The Alzheimer’s Dementia Patients’ Observed Illness Course and Experience in Ghana and Care Lessons to Be Learnt: A Mental Health Professional’s Perspective

Alzheimer’s disease (AD) and associated dementia patient numbers continue to increase globally with associated economic costs to healthcare systems. Of note is the increase in numbers in lower and middle-income countries (LMICs) including Sub-Saharan African (SSA) countries, which already face challenges with their health budgets from communicable and non-communicable diseases. Ghana, an SSA country, faces the problem of healthcare budgetary difficulties and the additional impact of AD as a consequence of increasing population strata of old aged persons (OAPs) due to the demographic transition effect. This article uses examples of known patients’ illness courses to give a perspective on the lived experience of patients with dementia (PWD) in Ghana, living amongst a populace with a culture of stigmatization of PWD, and a relatively fragile public mental health system (PMHS) for those with mental illness, including AD. The lived experience of AD patients is characterised by stigmatisation, discrimination, non-inclusiveness, diminished dignity and human rights abuses in the face of their mental disability, and eventually death. This article is an advocacy article giving voice to the voiceless and all persons suffering from AD and other dementias in Ghana, whilst pleading for a call to action from healthcare professionals and responsible state agencies.

Expectations and Level of Satisfaction of the Patient with Parkinson’s Disease Undergoing Deep Brain Stimulation Surgery at the National Institute of Neurology and Neurosurgery

Background: Deep brain stimulation (DBS) is an established treatment for patients with advanced Parkinson’s disease (PD). Reports show continued patient satisfaction after surgery despite not maintaining clinical improvement as measured by evolution scales. Objectives: The present study sought to explore expectations and level of satisfaction in patients after DBS surgery with a semi-structured questionnaire and subsequent correlation with functional scales, Quality of Life (QoL), and motor and non-motor symptoms. Methods: We performed descriptive statistics to represent demographic data, Wilcoxon rank tests to determine significant differences, and Spearman correlation between the applied scales. Results: We evaluated 20 patients with a history of DBS surgery. 45% were female, with a mean age of 55.7 ± 14.15 years, a mean disease duration of 13.42 ± 8.3 years, and a mean time after surgery of 3.18 ± 1.86 years. Patients reported surgery meeting expectations in 85.5% and continued satisfaction in 92%. These two variables showed a significant correlation. Conclusions: This sample of patients remained satisfied after DBS surgery, although we found no differences in motor and non-motor clinimetric scales. Further studies are needed to confirm the importance of assessing quality of life in patients with DBS.

Rate of Patient Delay among Students with Pulmonary Tuberculosis in China: A Meta-Analysis

Objective: To systematically review the rate of patient delay of pulmonary tuberculosis (PTB) patients among students in China. Methods: Databases including Web of Science Core Collection, PubMed, The Cochrane Library, CBM, CNKI, VIP, and WANFANG DATA were electronically searched to collect cross-sectional studies on the incidence of delayed consultation in students with PTB in China from January 1, 2000, to November 15, 2022. Two researchers independently screened studies, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by Stata 16.0 software. Results: In total, 60 cross-sectional studies with 260,707 cases involving 136,701 delayed consultation PTB patients were included. The results of meta-analysis showed that the rate of patient delay was 46.4% (95% CI 44.3% to 48.4%) among students with PTB in China. Results of subgroup analyses showed that: 1) The rates were 46.8% and 50.4% for male and female students, respectively. 2) The rates for the East, Central and West parts of China were 42.3%, 45.6% and 50.5%, respectively. 3) The rates were increased first and then decreased during 2007 to 2020. 4) The rates of students from primary school, junior high school, senior high school and university were 50.3%, 49.8%, 40.7% and 44.9%, respectively. 5) The rates for the Han and the other nationalities were 50.3% and 53.9%, respectively. 6) The rates for local and non-local students were 47.2% and 50.5%, respectively. 7) The rates of patients detected by consultation due to symptoms, recommendation due to symptoms, referral, tracking and healthy physical examination were 50.5%, 51.6%, 46.6%, 55.6% and 16.2%, respectively. 8) The rates of patients with initial PTB and retreatment PTB were 53.1% and 59.6%, respectively. 9) The rates of patients with positive etiology, negative etiology and without etiological results were 55.9%, 47.0% and 51.6%, respectively. 10) The rates of severe and non-severe patients were 59.4% and 52.9%, respectively. Conclusion: The patient delay rate for Chinese students with PTB is generally at a high level. There are substantial differences in the patient delay rate for students with PTB among different genders, regions, study stages, nationalities, household registration types, detection methods, and treatment classifications.

Clinical significance of diabetes on symptom and patient delay among patients with acute myocardial infarction——an analysis from China Acute Myocardial Infarction(CAMI) registry

Background Diabetes is frequently associated with poor prognosis among acute myocardial infarction(AMI)patients.Patients with these comorbidities often have atypical symptoms and subsequent delay in treatment.Few studies have reported detailed AMI symptoms in patients with diabetes.This study compared AMI symptoms and presentation characteristics between diabetics and non-diabetics.Methods We included patients from the China AMI registry diagnosed with AMI between January 2013 and September 2014.Baseline characteristics,symptomology,and delay in treatment were compared between diabetics and non-diabetics.Multivariable logistic regression analysis was used to explore independent predictors of atypical symptoms.Results A total of 4450(20.2%)patients had diabetes.They were older,more often women,higher in body mass index,and more likely to have non-ST segment elevation myocardial infarction.Fewer diabetic patients presented with persistent precordial chest pain(63.1%vs.68%,P<0.0001),diaphoresis(60.1%vs.65.6%,P<0.0001),fatigue(16.7%vs.18.3%,P=0.0123),and incontinence(0.4%vs.0.7%,P=0.0093).Time to hospital presentation was longer among patients with diabetes than those without.In multivariable analysis,diabetes was identified as an independent predictor of atypical symptoms(OR:1.112,95%CI:1.034?1.196).Conclusions Our study is the first large-scale study providing evidence that diabetics are less likely to present with typical chest pain and more likely to experience treatment delay when suffering from an AMI.Our results may increase clinician awareness of recognizing AMI patients rapidly to reduce diagnosis and treatment delay,particularly in the context of diabetes.

Effect of Nalmefene on Delayed Neurocognitive Recovery in Elderly Patients Undergoing Video-assisted Thoracic Surgery with One Lung Ventilation

The intravenous use of nalmefene has been found to exert neuroprotective effect in patients with severe traumatic brain injury and acute cerebral infarction;nonetheless,it is unknown whether nalmefene alleviates delayed neurocognitive recovery.Our purpose of the current research was to clarify the impact of nalmefene on delayed neurocognitive recovery in aged patients experiencing video-assisted thoracic surgery(VATS)with intraoperative use of one lung ventilation(OLV).The present study involved 120 paticents undergoing selective VATS,randomized to accept low-dose nalmefene(N1 group,n=40),high-dose nalmefene(N2 group,1n=40)or equal volume of physiologic saline(control group,1=40).A battery of neuropsychological tests were used to estimate cognitive function I day before surgery(o)and 10 days after surgery or before discharge(t).Regional cerebral oxygen saturation(rSO2)was detected 5 min before induction(t),5 min after induction(1),15 and 60 min after onset of OLV(62 and 13),and 15 min after termination of OLV(4).The plasma values of interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-a1 and adiponectin(ADP)were also detected prior to induction of anesthesia(T0),1 h,2 h and 6 h after surgery(TI,T2,T3).On 1,delayed neurocognitive recovery occurred in 5/40(12.5%)patients of NI group,in 5/40(12.5%)patients of N2 group and in 13/40(32.5%)patients of control group(P<0.05).There were no statistical differences in rSO2 among three groups at different time points.At Tl,T2 and T3,IL-1β,IL-6 and TNF-a values significantly increased and ADP value significantly decreased(P<0.05)in control group.In contrast,at TI,T2 and T3,IL-1β,IL-6 and TNF-a values decreased and ADP value decreased less in N1 and N2 groups(P<0.05).At TI,T2 and T3,IL-1β,IL-6 and TNF-a concentrations presented a trend of N2 group<N1 group<control group and ADP presented a trend of N2 group>Nl group>control group(P<0.05).The result of our present research supports the hypothesis that the perioperative intravenous treatment with nalmefene to VATS with OLV ameliorates postoperative cognitive function and decreases the incidence of delayed neurocognitive recovery,most likely by suppression of inflammatory responses.

Intensive care environment: Perspective of relatives of critically ill patient sustained by health technology

The intensive care unit(ICU)is a complex setting by nature,and some have described it as bizarre due to its numerous sirens that sound when anything is dangerous,constant activity,equipment,bright lights,and high fatality rate.The demands placed on nurses to care for critically ill patients in this environment frequently prevent nurses and other health‑care professionals from acknowledging the feelings of patient’s relatives or family caregivers,resulting in a hostile environment from the patient’s relative’s perspective.When a patient’s family enters the ICU,they feel that hospital administrators do little to nothing to alleviate their discomfort and fear.Despite research demonstrating the importance of providing a homely environment for patients’families,In Nigeria ICU is still far behind how a conventional ICU environment should be structured to accommodate patient’s relations in the unit.The goal of this study was to look at the patient’s relative’s perspective on providing care for a critically ill patient in an ICU,with a focus on the unit’s complexity and overall experience.Based on the findings of this study,we recommend that hospital administrators ensure that the environment of the upcoming ICU is designed to meet the needs of patient’s relatives by addressing identified environmental concerns,like caring neglect,by providing a friendly and stress‑free environment.

Crohn’s disease in human immunodeficiency virus-infected patient:A case report

BACKGROUND Inflammatory bowel disease(IBD)is an autoimmune condition treated with immunosuppressive drugs.However,the need for immune system suppression becomes questionable when infection with the human immunodeficiency virus(HIV)occurs simultaneously and impacts the course of IBD.Our reported case represents the clinical course,prescribed treatment and its effect,as well as clinical challenges faced by physicians in a combination of such diseases.We also present a comprehensive literature review of similar cases.CASE SUMMARY A 49-year-old woman suffering from a newly diagnosed Crohn’s disease was hospitalized due to exacerbated symptoms(abdominal pain,fever,and weight loss).During her hospital stay,she tested positive for HIV.With conservative treatment,the patient improved and was discharged.In the outpatient clinic,her HIV infection was confirmed as stage C3,and antiretroviral treatment was initiated immediately.That notwithstanding,soon the patient was rehospitalized with pulmonary embolism and developed a series of complications because of the subsequent coexistence of IBD and HIV.After intensive and meticulous treatment,the patient’s condition has improved and she remains in remission.CONCLUSION The paucity of studies and data on the coexistence of HIV and IBD leaves clinicians doubting the optimal treatment options.

Chinese expert consensus on prevention and treatment of delayed nausea and vomiting(2022 Edition)

Nausea and vomiting are common adverse reactions of antitumor therapy,among which chemotherapy-induced nausea and vomiting(CINV)has been studied most intensively.Because of insufficient prevention or insufficient attention,CINV brings a series of harms to can-cer patients and even lead to the delay or termination of antitumor therapy.Delayed CINV is often underestimated because it mostly occurs outside the hospital,and patients cannot report it immediately.In recent years,the proportion of outpatient chemotherapy and day-time chemotherapy patients in China has increased year by year.Therefore,the prevention of delayed CINV is particularly important.Currently,the challenges faced by delayed CINV include the need to deeply explore its physiological and pathological mechanisms,improve its risk assessment standards,and optimize its prevention programs.However,there is still lack of practice guidelines or consensus on delayed CINV.Therefore,the Committee of Neoplastic Supportive-Care of China Anti-Cancer Association organized multidisciplinary experts in this field to formulate this consensus based on the analysis and discussion of current evidence-based medical research in combination with clinical problems that need to be solved urgently.

Patient Safety in Delayed Diagnosis of Acute Appendicitis

Introduction: Acute appendicitis is the major surgical abdominal disease in emergency departments and is also among the five leading causes of litigation against emergency physicians. Delayed diagnosis of appendicitis is more likely to occur in patients, who present atypically, and those lack a thorough physical examination, or those received intramuscular narcotic analgesia. The aim of this study was to study the effect of delay in diagnosis of acute appendicitis as regard postoperative findings, length of hospital stay and post-operative complications. Patients & Methods: Patients with complicated appendicitis were subjected to the present study and treated by a single surgical team. The parameters of our study were incidence of perforation or gangrene at surgery, length of stay and post-operative complications. Results: The present study showed that delay in diagnosis of acute appendicitis is associated with a more advanced stage of disease and a higher morbidity. Conclusion: careful attention to the patient’s history;a thorough physical examination and early clinical review help to minimize the possibility of delayed diagnosis of appendicitis. Appendicitis with a delay in treatment usually leads to high perforation rates, and unfavorable outcome.

Clinical Utilization of Nursing Process in Improving Patient’s Outcome and Its Associated Factors: A Cross-Sectional Study among Nurses and Midwives Working at Njombe Regional Referral Hospital, Tanzania

Background: Improvement of patient care in any hospital depends primarily on the quality of nursing care. Nursing care is enhanced by the nursing process, which outlines the nursing activities to be provided for a patient. Methods and Materials: A cross sectional design employing quantitative methods was conducted in Njombe RRH in December 2021. Quantitative data were collected from nurses and midwives from all wards by simple random sampling techniques using a sample-size calculator. SPSS version 26.0 was used to analyse data whereby a p-value of 0.05 was considered a decision mark for the significance of the result;Chi-square and Logistic regression respectively were used to find out the association and its strength between variables. Result: Majority of the respondents, 41 (85.4%), had inadequate knowledge and 33 (68.8%) found them people with a negative attitude to the nursing process. Significantly, there is an association between knowledge and clinical utilization (AOR 2.24;95% CI: 1.6 - 2.5;P 0.04), attitude and clinical utilization (AOR 4.32;95% CI: 1.8 - 3.7;P Conclusion: A knowledge gap in relation to the utilization of the nursing process and a negative attitude were noted to be associated significantly with the utilization of the nursing process among nurses and midwives. It is recommended on-job training, supportive supervision, and Value Clarification and Attitude Transformation (VCAT) are the best interventions to address the knowledge gap and negative attitudes respectively.

Effects of Physical Exercise and Music Therapy on Cognitive Aspects in Tunisian Patients with Mild Alzheimer’s Type Dementia

Aim: The objective of this research is to highlight the effectiveness of physical exercise and music therapy in older patients with Alzheimer’s disease (AD). Methods: Patients with a mild level of AD were included in this study, divided into the therapy group (TG;N = 30, aged 68 ± 3.2 years) and the control group (CG;N=30, aged 65 ± 2.6 years). The therapy group was enrolled in an exercise-training program (walking, resistance and balance exercises) combined with musical therapy for 10 weeks (three sessions of 60 minutes per week). The Control group was instructed to follow their daily rhythm of life (e.g., rest, reading) under the same conditions. The intervention program was enrolled under the supervision of;one psychologist;a neurologist;two music therapists, and two physiotherapists, all belonging to the same hospital unit. After 10 weeks of participation in the combined program, cognitive parameters were improved in the therapy group measured with the Behavior Pathology in Alzheimer Disease (BEHAVE-AD), (p < 0.05) for activity disturbance, diurnal rhythm disturbances, anxieties and phobias, affective disturbance. The percentage range of improvements is 1.07% to 2.96%. Results: Our results demonstrate that physical exercise combined with music therapy improves cognitive function in patients with Alzheimer’s disease. Conclusions: Physical exercise and music therapy are beneficial combined treatments for improving life quality in older patients. This approach may be useful to help patients with a mild level of Alzheimer’s disease improve their behavioral and psychological parameters.

Exploring the Impact of Factors Affecting the Lifespan of HIVs/AIDS Patient’s Survival: An Investigation Using Advanced Statistical Techniques

This study investigates the impact of various factors on the lifespan and diagnostic time of HIV/AIDS patients using advanced statistical techniques. The Power Chris-Jerry (PCJ) distribution is applied to model CD4 counts of patients, and the goodness-of-fit test confirms a strong fit with a p-value of 0.6196. The PCJ distribution is found to be the best fit based on information criteria (AIC and BIC) with the smallest negative log-likelihood, AIC, and BIC values. The study uses datasets from St. Luke hospital Uyo, Nigeria, containing HIV/AIDS diagnosis date, age, CD4 count, gender, and opportunistic infection dates. Multiple linear regression is employed to analyze the relationship between these variables and HIV/AIDS diagnostic time. The results indicate that age, CD4 count, and opportunistic infection significantly impact the diagnostic time, while gender shows a nonsignificant relationship. The F-test confirms the model's overall significance, indicating the factors are good predictors of HIV/AIDS diagnostic time. The R-squared value of approximately 72% suggests that administering antiretroviral therapy (ART) can improve diagnostic time by suppressing the virus and protecting the immune system. Cox proportional hazard modeling is used to examine the effects of predictor variables on patient survival time. Age and CD4 count are not significant factors in the hazard of HIV/AIDS diagnostic time, while opportunistic infection is a significant predictor with a decreasing effect on the hazard rate. Gender shows a strong but nonsignificant relationship with decreased risk of death. To address the violation of the assumption of proportional hazard, the study employs an assumption-free alternative, Aalen’s model. In the Aalen model, all predictor variables except age and gender are statistically significant in relation to HIV/AIDS diagnostic time. The findings provide valuable insights into the factors influencing diagnostic time and survival of HIV/AIDS patients, which can inform interventions aimed at reducing transmission and improving early diagnosis and treatment. The Power Chris-Jerry distribution proves to be a suitable fit for modeling CD4 counts, while multiple linear regression and survival analysis techniques provide insights into the relationships between predictor variables and diagnostic time. These results contribute to the understanding of HIV/AIDS patient outcomes and can guide public health interventions to enhance early detection, treatment, and care.

Exploring the Impact of Factors Affecting the Lifespan of HIVs/AIDS Patient’s Survival: An Investigation Using Advanced Statistical Techniques

This study investigates the impact of various factors on the lifespan and diagnostic time of HIV/AIDS patients using advanced statistical techniques. The Power Chris-Jerry (PCJ) distribution is applied to model CD4 counts of patients, and the goodness-of-fit test confirms a strong fit with a p-value of 0.6196. The PCJ distribution is found to be the best fit based on information criteria (AIC and BIC) with the smallest negative log-likelihood, AIC, and BIC values. The study uses datasets from St. Luke hospital Uyo, Nigeria, containing HIV/AIDS diagnosis date, age, CD4 count, gender, and opportunistic infection dates. Multiple linear regression is employed to analyze the relationship between these variables and HIV/AIDS diagnostic time. The results indicate that age, CD4 count, and opportunistic infection significantly impact the diagnostic time, while gender shows a nonsignificant relationship. The F-test confirms the model's overall significance, indicating the factors are good predictors of HIV/AIDS diagnostic time. The R-squared value of approximately 72% suggests that administering antiretroviral therapy (ART) can improve diagnostic time by suppressing the virus and protecting the immune system. Cox proportional hazard modeling is used to examine the effects of predictor variables on patient survival time. Age and CD4 count are not significant factors in the hazard of HIV/AIDS diagnostic time, while opportunistic infection is a significant predictor with a decreasing effect on the hazard rate. Gender shows a strong but nonsignificant relationship with decreased risk of death. To address the violation of the assumption of proportional hazard, the study employs an assumption-free alternative, Aalen’s model. In the Aalen model, all predictor variables except age and gender are statistically significant in relation to HIV/AIDS diagnostic time. The findings provide valuable insights into the factors influencing diagnostic time and survival of HIV/AIDS patients, which can inform interventions aimed at reducing transmission and improving early diagnosis and treatment. The Power Chris-Jerry distribution proves to be a suitable fit for modeling CD4 counts, while multiple linear regression and survival analysis techniques provide insights into the relationships between predictor variables and diagnostic time. These results contribute to the understanding of HIV/AIDS patient outcomes and can guide public health interventions to enhance early detection, treatment, and care.

Delayed degeneration of an injured spinothalamic tract in a patient with diffuse axonal injury

Diffuse axonal injury （DAI） is one of the devastating mechanisms of traumatic brain injury （TBI） and shows extensive sub- cortical lesions due to shearing forces induced by rapid acceleration-deceleration and rotation of the brain （Adams et al., 1982; Meythaler et al., 2001）. As a result, conventional brain imaging techniques including brain MRI have been limited in demon- strating neuronal degeneration in patients with DAI. However, diffusion tensor tractography （DTT）, which is derived from diffusion tensor imaging （DTI） has enabled three-dimensional reconstruction of the neural tracts （Jang and Seo, 2014）. Since the introduction of DTI, several studies have demonstrated neuronal degeneration after TBI （Tomaiuolo et al., 2005; Hong and lang, 2010; Kwon and Jang, 2014）. However, little is known about delayed neuronal degeneration in patients with TBI.

The Impact of Delays during the Pandemic Months on Survival of Lung Cancer Patients in Canada in 2020

Background and Purpose: Most cancer deaths in the world are due to lung cancer and diagnosis and treatment delays sharply reduce survival in lung cancer patients. This study examined the impact of delays during the early months of the pandemic on the survival of newly identified lung cancer patients in Canada in 2020. Method: This was a secondary data analysis from published literature and openly available data sources. Cancer Statistics from existing literature were used as a proxy for the month-wise distribution of lung cancer cases in Canada. The incidence of lung cancer, using population statistics from Statistics Canada and incidence rates from the Canadian Cancer Statistics in 2020, was estimated. The population-based Excel model employed compounded cuts on the incidence to arrive at the outcomes. Plotdigitzer.com tool was used to digitize the survival versus time curves for each stage from secondary sources. Stage-wise incidences for each sex were calculated for each age group for each month of 2020. Using delay impact on each stage the final results were calculated. Results: A total of 5004 life years would have been lost due to 448 deaths in the long term (40 months) attributed to the delays caused during March, April, May and June in Canada. The estimated incidence for all stages of lung cancer for these months was 9801 although the observed incidence was expected to be 6571 due to reduced screenings. Hence, it was within the missing 3231 cases that delays would occur. Over the short term (10 months) there are expected to be 151 early deaths and 273 deaths in the intermediate-term (20 months). Conclusions: This study using a mathematical model showed that in 2020, the COVID epidemic resulted in higher mortality and fewer lung cancer diagnoses in Canada. As a result of the delays in assessment, screening, and treatment that accompanied the pandemic lockdowns, there has been a rise in total life years lost due to lung cancer, demonstrating the pandemic’s huge impact on lung cancer patients.

Digital Disparities:How Artificial Intelligence Can Facilitate Anti-Black Racism in the U.S.Healthcare Sector

This paper delves into the intricate interplay between artificial intelligence(AI)systems and the perpetuation of Anti-Black racism within the United States medical industry.Despite the promising potential of AI to enhance healthcare outcomes and reduce disparities,there is a growing concern that these technologies may inadvertently/advertently exacerbate existing racial inequalities.Focusing specifically on the experiences of Black patients,this research investigates how the following AI components:medical algorithms,machine learning,and natural learning processes are contributing to the unequal distribution of medical resources,diagnosis,and health care treatment of those classified as Black.Furthermore,this review employs a multidisciplinary approach,combining insights from computer science,medical ethics,and social justice theory to analyze the mechanisms through which AI systems may encode and reinforce racial biases.By dissecting the three primary components of AI,this paper aims to present a clear understanding of how these technologies work,how they intersect,and how they may inherently perpetuate harmful stereotypes resulting in negligent outcomes for Black patients.Furthermore,this paper explores the ethical implications of deploying AI in healthcare settings and calls for increased transparency,accountability,and diversity in the development and implementation of these technologies.Finally,it is important that I prefer the following paper with a clear and concise definition of what I refer to as Anti-Black racism throughout the text.Therefore,I assert the following:Anti-Black racism refers to prejudice,discrimination,or antagonism directed against individuals or communities of African descent based on their race.It involves the belief in the inherent superiority of one race over another and the systemic and institutional practices that perpetuate inequality and disadvantage for Black people.Furthermore,I proclaim that this form of racism can be manifested in various ways,such as unequal access to opportunities,resources,education,employment,and fair treatment within social,economic,and political systems.It is also pertinent to acknowledge that Anti-Black racism is deeply rooted in historical and societal structures throughout the U.S.borders and beyond,leading to systemic disadvantages and disparities that impact the well-being and life chances of Black individuals and communities.Addressing Anti-Black racism involves recognizing and challenging both individual attitudes and systemic structures that contribute to discrimination and inequality.Efforts to combat Anti-Black racism include promoting awareness,education,advocacy for policy changes,and fostering a culture of inclusivity and equality.

Patient Delay in Patients With ST-elevation Acute Myocardial Infarction

Objectives To examine patient delay (PD) in seeking treatment among patients with ST-elevation myocardial infarction (STEMI) and to identify factors influencing PD. Methods patients with STEMI were divided into two groups based on PD: Short PD group (PD ≤ 60 minutes after onset of symptoms) and long PD group ( > 60 minutes after symptom onset). A questionnaire developed to assess demographic characteristics, clinical factors and psychological factors. Patients were interviewed within 72 hours of admission to 2 hospitals. Results 329 consecutive confirmed STEMI patients (Mean age 61years; 72.5% men) with a median PD of 90 min and a pre-hospital delay time 170 min were studied, PD was less than 1 hours in 47.4% of patients, while more than 1 hours in 52.6%, In univariate analyses, patients with short PD were witness onset, progress course of symptom, severe pain, death anxiety, knowing AMI as a deadly disease and its presentation, taking the symptom seriously. Patients with longer PD were age ≥65 year, nocturnal onset, experienced their symptoms at home, gradual onset, ’waited to see whether symptoms disappeared’, ’worried about troubling others’, ’took pain medication’ and preinfarction angina. A stepwise multiple regression analysis further suggested that the following inde-pendent contributors to a late decision to seek medical help (relative risk, 95% confidence interval): taking pain medication (15.97; 1.70～149.8 ), wanting to wait and see (6.46; 1.92～21.74), not wanting to bother anybody (6.42; 2.87～14.34), preinfarct angina (2.73; 1.20～6.19), age ≥65 years (2.51; 1.15～5.48), gradual onset (2.40; 1.05～5.44), severe pain(0.38, 0.17～0.85), witness onset (0.27, 0.10～0.70), taking symptoms seriously (0.019; 0.08～0.46). Conclusions Age ≥65 years, gradual onset, witness onset, severe pain, preinfarct angina, emotional responses and coping strategies are the independent factors associated with patient delay or decision time in patients with AMI. Emotional responses and coping strategies are the major determinants of patient delay. Modification of these emotional factors might best be achieved by patients and public education.

Pregnancy and inflammatory bowel disease: Do we provide enough patient education? A British study of 1324 women

AIM To examine patient knowledge and factors influencing knowledge about pregnancy in British women with inflammatory bowel disease(IBD).METHODS This is a post hoc analysis of a study of female members of Crohn's and Colitis United Kingdom, aged 18-45 years who were sent an online questionnaire recording patient demographics, education, employment, marital status, and disease characteristics. Disease related pregnancy knowledge was recorded using Crohn's and colitis pregnancy knowledge score(CCPKnow).RESULTS Of 1324 responders, 776(59%) suffered from Crohn's disease, 496(38%) from ulcerative colitis and 52(4%) from IBD-uncategorised. CCPKnow scores were poor(0-7) in 50.8%, adequate(8-10) in 23.6%, good(11-13) in 17.7% and very good(≥ 14) in 7.8%. Multiple linear regression analysis revealed that higher CCPKnow scores were independently associated with higher educational achievement(P < 0.001), younger age at diagnosis(P = 0.003) and having consulted a health care professional about pregnancy and IBD(P = 0.001). CONCLUSION Knowledge was poor in 50%. Speaking with healthcare professionals was a modifiable factor associated with better knowledge. This illustrates the importance of disease related pregnancy

Induced pluripotent stem cells from Huntington's disease patients:a promising approach to define and correct disease-related alterations

Adult somatic cells such as skin or blood cells from either health donors or patients can be reprogrammed into induced pluripotent stem cells(iPSCs).Given their unlimited self-renewal and differentiation capacities,iPSCs are an invaluable resource to generate terminally differentiated cells.Thus,iPSCs can facilitate the study of human diseases and drug screening,holding great promise for regenerative medicine.Another significant advantage of iPSC disease-modeling is that normal and mutant proteins are expressed at endogenous levels.In addition,subtle phenotypes and the effects of genetic background variations can be assessed by comparison between iPSC lines obtained from different patients and healthy donors as well as isogenic lines,in which disease-related mutations are corrected.

Diagnostic delay in oral squamous cell carcinoma: the role of cognitive and psychological variables

This retrospective study investigated, in two cohorts of subjects living in Southern Italy and awaiting treatment for oral squamous cell carcinoma （OSCC）, the variables related to diagnostic delay ascribable to the patient, with particular reference to the cognitive and psychological ones. A total of 156 patients with OSCC （mean age： 62 years, M/F： 2.39 ： 1） were recruited at the Universities of Palermo and Naples. Risk factors related to patient delay included： sociodemographic, health-related, cognitive and psychological variables. The analysis was conducted by considering two different delay ranges： dichotomous （≤1 month vs. 〉 1 month） and polytomous （〈1 month, 1-3 months, 〉3 months） delay. Data were investigated by univariate and multivariate analyses and a Pvalue≤0.05 was considered statistically significant. For both delay measurements, the most relevant variables were： ＇Personal experience of cancer＇ （dichotomous delay： P=0.05, odds ratio （0R）=0.33, 95% confidence interval （CI）=0. 11-0.99; polytomous delay： P=0.006, Chi-square= 10.224） and ＇Unawareness＇ （dichotomous delay： P〈0.01, 0R=4.96, 95% CI--2.16-11.37; polytomous delay： P=0.087, Chi-square=4.77）. Also ＇Denial＇ （P〈0.01, 0R=6.84, 95% CI=2.31-20.24） and ＇Knowledge of cancer＇ （P=0.079, Chi-square=8.359） were found to be statistically significant both for dichotomous and for polytomous categorization of delay, respectively. The findings of this study indicated that, in the investigated cohorts, the knowledge about cancer issues is strongly linked to the patient delay. Educational interventions on the Mediterranean population are necessary in order to increase the patient awareness and to emphasize his/her key role in early diagnosis of OSCC.