Moral injury and well-being in essential workers during the COVID-19 pandemic: local survey findings

BackgroundEssential workers have faced many difficult situations working during the pandemic. Staff may feel that they, or other people, have acted wrongly and be distressed by this. This represents moral injury, which has been linked with significant mental ill health.MethodsThis survey asked essential workers in County Durham and Darlington about their experiences during the first wave of the pandemic and anything they felt would help. Well-being and moral injury were rated using sliders.ResultsThere were 566 responses. A majority of respondents reported feeling troubled by other people’s actions they felt were wrong (60% scored over 40, where 0 is ‘not at all troubled’ and 100 ‘very troubled’, median score=52.5). Respondents were generally less troubled by their own actions (median score=3). Well-being and moral injury scores varied by employment sector (eg, National Health Service (NHS) staff were more troubled by the actions of others than non-NHS staff).Staff suggestions included regular supervisor check-ins, ensuring kindness from everyone, fair rules and enforcement and improving communication and processes. Respondents offered simple, practical actions that could be taken by leaders at team, organisation, societal and governmental levels to tackle moral injury and the underlying causes of moral injurious environments.ConclusionUsing these findings to develop a strategy to address moral injury is important, not only for staff well-being, but staff retention and continued delivery of vital services in these challenging times. Working together, we can seek to reduce and mitigate ‘moral injury’ the same way we do for other physical workplace ‘injuries’.

Effects of Pharmacy Care Program on medication adherence in outpatients with stable coronary artery disease: a randomized controlled study

Aim. To assess the effects of the Pharmacy Care Program on medication adherence in outpatients with stable coronary artery disease (SCAD).Material and methods. An open randomized controlled study was conducted in primary care clinic over the period of 2019-2020. All subjects (n=126) were randomized at visit 1 into the multifaceted intervention group (n=63) or control group (n=63) and invited 12 months after to visit 2. Patients of intervention group were included into the Pharmacy Care Program, which consisted of the following components: pharmacist-led counseling, provision of education materials and 7-day pillbox, weekly SMS-reminders. Medication adherence was measured initially and at the end of the study period by means of eight-item Morisky Medication Adherence Scale (MMAS-8) and Self-Efficacy for Appropriate Medication Use Scale (SEAMS).Results. The implementation of the Pharmacy Care Program improved medication adherence in SCAD outpatients with MMAS-8 median score of 7,0-8,0 (p<0,001) and SEAMS median score of 35,0-36,0 (p=0,017). In the control group, no changes (p=0,123) in MMAS-8 score were revealed, while SEAMS score decreased from 35,0 down to 34,5 (p=0,003). The reduction in systolic blood pressure (p=0,049) and risk of urgent hospital admission (OR=0,28; 95% CI, 0,08-0,99; p=0,041) was registered in the intervention group in contrast to the control group over the 12-month period.Conclusion. The multicomponent intervention within the Pharmacy Care Program contributed to an increase in the adherence to pharmacotherapy of outpatients with stable CAD.

Expression of OLFM4 and Lysozyme During Necrotizing Enterocolitis and Volvulus in Newborns: a Comparative Observational Research Study

Background: In neonatal patients with necrotizing enterocolitis (NEC) and volvulus the inflammatory response is mediated by a plurality of different proteins. The proteins olfactomedin 4 (OLFM4) and lysozyme (LYZ) are part of the intestinal mucosal defense and especially OLFM4 has rarely been evaluated in neonatal gastrointestinal diseases. The aim of this study was to compare the expression levels of OLFM4 and lysozyme during NEC and volvulus in neonates. Methods: Intestinal tissues of patients with NEC and patients with volvulus were examined using immunohistochemical staining of OLFM4 and lysozyme of formalin-fixed and paraffin-embedded sections of resected tissue. Staining-positive tissues were semi-quantitatively scored from 0 (no staining), 1 (weak staining), 2 (moderate staining) to 3 (highly intense staining) by two individual investigators.Results: Both applied antibodies against OLFM4 showed different staining patterns with higher staining intensity of the antibody OLFM4 (D1E4M). OLFM4 (median score of the antibody OLFM4 (D1E4M): 3.0) and lysozyme (median score: 3.0) are highly expressed in intestinal and immune cells during NEC. The expression of OLFM4 and lysozyme in tissue with intestinal volvulus was also observable (median score of the antibody OLFM4 (D1E4M): 1.25) and median score of the antibody against LYZ: 2.0), but lower levels could be seen in comparison to tissue with NEC (p=0.033 and p=0.037, respectively).Conclusions: Both proteins, OLFM4 and lysozyme, may play a role in the pathogenesis of NEC and volvulus in neonatal patients, but the exact mechanisms of OLFM4 and lysozyme function and their role in immunological responses have not yet been resolved. These observations add new insights as basis for further large-scale population research.

Travel Motivations and Travel Careers of Malaysian Backpackers

The study's two primary goals are to determine the main travel motives of Malaysian backpackers and to examine the variations in travel motivations across three categories of backpackers: first-time, repeat, and serial. The results were collected using a self-administered online survey adopting a convenience sample technique. The non-normally distributed data were examined using exploratory factor analysis, median score assessment, and Kruskal-Wallis H tests on a sample of 249. Stimulation is the most crucial factor motivating backpackers, while recognition is the least important. The study also found that backpackers' motivation varied with travel experience. Due to limited research on Asian motivational travel determinants, notably among Malaysian backpackers, this study's motivational features are drawn from other countries. Future research should focus on non-Western motivators impacting backpackers. There is a need for more research on Asian tourism, notably Malaysian backpackers at various stages of their travel careers.

Community Perception on Trypanosomosis, Parasitological, and Entomological Studies in Two Selected Districts of South Omo Zone, Ethiopia

Participatory investigation and trypanosomosis prevalence studied during April 2019 and March 2020 in two selected districts of South Omo, Ethiopia. The study site is located in the gridline of 04.90 to 5.60oN and 35.80 to 36.900 E. Twelve community groups are employed. A cross-sectional study design and 288 animals bled and examined a wet film prepared from the buffy coat. Sixty NGU traps baited with acetone and cow urine were deployed for 48 hrs to estimate the apparent density. Data generated from focus group discussion and trypanosomosis prevalence analyzed using an appropriate statistical package. Proportional piling showed that cattle, goats, and sheep were proportionally dominant with a high median score of 32(14–40), 26(12–33), and 21(5–23), respectively; trypanosomosis ranked first with a proportional median score of 24(13–26) followed by contagious bovine/caprine pleuropneumonia with a proportional median score of 23(19–26) among others. Community unanimously agreed that (W = 0.9) trypanosomosis affects their socioeconomic status and was able to describe clinical signs with significant (p < 0.05) agreement. Tsetse fly (Echut and Kusubo) is the main vector with the agreement of W = 0.9(p < 0.05). Perception on human trypanosomosis varies between Benna Tsemay and Gnagatom districts. Therefore, further study supported by laboratory like molecular test is very important to conclude the presence of human trypanosomosis in the suggested area. The overall prevalence of cattle trypanosomosis was 10.1%. The prevalence of trypanosomosis was significantly higher in poor body condition (OR = 2.1, P < 0.05) and in black coat color (OR = 13.5, P < 0.05) animals. T. congolense and T. vivax were circulating in the area. A total of 455 Glossina (385 G. pallidipes, 17 G. tachinoides, and 53 G. fuscipes) were trapped. The overall apparent density of Glossina was 3.79 Flies/Trap/Day. Three species of Glossina, namely G. pallidipes, G. tachinoides, and G. fuscipes, were distributed in the study areas. Therefore, the finding suggests that the problem is significant and the human trypanosomosis is doubtful. Hence regular control measures and molecular diagnosis need to be conducted.

AMPATH Surgical App: Open Appendectomy

Background/Objective: Due to a geographic shortage of surgical providers within Kenya, doctors without surgical training are expected to complete emergency surgical procedures. The Academic Model Providing Access to Healthcare (AMPATH) surgical team is developing an education module, delivered via mobile phone app and self-made simulators, dedicated to the skills necessary to complete open appendectomy. We hypothesize that our model and curriculum will provide a low-cost method of effectively simulating the open appendectomy. Methods: After developing a step-based curriculum, an initial prototype of a model for the appendectomy was constructed. Expert academic surgeons from Indiana University were identified to test the prototype by performing an open appendectomy on the model. Feedback on both the model and the procedure was obtained via recorded video and REDCap. Results: A total of 8 expert surgeons were consulted on the model, each presented with an updated version of the appendectomy model and procedure based on feedback. Experts provided feedback on the model and each substep of the curriculum. Overall, the curriculum was clear with each substep receiving a median score of at least 82 out of 100 for clarity. While the model received lower scores in utility and “realism, expert feedback was incorporated in an iterative process such that latter models demonstrated net improvement in the realism and utility of several substeps, including “the appendectomy”. Conclusion: A low-cost appendectomy model with corresponding curriculum was developed, and refined with expert feedback, to facilitate this project’s transition to its next stage – testing on medical trainees. Additionally, the model and curriculum will enable the development of an AI algorithm to give the learner real-time feedback as they perform the simulation. Implications: Ultimately, this study may create a platform that increases access to best possible practice and improves outcomes in settings where surgical education is limited.

Immunomodulatory Activity of Aqueous Extract of Polyherbal Formulation on Macrophage Function and Humoral Immune Response against SRBCs in Mice

Several herbal formulation were not properly documented due to poor scientific data as well as poor standard regulation in preparation and marketing. The study evaluate the effect of aqueous extract of Polyherbal formulation on Macrophages’ phagocytic function and Humoral immune response in Mice A total of Sixteen 16 Mice was used. Group I received normal saline, Group II-IV received 500 mg, 1000 mg, and 1500 mg of Polyherbal formulation respectively for 21 days each. The animals were sensitized and challenged with Sheep red blood cells at day 14th and 19th of the treatment respectively. On day 21st all the animals were injected with 0.1 ml Indian ink for carbon clearance assay and blood sample was collected at 1 minute and 15 minutes of the injection. The phagocytic function of Macrophages and humoral immune response were determined spectrophotometrically and Hemagglutination assay respectively. The results show that the highest carbonic particle clearances index (K) median score (Median=0.0228), Macrophage phagocytose index (α) median score (Median=3.249), organ weight index (g/100g) mean score (M=0.06633) and Hemagglutination antibody titre median score (Median=32.00) was recorded by Group IV when compared with other groups. The carbonic particle clearance (K) (p=0.02), phagocytic index of Macrophage (α) (p=0.03), and organ weight index (g/100g) (p<0.0001) significantly increase with increase in the Polyherbal formulation concentration. Hemagglutination antibody titre against Sheep red blood cells (p=0.02) also significantly increased. The extract has potential immunostimulatory activity on both Macrophages’ phagocytic function and humoral immune response in mice thus could be useful in improving immune responses.

Homoeopathic treatment of vitiligo: an open observational pilot study

Background: Vitiligo is a common hypopigmentation disorder with significant psychological impact. An evaluation of homeopathic treatment was performed in individuals with vitiligo in a hospital outpatient clinic in West Bengal, India. Methods: Thirty participants (median age 27 years old, 57% female) were recruited for a prospective open-label pilot study and treated with individualized homeopathic medicines for 6 months. Efficacy was assessed after 3 months and 6 months using Vitiligo Area Scoring Index (VASI) score, Vitiligo European Task Force (VETF) score, and Dermatological Life Quality Index (DLQI) score, which are validated outcome measures evaluating the area, intensity, spread of depigmentation of vitiligo lesions, and quality of life (QoL). Results: A total of 27 participants completed the trial; 3 dropped out. After 6 months of treatment, the median VASI total score improved significantly by 0.1 units (p=0.003), from 0.8 (0.5, 1.5) to 0.7 (0.3, 0.8) on a scale from 0 (no depigmentation) to 100 (completely depigmented). Similarly, the VETF median score improved by 2 units (p=0.0001) from 1 (0, 1) to –1 (–1, 0) and the staging score changed from 1 (1, 2) to 1 (0, 1), p=0.002. The total DLQI median score exhibited significant reduction from 21 (17, 22) to 13.6 (10, 17), change 7.4 (p=0.0001), as also did its components. Conclusions: Individualized homeopathic treatment associated with significant improvement of VASI, VETF and DLQI scores. The extent to which the observed effects were due to placebo needs clarification in future randomized double-blind clinical studies preceded by feasibility studies. Trial Registration: Clinical Trials Registry, India registration number CTRI/2013/08/003879.

The role of stromal immune microenvironment in the progression of ductal carcinoma in situ (DCIS) to invasive breast cancer

Aim The first aim of the study was to compare the scores and types of stromal immune cells in 30 patients with primary DCIS and in the same patients after invasive breast recurrence in order to assess possible differences in both during tumor progression. The second aim was to evaluate possible differences in stromal cells of 30 patients with primary DCIS before progression and in the control group of 11 DCIS patients without recurrence during long-term follow-up. Material and methods Evaluation of tumor-infiltrating lymphocytes (TILs) and immunohistochemical stains for immune cell markers CD4, CD8, CD20, CD138, FOXP3, CD163 and TGF beta was performed on the stroma of primary DCIS before progression, invasive breast cancer of the same patients after progression and DCIS without progression. Results The comparison of stromal cells in 30 patients with initial DCIS and its invasive recurrence revealed an increased level of CD20 + immune cells (median score 5% vs. 17%, respectively, p < 0.001) and CD163 + cells (median score 1% vs. 5%, respectively, p < 0.001) in invasive breast cancer. The comparison of stromal cells in 30 patients with initial DCIS before recurrence and the control group of 11 patients with DCIS without recurrence showed statistically significant difference for CD138 + cells, which were more prevalent in patients with worse prognosis (median score 0 vs. 2%, respectively, p < 0.001). No similar relationship was found for the other tested cells as well as for TGF-beta. Conclusions CD138 + immune cells that were more prevalent in patients with a worse prognosis should be explored in further studies to confirm or exclude their role as a potential biological marker of DCIS invasive recurrence.

Effectiveness of Innovation Basic Life Support Training Devices to Layperson: A Randomized Controlled Trial

Objectives: The use of a cardiopulmonary resuscitation feedback device and automated external defibrillator trainer is beneficial in basic life support (BLS) training. Nevertheless, Thailand lacks these devices in BLS support training. This study aimed to compare the efficacy of the Chiang Mai BLS training devices with conventional training devices in BLS training for laypeople.Material and Methods: A randomized controlled trial was conducted to compare the efficacy of the Chiang Mai device group with the conventional device group, by assessing the theory and practical examination scores of the participants; who were adult, laypeople attending the BLS provider course endorsed by the Thai Resuscitation Council. Evaluating instructors were blinded from both groups of participants.Results: A total of 60 adult, laypeople participants were divided into two groups: 32 and 28 participants of the Chiang Mai device group and conventional device group, respectively. Overall examination scores of included participants were very high. The participants in the Chiang Mai device group had a higher median score of multiple-choice question assessment [9.0/9.0 (8.5-9.0) vs 8.5/9.0 (8.0-9.0) points, p-value=0.134] as well as a higher median score of practical examination [26.0/26.0 (24.3-26.0) vs 25.0/26.0 (24.0-26.0) points, p-value=0.278] when compared to those using conventional BLS training devices. However, there was no statistical significance between both groups.Conclusion: The effectiveness of the Chiang Mai BLS training device in basic life support training for adult laypeople is comparable to conventional BLS training devices.