卷中的项目进行测量。在18个月时测量婴儿体重和身长,有超重风险的婴儿被定义为体重/身长z分数(WLZ) >1. 采用因素分析确定喂养方式及其与超重风险的关联,采用国家和卫生诊所的多水平logistic回归核算进行评估。根据婴儿和母亲的协变量调整逻辑回归模型,最终模型包括抑郁症状评分。结果在366名被评估的婴儿中,18.9%存在超重风险。确定了五种喂养方式:不参与、放纵、强制、限制和响应。只有限制性喂养与超重风险增加有关(OR [95% CI], 1.61[1.22, 2.13])。在调整了母亲抑郁症状后,这种关联增强了(OR [95% CI], 1.79[1.30, 2.30]),表明超重的风险增加了11.18%。结论针对限制性喂养的干预措施可能是降低加勒比地区母婴双体超重风险的一种策略。
{"title":"Maternal feeding styles and the risk of overweight in a cohort of Caribbean infants","authors":"Amika S. Wright,&nbsp;Marshall K. Tulloch-Reid,&nbsp;Susan M. Chang,&nbsp;Susan P. Walker","doi":"10.1002/lim2.77","DOIUrl":"10.1002/lim2.77","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Parental feeding styles in the first years of life may increase childhood overweight risk. There are few studies on this association in children under 2 years. The current study aimed to investigate the association between maternal feeding styles and Caribbean infants’ risk of overweight at 18 months and determine whether maternal depression is an important confounder in the association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>It is a prospective study of mother–child dyads that participated in a three-island parenting trial. Maternal and infant characteristics were collected at infant age 6–10 weeks with maternal depression assessed using the Center for Epidemiologic Studies Depression (CES-D) scale questionnaire. Feeding styles were measured using items from the Toddler Feeding Behaviour Questionnaire at 12 months. Infant weight and length were measured at 18 months, and infants at risk of overweight were defined as weight-for-length <i>z</i>-scores (WLZ) &gt; 1. Factor analysis was used to identify feeding styles and associations with overweight risk assessed using multilevel logistic regression accounting for country and health clinic. Logistic regression models were adjusted for infant and maternal covariates, with a final model including depressive symptom scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 366 infants assessed, 18.9% were affected by the risk of overweight. Five feeding styles were identified—uninvolved, indulgent, forceful, restrictive and responsive. Only restrictive feeding was associated with an increased risk of overweight (OR [95% CI], 1.61 [1.22, 2.13]). The association strengthened after adjusting for maternal depressive symptoms (OR [95% CI], 1.79 [1.30, 2.30]), representing an 11.18% increase in the risk of overweight odds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Interventions that address restrictive feeding may be one strategy to reduce overweight risk among Caribbean maternal–infant dyads.</p>\u0000 </section>\u0000 </div>","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lim2.77","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43151914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Human social genomics: Concepts, mechanisms, and implications for health 人类社会基因组学:概念、机制和对健康的影响
Q3 Medicine Pub Date : 2023-02-25 DOI: 10.1002/lim2.75
George M. Slavich, Summer Mengelkoch, Steven W. Cole

The exciting field of human social genomics provides an evolutionarily informed, multilevel framework for understanding how positive and negative social–environmental experiences affect the genome to impact lifelong health, well-being, behavior, and longevity. In this review, we first summarize common patterns of socially influenced changes in the expression of pro-inflammatory and antiviral immune response genes (e.g., the Conserved Transcriptional Response to Adversity), and the multilevel psychological, neural, and cell signaling pathways by which social factors regulate human gene expression. Second, we examine how these effects are moderated by genetic polymorphisms and the specific types of social–environmental experiences that most strongly affect gene expression and health. Third, we identify positive psychosocial experiences and interventions that have been found to impact gene expression. Finally, we discuss promising opportunities for future research on this topic and how health care providers can use this information to improve patient health and well-being.

人类社会基因组学这一令人兴奋的领域为理解积极和消极的社会环境经历如何影响基因组从而影响终身健康、幸福、行为和寿命提供了一个进化信息,多层次的框架。在这篇综述中,我们首先总结了社会影响促炎和抗病毒免疫反应基因表达变化的常见模式(例如,逆境保守转录反应),以及社会因素调节人类基因表达的多层次心理、神经和细胞信号通路。其次,我们研究了这些影响是如何被基因多态性和特定类型的社会环境经历所调节的,这些经历对基因表达和健康的影响最大。第三,我们确定了积极的社会心理体验和干预措施,已经发现影响基因表达。最后,我们讨论了关于该主题的未来研究的有希望的机会,以及医疗保健提供者如何使用这些信息来改善患者的健康和福祉。
{"title":"Human social genomics: Concepts, mechanisms, and implications for health","authors":"George M. Slavich,&nbsp;Summer Mengelkoch,&nbsp;Steven W. Cole","doi":"10.1002/lim2.75","DOIUrl":"10.1002/lim2.75","url":null,"abstract":"<p>The exciting field of human social genomics provides an evolutionarily informed, multilevel framework for understanding how positive and negative social–environmental experiences affect the genome to impact lifelong health, well-being, behavior, and longevity. In this review, we first summarize common patterns of socially influenced changes in the expression of pro-inflammatory and antiviral immune response genes (e.g., the Conserved Transcriptional Response to Adversity), and the multilevel psychological, neural, and cell signaling pathways by which social factors regulate human gene expression. Second, we examine how these effects are moderated by genetic polymorphisms and the specific types of social–environmental experiences that most strongly affect gene expression and health. Third, we identify positive psychosocial experiences and interventions that have been found to impact gene expression. Finally, we discuss promising opportunities for future research on this topic and how health care providers can use this information to improve patient health and well-being.</p>","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lim2.75","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9584948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Public health reimagined 重新构想公共卫生
Q3 Medicine Pub Date : 2023-01-04 DOI: 10.1002/lim2.76
Julian Abel, Allan Kellehear

This essay offers a critical assessment and reflection on the field of public health based on policy directions and themes gleaned from the historical story of John Snow and the Broad Street pump in 19th century London and recent international responses to Covid-19. Dominant public health strategies, especially for infectious disease emergencies, demonstrate a persistent tendency towards authoritarian claims about science that marginalise concerns about human rights, showing disregard for interprofessional and partnership working, antipathy toward critical voices and a retreat into old ideas about death and dying as medical failure. There is also neglect of the fundamental importance of social relationships as a primary source of health and well-being. Recommendations for a more positive approach for the future of public health are made. These include restoration of, and recommitment to, partnership working with communities, experiential literacy, the prioritising of social support and incentives over negative sanctions, and the acknowledgement and support of end-of-life experiences as a focus for special and overdue public health attention. These suggestions advocate for the application of ‘new’ public health priorities to address and rebalance the limitations of the old, usual approach.

本文根据从19世纪伦敦的约翰·斯诺和宽街水泵的历史故事以及最近对Covid-19的国际反应中收集的政策方向和主题,对公共卫生领域进行了批判性的评估和反思。主要的公共卫生战略,特别是针对传染病紧急情况的公共卫生战略,显示出一种对科学的专制主张的持续趋势,这种主张将对人权的关切边缘化,表现出对专业间和伙伴关系工作的漠视,对批评声音的反感,并退回到将死亡和死亡视为医疗失败的旧观念。人们还忽视了社会关系作为健康和幸福的主要来源的根本重要性。为公共卫生的未来提出了更积极的建议。这些措施包括恢复和重新致力于与社区合作的伙伴关系、体验式扫盲、优先考虑社会支持和奖励而不是消极制裁,以及承认和支持将临终经历作为特别和迟来的公共卫生关注的重点。这些建议提倡应用“新的”公共卫生优先事项,以解决和重新平衡旧的常规方法的局限性。©2023作者。John Wiley & Sons Ltd出版的《生活方式医学》。
{"title":"Public health reimagined","authors":"Julian Abel,&nbsp;Allan Kellehear","doi":"10.1002/lim2.76","DOIUrl":"10.1002/lim2.76","url":null,"abstract":"<p>This essay offers a critical assessment and reflection on the field of public health based on policy directions and themes gleaned from the historical story of John Snow and the Broad Street pump in 19th century London and recent international responses to Covid-19. Dominant public health strategies, especially for infectious disease emergencies, demonstrate a persistent tendency towards authoritarian claims about science that marginalise concerns about human rights, showing disregard for interprofessional and partnership working, antipathy toward critical voices and a retreat into old ideas about death and dying as medical failure. There is also neglect of the fundamental importance of social relationships as a primary source of health and well-being. Recommendations for a more positive approach for the future of public health are made. These include restoration of, and recommitment to, partnership working with communities, experiential literacy, the prioritising of social support and incentives over negative sanctions, and the acknowledgement and support of end-of-life experiences as a focus for special and overdue public health attention. These suggestions advocate for the application of ‘new’ public health priorities to address and rebalance the limitations of the old, usual approach.</p>","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lim2.76","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41738231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
How can patient partnership help to improve equality as COVID-19 moves from pandemic to endemic? 随着COVID-19从大流行转变为地方性流行,患者伙伴关系如何有助于改善平等?
Q3 Medicine Pub Date : 2022-12-29 DOI: 10.1002/lim2.74
Natasha Treagust

One of the stated aims of the National Health Service (NHS) within its constitution is the promotion of equality. However, there is evidence inequality has increased over the last decade and the COVID-19 pandemic has exacerbated this. The current pressures on healthcare mean that there is a case for a shift in approach as we transition to living with endemic COVID-19. This article sets out how putting patient partnership front and centre at an individual, systems and national level has the potential to improve equality and assist the NHS in achieving its founding principles.

国民保健服务制度在其宪法中规定的目标之一是促进平等。然而,有证据表明,在过去十年中,不平等现象有所加剧,COVID-19大流行加剧了这种情况。当前医疗保健面临的压力意味着,随着我们过渡到与COVID-19流行病共存,有必要改变方法。这篇文章阐述了如何把病人的合作伙伴关系的前线和中心在个人,系统和国家层面有潜力改善平等和协助国民保健服务在实现其创始原则。
{"title":"How can patient partnership help to improve equality as COVID-19 moves from pandemic to endemic?","authors":"Natasha Treagust","doi":"10.1002/lim2.74","DOIUrl":"10.1002/lim2.74","url":null,"abstract":"<p>One of the stated aims of the National Health Service (NHS) within its constitution is the promotion of equality. However, there is evidence inequality has increased over the last decade and the COVID-19 pandemic has exacerbated this. The current pressures on healthcare mean that there is a case for a shift in approach as we transition to living with endemic COVID-19. This article sets out how putting patient partnership front and centre at an individual, systems and national level has the potential to improve equality and assist the NHS in achieving its founding principles.</p>","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lim2.74","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10274189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Influences on technology use and interpretation among young people living with type 1 diabetes 1型糖尿病患者对技术使用和解释的影响
Q3 Medicine Pub Date : 2022-12-07 DOI: 10.1002/lim2.73
Laura N. Cushley, Aniela Krezel, Katie Curran, Kathryn Parker, Sarinda Millar, Tunde Peto

Aims

To characterise continuous glucose monitor and flash glucose monitor use and related issues (both positive and negative) in the population of children and young people living with type 1 diabetes in the Southern Health and Social Care Trust (SHSCT), Northern Ireland.

Methods

Four focus groups were conducted in the SHSCT with people with type 1 diabetes and their families, to assess opinions of diabetes technology. In addition, questionnaires were distributed to diabetes specialist nurses (DSNs), young people and their families about use and access to diabetes technology.

Results

Questionnaires were completed by 68 children, young people (0–18 years) and their parents/guardians. Nearly all (98.5%) had access to their own diabetes related data, and 70.6% used diabetes data systems, for example, Libreview. Most of those using these systems found them beneficial and easy for daily use and clinical review.

Most DSNs (83.9%) agreed that the systems were easy to use, and 82.3% were confident in interpreting the data accurately. DSNs felt virtual review was beneficial in over half of young people with 62.9% advising changes to diabetes management based on the data.

Focus groups participants deemed diabetes technology a ‘gamechanger’ and ‘lifechanging’. Some drawbacks included ‘disruptive’ alarms, self-confidence issues, visible diabetes technology and problems in school.

Conclusions

Most young people, their families and healthcare professionals reported they were confident in interpreting diabetes data and technology was easy to use. Diabetes technology could improve access to care through virtual clinics, improve clinical outcomes and enhance quality of life.

目的分析北爱尔兰南部健康和社会保健信托基金(SHSCT)儿童和青少年1型糖尿病患者中连续血糖监测仪和瞬时血糖监测仪的使用情况及相关问题(阳性和阴性)。方法在SHSCT中对1型糖尿病患者及其家属进行4个焦点小组的调查,评估对糖尿病技术的看法。此外,还向糖尿病专科护士(DSNs)、年轻人及其家人分发了关于糖尿病技术使用和获取的问卷。结果共对68名儿童、青少年(0 ~ 18岁)及其父母/监护人进行问卷调查。几乎所有(98.5%)的人都可以访问自己的糖尿病相关数据,70.6%的人使用糖尿病数据系统,例如Libreview。大多数使用这些系统的人发现它们有益且易于日常使用和临床审查。大多数dsn(83.9%)认为该系统易于使用,82.3%的人对准确解释数据有信心。dsn认为虚拟评价对超过一半的年轻人有益,62.9%的人根据数据建议改变糖尿病管理。焦点小组的参与者认为糖尿病技术“改变了游戏规则”和“改变了生活”。一些缺点包括“破坏性”警报、自信心问题、可见的糖尿病技术和学校问题。大多数年轻人、他们的家人和医疗保健专业人员报告说,他们对解释糖尿病数据有信心,而且技术易于使用。糖尿病技术可以通过虚拟诊所改善获得护理的机会,改善临床结果,提高生活质量。
{"title":"Influences on technology use and interpretation among young people living with type 1 diabetes","authors":"Laura N. Cushley,&nbsp;Aniela Krezel,&nbsp;Katie Curran,&nbsp;Kathryn Parker,&nbsp;Sarinda Millar,&nbsp;Tunde Peto","doi":"10.1002/lim2.73","DOIUrl":"10.1002/lim2.73","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To characterise continuous glucose monitor and flash glucose monitor use and related issues (both positive and negative) in the population of children and young people living with type 1 diabetes in the Southern Health and Social Care Trust (SHSCT), Northern Ireland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Four focus groups were conducted in the SHSCT with people with type 1 diabetes and their families, to assess opinions of diabetes technology. In addition, questionnaires were distributed to diabetes specialist nurses (DSNs), young people and their families about use and access to diabetes technology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Questionnaires were completed by 68 children, young people (0–18 years) and their parents/guardians. Nearly all (98.5%) had access to their own diabetes related data, and 70.6% used diabetes data systems, for example, Libreview. Most of those using these systems found them beneficial and easy for daily use and clinical review.</p>\u0000 \u0000 <p>Most DSNs (83.9%) agreed that the systems were easy to use, and 82.3% were confident in interpreting the data accurately. DSNs felt virtual review was beneficial in over half of young people with 62.9% advising changes to diabetes management based on the data.</p>\u0000 \u0000 <p>Focus groups participants deemed diabetes technology a ‘<i>gamechanger</i>’ and <i>‘lifechanging’</i>. Some drawbacks included <i>‘disruptive’</i> alarms, self-confidence issues, visible diabetes technology and problems in school.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Most young people, their families and healthcare professionals reported they were confident in interpreting diabetes data and technology was easy to use. Diabetes technology could improve access to care through virtual clinics, improve clinical outcomes and enhance quality of life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lim2.73","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47127336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The effects of mantra-based AMI Meditation on burnout, secondary traumatic stress, and compassion satisfaction levels in healthcare providers 基于咒语的MI冥想对医护人员倦怠、继发性创伤压力和同情满意度的影响
Q3 Medicine Pub Date : 2022-11-07 DOI: 10.1002/lim2.72
Mark Pettus, Beth Netter, Leonard Perlmutter, Jenness Cortez Perlmutter, Akiko S. Hosler

Importance

There is an abundance of research demonstrating the growing challenge of burnout in healthcare professionals. This has been further exacerbated by the COVID-19 pandemic. The use of meditation using various techniques has shown promising results in the reduction of stress and its sequelae.

Objective

To determine the efficacy of a mantra-based meditation protocol developed by the American Meditation Institute to reduce caregiver stress by evaluating changes in burnout and secondary traumatic stress (components of compassion fatigue) and compassion satisfaction with the application of the meditation protocol.

Design, Setting, and Participation

This pre–post cohort analysis was conducted on prospective enrollees of the Continuing Medical Education (CME)-accredited American Meditation Institute's annual Heart and Science of Yoga® Conference, a comprehensive training in Yoga Science as Holistic Mind/Body Medicine for physicians and other healthcare providers held in October in Lenox, Massachusetts. Enrollees were trained in mantra-based AMI Meditation at the conference and monitored during the 6-month period following the conference.

Interventions

The mantra-based AMI Meditation intervention included a 5-day in-person training, a daily practice of a guided mantra-based AMI Meditation using a 20-min CD or MP3 recording, and receipt of a monthly motivational letter. Study participants completed the Professional Quality of Life (ProQOL) Measure (a survey) and a demographic survey at baseline, and the ProQOL Measure and an informational survey at 3 and 6 months.

Main Outcomes and Measures

The primary outcome was a change from baseline in participants’ level of burnout using the ProQOL assessed at baseline and 3 and 6 months. Secondary outcomes included change from baseline in participants’ level of secondary traumatic stress and compassion satisfaction assessed at 3 and 6 months using the ProQOL Measure. Qualitative data were also collected from participant feedback, via the informational surveys, at 3 months and after completion of the program at 6 months.

Results

Of the 54 participants who en

重要性:有大量的研究表明,职业倦怠对医疗保健专业人员的挑战越来越大。COVID - 19大流行进一步加剧了这种情况。使用各种技巧进行冥想,在减轻压力及其后遗症方面显示出有希望的结果。目的:通过评估冥想方案在职业倦怠和继发性创伤压力(同情疲劳的组成部分)以及同情满意度方面的变化,确定美国冥想研究所开发的基于咒语的冥想方案在减少照顾者压力方面的效果。设计、环境和参与:这项前后队列分析是对继续医学教育(CME)认证的美国冥想协会年度瑜伽心脏和科学®会议的潜在参与者进行的,该会议是10月在马萨诸塞州莱诺克斯举行的针对医生和其他医疗保健提供者的瑜伽科学整体身心医学的全面培训。与会者在会议上接受了基于咒语的AMI冥想培训,并在会议后的6个月期间进行了监测。干预:基于咒语的AMI冥想干预包括为期5天的亲自培训,每天使用20分钟的CD或MP3录音进行指导的基于咒语的AMI冥想练习,以及每月收到一封激励信。研究参与者在基线时完成了职业生活质量(ProQOL)测量(一项调查)和人口统计调查,并在3个月和6个月时完成了ProQOL测量和信息调查。主要结果和测量:主要结果是在基线和3个月和6个月时使用ProQOL评估参与者的倦怠水平与基线相比的变化。次要结果包括受试者在3个月和6个月时使用ProQOL量表评估的继发性创伤应激水平和同情满意度的基线变化。定性数据也从参与者反馈中收集,通过信息调查,在3个月和6个月后完成项目。结果:入组并完成基线调查的54名参与者中,30名在3个月时完成随访,21名在6个月时完成随访。从基线到6个月,所有三个ProQOL量表的得分都有统计学上的显著改善。采用配对t检验,倦怠得分降低23.2% (p < 0.0001),继发创伤应激得分降低19.9% (p = 0.001),同情满意度得分提高11.2% (p < 0.0001)。对于继发性创伤应激和同情满意度评分,在3个月时看到大多数改善。对于倦怠,在3个月和6个月的随访中,改善是恒定的。结论:在这个医疗保健专业人员的小队列中,基于咒语的AMI冥想计划显著改善了照顾者压力的所有三个领域,改善了倦怠和继发性创伤压力,改善了同情心。越来越多的研究支持这些工具和技能在减轻照顾者压力方面的关键重要性。
{"title":"The effects of mantra-based AMI Meditation on burnout, secondary traumatic stress, and compassion satisfaction levels in healthcare providers","authors":"Mark Pettus,&nbsp;Beth Netter,&nbsp;Leonard Perlmutter,&nbsp;Jenness Cortez Perlmutter,&nbsp;Akiko S. Hosler","doi":"10.1002/lim2.72","DOIUrl":"10.1002/lim2.72","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Importance</h3>\u0000 \u0000 <p>There is an abundance of research demonstrating the growing challenge of burnout in healthcare professionals. This has been further exacerbated by the COVID-19 pandemic. The use of meditation using various techniques has shown promising results in the reduction of stress and its sequelae.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the efficacy of a mantra-based meditation protocol developed by the American Meditation Institute to reduce caregiver stress by evaluating changes in burnout and secondary traumatic stress (components of compassion fatigue) and compassion satisfaction with the application of the meditation protocol.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, Setting, and Participation</h3>\u0000 \u0000 <p>This pre–post cohort analysis was conducted on prospective enrollees of the Continuing Medical Education (CME)-accredited American Meditation Institute's annual <i>Heart and Science of Yoga</i><sup>®</sup> Conference, a comprehensive training in Yoga Science as Holistic Mind/Body Medicine for physicians and other healthcare providers held in October in Lenox, Massachusetts. Enrollees were trained in mantra-based <i>A</i>MI Meditation at the conference and monitored during the 6-month period following the conference.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>The mantra-based <i>A</i>MI Meditation intervention included a 5-day in-person training, a daily practice of a guided mantra-based <i>A</i>MI Meditation using a 20-min CD or MP3 recording, and receipt of a monthly motivational letter. Study participants completed the Professional Quality of Life (ProQOL) Measure (a survey) and a demographic survey at baseline, and the ProQOL Measure and an informational survey at 3 and 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes and Measures</h3>\u0000 \u0000 <p>The primary outcome was a change from baseline in participants’ level of burnout using the ProQOL assessed at baseline and 3 and 6 months. Secondary outcomes included change from baseline in participants’ level of secondary traumatic stress and compassion satisfaction assessed at 3 and 6 months using the ProQOL Measure. Qualitative data were also collected from participant feedback, via the informational surveys, at 3 months and after completion of the program at 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 54 participants who en","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lim2.72","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43320381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Embedding social relations into primary care: A population-based approach. What matters most? Population practice of social ecology in medicine and communities 将社会关系嵌入初级保健:基于人口的方法。什么最重要?社会生态学在医学和社区中的人口实践
Q3 Medicine Pub Date : 2022-10-27 DOI: 10.1002/lim2.71
Helen Mary Kingston, Frances da Cunha

Background

The importance of social connectedness has long been an area of research in medical research. The damaging impact of social isolation is recognised and proven. This article describes our experiences of embedding routine enquiry about networks of support into routine clinical care.

Aims

The majority of care happens through the strength of bonds and support between the network of immediate family and friends. Acknowledging these networks and actively working to support them is central to health and wellbeing.

Results

In parallel, working to improve professional networks builds trust, shared understanding and stronger relationships that benefit us all. The strengthening of bonds across and between teams delivering health care can benefit those working within them and lead to improved outcomes for both staff and patients.

Conclusion

Developing Frome as a compassionate community has enabled improved patient care, improved staff wellbeing and financial savings for the health community.

社会联系的重要性长期以来一直是医学研究的一个研究领域。社会孤立的破坏性影响已得到承认和证实。这篇文章描述了我们在日常临床护理中嵌入关于支持网络的常规询问的经验。大多数关怀是通过直系亲属和朋友之间的纽带和支持来实现的。承认这些网络并积极努力支持它们对健康和福祉至关重要。与此同时,努力改善职业网络可以建立信任、共享理解和更牢固的关系,这对我们所有人都有利。加强医疗保健团队之间和团队之间的联系,可以使团队内部的工作人员受益,并为工作人员和患者带来更好的结果。作为一个富有同情心的社区,“发展中国家”改善了患者护理,改善了员工福利,并为卫生界节省了资金。
{"title":"Embedding social relations into primary care: A population-based approach. What matters most? Population practice of social ecology in medicine and communities","authors":"Helen Mary Kingston,&nbsp;Frances da Cunha","doi":"10.1002/lim2.71","DOIUrl":"10.1002/lim2.71","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The importance of social connectedness has long been an area of research in medical research. The damaging impact of social isolation is recognised and proven. This article describes our experiences of embedding routine enquiry about networks of support into routine clinical care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The majority of care happens through the strength of bonds and support between the network of immediate family and friends. Acknowledging these networks and actively working to support them is central to health and wellbeing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In parallel, working to improve professional networks builds trust, shared understanding and stronger relationships that benefit us all. The strengthening of bonds across and between teams delivering health care can benefit those working within them and lead to improved outcomes for both staff and patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Developing Frome as a compassionate community has enabled improved patient care, improved staff wellbeing and financial savings for the health community.</p>\u0000 </section>\u0000 </div>","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lim2.71","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48323262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Is the lack of appropriate cognitive demand the primary driver of dementia risk? 缺乏适当的认知需求是痴呆风险的主要驱动因素吗?
Q3 Medicine Pub Date : 2022-10-09 DOI: 10.1002/lim2.70
Thomas R. Wood, Josh Turknett

With the general trend of increasing lifespan alongside population-level success in reducing the mortality from cardiovascular and cerebrovascular diseases, the population burden of Alzheimer's disease (AD) has steadily accelerated. In the United States, the mortality rate due to AD has increased from less than 0.5 per 100,000 in 1980 to approximately 30 per 100,000 in 2019.1 Worldwide, the number of individuals with dementia is expected to at least triple by 2050,2 with some reports suggesting that AD has the potential to bankrupt healthcare systems.3 At the same time, the development of, and investment in, multiple pharmacological agents directed toward modifying the pathological “hallmarks” of AD have yielded disappointing results. Existing pharmaceuticals offer modest symptomatic benefits, at best, without modifying the course of the disease. Taken together, these factors highlight the urgent need for a critical reappraisal of the underlying risk factors for AD and potential interventions.

In an attempt to reframe potential preventative and therapeutic approaches to AD, we recently proposed a model that suggests demand–function coupling in the brain is the critical upstream factor driving long-term cognitive function.4 In this model, we describe how the health and function of any tissue, including the brain, is shaped by the demands placed upon it. In the setting of increased demand, demand–function coupling drives increases in growth and function, but also upregulates processes of cellular repair and regeneration. The result is a tissue that is more resilient, plastic, and with a greater capacity for increased work output in the face of increased requirements. In this way, we propose that the structure and function of the brain are driven by the demands placed upon it, much as cardiac and skeletal muscles respond to exercise. And as muscle or cardiovascular function decline with bed rest or detraining, the structure and function of the brain decline in a coupled manner when adequate demands are not placed upon it. Cognitive decline is then essentially an expression of “frailty” of the brain - defined as lacking additional capacity to function above basic requirements - as a result of reduced demand. Although it may appear subtle, this reframing of the cascade may be critical in understanding the disease process and intervening as healthcare providers. Whereas the prevailing explanations to date have described cognitive activity as a mitigating force; in this model, we propose that cognitive demand instead impacts the primary pathogenetic process. In fact, given the established phenomenon of demand coupling in neural tissue, we believe that this model provides the most parsimonious account of disease pathogenesis.

In order to explain the approach, we first made two suggestions for a cognitive framework that we believe are essential i

随着人类寿命不断延长的大趋势以及人口水平在降低心脑血管疾病死亡率方面的成功,阿尔茨海默病(AD)的人口负担稳步增加。在美国,阿尔茨海默病的死亡率从1980年的每10万人不到0.5人增加到2019年的每10万人约30人。1在世界范围内,痴呆症患者的数量预计到2050年将至少增加两倍,2一些报告表明,阿尔茨海默病有可能使医疗系统破产与此同时,针对改变阿尔茨海默病病理“特征”的多种药物的开发和投资却产生了令人失望的结果。现有的药物最多只能提供适度的对症治疗,而不能改变疾病的进程。综上所述,这些因素突出了迫切需要对阿尔茨海默病的潜在危险因素和潜在干预措施进行关键的重新评估。为了重新构建AD的潜在预防和治疗方法,我们最近提出了一个模型,该模型表明大脑中的需求-功能耦合是驱动长期认知功能的关键上游因素在这个模型中,我们描述了包括大脑在内的任何组织的健康和功能是如何被施加在它身上的需求所塑造的。在需求增加的背景下,需求-功能耦合驱动生长和功能的增加,但也上调细胞修复和再生过程。其结果是一种更有弹性、可塑性的组织,在面对增加的需求时,具有更大的工作输出能力。通过这种方式,我们提出大脑的结构和功能是由施加在它身上的需求驱动的,就像心脏和骨骼肌对运动的反应一样。当肌肉或心血管功能随着卧床休息或去训练而下降时,当没有适当的需求时,大脑的结构和功能也会以一种耦合的方式下降。因此,认知能力下降本质上是大脑“脆弱”的一种表现——定义为缺乏超出基本需求的额外功能——这是需求减少的结果。虽然它可能看起来很微妙,但这种级联的重构可能对理解疾病过程和作为医疗保健提供者进行干预至关重要。鉴于迄今为止的主流解释将认知活动描述为一种缓解力量;在这个模型中,我们提出认知需求反而影响了原发性发病过程。事实上,考虑到神经组织中需求耦合的既定现象,我们认为该模型提供了疾病发病机制的最简洁的解释。为了解释这种方法,我们首先对认知框架提出了两个建议,我们认为如果我们要更好地理解痴呆症的机制基础并试图干预疾病过程,这两个框架是必不可少的。第一个建议是,我们应该将迟发性或“散发性”AD与早发性家族性AD区分开来。尽管在历史上,由于在尸检中有共同的神经病理特征,它们都被标记为AD的形式,但就其危险因素和病程而言,它们是完全不同的疾病。因此,我们的模型只讨论了晚发性阿尔茨海默病,我们称之为年龄相关性痴呆(ARD),在此之前会出现一段与年龄相关的认知衰退(ARCD)。第二个建议是,我们应该抓住机会从不同的生物组织水平探索ARD的病因和干预点。每一种生物现象都可以在生物组织的多个层面上进行描述和表征,从细胞和分子的层面到种群和生态系统的层面因此,每种疾病现象都有一个最适合连贯解释发病机制的分析和表征水平,这通常是因果链中最上游的水平。在较低层次的组织中对下游结果的描述,不管其详细程度如何,都不一定赋予额外的或更大的解释力。在ARD的情况下,该领域通常集中在颗粒,较低水平的分子和神经病理细节。尽管有越来越多的证据表明,生活方式和环境——代表生物组织的有机体或社会层面——是导致ARD的最终原因。如果情况确实如此,那么机体水平的干预措施可能是最有效的,这也解释了(迄今为止)针对AD和ARD的分子水平干预措施的普遍失败。改变我们干预疾病过程的组织水平的一个问题是,它要求我们放弃纯粹从定义良好的生化机制的角度来思考。 在开发药物制剂时,关键是要针对单一机制,同时尽量减少脱靶效应。相比之下,当在有机体层面进行干预时,干预可能会产生强大的结果,而无需完全了解其生化效应。事实上,当试图在医疗系统的社会层面建立生活方式医学时,在组织的分子或细胞水平上缺乏单一的机制似乎是一个根本问题,因为医疗系统只关注特定干预的作用机制。这方面的一个很好的例子是身体活动,它可能是治疗和预防非传染性疾病的最有效的单一干预措施尽管我们仍然不能完全确定体育活动是如何“起作用”的,但所有政府、非政府组织和健康相关组织都一致建议增加锻炼和非锻炼性体育活动。几十年来,许多将身体活动与健康联系起来的机制,包括对运动的急性和慢性功能适应,已经得到阐明和记录。然而,即使在最近几年,我们继续发现运动调节全身健康和功能的机制,包括涉及鸢尾素、MOTS-c (12S rRNA型c的线粒体开放阅读框架)和Lac-Phe (n -乳酸基苯丙氨酸)的新途径,这只是在高影响力期刊上发表的几个例子,引起了大量相关媒体和媒体的兴趣。7-9如果我们接受具有多效性(有时尚未完全理解)效果的机体层面干预可能对人类健康的某些方面有最大的益处,这将使我们能够重新构建迄今为止尚未取得进展的疾病的方法,例如ARD。在与临床医生和研究人员讨论ARD的需求模型时,他们通常会询问其他已确定的风险因素,特别是与一般健康和环境相关的风险因素。因此,我们必须非常清楚地表明,我们认为ARCD和ARD的环境成分是完善的,10-14,应该是任何疾病病因学或干预模型的重要组成部分。这包括与身体活动减少、10,15 -17睡眠不足、10,18,19代谢疾病、20,21营养缺乏、14,22激素不足、23身体组成改变、24-27和社会孤立或社会支持不足相关的痴呆症风险显著增加的证据越来越多的早期证据表明,生活方式和环境的改变有可能预防甚至逆转ARD,特别是在疾病过程的早期开始。14,29,30这方面的一个主要例子是David Smith教授及其同事的开创性工作,他们表明,用B族维生素来降低高同型半胱氨酸的干预可以减缓脑萎缩和认知能力下降的速度,特别是在omega-3脂肪酸充足的情况下重要的是,环境对ARD风险的影响直接映射到生活方式医学的六个基于证据的支柱(图1)。因此,我们警告不要认为因素是相互排斥的,相反,我们认为上述生活方式和环境因素是大脑中最佳需求-功能耦合所需的关键组成部分。为了适应组织中增加的需求,该组织还必须有足够的营养供应,激素和营养支持,血管供应,以及缺乏有毒物质暴露和睡眠恢复和适应的机会(例如睡眠)。这些因素中的任何一个不足都可能破坏对认知需求的健康促进适应。回到与运动的比较上来,一个人可能拥有建立健康肌肉组织所需的所有要素——营养、荷尔蒙状态、睡眠等——但如果缺乏体育锻炼,他们就不会提高健康水平。我们相信所有的证据都指向大脑功能,毫不奇怪,是一样的。超越假设,认知需求的首要重要性的证据是什么,这对未来的AD研究和干预可能意味着什么?Yu等人最近的一项荟萃分析发现,晚年的认知需求是对抗AD的唯一最具保护作用的因素。同样,多项流行病学研究表明,退休导致的与工作相关的认知刺激的丧失导致认知能力下降的风险同时增加,即使在调整了可能解释提前退休和认知能力下降的混杂因素(如合并症)之后也是如此。 31-33丧失认知刺激的负面影响也是可逆的,丧失感觉功能(如视觉、嗅觉或听觉)的人认知能力下降的风险增加就证明了这一点,这可以通过恢复受损感觉的干预措施来克服。34-38其他类型的有益认知需求包括双语能力或演奏乐器,对那些练习更具挑战性的人的大脑结构有更大的好处。39-45与没有协调成分的高强度运动相比,协调性运动(如瑜伽、太极或舞蹈)似乎对大脑结构和功能有更大的好处。46,47即使是结构化的大脑训练也可以延续到现实生活中记忆和执行功能的改善。39,48 -5
{"title":"Is the lack of appropriate cognitive demand the primary driver of dementia risk?","authors":"Thomas R. Wood,&nbsp;Josh Turknett","doi":"10.1002/lim2.70","DOIUrl":"10.1002/lim2.70","url":null,"abstract":"<p>With the general trend of increasing lifespan alongside population-level success in reducing the mortality from cardiovascular and cerebrovascular diseases, the population burden of Alzheimer's disease (AD) has steadily accelerated. In the United States, the mortality rate due to AD has increased from less than 0.5 per 100,000 in 1980 to approximately 30 per 100,000 in 2019.<span><sup>1</sup></span> Worldwide, the number of individuals with dementia is expected to at least triple by 2050,<span><sup>2</sup></span> with some reports suggesting that AD has the potential to bankrupt healthcare systems.<span><sup>3</sup></span> At the same time, the development of, and investment in, multiple pharmacological agents directed toward modifying the pathological “hallmarks” of AD have yielded disappointing results. Existing pharmaceuticals offer modest symptomatic benefits, at best, without modifying the course of the disease. Taken together, these factors highlight the urgent need for a critical reappraisal of the underlying risk factors for AD and potential interventions.</p><p>In an attempt to reframe potential preventative and therapeutic approaches to AD, we recently proposed a model that suggests demand–function coupling in the brain is the critical upstream factor driving long-term cognitive function.<span><sup>4</sup></span> In this model, we describe how the health and function of any tissue, including the brain, is shaped by the demands placed upon it. In the setting of increased demand, demand–function coupling drives increases in growth and function, but also upregulates processes of cellular repair and regeneration. The result is a tissue that is more resilient, plastic, and with a greater capacity for increased work output in the face of increased requirements. In this way, we propose that the structure and function of the brain are driven by the demands placed upon it, much as cardiac and skeletal muscles respond to exercise. And as muscle or cardiovascular function decline with bed rest or detraining, the structure and function of the brain decline in a coupled manner when adequate demands are not placed upon it. Cognitive decline is then essentially an expression of “frailty” of the brain - defined as lacking additional capacity to function above basic requirements - as a result of reduced demand. Although it may appear subtle, this reframing of the cascade may be critical in understanding the disease process and intervening as healthcare providers. Whereas the prevailing explanations to date have described cognitive activity as a mitigating force; in this model, we propose that cognitive demand instead impacts the primary pathogenetic process. In fact, given the established phenomenon of demand coupling in neural tissue, we believe that this model provides the most parsimonious account of disease pathogenesis.</p><p>In order to explain the approach, we first made two suggestions for a cognitive framework that we believe are essential i","PeriodicalId":74076,"journal":{"name":"Lifestyle medicine (Hoboken, N.J.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lim2.70","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45996131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Lifestyle medicine (Hoboken, N.J.)
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1