Awareness for People With Alzheimer’s Disease: Profiles and Weekly Trajectories

Objective: To understand awareness and fluctuations of awareness in Alzheimer’s disease (AD), it is fruitful to consider the objects of awareness, e.g., cognitive functioning or recognition of the disease, as well as the mechanisms and modes of expression underlying awareness. With a holistic and discourse-centered approach, we aimed to identify different awareness profiles and test whether these profiles were stable or whether transitions from one profile to another occurred over short time intervals.Methods: Twenty-eight residents of nursing homes with a diagnosis of AD participated in four semistructured interviews at biweekly intervals. These interviews were cluster analyzed to determine profiles of awareness. A Markov chain was applied to model their fluctuation.Results: Five awareness profiles were observed that differed in terms of objects and underlying processes. Awareness proved to be quite stable for four of the five profiles. Interindividual variability in awareness was also observed through numerous different trajectories that were identified.Discussion: Self-awareness and disease awareness are characterized by profiles that vary subtly between individuals. Fluctuations in awareness underscore the need to employ assessment intervals that closely reflect daily life in institutions.

Application Effect of the Standard Operating Procedure in the Prevention of Venous Thromboembolism

Objective. To investigate the application effect of the standard operating procedure (SOP) in the prevention of venous thromboembolism (VTE). Methods. The clinical data of patients admitted to respiratory, cardiovascular, neurological, and geriatric departments in the hospital (November 2020–May 2021) were retrospectively analyzed, and the patients in line with the inclusion criteria were equally randomized into the observation group (OG) and the control group (CG). The CG was treated with the routine nursing, and the OG received the SOP of VTE prevention additionally. After the record of the incidence of VTE and nursing satisfaction of the two groups, scores of VTE awareness were compared. Results. One hundred and twenty patients were included in this study, and no obvious difference was found in the general data of patients ( P > 0.05). Compared with the CG, the incidence of VTE of the OG was obviously lower ( P < 0.05). After nursing, compared with the CG, scores of VTE awareness in the OG were conspicuously higher ( P < 0.001), and scores of VTE awareness of the nursing staff were conspicuously higher than those before nursing ( P < 0.001). Compared with the CG, nursing satisfaction of the OG was obviously higher ( P < 0.001). Conclusion. SOP can reduce the incidence of VTE of patients, improve their disease awareness, and enhance their nursing satisfaction, which should be popularized in practice.

Disease Awareness Campaigns

Currently, professional training goes beyond the discipline itself and focuses also on being able to improve our society. Professionals have a great responsibility as active participants in the local, regional, national, or global community they belong to. In the healthcare area, all disciplines must contribute to a deep transformation of the quality of life of all the people in the society, not limited to the patients themselves, but embracing their context, with relatives, friends, etc. The healthcare professional, and professionals of all other areas must, therefore, be competent in their discipline and other transversal components to become an effective change agent. Transversal competencies or soft skills, including citizenship, can also be seen as power skills for all professionals, as they empower them to have a greater impact in their community. Activities focused on the development and self-awareness of these contribute to the training of better professionals in our universities.

Expert opinion on current trends in hyperpigmentation management: Indian perspective

<p class="abstract">Hyperpigmentation is a common pigmentary disorder characterized by increased production of melanin. It is present in Asian skin phototypes, with a higher prevalence in the Indian population. Skin heterogeneity is seen in more than 80% of individuals of all age groups and genders in several cities across India. In children, the prevalence of hyperpigmentary disorders accounts for 1.54 per 1000 children.Sixty expert dermatologists participated in expert group meetings via teleconference webinar to elaborate on the current trends in the management of hyperpigmentary disorders. The major reasons for hyperpigmentary disorders in India include melanocyte function followed by exposure to ultraviolet radiation, race, ethnicity, use of medications, pregnancy, and use of cosmetic. There are wide varieties of skin-lightening or depigmenting agents and skin resurfacing procedures that aid in the management of hyperpigmentation. However, treatment becomes challenging due to compliance issues related to affordability, complexity of prescriptions, and treatment duration. Compliance increases only if the patient sees any improvement or discontinues treatment due to higher expectations. Hence, the success of the treatment lies in patient adherence. This article summarizes expert opinions on identifying, diagnosing, and managing hyperpigmentation with the help of topical depigmenting agents in the Indian scenario. It also emphasizes treatment adherence issues along with the role of patient counseling and education regarding disease awareness and treatment strategies.</p>

MODELING THE IMPACT OF EDUCATIONAL CAMPAIGN ON THE TRANSMISSION DYNAMICS OF EBOLA

Disease awareness that informs the public about the severity and transmission pathways of infectious diseases such as Ebola is key to curtailing an outbreak. Public health education when available can limit the intensity and duration of an Ebola outbreak in any community if there is compliance. It is important that all population groups be informed about the methods in which Ebola is transmitted to control the disease when there is an outbreak. In this paper, we study the impact of public health education that leads to behavioral changes on the dynamics of Ebola spread. The model is formulated as a system of ordinary differential equations and incorporates direct transmission from infectious, hospitalized, and deceased individuals with Ebola. We establish the existence of a disease free equilibrium and an endemic equilibrium, and investigate them for local and global stability. Model predictions show that a more informed community results in fewer cases, and thus limits the impact of an Ebola outbreak. Further, the model also predicts subsequent outbreak waves within a community in the absence of complete eradication. Lastly, the model successfully captures the dynamics of the 2014–2016 West Africa Ebola outbreak and the 2018–2020 Democratic Republic of Congo Ebola outbreak.

Management of patients with severe asthma: results from a survey among allergists and clinical immunologists of the Central Italy Inter-Regional Section of SIAAIC

Background Asthma, and severe asthma in particular, is often managed within a specialized field with allergists and clinical immunologists playing a leading role. In this respect, the National Scientific Society SIAAIC (Società Italiana di Allergologia, Asma ed Immunologia Clinica), structured in Regional and Inter-Regional sections, interviewed a large number of specialists involved in the management of this respiratory disease. Methods A survey entitled “Management of patients with asthma and severe asthma” based on 17 questions was conducted through the SIAAIC newsletter in 2019 thanks to the collaboration between GlaxoSmithKline S.p.A. and the Inter-Regional Section of SIAAIC of Central Italy. Results Fifty-nine allergists and clinical immunologists participated to the survey, and 40 of them completed the entire questionnaire. Almost all of the specialists (88%) reported that asthma control was achieved in above 50% of their patients, even if only one third (32%) actually used validated clinical tools such as asthma control test (ACT). Poor adherence to inhaled therapy was recognized as the main cause of asthma control failure by 60% of respondents, and 2–5 min on average is dedicated to the patient inhaler technique training by two-thirds of the experts (65%). Maintenance and as-needed therapy (SMART/MART) is considered an appropriate approach in only a minority of the patients (25%) by one half of the respondents (52%). A high number of exacerbations despite the maximum inhalation therapy were recognized as highly suspicious of severe asthma. Patients eligible for biological therapies are 3–5% of the patients, and almost all the responders (95%) agreed that patients affected by severe asthma need to be managed in specialized centers with dedicated settings. Biological drugs are generally prescribed after 3–6 months from the initial access to the center, and once started, the follow-up is initially programmed monthly, and then every 3–6 months after the first year of treatment (96% of responders). After phenotyping and severity assessment, comorbidities (urticaria, chronic rhinosinusitis with or without nasal polyps, vasculitis, etc.) are the drivers of choice among the different biological drugs. In the management of severe asthma, general practitioners (GPs) should play a central role in selecting patients and referring them to specialized centers while Scientific Societies should train GPs to appropriately recognize difficult asthma and promote public disease awareness campaigns. Conclusions This survey which collects the point of view of allergists and clinical immunologists from Central Italy highlights that asthma control is still not measured with validated instruments. There is a general consensus that severe asthma should be managed only in dedicated centers and to this aim it is essential to encourage patient selection from a primary care setting and develop disease awareness campaigns for patients.

AWARENESS REGARDING DIABETES AND ITS MANAGEMENT AMONGST PATIENTS VISITING TERTIARY CARE HOSPITALS AND ITS IMPACT ON GLYCEMIC CONTROL

Objective: To assess factors affecting disease awareness in diabetics, and its association with glycemic control. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi from Jan to Apr 2019. Methodology: Outdoor patients with type-II diabetes mellitus were selected using a consecutive sampling technique. Disease awareness was assessed with a modified Diabetes Knowledge Questionnaire, with scores >70% considered satisfactory. Recent HbA1c levels were used to determine glycemic control (<7% reflecting good glycemic control). Demographic data, including age, gender, level of education, residence, duration of diabetes, mode of treatment, smoking status and co-existing hypertension, were also recorded. Results: There were 212 patients with equal gender distribution and mean age of 55.90 ± 11.96 years. Of these, 117 (55.18%) lived in rural areas, 77 (36.32%) were educated, 34 (16.03%) were smokers and 121 (57.07%) had co-existing hypertension. The mean duration of diabetes was 81.72 ± 71.67 months (range 3-360 months) and mean HbA1c levels were 9.55 ± 2.56%. Higher HbA1c levels were associated with poorer DKQ scores. The level of education and the duration of diabetes significantly predicted DKQ scores. Conclusion: Lack of disease awareness leads to poor glycemic control. Better education and longer disease duration impact the understanding of diabetes.

Development and application of a chronic kidney disease-specific health literacy, knowledge and disease awareness assessment tool for patients with chronic kidney disease in Taiwan

ObjectivesThis study aims to develop an assessment tool for health literacy and knowledge specific to chronic kidney disease (CKD) for use in examining the associations between health literacy, disease-specific knowledge and disease awareness among patients with CKD in Taiwan.DesignAn assessment tool in Mandarin and Taiwanese was developed based on patient input, panel discussions with experts and a literature review, and checked for validity and reliability in a pilot test. Formal data were collected through population-based sampling with a set quota according to region and hospital accreditation level. Cross-sectional data were collected to confirm the reliability and validity of the assessment tool. Levels of health literacy, disease knowledge, and disease awareness were then reported and analysed.SettingSample hospitals included 10 medical centres, 18 regional hospitals and 15 local hospitals in Taiwan. Researchers were granted Internal Review Board approval and obtained agreement to collect data in all study settings.ParticipantsPatients at least 20 years old who had been diagnosed with CKD of any stage were eligible to participate. The formal assessment collected 1155 valid questionnaires, yielding an 87.3% response rate. The mean age of participants was 67.48 years (SD=12.87, range 22–98), while 484 (41.95%) were female and 78% were aware they had CKD.ResultsThe self-devised instrument proved to have excellent reliability and validity. Use of the instrument in the main study showed that CKD-specific health literacy was significantly associated with age (β=−0.33, p<0.00), educational attainment and disease awareness (β=0.13, p<0.00). CKD-specific knowledge was also significantly associated with age (β=−0.18, p<0.00), educational attainment and disease awareness (β=0.19, p<0.00).ConclusionsThis CKD-specific health literacy and knowledge assessment tool developed for Mandarin and Taiwanese-speaking patients is reliable and well validated. Patients with CKD who are aware of and understand their disease performed better in the assessment.