Sarcopenia in Hepatocellular Carcinoma: Pathogenesis and Management

Background: Sarcopenia is almost constantly observed in patients with cirrhosis and hepatocellular carcinoma. Summary: Chronic liver disease represents a unique pathophysiological scenario in which sarcopenia develops and all factors involved in the pathogenesis should be taken into account for an appropriate management of the disease. No properly designed intervention studies on this topic are available and, thus, no effective strategies have been developed for clinical practice. Apart from any targeted intervention, treatment and optimization of liver disease is crucial. Key Messages: In patients with cirrhosis and hepatocellular carcinoma, nutritional support to maintain and restore nutrition status, a targeted use of branched-chain amino acids and a guided physical exercise, should all be an integral part of the multidimensional assessment and tailored interventions.

Personal Credit and Financial Vulnerability

Rather than a narrow focus on risk of default, this paper advocates for lenders to take a broader data-led approach to tackling the challenges posed by financial vulnerability due to its latent and transient nature. Earlier identification and intervention when customers are experiencing financial hardship may help prevent default. Firstly, we consider how macro and micro data sources, in combination with emerging theoretical frameworks that conceptualise financial vulnerability, could be used by lenders for earlier identification of vulnerable customers. Secondly, we look at tailored interventions that could help financially vulnerable consumers once they have been identified, with passive and active methods inspired by protective efforts currently underway within the gambling industry. Lastly, when consumers do enter the arrears process, we highlight how lenders have a responsibility to help mitigate cognitive biases and promote behaviours that will help consumers escape perpetual debt.

Adequacy and timeliness of antenatal care visits among Ethiopian women: a community-based panel study

ObjectivesThe purposes of the study are; (A) to identify whether Ethiopian women’s antenatal care (ANC) visits are adequate and timely and (B) to explore factors that determine these.DesignPanel study design.SettingEthiopia.ParticipantsA total of 2855 women nested within 217 enumeration areas.Primary outcome measuresAdequacy and timeliness of ANC visits.ResultsOf all the 2855 respondents, 65% had made an ANC visit once, while 26.8% initiated ANC visits in a timely way and 43.3% attended adequate ANC visits. Rural residence (adjusted OR (AOR)=0.55, 95% CI: 0.36 to 0.84), attending higher level of education (AOR=2.64, 95% CI: 1.47 to 4.77), being multipara (AOR=0.53, 95% CI: 0.32 to 0.89) and encouragement by partners to attend clinic for ANC (AOR=1.98, 95% CI: 1.14 to 3.44) were significantly associated with timeliness of ANC visit. Similarly, residing in rural areas (AOR=0.20, 95% CI: 0.12 to 0.35), attending higher level of education (AOR=2.96, 95% CI: 1.38 to 6.15), encouragement by partners to attend clinic for ANC (AOR=2.11, 95% CI: 1.31 to 3.40) and timeliness of ANC visit (AOR=4.59, 95% CI: 2.93 to 7.21) were significantly associated with adequacy of ANC visits.ConclusionsA quarter of the pregnant women started ANC visits during the first trimester and nearly half attended adequate ANC visits with wider disparities across regions of their origin and their background characteristics. Concerted efforts on tailored interventions for rural residents, female education and partner involvement are recommended for early and adequate ANC visit(s).

Malnutrition and Inadequate Eating Behaviour during Hospital Stay in Geriatrics—An Explorative Analyses of NutritionDay Data in Two Hospitals

(1) Background: Malnutrition in hospitalized patients is prevalent worldwide, but the severity of the issue is often underestimated by practitioners. The purpose of this study is to investigate the prevalence of malnutrition and inadequate eating behaviour in a geriatric sample. (2) Methods: Two hospitals participated with six wards on nutritionDay in 2017, 2018 and 2019. Nutritional status, food intake, and nutritional interventions were analyzed for all patients ≥ 65 years (n = 156), using the official nutritionDay questionnaires. Malnutrition risk is identified by Malnutrition Universal Screening Tool (MUST), malnutrition by the ESPEN criteria (European Society of Clinical Nutrition and Metabolism). (3) Results: According to MUST (n = 136) 16.9% (n = 23) were at medium risk of malnutrition, 33.8% (n = 46) at high risk of malnutrition, 28.1% (n = 38) were malnourished. Overall, 62.8% (n = 98) showed an inadequate eating behaviour during hospital stay. Moreover, patients with inadequate nutrition had significantly worse self-reported health statuses (p = 0.001; r = −0.276), were less able to walk on nutritionDay (p = 0.002; r = −0.255), had eaten little in the week before admission to hospital (p < 0.001; r = −0.313), and had an increased length of stay (p = 0.036; r = −0.174). (4) Conclusion: To identify malnourished patients is a significant barrier for practitioners seeking to administer specific, tailored interventions. Malnutrition screening protocols must be improved, just as nutrition monitoring in general.

“That’s the whole thing about vaping, it’s custom tasty goodness”: a meta-ethnography of young adults’ perceptions and experiences of e-cigarette use

Background E-cigarettes are increasing in popularity, particularly among young adults. With public health organisations contesting the possible benefits of e-cigarettes, research is required to explore young adults’ use of e-cigarettes as a smoking cessation and recreational tool. This study examined existing qualitative data to understand how transition into adulthood and issues of identity affect young adults’ perceptions and experiences of e-cigarette use. Methods A meta-ethnography was conducted to examine how young adults perceive and use e-cigarettes. Data were synthesised using Noblit and Hare’s (1988) meta-ethnographic approach. Bronfenbrenner’s socio-ecological model (1979) was used to conceptualise themes and map findings. Results A total of 34 studies were included in the review. Young adults viewed e-cigarettes as a safer alternative to traditional cigarette smoking and perceived e-cigarettes as an effective cessation tool. Users were able to personalise their e-cigarette use due to the variety of flavours and devices available. E-cigarettes were found to be a sociable tool as they allowed users to align themselves with their peers who used e-cigarettes and facilitated use within smoke-free environments. Young adults demonstrated high levels of self-efficacy with regards to obtaining e-cigarettes from various retailers and were active consumers of e-cigarette marketing. Conclusion This meta-ethnography provides an in-depth insight into social norms around e-cigarette use and beliefs that e-cigarettes could be a safer alternative to traditional cigarettes. As young adults increasingly engage with e-cigarettes, there is a need for informed policy decisions regarding appropriate use. Engagement with e-cigarettes is often reflected within social media, so this medium could be a key platform for creating tailored interventions which inform young adults about the appropriate use of these products.

Impact of Working from Home on Cardiovascular Health: An Emerging Issue with the COVID-19 Pandemic

Mandatory working from home is one of the consequences of the COVID-19 pandemic for a large number of workers. Transition to working from home may significantly impact lifestyle, psychosocial status, and the overall health of workers. This review summarizes available data about the effects of lockdown measures, particularly working from home, on cardiovascular risk factors including sedentary lifestyle, unhealthy diet pattern, psychological distress, smoking, alcohol misuse, and cardiometabolic parameters. Finally, we suggest countermeasures that can attenuate the negative health impact of working from home. Indeed, timely and tailored interventions implemented by companies in cooperation with the health care system could allow workers to benefit more from some of the advantages associated with working from home.

Development and Validation of the Multidimensional Procrastination Scale in Chinese

Procrastination is a complicated phenomenon with many thoughts, behaviors, and feelings that may characterize different subgroups of procrastinators. Such phenomenon has not been well studied in an integrated theoretical framework. This study aims to establish a theory about the behavioral, cognitive, and affective aspects of procrastination and to develop and validate an operational instrument. In Study 1, we conducted qualitative research based on grounded theories and generated seven initial categories with 22 themes associated with the components in procrastination. In Study 2, we developed an instrument, the Multidimensional Procrastination Scale (MPS), and established a five-dimension structure for the MPS using explanatory factor analysis (EFA; N = 435) and confirmatory factor analysis (CFA; N = 387). In Study 3, we established construct validity and predictive validity for the MPS by building a nomological framework and predicting behavioral procrastination, respectively. The theoretical framework of procrastination included maladaptive (i.e., impulsive and unorganized, hesitation, lack of incentives, avoidance) and adaptive (i.e., arousal and rationalization) components. The MPS demonstrated acceptable reliability, factorial validity, construct validity, and predictive validity. The findings of this study have implications for further studies on the typology of procrastination and the development of tailored interventions to alleviate maladaptive aspects of procrastination.

Types of Caregiving Experience and Their Association With Caregiver Depressive Symptoms and Quality of Life

Objective This study examines distinct types of caregiving experience, each formed by varied combinations of caregiving burden and benefits, and their association with caregiver depressive symptoms and quality of life. Methods: We apply latent profile analysis and multivariable regression to data on 278 caregivers participating in the Caregiving Transitions among Family Caregivers of Elderly Singaporeans (TraCE) study in 2019–2020. Results: We identify four caregiving experience types: (1) balanced (low burden and moderate benefits, 40% of caregivers), (2) satisfied (low burden and high benefits, 33%), (3) intensive (high burden and high benefits, 17%), and (4) dissatisfied (moderate burden and low benefits, 10%). Caregivers with dissatisfied and intensive caregiving experience tend to report higher depressive symptoms and lower quality of life compared to those with satisfied caregiving experience. Discussion: A person-centered approach helps capture the heterogeneity in caregiving experience. Policymakers should develop tailored interventions by caregiving experience types for promoting caregiver well-being.

Syrian refugees perspectives on substance use

Background Little is known about Syrian refugees ‘perspectives on substance use. Syrians have been the largest groups of refugees in Germany since 2014. To investigate Syrian refugees’ perspectives on substance use we applied a qualitative study design. Methods Five semi-structured focus group discussions with a total of 19 refugees were conducted in 2019 among the difficult to reach population of Syrian refugees. Audio recordings were translated and transcribed, and inductive thematic was analysis conducted. Results The following common themes were identified: (a) perception that substances are widely accepted and available in Germany; (b) availability of substances is linked to rules and norms in Germany which are different in Syria, (c) and to the intention to escape not only the past (d) but the present and finally that (e) mental health professional treatment for substance use is associated with shame. Conclusions Findings support Syrian refugees ‘perspectives of substance use as a way of escaping past and present in a socio-ecological understanding which includes past and present exposures. Understanding the explanatory model of Syrian refugees can inform future interventions to prevent substance abuse and design tailored interventions. Further studies with Syrian refugees in more countries are needed to better understand resettled refugees’ perspectives on substance use. Messages The intention to escape past and present elucidates links between the context of using substances and context of feeling rejected. Context specific knowledge of substance use is necessary which includes past and present factors.