Thalassemia Major and Associated Psychosocial Problems: A Narrative Review

Thalassemia is an inherited disease that causes the production of damaged hemoglobin chains. Patients are diagnosed with thalassemia major due to major clinical signs and deep anemia. This study aimed to examine the major thalassemia and psychosocial aspect of it, which is such an important issue, to serve as a roadmap for better handling these patients and to contribute to the literature. The method used in this study was narrative review. A literature review was conducted by searching the materials published in databases including Web of Science, PubMed, Scopus, and Google Scholar search engine from 2001 to 2020. Besides WHO website was searched. Thalassemia major damages the heart, liver, lungs and endocrine organs due to anemia and iron accumulation. In addition, the patient may experience mental and social problems due to the congenital nature of the disease and its lifelong duration. The psychosocial problems and treatment burdens of thalassemia patients are very high. There are many studies about the prevalence and physical consequences of thalassemia. However, there are not enough articles and researches describing the psychosocial effects of thalassemia on patients and what can be done about these effects. For this reason, this paper focuses on the process of thalassemia and the psychosocial problems it creates to contribute to the literature and to be a roadmap for better handling these patients.

Support needs of Dutch young adult childhood cancer survivors

Background Studies about support needs of young adult childhood cancer survivors (YACCS) previously focused mainly on information needs. This study assessed support needs and associated factors (sociodemographic, medical, and psychosocial functioning) in Dutch YACCS. Methods YACCS (aged 18–30, diagnosed ≤ 18 years, time since diagnosis ≥ 5 years) cross-sectionally filled out a questionnaire regarding their need for various types of support (concrete information, personal counseling, and peer contact) in eight domains (physical consequences of childhood cancer, social-emotional consequences, relationships and sexuality, fertility, lifestyle, school and work, future perspective, insurance and mortgage), and questionnaires assessing health-related quality of life (PedsQL-YA), anxiety and depression (HADS), and fatigue (CIS-20R). Descriptive statistics were used to describe support needs. Linear regression was used to identify characteristics associated with support needs. Results One hundred fifty-one YACCS participated (response = 40%). Most YACCS reported a need for support in one or more domains (88.0%, N = 133). More than half of the participants reported a need for concrete information in the domains lifestyle, fertility, and physical consequences of childhood cancer and 25–50% in the domains insurance and mortgages, future perspective, and social-emotional consequences of childhood cancer. In the domains lifestyle and physical as well as emotional consequences of childhood cancer, 25–50% reported a need for counseling. Overall need for support was positively associated with middle (β = 0.26, p = 0.024) and high (β = 0.35, p = 0.014) compared to low educational attainment and (sub)clinical anxiety (β = 0.22, p = 0.017), and negatively associated with social functioning (β = − 0.37, p = 0.002) in multivariate analyses. Conclusion YACCS report the strongest need for support, for concrete information, in the domains lifestyle, fertility, and physical consequences of childhood cancer. Associated factors were mostly socioeconomic and psychosocial in nature. Psychosocial care should be an integral part of survivorship care for YACCS, with screening for psychosocial problems, information provision including associated emotional consequences and support if necessary (psycho-education) and tailored interventions, and adequate referrals to more specialized care if necessary.

Designing Public Health Policy to Curb Health and Economic Impact of Khat Chewing

Introduction and Background: Khat (Catha edulis Forsk) known for long period as an indigenous plant to Ethiopia, has many mixed effects and impact. Some consider it as a good means to socialize. Others consider it as a good source of income. Nowadays, as a result of its effect on health, public health concern is growing. However, there are no policies controlling these khat effects. Objective: To present policy option to curtail health and economic impact of khat chewing practice in Ethiopia. Methods: Narrative literature review was made to look into different effects of khat chewing with a particular reference to Ethiopia. Key findings khat chewing has stimulating, euphoric and addictive effects. It has a constricting effect on blood vessels leading to hypertension. It has also neuropsychiatric and physical consequences including aggression, suicidal ideation, anxiety, paranoia, manic behaviors, insomnia, depression, increased heart rate, anorexia and weight loss, dental and pulmonary problems. Additionally, khat abuse found linked to liver damage and failure. Conclusion: Given that medical risks of khat use are modest, or studies are not conclusive, there should be a regulatory framework with the objective of protecting consumers and community. This is best achieved by establishing processes for the quality control of khat and by regulating access and availability. Conclusive studies are very rare and even some are inadequate and contradictory. Most of the evidences on adverse effects of khat come from case reports and observational studies. Therefore, high quality research is justified.

A Discussion on Sea Level Rise, Rate Ad Acceleration. Venice as a Case Study

The paper discusses the equations used to represent the sea level rise, and in particular the second-order polynomial, generally preferred because its second-order coefficient is related to acceleration. The long series of the sea level rise in Venice offers a particularly useful case study from 1350 to 2016, because it may be equally represented, at the same level of explained variance, by an exponential or a quadratic best-fit equation. The first-order and the second-order derivatives respectively represent the rate and the acceleration of sea level rise. The derivatives obtained from the second-order polynomial representation generate a linear rate and a constant acceleration, while those derived from an exponential preserve the exponential character. The two rates (i.e. from the quadratic and the exponential equations), and the two accelerations are characterized by different equations and different plots, but their average values are the same. The second-order polynomial with constant acceleration is in line with a climate with constant forcing factors; the exponential with a dynamic condition with increasing forcing factors and acceleration. Mathematical formulae and physical consequences are discussed in the framework of different scenarios. Finally, the trend-forecast extrapolation is discussed and applied to the case study of Venice. It is shown that, in the most optimistic assumption of forcing increasing at unchanged rate, the sea level in Venice will rise by 33.8 ± 4 cm over this century, that may be compared to the 31 cm of the similar, most optimistic prediction made by IPCC for business-as-usual.

Long-term outcomes following severe COVID-19 infection: a propensity matched cohort study

BackgroundThere are limited data describing the long-term outcomes of severe COVID-19. We aimed to evaluate the long-term psychosocial and physical consequences of severe COVID-19 for patients.MethodsWe conducted a multicentre observational cohort study; between 3 and 7 months posthospital discharge, patients who had been admitted to critical care due to severe COVID-19 were invited to an established recovery service. Standardised questionnaires concerning emotional, physical and social recovery, including information on employment, were completed by patients. Using propensity score matching, we explored outcomes between patients admitted to critical care with and without COVID-19, using data from the same recovery programme.ResultsBetween July 2020 and December 2020, 93 patients who had been admitted to critical with COVID-19 participated. Emotional dysfunction was common: 46.2% of patients had symptoms of anxiety and 34.4% symptoms of depression. At follow-up 53.7% of previously employed patients had returned to employment; there was a significant difference in return to employment across the socio-economic gradient, with lower numbers of patients from the most deprived areas returning to employment (p=0.03). 91 (97.8%) COVID-19 patients were matched with 91 non-COVID-19 patients. There were no significant differences in any measured outcomes between the two cohorts.InterpretationEmotional and social problems are common in survivors of severe COVID-19 infection. Coordinated rehabilitation is required to ensure patients make an optimal recovery.

Cognitive Behavioral Therapy for Insomnia in Geriatric Primary Care

Insomnia is common in older adults and may have adverse cognitive, emotional, and physical consequences. Some older people are prescribed sleep medications for insomnia despite longstanding concerns about their use with older people (i.e., BEERS criteria). Cognitive Behavioral Therapy for Insomnia (CBT-I) is highly effective in the treatment for insomnia in adults and older adults. However, most studies of CBT-I in late life have been conducted with individuals younger than 70. This paper discusses four years of experience of providing CBT-I to older people in geriatric primary care, two-thirds of whom were older than 75 years of age. Among the subgroup of 29 individuals who completed a full course of CBT-I, almost all of those who had been on sleep medications discontinued them. Treatment outcomes were large and clinically meaningful. This paper will also describe our experience in providing CBT-I via telehealth because of the COVID pandemic.

Lifetime Major Discrimination Experiences Moderate the Impact of Depressive Symptoms on Chronic Conditions among Black Americans

To clarify the ways in which Black Americans’ experiences of structural racism may influence their mental and physical health in distinct ways, the present study evaluated whether major discrimination moderates the association between depressive symptoms and chronic physical health conditions among this population. T-tests and chi-squared tests of significance were used to determine significant differences between women and men. The association between major discrimination and depressive symptoms was examined by assessing mean depressive symptoms scores across levels of major discrimination. ANOVA tests indicated whether there were significant differences in symptom scores across each discrimination category. Additional t-tests determined significant gender differences within each level of discrimination. Gender-stratified negative binomial models were used, and odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the relationship between depressive symptoms, major discrimination, and chronic conditions. Our findings indicated that the association between depressive symptoms and chronic conditions depends on lifetime experiences of major discrimination among Black Americans and varies significantly between women and men. Considering that major discrimination conditioned the depressive symptom-chronic conditions association among our sample, this provides insight into potential pathways for intervention in efforts to offset the detrimental mental and physical consequences of experiencing racism.

Learning from the physical consequences of our actions improves motor memory

Actions have consequences. Motor learning involves correcting actions that lead to movement errors and remembering these actions for future behavior. In most laboratory situations, movement errors have no physical consequences and simply indicate the progress of learning. Here we asked how experiencing a physical consequence when making a movement error affects motor learning. Two groups of participants adapted to a new, prism-induced mapping between visual input and motor output while performing a precision walking task. Importantly, one group experienced an unexpected slip perturbation when making foot-placement errors during adaptation. Because of our innate drive for safety, and the fact that balance is fundamental to movement, we hypothesized that this experience would enhance motor memory. Learning generalized to different walking tasks to a greater extent in the group who experienced the adverse physical consequence. This group also showed faster relearning one week later despite exposure to a competing mapping during initial learning—evidence of greater memory consolidation. The group differences in generalization and consolidation occurred even though they both experienced similar magnitude foot-placement errors and adapted at similar rates. Our results suggest the brain considers the potential physical consequences of movement error when learning and that balance-threatening consequences serve to enhance this process.