Conectar
by Simon Knobloch, Philipp Haul, Saskia Rusche, Heiko Paland, Darius Zokai, Moritz Haaf, Jonas Rauh, Christoph Mulert, Gregor Leicht
When confronted with dichotically presented syllables, right-handed healthy individuals tend to consciously perceive syllables presented to the right ear more often. This phenomenon, known as the right-ear advantage, is driven by delayed processing of information from the left ear in left temporal auditory cortex due to its indirect relay through the corpus callosum. In contrast, less is known about about the corresponding mechanisms for stimuli processed in the right temporal hemisphere. In this study, we developed a melody-based dichotic listening paradigm designed to induce a left-ear advantage. This novel paradigm, alongside a classical syllable-based paradigm was tested in 40 healthy right-handed participants. We also examined the influence of musical education on lateralization of auditory processing. Our results revealed a significant left-ear advantage for the perception of dichotically presented melodies and replicated established findings of a right-ear advantage for syllables. No group differences emerged between participants with or without current or past musical practice. However, among those with musical training, a greater number of years of practice was associated with a reduced right-ear advantage for syllables and an increased report of melodies presented to the left-ear. These findings suggest that the left-ear advantage in dichotic perception of melodies reflects right hemispheric processing of musical stimuli. Moreover, monitoring of the left ear seems to be altered by musical practice. Future research using neuroimaging techniques will be necessary to confirm this finding.
by Ibrahim Aqtam, Ahmad Ayed, Ahmad Batran, Moath Abu Ejheisheh, Riham H. Melhem, Mustafa Shouli
IntroductionWork engagement, defined as a positive, fulfilling, work-related state of mind characterized by vigor, dedication, and absorption, is crucial for nurse retention and quality of care in high-stress environments. Neonatal Intensive Care Units (NICUs) present unique emotional and psychological challenges for nurses, necessitating skills like emotional intelligence (EI) to enhance work engagement. This study investigates the association between EI, demographic factors, and work engagement among Palestinian NICU nurses.
MethodsA cross-sectional, descriptive correlational design was employed during February-April 2025. Of 230 nurses invited, 207 completed the survey (response rate = 90.2%) across 12 Palestinian NICUs using convenience sampling. Data analysis was conducted using descriptive statistics, Pearson’s correlation, and multiple linear regression via SPSS v26. Validated tools, the Schutte Self-Report Emotional Intelligence Test (SSEIT) and Utrecht Work Engagement Scale (UWES), were used.
ResultsEmotional intelligence (EI) demonstrated a strong positive correlation with work engagement (r = 0.693, p B = 0.463, β = 0.535, p = 0.002), female gender (B = −2.250, β = −0.115, p = 0.017), and rotating shifts (B = 1.579, β = 0.105, p = 0.028) were significant predictors. EI was the strongest predictor (B = 0.358, β = 0.593, p M = 47.3 ± 5.8).
DiscussionThe findings demonstrate strong associations between EI and engagement in high-stress NICU environments. Based on these findings, we propose implementing comprehensive EI training programs in nursing curricula, establishing mentorship programs to address age-related disparities, and developing gender-sensitive workplace policies to optimize work engagement and improve patient care quality.
by Myriam El Khoury-Malhame, Souheil Hallit, Maria-Jose Sanchez-Ruiz, Sleiman El Hajj, Rita Doumit
IntroductionAnxiety is one of the major global mental health concerns, particularly amidst accumulating adversities. It is the leading cause of distress in adolescents worldwide and has a profound deleterious impact on their mental and physical health and wellbeing. This paper seeks to identify and validate the psychometric properties of the Arabic version of the GAD-7 in Lebanon, aiming to improve the much-needed overall mental health screening in Middle Eastern countries.
MethodsThis study includes a cross-sectional design including 638 adolescents in Lebanese public schools. Participants aged 15−18 years were assessed using GAD-7 (anxiety), PCL-5 (post-traumatic stress disorder), and PTGi (post-traumatic growth) in their Arabic versions at two-time points, spaced three months apart.
ResultsOur analyses revealed that the 7 items of the GAD-7 converged into a single factor. Composite reliability of scores was adequate in the total sample (ω = .88/ α = .87). The convergent validity for this model was satisfactory. Results showed invariance across gender at the configural, metric, and scalar levels, with males showing a higher level of wellbeing compared to females. The pre-posttest assessment for the GAD-7 scale was conducted on 359 participants; the intraclass correlation coefficient was adequate 0.83 [95% CI.79;.86]. Our analyses also show that anxiety symptoms were significantly correlated with higher PTSD (r = 0.68; p r = −.12; p = .004).
ConclusionThe Arabic GAD-7 among Lebanese adolescents displayed highly satisfactory psychometric properties, underscoring its validity. This scale could be valuable for educators and clinicians as a screening tool to rapidly detect anxiety among this vulnerable age group as GAD-7 is easy-to-use, easy to understand, culturally sensitive for Arab population and age appropriate for 15–18-year-old students.
by Sewon Lim, Hajin Kim, Youngjin Lee, for the Alzheimer’s Disease Neuroimaging Initiative
Longitudinal studies that analyze the changes in the axial diffusivity (AxD) and radial diffusivity (RD) values over time can elucidate the progression of white matter damage and its causal relationship with cognitive decline. This study aimed to investigate the longitudinal changes in white matter integrity based on AxD and RD and their association with cognitive decline in patients with mild cognitive impairment (MCI) that progressed to Alzheimer’s disease (AD). Eighteen participants diagnosed with MCI at baseline and AD at the follow-up examination were selected from the AD Neuroimaging Initiative and included in this 2-year study Tract-based spatial statistics (TBSS) was used to assess longitudinal changes in WM. Voxel-wise and region-of-interest (ROI) analyses were conducted, and statistical models controlled for age, sex, education, and APOE ε4 status. Correlation and multiple regression analyses were performed to examine the association between AxD/RD changes and changes in clinical dementia rating (CDR) scores. Significant increases in AxD and RD were observed over 2 years in widespread WM tracts, including the corpus callosum, internal capsule, corona radiata, cingulum, superior longitudinal fasciculus, and fornix. AxD changes, particularly in the left retrolenticular internal capsule, left posterior corona radiata, left fornix, and right superior longitudinal fasciculus, showed significant correlations with cognitive decline. In contrast, RD changes were not significantly associated with CDR changes in any region. Multivariate regression analysis identified AxD in the left retrolenticular internal capsule as a significant independent predictor of CDR changes. AxD was sensitive to microstructural alterations in WM associated with cognitive decline during the transition from MCI to AD and may serve as a valuable biomarker for early detection and monitoring of AD progression. Longitudinal DTI analyses provide critical insights into the temporal dynamics of WM degeneration and its role in clinical deterioration.
by Mohammadhassan Rostami, Mina Babashahi, Masoud Karimi, Soheila Khodakarim
BackgroundEnergy drink (ED) consumption has risen sharply among children and adolescents, posing health risks such as obesity and overweight, heart problems, mood disorders, and insomnia. Recognizing these concerns, international organizations have issued guidelines discouraging adolescent ED consumption, leading to policy measures in many countries. This study leverages social marketing theory to develop targeted policy recommendations for managing ED consumption in secondary school students.
MethodsThis study utilizes a cross-sectional design with a mixed-methods approach to collect data and formulate policy recommendations. A multistage cluster sampling method was employed to randomly select students from 24 schools, serving as the primary data source. Information is gathered through a questionnaire based on the Theory of Planned Behavior (TPB). Additionally, a food environment analysis of the selected schools, a critical factor influencing ED consumption, is conducted using the NEMS-S INFORMAS tool. This tool assesses the availability, pricing, and marketing of EDs. The study further explores stakeholder perspectives through key informant interviews and a systematic literature review, providing valuable insights into existing policy frameworks. The study aims to develop actionable policy recommendations to effectively address ED consumption by synthesizing findings from all these phases.
DiscussionThe social marketing model focuses on understanding the audience and evaluating outcomes to develop effective policy proposals. It is particularly useful for behavior change policies, offering evidence-based recommendations that often surpass traditional health promotion methods. This study will analyze ED consumption and its influencing factors using the model’s constructs to present informed and practical policy recommendations.
by Rhonda M. Merwin, Patrick J. Smith, J.A. Riley, Jordan Infield, Christine O’Connell, Dorothy Mayo, Ashley A. Moskovich, Lauren Hill, Hilary Winthrop, Amy Bush, Ernaya Johnson, Francesca Scheiber, Anthony D. Sung
Introduction: Allogeneic hematopoietic stem cell transplant (HCT) has the potential to cure patients with hematologic malignancies, but treatment-related morbidity and mortality is high. Transplant outcomes are optimized by patients maintaining physical activity. The aim of the current study was to examine whether a brief Acceptance and Commitment Therapy (ACT) intervention is acceptable to HCT patients and caregivers and helps patients engage in healthy behavior despite physical and emotional discomfort. Methods: Patients ≥ 18 years of age who were undergoing allogenic HCT for any cancer or non-cancer illness and their caregivers were invited to complete six ACT sessions between transplant day − 30 and day + 90. Multiple small cohorts of n = 3 dyads were enrolled, and the protocol content was iterated after each cohort to reflect the experiences and breadth of concerns of individuals undergoing HCT. Acceptability was indexed by session completion rates and acceptability surveys. Pre-post 6-minute walk distance was collected as an index of physical function as part of standard care. Results: Sixteen HCT dyads enrolled in the study; 12 continued to treatment. Most participants completed all assigned sessions. Participants perceived ACT to be helpful and 70% (5 of 7) of the patients with pre-post 6-minute walk test data showed improvement. Conclusion: ACT is an acceptable and potentially useful intervention for individuals undergoing HCT. Additional controlled studies are warranted.
by Féline E. V. Scheijmans, Roosmarijn van der Wal, Margot L. Zomers, Johannes J. M. van Delden, W. Ludo van der Pol, Ghislaine J. M. W. van Thiel
ObjectivesSolidarity-based healthcare systems are being challenged by the incremental costs of new and expensive medicines for cancer and rare diseases. To regulate reimbursement of such drugs, the Dutch government introduced a policy instrument known as the Coverage Lock (CL) in 2015. Little is known about the public opinion regarding such policy instruments and their consequences, i.e., reimbursement of some, but not all, expensive medicines. We aimed to identify the preferences of Dutch citizens regarding the reimbursement of expensive medicines, and to investigate the views of the public on the use of the CL as a healthcare policy instrument and their input for improvement.
MethodsWeb-based survey of a representative sample of 1999 Dutch citizens aged 18 years and older (panel of research company Kantar Public). Potential respondents were approached via e-mail. Several policy measures, real-life cases and statements related to the CL were presented in the survey to respondents. Their responses were analysed by tabulating descriptive statistics (proportions and percentages).
Results1179 individuals (response rate 59%) filled in the questionnaire. Although a majority considered the CL policy unjustified, they preferred it to the alternative policy measures that were presented. In four real-life case descriptions of patients in need of expensive medicines, respondents most often indicated effectiveness, lack of availability of alternative treatment and improved quality of life due to treatment as reasons for a positive reimbursement decision. An unfavourable cost-benefit ratio was their main reason to be against reimbursement. Some argued that withholding reimbursement was a way of informing manufacturers that extremely high prices are unacceptable.
ConclusionThere is public support for patients in need of expensive medicine. Many respondents supported the CL as a reimbursement policy. However, there is a wish to optimize the interpretation of the assessment criteria and the weight these are attributed in decision making about reimbursement of expensive innovative medicine for patients.
by Shouhei Hanaoka, Yukihiro Nomura, Naoto Hayashi, Issei Sato, Soichiro Miki, Takeharu Yoshikawa, Hisaichi Shibata, Takahiro Nakao, Tomomi Takenaga, Hiroaki Koyama, Shinichi Cho, Noriko Kanemaru, Kotaro Fujimoto, Naoya Sakamoto, Tomoya Nishiyama, Hirotaka Matsuzaki, Nobutake Yamamichi, Osamu Abe
A general-purpose method of emphasizing abnormal lesions in chest radiographs, named EGGPALE (Extrapolative, Generative and General-Purpose Abnormal Lesion Emphasizer), is presented. The proposed EGGPALE method is composed of a flow-based generative model and L-infinity-distance-based extrapolation in a latent space. The flow-based model is trained using only normal chest radiographs, and an invertible mapping function from the image space to the latent space is determined. In the latent space, a given unseen image is extrapolated so that the image point moves away from the normal chest X-ray hyperplane. Finally, the moved point is mapped back to the image space and the corresponding emphasized image is created. The proposed method was evaluated by an image interpretation experiment with nine radiologists and 1,000 chest radiographs, of which positive suspected lung cancer cases and negative cases were validated by computed tomography examinations. The sensitivity of EGGPALE-processed images showed +0.0559 average improvement compared with that of the original images, with -0.0192 deterioration of average specificity. The area under the receiver operating characteristic curve of the ensemble of nine radiologists showed a statistically significant improvement. From these results, the feasibility of EGGPALE for enhancing abnormal lesions was validated. Our code is available at https://github.com/utrad-ical/Eggpale.
by Tara L. Alvarez, Mitchell Scheiman, Suril Gohel, Farzin Hajebrahimi, Melissa Noble, Ayushi Sangoi, Chang Yaramothu, Christina L. Master, Arlene Goodman
PurposeTo describe CONCUSS, a randomized clinical trial (RCT) designed to compare the following: the effectiveness of immediate office-based vergence/accommodative therapy with movement (OBVAM) to delayed OBVAM as treatments for concussion-related convergence insufficiency (CONC-CI) to understand the impact of time (watchful waiting), the effect of OBVAM dosage (12 versus 16 therapy sessions), and to investigate the underlying neuro-mechanisms of OBVAM on CONC-CI participants.
MethodsCONCUSS is an RCT indexed on https://clinicaltrials.gov/study/NCT05262361 enrolling 100 participants aged 11–25 years with medically diagnosed concussion, persistent post-concussive symptoms 4–24 weeks post-injury, and symptomatic convergence insufficiency. Participants will receive standard concussion care and will be randomized to either immediate OBVAM or delayed (by six weeks) OBVAM. At the Outcome 1 examination (week 7), clinical assessments of success as determined by changes in the near point of convergence (NPC), positive fusional vergence (PFV), and symptoms will be compared between the two treatment groups. After the Outcome 1 visit, those in the delayed group receive 16 visits of OBVAM, while those in the immediate OBVAM group receive four more therapy visits. Outcome 2 assessment will be used to compare both groups after participants receive 16 sessions of OBVAM. The primary measure is the between-group differences of the composite change in the NPC and PFV at the Outcome 1 visit. Secondary outcome measures include individual clinical measures, objective eye-tracking parameters, and functional brain imaging.
ConclusionsMajor features of the study design include formal definitions of conditions and outcomes, standardized diagnostic and treatment protocols, a delayed treatment arm, masked outcome examinations, and the incorporation of objective eye movement recording and brain imaging as outcome measures. CONCUSS will establish best practices in the clinical care of CONC-CI. The objective eye movement and brain imaging, correlated with the clinical signs and symptoms, will determine the neuro-mechanisms of OBVAM on CONC-CI.
by Julia M. Bes, Robert A. Verheij, Bart J. Knottnerus, Karin Hek
PurposeGlobal prevalence of tinnitus (15%) is rising, indicating an increase in patients seeking help for this common symptom and potentially affecting the accessibility of care. The aim of this retrospective study is twofold; describing the morbidity trends and healthcare utilization among patients with recorded tinnitus at Dutch general practices (GP), and comparing overall healthcare utilization before and after tinnitus to similar patients without recorded tinnitus.
Patients and methodsRoutine electronic health records data from general practices participating in Nivel Primary Care Database were used to describe trends in age- and sex-specific incidence, contact prevalence and healthcare utilization (contacts, prescriptions, and referrals to secondary care) for tinnitus from 2012 to 2021. Patients with tinnitus were matched (on sex, age, general practice) to patients without tinnitus (1:2). Healthcare use one year before and after a first GP contact for tinnitus (period) was analyzed with negative binominal (number of contacts) and logistic regression (prescriptions or referrals).
ResultsBetween 2012 and 2021, tinnitus incidence increased by 33% (3.3 to 4.4 per 1000 person-years). The largest increase was observed among 20-44-years (2.6 to 3.8 per 1000 person-years). One year after the first GP contact for tinnitus, patients with tinnitus utilized healthcare more frequently than patients without tinnitus. The referral rate increased the most (OR 1.99, 95%CI 1.83–2.16). The year before tinnitus at the GP, patients with tinnitus had more often GP consultations (IRR 1.16, 95%CI 1.12–1.19) and referrals (OR 1.09, 95%CI 1.01–1.18) than patients without tinnitus.
ConclusionAlthough GPs saw an increased number of patients with tinnitus, absolute numbers of patients remained low. Patients’ healthcare use increased after the first tinnitus complaint at the GP, mainly for secondary care. Yet, they already used healthcare services more frequently than similar patients without tinnitus. Insight into possible explanations for these health disparities could contribute to targeted prevention.
by Nádia Cristina Pinheiro Rodrigues, Joaquim Teixeira-Netto, Denise Leite Maia Monteiro, Mônica Kramer de Noronha Andrade
BackgroundThe COVID-19 pandemic has significantly impacted global health, with diverse factors influencing the risk of death among reported cases. This study mainly analyzes the main characteristics that have contributed to the increase or decrease in the risk of death among Severe Acute Respiratory Syndrome (SARS) cases classified as COVID-19 reported in southeast Brazil from 2020 to 2023.
MethodsThis cohort study utilized COVID-19 notification data from the Sistema de Vigilância Epidemiológica (SIVEP) information system in the southeast region of Brazil from 2020 to 2023. Data included demographics, comorbidities, vaccination status, residence area, and survival outcomes. Classical Cox, Cox mixed effects, Prentice, Williams & Peterson (PWP), and PWP fragility models were used to assess the risk of dying over time.
ResultsAcross 987,534 cases, 956,961 hospitalizations, and 330,343 deaths were recorded over the period. Mortality peaked in 2021. The elderly, males, black individuals, lower-educated, and urban residents faced elevated risks. Vaccination reduced death risk by around 20% and 13% in 2021 and 2022, respectively. Hospitalized individuals had lower death risks, while comorbidities increased risks by 20–26%.
ConclusionThe study identified demographic and comorbidity factors influencing COVID-19 mortality. Rio de Janeiro exhibited the highest risk, while São Paulo had the lowest. Vaccination significantly reduces death risk. Findings contribute to understanding regional mortality variations and guide public health policies, emphasizing the importance of targeted interventions for vulnerable groups.
by Chanel Avenant, Mandisa Singata-Madliki, Alexis J. Bick, Donita Africander, Yusentha Balakrishna, Karl-Heinz Storbeck, Johnson M. Moliki, Sigcinile Dlamini, Salndave Skosana, Jenni Smit, Mags Beksinska, Ivana Beesham, Ishen Seocharan, Joanne Batting, George J. Hofmeyr, Janet P. Hapgood
HIV acquisition risk with norethisterone (NET) enanthate (NET-EN) is reportedly less than for depo-medroxyprogesterone acetate intramuscular (DMPA-IM). We investigated the effects of these progestin-only injectable contraceptives on serum testosterone and sex hormone binding globulin (SHBG) levels, since these may play a role in sexual behavior and HIV acquisition. The open-label WHICH clinical trial, conducted at two sites in South Africa from 2018–2019, randomized HIV-negative women aged 18–40 years to 150 mg DMPA-IM 12-weekly (n = 262) or 200 mg NET-EN 8-weekly (n = 259). We measured testosterone by UHPLC-MS/MS and SHBG by immunoassay in matched pairs of serum samples collected at baseline (D0) and at peak serum progestin levels at 25 weeks post initiation (25W) (n = 214–218 pairs). Both contraceptives substantially decreased, from D0 to 25W, the total testosterone [DMPA-IM D0 0.560, 25W 0.423 nmol/L, -24.3% (p
by Nico Tannemann, Raimund Erbel, Markus M. Nöthen, Karl-Heinz Jöckel, Sonali Pechlivanis
Short telomeres are associated with cardiovascular disease (CVD). We aimed to investigate, if genetically determined telomere-length effects CVD-risk in the Heinz-Nixdorf-Recall study (HNRS) population. We selected 14 single-nucleotide polymorphisms (SNPs) associated with telomere-length (p−8) from the literature and after exclusion 9 SNPs were included in the analyses. Additionally, a genetic risk score (GRS) using these 9 SNPs was calculated. Incident CVD was defined as fatal and non-fatal myocardial infarction, stroke, and coronary death. We included 3874 HNRS participants with available genetic data and had no known history of CVD at baseline. Cox proportional-hazards regression was used to test the association between the SNPs/GRS and incident CVD-risk adjusting for common CVD risk-factors. The analyses were further stratified by CVD risk-factors. During follow-up (12.1±4.31 years), 466 participants experienced CVD-events. No association between SNPs/GRS and CVD was observed in the adjusted analyses. However, the GRS, rs10936599, rs2487999 and rs8105767 increase the CVD-risk in current smoker. Few SNPs (rs10936599, rs2487999, and rs7675998) showed an increased CVD-risk, whereas rs10936599, rs677228 and rs4387287 a decreased CVD-risk, in further strata. The results of our study suggest different effects of SNPs/GRS on CVD-risk depending on the CVD risk-factor strata, highlighting the importance of stratified analyses in CVD risk-factors.
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