Examining the characteristics of patients with long-term impaired work ability in primary health care – a cross-sectional study

To examine characteristics of primary healthcare patients with long-term impaired work ability, and to assess the correlation between sense of coherence and factors related to health, function, and work ability. Cross-sectional study including patients from the LEARN-to-COPE cluster-randomized controlled trial, conducted across 40 primary care centers in Region Västra Götaland, Sweden. Primary healthcare patients with recurrent or long-term sick leave or health-related unemployment ( n  = 243). Sick leave data were collected from the Swedish Social Insurance Agency. Demographics and contextual data were patient-reported or retrieved from personal identity numbers. Symptoms, health-related quality of life, health literacy, sense of coherence, perceived work ability, and lifestyle were assessed using validated questionnaires. Mean age was 47.4 years. Most were women born in a Nordic country, had at least secondary education, and were gainfully employed. A third was unemployed. Mean number of sick days was 1,215 (SD 1,010), and 67.9% were on full-time sick leave. Perceived work ability was low. Participants reported severe anxiety and exhaustion, moderate depression, and a high risk of long-term sick leave due to pain. Health-related quality of life was extremely low. Half reported inadequate or problematic health literacy, and sense of coherence was low. Smoking and obesity were common, physical activity levels were average, and excessive alcohol consumption was below average. About half participated in any rehabilitation activities. Sense of coherence was significantly correlated with health literacy, health-related quality of life, symptoms of mental illness, perceived work ability, and pain (all p  < 0.001); but not with sick leave duration or participation in rehabilitation. Given participants’ pronounced suffering, improving health-related quality of life among primary healthcare patients with long-term impaired work ability should be prioritized. Sense of coherence was associated with several determinants of sick leave, but not with its previous duration. clinicaltrials.gov NCT04254367.

Lacrimal History – Part 50: Doyens of Dacryology Series – The Surgical Treatises of Dominique Anel (1679–1730) and His Concepts of the Dropsy of the Lacrimal Ducts

Considering propagation of additive manufacturing optimisations inside a complex system during early design stage: application to a helicopter hydraulic system

Advances in additive manufacturing technologies, coupled with new post-processing and optimisation methods, are paving the way for redesigning parts and sometimes assemblies of a system. In a classical redesign approach, several parts – called here AM candidates – (those identified as having the greatest potential for AM) are optimised while others are considered unchanged, leading to an unoptimised system. This raises a key question: can optimisations obtained on AM candidates generate improvements on non-AM candidates? This article investigates the impact of propagating improvements from optimised subsystems to other parts, including non-AM candidates, through a novel approach called Propagated Redesign Method (PRD). This PRD method where operating parameters are re-evaluated following the results of the first optimisation, is compared with the traditional No-Propagation Redesign method (NPRD). Applied to the optimisation of a helicopter hydraulic system, results indicate that following NPRD enables a 23.5% reduction in overall system mass. With PRD, the mass of the new system could be reduced further by 26.9%, with additional benefits like 87.5% lower pressure drop and 25.7% lower energy consumption. These significant improvements underscore the crucial role of considering not only the system AM candidates but also their interactions with non-AM candidates for optimising a complex system.

French money doctors in Spain: Rist, Quesnay, and Mitzakis and the stabilisation plans for the peseta 1929–1931

In 1929, Spain called upon the financial expertise of French “money doctors” in its attempts to stabilise the peseta. Charles Rist, ex-Deputy Governor of the Banque de France , and Pierre Quesnay, General Manager of the Bank for International Settlements, were consulted. Both supported stabilisation over revaluation. The differing advice related to the implementation of the stabilisation plans reflects the fundamental tensions in central banking theory during that period. In their turn, domestic factors shaped both the success and the reception of the French doctor’s advice. The changing political backdrop along with institutional and money market constraints conflicted with their recommendations.

Multiracial emerging adults’ experiences with mental health care: ‘To me, it's complicated’

Drawing on critical multiracial theory, the objective of this study was to describe Multiracial emerging adults’ experiences with mental health care. A total of 12 Multiracial emerging adults participated in this phenomenological study that used semi-structured interviews. Participants shared that Multiracial and Black providers were emphatic, but White providers engaged in covert and subtle racism. They further discussed the need for providers to be more culturally competent and the need for more racial and ethnic representation among mental health care providers. Findings suggest that providers need to understand their clients’ experiences better, such as participants’ experiences with racism when both receiving mental health care and navigating developmental milestones, such as dating. This understanding, in turn, could improve the quality of mental health care. Participants in this study also provided suggestions for improving the quality of mental health care, with recommendations ranging from broaching the topic of race to increased racial representation among providers.

Unravelling the meaning of suffering in the context of euthanasia and assisted suicide: a multiperspective meta-ethnography

This meta-ethnography aims to unravel the meaning of suffering in the context of euthanasia and assisted suicide (EAS) using a multiperspective and international framework. More precisely, we seek to understand how the experience of suffering is (1) interpreted by the patients with a request, their close ones, and physicians and nurse practitioners who provide EAS and (2) how the cultural context may shape the way suffering is described. Using PRISMA guidelines, we included 19 articles (1) focusing on the experience of suffering; (2) written in Dutch, English, or French; (3) published in a peer-reviewed journal; and (4) using a qualitative design or containing rich qualitative data. Five intertwined dimensions were identified: existential, physical-neurocognitive, psycho-emotional, socio-environmental and systemic. Our results he nuances in the description of suffering across perspectives and cultural contexts. Our results may inspire those working on the threshold of suffering to adopt a nuanced and holistic approach when assessing patients with an EAS request.

Exploring the experience of presenteeism among fathers returning to work following a perinatal death

Perinatal death is a frequent event that affects one in five pregnancies in western countries. It disrupts parents’ different life spheres, including their work. Fathers, more specifically, usually return to work quickly after their loss. Given the significant psychological impacts of this traumatic experience, they are likely to engage in presenteeism, i.e. reporting to work while still mourning their loss and experiencing psychological distress. However, few studies have documented this phenomenon. To fill this gap, the present study seeks to understand the nature, underlying motivations and perceived repercussions of presenteeism in fathers returning to work following a perinatal death. Semi-structured interviews were conducted with 41 fathers who experienced an early or late perinatal death. Thematic analysis indicates that many fathers returned to work while still experiencing acute symptoms of psychological distress and thus engaged in presenteeism. For most fathers, presenteeism was involuntary and associated with working conditions beyond their control (e.g. workload, lack of paid leave). However, some participants returned to work out of intrinsic interest. Fathers perceived that their act of presenteeism affected them personally, as well as their organization, and their family (i.e. spouse, other children).

Attention and physiological responses to task-irrelevant sounds in misophonia

Misophonia is a disorder in which certain sounds (known as triggers) cause a negative and often overwhelming emotional response. Common triggers include human-produced and repetative sounds such as chewing and tapping. The extent to which this response is modulated by task focus – such as whether a sound is attended or not – is largely unknown. Similarly, the extent to which these responses are specific to triggers or found, to some degree, for a wider range of stimuli is unclear. In this study, two groups (misophonics, controls) engage in a visuo-motor task during the presence of irrelevant sounds (misophonic triggers, unpleasant sounds, neutral sounds) whilst the effects of distraction (poorer performance in the visuo-motor task) and psychophysiological responsiveness (heart and skin conductance) are measured. The results show that misophonic triggers elicit more distraction than other sounds (for people with misophonia), but this is set against a backdrop of an overall tendency for people with misophonia to be more distracted by all sounds. We found no differences in skin conductance, but significant group differences in heart rate and heart rate variability across both sounds and silence. These findings suggest that misophonia is linked to trait-like differences in attentional style and emotional regulation.

Atg5 /Autophagy inactivation in mouse bone microenvironment promotes tumor development

Bone is an attractive site for cancer colonization, both for primary tumors such as osteosarcoma and for metastases of various malignancies. Preventing bone metastasis, which is associated with a poor prognosis, is a major challenge and identifying the factors involved in skeletal tumoral development is crucial to improve survival. In the present work, we showed that inactivation of the macroautophagy/autophagy-essential gene Atg5 in osteoblasts, the cells in charge of bone formation, stimulates osteosarcoma and breastbone metastasis growth as well as metastatic dissemination. We determined that Atg5 inactivation leads to systemic inflammation and bone proteome modifications including translation downregulation, stress granule formation, and upregulation of fatty acid beta-oxidation. In addition, Atg5 inactivation triggered lysosomal exocytosis through an autophagy-independent effect. Thus, our findings indicated that autophagy/ATG5 deficiency in the bone microenvironment generates a favorable environment for tumor development through several mechanisms and suggested that a bone-targeted autophagy inducer could be used to delay bone metastasis appearance. Abbreviations: ACP5/TRAP : acid phosphatase 5, tartrate resistant; CHI3L1 : chitinase 3 like 1; COL1A1 : collagen type I alpha 1 chain; ECM: extracellular matrix ; FDR: false discovery rate; G3BP1 : G3BP stress granule assembly factor 1; GSEA : gene set enrichment analyses; IFNG : interferon gamma; IL1B : interleukin 1 beta; IL23A : interleukin 23; IPA: ingenuity pathway analyses; ITGAX/CD11c : integrin subunit alpha X; KO : knockout; LAMP1 : lysosomal associated membrane protein 1; LGALS3 : galectin 3; LLOMe : L-leucyl-L-leucine methyl ester; OB : osteoblast; OC : osteoclast; PDCD6IP/Alix : programmed cell death 6 interacting protein; PDK4 : pyruvate dehydrogenase kinase 4.

Too Difficult a Task? Principals’ Commitment to Sustaining Academic Standards during Distance Learning and the Role of Disadvantaged Contexts

During the COVID-19-related distance learning in 2020, it was assumed that sustaining academic learning would be particularly challenging for schools serving disadvantaged communities (SSDC). One effect may be that educators at SSDC lowered their standards, and thus students had fewer learning opportunities during distance learning. Using quantitative data from Austria, we analyzed principals’ commitment to sustaining academic learning during distance learning. The data showed that principals were less likely to be committed to that goal the more disadvantaged their students were. This was affected by their expectation toward students’ ability to learn as well as organizational factors of the schools.