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Abstract Background Cardiac manifestations are infrequently reported in association with celiac disease, but clear link has not been established. The aim of this study was to explore the connection of dilated cardiomyopathy in celiac disease. This systematic review also provides a comprehensive overview of the association between celiac disease and various cardiac manifestations with pathophysiology and management. Main body We searched PubMed, Cochrane Library, Google Scholar, Embase, Scopus, and Springer nature databases through June 4th 2023 for preferred studies related to our topic using MeSH and Regular keywords. After comprehensive search analysis, data extraction and quality appraisal 19 studies were included in the study. Although results varied across studies, majority of the studies revealed a positive link. Notably, some studies suggested an association between celiac disease and dilated cardiomyopathy, while others did not. These discrepancies could be attributed to differences in methodologies, study populations, and regional variations. Several studies have shown the association of various cardiac manifestations in celiac disease. Conclusion Although dilated cardiomyopathy is associated with celiac disease in majority of the studies, there are also studies that conflict with the association. The complex relationship between celiac disease and cardiovascular manifestations potentiates the need for further research with standardized methodologies, larger sample sizes, and consideration of regional variations. Such insights are vital for improving clinical practice by establishing preventive strategies, active screening, early diagnosis, mitigating risks which helps in optimizing cardiovascular health in individuals with celiac disease.

Psychosis in patients with dementia-related disorders has long been a challenging issue to be tackled by the medical fraternity. Although atypical antipsychotics (AP) are in use for the same reason, there has always been a question regarding their safety and tolerability in this group of patients. Pimavanserin, a serotonin receptor inverse agonist or antagonist, is the only drug that is Food and Drug Administration-licensed to be used for the treatment of Parkinson's disease psychosis. This systematic review, which was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020, had the objective of examining the effects of pimavanserin in patients with dementia-related psychosis (DRP). Among the publications (January 1, 2013–July 12, 2023) we gathered and examined were case–control and cohort studies, systematic reviews, meta-analyses, clinical trials, literature reviews, and randomized and nonrandomized control trials. The databases used to construct this list of publications were PubMed, Cochrane Library, and Google Scholar. These three databases yielded 157 reports in total once the relevant filters were applied. They were then further screened and put through quality evaluation processes, which led to the final nine papers that were included in this systematic review. We concluded from our review that pimavanserin proves to be a promising alternative for the treatment of DRP, showing significant improvements and fewer side effects compared to other atypical AP.

OBJECTIVE: Moral distress emanating from value conflicts comprising ethical dimensions pose a threat to nurses’ health and retention, as well as to the quality of care. The aim of the present study was to investigate the relationships between the frequency of ethical value conflicts (EVC), and the perceived distress when they occur, respectively, and nurses’ work-related stress, burnout symptoms, turnover intent, team effectiveness, and patient safety. METHODS: A two-wave longitudinal cohort questionnaire study was performed among registered nurses at six hospitals in two Swedish regions. Cross-sectional analyses (T1) were based on 1817 nurses in 228 care units (CU), and longitudinal analyses (T1 – T2) on 965 nurses in 190 CU. Hypothesis testing was performed using multilevel controlled regression modeling. RESULTS: The results indicated that nurses who were often exposed to EVC also to a higher extent tended to report these conflicts as stressful. Frequent exposure to EVC induced by insufficient resources, inapt organizational structures or interpersonal staff relations were cross-sectionally associated with work-related stress, burnout symptoms, turnover intent, and team effectiveness. The longitudinal analyses indicated that EVC induced by a lack of resources primarily had negative effects on nurses’ health and well-being. At the CU level, such conflicts also impaired team effectiveness. At the individual level, EVC induced by organizational constraints or interpersonal relations negatively affected care effectiveness. CONCLUSIONS: EVC are related to negative consequences in healthcare, and such processes take place both on the individual and organizational levels.

Abstract Background Stress-related disorders have become a major challenge for society and are associated with rising levels of sick leave. The provision of support to facilitate the return to work (RTW) for this patient group is of great importance. The aim of the present study was to evaluate whether a new systematic procedure with collaboration between general practitioners (GPs), rehabilitation coordinators (RCs) and employers could reduce sick leave days for this patient group. Method Employed patients with stress-related diagnoses seeking care at primary health care centres (PHCCs) were included in either the intervention group (n = 54), following the systematic intervention procedure, or the control group (n = 58), receiving treatment as usual (TAU). The intervention included a) a training day for participant GPs and RCs, b) a standardised procedure for GPs and RCs to follow after training, c) the opportunity to receive clinical advice from specialist physicians in the research group. Outcome measures for RTW were sick leave days. Results The median number of registered gross sick leave days was lower for the control group at six, 12 and 24 months after inclusion, but the difference was not statistically significant. The control group had significantly fewer net sick leave days at three months (p = 0.03) at six months (p = 0.00) and at 12-months follow-up (p = 0.01). At 24 months, this difference was no longer significant. Conclusions The PRIMA intervention, which applied a standardized procedure for employer involvement in the rehabilitation process for patients with stress-related disorders, actually increased time to RTW compared to TAU. However, at 24 months, the benefit of TAU could no longer be confirmed. The study was registered on 16/01/2017 (ClinicalTrials.gov, NCT03022760).

Physical activity promotion in health care settings is poorly understood and has limited uptake among health care providers. The environmental and health care context of rural communities is unique from urban areas and may interact to influence intervention delivery and success. The aim of this rapid realist review was to synthesize knowledge related to the promotion of physical activity in rural health and social care settings. We searched Medline EBSCO, CINAHL, PsychINFO, and SPORTDiscus for relevant publications. We included qualitative or quantitative studies reporting on an intervention to promote physical activity in rural health (e.g., primary or community care) or social (e.g., elder support services) care settings. Studies without a rural focus or well-defined physical activity/exercise component were excluded. Populations of interest included adults and children in the general population or clinical sub-population. Intervention mechanisms from included studies were mapped to the Behaviour Change Wheel (capability, opportunity, motivation (COM-B)). Twenty studies were included in our review. Most interventions focused on older adults or people with chronic disease risk factors. The most successful intervention strategies leading to increased physical activity behaviour included wearable activity trackers, and check-ins or reminders from trusted sources. Interventions with mechanisms categorized as physical opportunity, automatic motivation, and psychological capability were more likely to be successful than other factors of the COM-B model. Successful intervention activities included a method for tracking progress, providing counselling, and follow-up reminders to prompt behaviour change. Cultivation of necessary community partnerships and adaptations for implementation of interventions in rural communities were not clearly described and may support successful outcomes in future studies.

OBJECTIVE: This study aimed to explore the development of working conditions within and between occupations in the Swedish labor market from 1997 to 2015 and whether any polarization in working conditions concurrently occurred between occupations. METHODS: Cross-sectional data from ten waves of the Swedish Work Environment Surveys (1997–2015) were used and an aggregated occupational-level dataset was created using the Swedish Standard Classification of Occupations. To capture the patterns of change in working conditions over time (ie, growth), growth curve modeling was used to identify the starting points for 89 occupations (intercepts) as well as both the shape (functional form) and rate of growth (slope) over time. RESULTS: The Swedish labor market was stable overall, with some small, mainly positive, changes in job demands and resources. Different occupations developed in divergent directions, but there was no evidence of polarization. CONCLUSIONS: The findings indicate that macro-level stability can hide highly heterogeneous patterns of change among different occupational groups. This type of analysis, taking context into account, could be valuable for decision makers intending to improve the work environment.

Psychosis in patients with dementia‑related disorders has long been a challenging issue to be tackled by the medical fraternity. Although atypical antipsychotics (AP) are in use for the same reason, there has always been a question regarding their safety and tolerability in this group of patients. Pimavanserin, a serotonin receptor inverse agonist or antagonist, is the only drug that is Food and Drug Administration‑licensed to be used for the treatment of Parkinson’s disease psychosis. This systematic review, which was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta‑analyses 2020, had the objective of examining the effects of pimavanserin in patients with dementia‑related psychosis (DRP). Among the publications (January 1, 2013–July 12, 2023) we gathered and examined were case–control and cohort studies, systematic reviews, meta‑analyses, clinical trials, literature reviews, and randomized and nonrandomized control trials. The databases used to construct this list of publications were PubMed, Cochrane Library, and Google Scholar. These three databases yielded 157 reports in total once the relevant filters were applied. They were then further screened and put through quality evaluation processes, which led to the final nine papers that were included in this systematic review. We concluded from our review that pimavanserin proves to be a promising alternative for the treatment of DRP, showing significant improvements and fewer side effects compared to other atypical AP. [ABSTRACT FROM AUTHOR]

Abstract Background Physical literacy is a multidimensional concept that describes a holistic foundation for physical activity engagement. Understanding the utilization and effectiveness of physical literacy in the context of health and the health care setting will support clinical and population health programming. The purpose of this rapid scoping review was to: 1) map the conceptualization of physical literacy as it relates to health; 2) identify and describe the utilization of physical literacy in the context of health and engagement of health care providers; and 3) better understand the relationship between physical literacy, physical activity, and health. Methods Following established scoping review methods adapted for a rapid review approach, we searched electronic databases Medline OVID, CINAHL Ebsco, PsycInfo Ebsco, Web of Science ISI, and ERIC Ebsco from conception until September 2019. Tabulation coding was used to identify the key themes across included articles and synthesize findings. The review follows an integrated knowledge translation approach based on a partnership between the health system, community organizations, and researchers. Results Following removal of duplicates, our search identified 475 articles for title and abstract screening. After full text review, 17 articles were included (12 original research papers and five conceptual or review papers). There was near consensus among included papers with 16 of 17 using the Whiteheadian definition of physical literacy. There was limited involvement of health care providers in the concept of physical literacy. Physical literacy was connected to the following health indicators: BMI and body weight, waist circumference, cardiorespiratory fitness, physical activity, and sedentary behaviour. The primary demographic focus of included studies was children and there was a conceptual focus on the physical domain of physical literacy. Conclusions Despite growing popularity, the empirical evidence base linking physical literacy and health outcomes is limited and the relationship remains theoretical. Physical literacy may present a novel and holistic framework for health-enhancing physical activity interventions that consider factors vital to sustained participation in physical activity across the life course. Future work should continue to explore the nature and direction of the relationship between physical activity and physical literacy to identify appropriate focused approaches for health promotion.

Abstract Background Community engagement in research has the potential to support the development of meaningful health promotion interventions to address health inequities. People living in rural and remote areas face increased barriers to participation in health research and may be unjustly excluded from participation. It is necessary to understand the process of patient and public engagement from the perspective of community members to support partnered research in underserved areas. The aim of this project was to increase understanding on how to include community members from rural and remote areas as partners on research teams. Methods Using purposive sampling, we completed semi-structured interviews with a representative sample of 12 community members in rural and remote areas of northern British Columbia, Canada. Interviews were audio recorded and transcribed verbatim. Following an integrated knowledge translation approach, an inductive thematic analysis was completed to incorporate researcher and knowledge user perspectives. Results The factors important to community members for becoming involved in research include: 1) relevance; 2) communication; and 3) empowering participation. The analysis suggests projects must be relevant to both communities and individuals. Most participants stated that they would not be interested in becoming partners on research projects that did not have a direct benefit or value for their communities. Participants expressed the need for clear expectations and clarification of preferred communication mechanisms. Communication must be regular, appropriate in length and content, and written in a language that is accessible. It is essential to ensure that community members are recognized as subject matter experts, to provide appropriate training on the research process, and to use research outcomes to support decision making. Conclusions To engage research partners in rural and remote communities, research questions and outcomes should be co-produced with community members. In-person relationships can help establish trust and bidirectional communication mechanisms are prudent throughout the research process, including the appropriate sharing of research findings. Although this project did not include community members as research team members or in the co-production of this research article, we present guidelines for research teams interested in adding a patient or public perspective to their integrated knowledge translation teams.

The VElocity foR Direct particle Identification spectrometer (VERDI) is a 2E-2v fission spectrometer that allows the measurement of the total mass distribution of secondary fission fragments with a resolving power of 1-2 u. It consists of two time-of-flight (ToF) arms, with one Micro Channel Plate (MCP) detector and up to 32 Silicon PIPS (Passive Implanted Planar Silicon) detectors per arm. The MCPs provide the start timing signals and the PIPS detectors provide both the energy and the stopping ToF signals. In real conditions, the PIPS signals are affected by the formation of plasma from the interaction between the heavy ions and the detector material. The plasma contributes to a reduction in signal amplitude, resulting in a Pulse Height Defect (PHD), and introduces a signal delay, known as Plasma Delay Time (PDT). An experiment to characterize the PDT and PHD was performed at the LOHENGRIN recoil separator of the Institut Laue Langevin (ILL). Characteristic fission fragments from the 239Pu(n,f) reaction were separated based on their A/Q and E/Q ratios, allowing the measurement of a wide range of energies from 21 to 110 MeV and masses between 80 and 149 u. Six PIPS detectors were characterized to study their individual responses to the PDT and PHD effects. The signals were recorded in a digital acquisition system to completely exploit the offline analysis capabilities. Achieved combined timing and energy resolutions for fission fragments varied between 72(2) ps and 100(4) ps and 1.4% - 2% (FWHM), respectively. Preliminary PHD and PDT data are presented from the masses A=85, 95, 130 and 143. The PHD trends are strongly correlated with both the ion energy and mass. The PDT, on the other hand, shows a strong variation as a function of the ion kinetic energy but a smaller dependence on the ion mass.

Abstract Background Although it is generally accepted that engaging with members of the public contributes to more actionable and relevant research, there are a limited number of reported evaluations of community engagement initiatives. Certain populations, such as those with lower socioeconomic status and those who live in rural or dispersed communities, tend to face increased barriers to engagement. For researchers and community members alike, it is important to understand and evaluate engagement initiatives to support participatory research methods, particularly when working with underserved or hard to reach populations. Methods Over 2-days in October 2018, we hosted a Research Agenda Development Workshop and Physical Activity Summit with relevant researchers, health professionals, and community partners. The objectives of this initiative were to develop a physical activity research agenda based on community-identified priorities, create networking opportunities, and understand factors impacting physical activity participation in communities across northern British Columbia (BC). An evaluation plan was created early in the planning process to understand the reach of the event based on representation targets. Stakeholder satisfaction with the event was evaluated with a post-meeting survey. Results The event was successful in engaging community members from a broad geographic region with at least 90 people in attendance from 11 different northern BC communities, representing 46 different organizations. Meeting attendees indicated they were satisfied with the event and felt their perspectives were heard. To advance physical activity in the region, the most commonly desired outcome from the event was the need for ongoing communication channels to support knowledge translation and capacity building in the low-resourced communities of northern BC. There were some gaps in representation targets present at the event. Namely, there were a limited number of people representing Indigenous organizations, and the education and private sectors. Conclusions This two-day event was successful at achieving its objectives and engaged a diverse group of stakeholders from a broad geographic region. The outcomes from this event are being used to develop a community-partnered physical activity research agenda and contribute to ongoing learning by the research team to understand contextual factors influencing physical activity in the communities of northern BC. This model of engagement could be used by other researchers interested in engaging with a diverse, multi-sector group of academics, health professionals and community members to support community-centered population health research.

The clinical impact of tumor-infiltrating lymphocytes (TILs) is less known for breast cancer patients with the estrogen receptor-positive (ER+)/human epidermal growth factor receptor-negative (HER−) subtype. Here, we explored the prognostic and predictive value of TILs regarding distant recurrence-free interval (DRFI) and breast cancer-specific survival (BCSS) in 763 postmenopausal patients randomized to receive tamoxifen vs. no systemic treatment. TILs were assessed in whole section tumor samples stained with H&E and divided into low (

Compared with urban centers, rural, remote, and northern communities face substantial health inequities and increased rates of noncommunicable disease fuelled, in part, by decreased participation in physical activity. Understanding how the unique sociocultural and environmental factors in rural, remote, and northern communities contribute to implementation of physical activity interventions can help guide health promotion policy and practice. A scoping review was conducted to map literature describing the implementation of physical activity interventions in rural, remote, and/or northern communities. Databases MEDLINE, PsycINFO, EMBASE, CINAHL, and SPORTDiscus were searched using a predetermined search strategy. Outcomes of interest included community demographics, program characteristics, intervention results, measures of implementation, and facilitators or barriers to implementation. A total of 1672 articles were identified from a search of databases, and 8 from a targeted hand search. After screening based on inclusion and exclusion criteria, 12 articles were summarized in a narrative review. Prominent barriers to physical activity program implementation included transportation, lack of infrastructure, sociocultural factors, and weather. Facilitators of program success included flexibility and creativity on the part of the implementation team, leveraging community relationships, and shared resources. Few papers reported on traditional implementation outcomes such as fidelity, dose, and quality. There is a lack of rigorous implementation evaluations of physical activity interventions delivered in rural, remote, or northern communities. Positive aspects of rural life, such as social cohesion and willingness to share resources, appear to contribute to successful program implementation.

Abstract Background Work-related stress has become a major challenge for social security and health care systems, employers and employees across Europe. In Sweden, sickness absence particularly due to stress-related disorders has increased excessively in recent years, and the issue of how to improve sustainable return to work in affected employees is high up on the political agenda. The literature on interventions for return to work in patients with common mental disorders is still inconclusive. This randomized controlled trial (RCT) aims to contribute with knowledge about how physicians and rehabilitation coordinators in primary health care can involve the employer in the rehabilitation of patients with stress-related disorders. The objective is to evaluate whether the early involvement of the patient’s employer can reduce the time for return to work compared to treatment as usual. A process study will complete the RCT with information about what prerequisites primary health caregivers need to succeed with this endeavor. Methods Twenty-two primary care centers were randomized to either intervention or control group. At the intervention centers, physicians and rehabilitation coordinators underwent training, providing them with both knowledge and practical tools to involve the employer in rehabilitation. At the patient level, employed patients with an ICD-10 F43 diagnosis were eligible for participation (n=132). Difference in proportion of patients on full- or part-time sick leave at three, six and 12 months after inclusion will be investigated. Register data, logbooks and interviews with coordinators and physicians at both intervention and control centers will be used for process evaluation. Discussion Although the issue of how to tackle work-related stress can be recognized all across Europe, Sweden face an urgent need to curb the disproportional increase of stress-related disorders in the sick-leave statistics. Since physicians are limited by time constraints, the rehabilitation coordinator may be a helpful resource to take this contact. The current study will contribute to knowledge about how this collaboration can be organized to facilitate employer involvement and reduce time to return to work among patients suffering from work related stress. Trial registration Registered on 1 November 2016, ClinicalTrials.gov, NCT03022760.