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Subjective well-being in informal caregivers during the COVID-19 pandemic

  • Daniela Alves Guedes , Nadirlene Pereira Gomes and Amâncio António de Sousa Carvalho EMAIL logo
Published/Copyright: June 16, 2023
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Open Medicine
From the journal Open Medicine Volume 18 Issue 1

Abstract

The study of subjective well-being (SWB) is important as it is related to the reduction of morbidity and mortality, with the maintenance of functionality and autonomy in the elderly population. The impact of the formative intervention on the SWB of informal caregivers (ICGs) during the pandemic crisis of COVID-19 was analyzed. This study is a quasi-experimental single-group, longitudinal study with a sample of 31 ICGs and their dependents. A form was used for data collection, and data processing was performed using IBM SPSS (Statistical Package for the Social Sciences), using descriptive statistics and inferential statistics. Of the total sample, the majority were female (90.3%). The difference between the mean of positive affection and negative affection at Moment 1 (M1) was –0.0581 ± 0.71590 and 0.04645 ± 0.53326 at Moment 2 (M2). The mean rank ordering of the difference between the two types of affection differed significantly between M2 and M1 (Wilcoxon: p < 0.000), with that of M2 being higher than M1 (16.93 > 2.50). The formative intervention, within the scope of community nursing, had a significant impact on increasing the SWB of the ICG in this sample. This study may contribute to improving the SWB of ICG and their dependents.

Keywords: subjective well-being; informal caregivers; COVID-19; community health nursing

1 Introduction

The increase in average life expectancy, combined with a sharp fall in fertility rates, has led to an acceleration of population aging worldwide. These demographic changes have brought undeniable consequences for health, including an increase in the prevalence of chronic diseases, also causing an increase in the demand for health services by this population group, with an increasing trend in recent decades [1].

In Portugal, as in many other countries, the scenario is not different, with an increasingly notorious aging population. Indeed, it is the third country in Europe with the highest aging rate, according to the most recent statistics, referring to the year 2018 [2].

Older people with functional disabilities associated with chronic physical diseases, cognitive, mental or emotional, and motor diseases are recognized by the World Health Organization (WHO) as vulnerable or dependent. The same author states that the Council of Europe considers dependent as individuals who, for reasons associated with the reduction or even lack of some functional capacity, need to be helped to perform daily living activities, implying the presence of at least another person to support them. Such difficulties are classified into two categories: basic activities of daily living and instrumental activities of daily living. The first category includes self-care tasks such as dressing, eating, personal hygiene and moving around. The second includes the ability to perform activities necessary for personal and social development: participating in the community, performing practical tasks such as shopping, paying bills, keeping social appointments, using means of transportation, cooking, communicating, taking care of one’s health and maintaining one’s integrity and safety [3].

It should be noted that getting old is not synonymous with disease, disability or dependence, but it will not always be possible to reach this stage of life in perfect physical and mental health conditions. As the years pass by, there is an increasing probability of the individual acquiring a chronic and/or degenerative disease typical of the aging process itself, conditions which may incapacitate him/her and make him/her dependent, which will directly interfere with his/her autonomy, bringing damages to the domains related to his/her self-control and self-sufficiency [4].

Faced with this situation of dependence, the need for informal care emerges. According to the literature consulted, gerontology denominates informal caregivers (ICGs) as people who are part of the family nucleus, nucleus of friends, neighbors or other people from the community who, on a voluntary basis, without specific training and remuneration, exercise the role of ICG at home [5].

The task of informal care largely exceeds the simple assistance to the person who is incapacitated. According to Castro et al., ICGs are the main actors responsible for ensuring the well-being of family members who are dependent at home, besides being considered an added value for the National Health System, since they can complement, with their work, that which public health services, for whatever reasons, cannot meet in a timely manner [4].

Given the changes that have been emerging, Portugal has sought to provide an adequate response, namely through the creation of the ICG statute, approved as an annex to Law no. 100/2019, of 6 September. This statute was approved in Portugal in July 2019, being quite recent, aiming to improve the conditions and promote their well-being [6].

Performing the complex task of ICG may lead to uncomfortable and exhausting demands, which may affect their personal life. The experience of all these phenomena experienced in the exercise of the ICG activity is called burden in the literature, which may be of two types: objective burden and subjective burden [4].

Objective burden is related to the caregiving task and refers to time restriction, increased physical effort, economic expenses, changes in personal life, family relationships, and physical and mental health, and is related to the concrete events and activities that lead to changes in the caregiver’s life, being observable and quantifiable. In turn, the subjective burden is based on the caregiver’s particular understanding of the effects of the care task. This dimension of burden becomes evident when the ICG begins to manifest changes and damage in their psychological well-being, such as the feelings, attitudes and emotional relationships of the caregiver to the experience of caring and may contain indicators that assess the objective burden [5].

The ICGs who find themselves involved in care provision without prior preparation and due to lack of social support for this task are forced to give up their jobs, social and even family life. This activity is often carried out without the help and recognition of other family members, which generates a high degree of burden and abdications. This burden is associated with emotional exhaustion (emotional stress, depression) and physical exhaustion (chronic illnesses), in addition to social isolation, family conflicts, and financial difficulties [7].

Under normal circumstances, caregiving can be complex and potentially stressful. While offering some benefits, caregiving can also compromise the health and well-being of caregivers. Caregivers, both short and long term, also reported worse mental health and greater fatigue than non-caregivers. The COVID-19 pandemic has the potential to exacerbate the potential stresses of family caregiving [8].

This phenomenon of ICG burden has been greatly aggravated by the pandemic situation caused by Covid-19, which was decreed by the World Health Organization (WHO) in March 2020. In a desperate attempt to contain the spread of the virus and the spread of the disease Covid-19 causes, governments around the world have taken unprecedented measures. Entire cities, regions, and countries were isolated; travel was banned; schools and universities were closed; shops were beginning to run out of stock; and all economic, cultural, and social activities were stopped. Never before in modern history has a health problem had such an overwhelming impact on the society. Health (or rather the threat of health problems) has become the predominant concern that takes precedence over all other issues, causing health in all policies to become a reality, although not in the way it was intended [9].

According to Batello et al. [10], during the pandemic period, the preventive measure of social distancing caused a change in the routine of the person being cared for and required increased attention from the caregiver to prevent the contagion by the coronavirus, so they tend to have work overload. In addition, this whole scenario causes physical, emotional, and relational exhaustion in ICGs, which may compromise their health and the act of caring.

In turn, another study [11], based on a study including several European countries, states that large proportions of caregivers have experienced an increased burden and stress-related symptoms like trouble sleeping since the outbreak of the pandemic. Furthermore, ICGs frequently reported worsened physical and mental health, such as being depressed or anxious as well as feeling more socially isolated and lonely. Dellafiore et al. [12], in a systematic review on the consequences of the pandemic of COVID-19 on ICGs, identified two major themes: family caregivers' COVID-19-related stress and (Mal)adaptive strategies to the “new” normality.

In order to standardize the Covid-19 guidelines, the WHO has produced a guide with all the guidelines, which almost all countries worldwide have followed as a reference. This organization has prioritized the evaluation of approaches to care, using appropriate personal protective equipment (PPE), in order to prevent further contagion [13].

The Directorate-General for Health (DGH) in Portugal produced a manual with general measures for the prevention and control of COVID-19, which aimed to present the general measures to be adopted by all, being completed by several volumes with specific measures to be adopted in different contexts, based on the principles of evidence and scientific knowledge [14].

Sequeira reports that the biggest problem present in most ICGs focuses on the domain of information that lacks knowledge inevitably impacts on the recognition of early symptoms, delaying their integration into the care network and decreasing the possibilities of early intervention [5].

A study conducted in Portugal showed that the lack of training and technical ability on the part of the ICG were factors that implied insecurity to perform the care of the frail elderly [15].

The empowerment of the ICG to perform the role of caregiver to the person with dependence is a specific intervention of the health professionals involved in the care process. In this empowerment process, health professionals have an essential role. Through their empowerment process, it is possible to reduce healthcare costs and improve the quality of life of the service user and the ICG, their mental health, as well as their satisfaction with care. The contribution of caregivers will only be possible if they are given learning and training opportunities, as well as accessible and relevant support [16].

Some Portuguese authors address the construct of subjective well-being (SWB) based on the theory of Wilson (1967), one of the first authors to study this concept, stating that Wilson studied two hypotheses of well-being. In the first hypothesis, he related the concept of satisfaction and happiness, from a bottom-up perspective to immediate satisfaction of the needs that produce happiness. In the second, he related well-being to the degree of satisfaction necessary to produce happiness, originating from the top-down perspective [17].

Later, in the 1970s, the construct of well-being appeared associated with the concept of health, especially mental health, including positive dimensions such as SWB, perceived self-efficacy, autonomy, competence, self-actualization of intellectual and emotional potential, referring to SWB as a dimension of mental health [17].

Matamá et al. also argue that SWB requires self-assessment, i.e., this construct can only be observed and reported by the subject him/herself, considering SWB to be the assessment that people make of their own lives. They also add that the SWB can also be considered a positive dimension of health, which encompasses other concepts such as quality of life, positive affect, and negative affect, being seen as a broad set of phenomena that include emotional responses, domains of satisfaction, and global judgments of satisfaction with life [17].

Emotions are extremely important in people’s lives and assist in the choice of adaptive responses to face the difficulties of daily life, known as coping strategies, in addition to preserving social bonds and personal well-being. The process of choice that involves understanding, balancing, and deciding which emotions to feel and express is called emotional regulation. Acts of conscious regulation require the person to identify their desirable affective states and engage in some type of action, thought or behavior to adaptively cope with the momentary emotional experience. The ability to regulate positive emotions is of particular relevance to adaptation and mental health, as it strengthens attention, cognition, and creativity, increasing well-being, the quality of social relationships and work performance [17].

Concerning well-being and psychological well-being, several theoretical models have been proposed and developed, contributing to their definition, operationalization, and, consequently, assessment. The concept of SWB encompasses a cognitive component, formed by people’s reflective judgments about their satisfaction with life and an affective component, formed by emotional experiences, with a predominance of positive or pleasant emotions over negative or unpleasant ones [18].

Lima and Morais state that SWB is defined by individual and subjective evaluations that include the cognitive judgment of satisfaction with life and emotional reactions to life events. This construct for bottom-up theories is explained by the influence of external factors, situations, and variables; while in top-down theories, subjective variations, such as personality traits, are emphasized in the determination of well-being [19].

There are two main approaches to the concept of well-being: the hedonic and the eudaimonic perspectives. SWB is framed in the hedonic perspective, which refers to personal evaluations of the level of satisfaction with life, including personal analysis of the frequency with which positive and negative emotions are experienced in daily life. The eudaimonic perspective is based on psychological well-being, a construct that is not part of our object of study in this article [17].

The concept of SWB has received increased attention over the past few decades and basically consists of three components: positive affect, negative affect, and satisfaction with life [20].

Positive affects concern how enthusiastic, active, alert, jovial, self-confident, and caring a person is feeling. It refers to pure hedonic contentment, experienced at a given moment as a state of attentiveness and activity. On the other hand, negative affects refer to the general dimension of distress and dissatisfaction, a discomfort, including aversive mood states such as anger, guilt, disgust, and fear. Therefore, a high SWB means high rates of positive affects and satisfaction with life and low rates of negative affects [21].

Affects are the immediate response that a person has to a stimulus or event. They are based on the sensation of arousal, which allows us to evaluate the event as pleasurable or painful for the subject. Affects actively interfere in the way the subject sees his/her own life and the people around him/her. In this way, people with a higher prevalence of positive affect tend to feel more happy in their daily activities and those with more negative affect tend to look at daily life in a negative and sad way [21].

There are three aspects of SWB that are important to be highlighted: the first is subjectivity, in which well-being resides within the individual’s experience; the second consists of understanding that well-being is not only the absence of negative factors but also the presence of positive factors; the third emphasizes that well-being includes a global measure instead of only a limited measure of an aspect of life [20].

The term SWB is characterized by subjectivity in relation to the self-assessment of satisfaction with life, not only being identified by positive affections, such as joy, pleasure, and optimism, but also by the absence of negative affections. This construct is related to the reduction of morbidity and mortality, with the satisfactory maintenance of functionality and autonomy of the elderly population. Hence, it is important to study this phenomenon in dependent elderly people [22].

SWB has both short- and long-term impacts on people’s lives, and this is an important variable for the mental health of individuals. Thus, practices aimed at increasing SWB levels have positive impacts on the success of individuals, as well as on society as a whole. SWB is related to primary prevention, regarding the work of identifying negative factors, before something negative happens, seeking to prevent the disease [21].

A longitudinal type study with a sample of 22,576 patients aged 50 years or older, with coronary artery disease, by means of generalized estimating equations, showed that despite being an asymptomatic disease, patients with higher blood pressure had higher chances of reporting SWB levels below the ideal. It also showed that female patients, of the black race, with a history of smoking, diabetes, myocardial infarction, stroke, and cancer, also have higher chances of reporting low levels of SWB [20].

This study aims to analyze the impact of a formative intervention on the SWB of ICG during the pandemic crisis of COVID-19.

2 Methods

This is a quasi-experimental, single-group, longitudinal study with a quantitative approach [23]. The following inclusion criteria were used to define the population: (i) being an ICG of a dependent person in the geographical area of the Community Care Unit of the city of Amarante (Portugal) and (ii) being an ICG for at least half a year. After the application of the inclusion criteria, the target population was composed of 31 ICGs of dependent people, registered in the health units of Amarante in the year 2020/2021. The exclusion criteria were as follows: (i) the dependent person had died during the study and (ii) the ICG was on sick leave during the same period. As no ICGs were excluded, the sample coincided with the accessible population, which consisted of 31 ICGs. In this study, no sampling technique was applied due to the small size of the population.

A form consisting of four parts was used for data collection: the first part aimed at characterizing the population in socio-demographic terms; the second part aimed at assessing the ICGs’ knowledge about the prevention of Covid-19 disease; the third part contained the SWB scale – PANAS (original version built by Watson et al., [24]), through which the positive affect and negative affect were assessed, which was adapted and validated for the Portuguese population by Galinha and Pais-Ribeiro [25]. This scale is a measure of the SWB, assessing on a 5-point Likert-type scale ranging from “not at all” or “very slightly” (1), “a little” (2), “moderately” (3), “quite a lot” (4), and “extremely” (5), and how respondents experience, at the moment, ten positive emotions and ten negative emotions. The Portuguese version of PANAS presents an internal consistency of 0.86 for the Positive Affect Scale and 0.89 for the Negative Affect Scale [25]. The scale allows for determining the SWB, resulting from subtracting the negative affects from the positive affects; the fourth part of the form is composed of the Checklist – Handwashing elaborated based on the manual of General Prevention and Control Measures COVID-19 of the DGS, to guide the observation of the ICG in handwashing. In the present study, we only used parts I and III.

All ethical procedures were followed, taking into account the respect for human dignity, the right to confidentiality, the protection of anonymity and data confidentiality. In order to conduct the study, a request for authorization to apply the data collection form was submitted to the President of the Ethics Committee of the Regional Health Administration of the North, with a favorable opinion, reference no. CE/2021/24, dated June 17, 2021. Data collection was performed by researchers at the home of each ICG, during a home visit, having previously requested informed consent. Data collection took place, from the first moment (M1), in the period from April 1 to 9, 2021 and the second moment (M2), in the period from April 19 to 30, 2021. Between M1 and M2 of data collection, from April 12 to 16, 2021, training interventions were performed at the ICGs’ homes on an individual basis due to the pandemic context that we were going through, which prevented a group approach on the correct use of the mask and knowledge about the signs and symptoms of Covid-19, preventive measures, and the importance of proper hand hygiene. The intervention consisted of two individual health education sessions at the home of each ICG due to the pandemic situation that the country was going through. At the end of these sessions, a flyer was distributed to reinforce the issues addressed and the questionnaire for evaluation. The overall objective was to empower ICGs with knowledge and skills on the infection of COVID-19 and increase SWB. Knowledge was imparted on the signs and symptoms of this infection, infection control, going shopping, hand hygiene, and use of PPE, with demonstration and training of these last two preventive measures.

Data were processed and analyzed using IBM Statistical Package for the Social Sciences (SPSS), and a database was built in which they were entered. In terms of descriptive statistics, the absolute and relative frequency and mode were calculated for all variables. In the case of ordinal variables, the order statistics (percentiles, deciles) were also requested, and in the case of scalar variables, the calculation of the measures of central tendency and dispersion was also requested. In the case of inferential statistics, parametric statistical tests were used (Student’s t-test and ANOVA) and when the assumptions for their use were not met, non-parametric tests were used (Mann–Whitney and Kruskal–Wallis). The Wilcoxon test was used to compare the ordination means between the two data collection moments (M1 and M2). A statistical significance level of 0.05 was considered for all analyses performed [26].

3 Results

From the total sample (n = 31), most of the ICGs were female (90.3%), belonged to the age group of 45–64 years (61.3%), had a marital status of married (67.7%), had between 1 and 2 children (64.5%), had first cycle education (38.7%), a non-active labor situation (74.2%), the degree of kinship with the dependent was of son/daughter (61.3%), and lived with the dependent (58.1%) (Table 1).

Table 1

Sociodemographic characterization of ICGs: Amarante, Portugal, 2021 (n = 31)

Variables Af Rf
Gender Male 3 9.7
Female 28 90.3
Age group 18–44 years old 5 16.1
45–64 years old 19 61.3
65 and more 7 22.6
Marital status Single 6 19.4
Married/living together 21 67.7
Divorced 4 12.9
Number of children No children 6 19.4
1 to 2 children 20 64.5
3 or more children 5 16.1
Academic qualifications First cycle (4th year) 12 38.7
Second cycle (9th Year) 7 22.6
Third cycle (12th year) 9 29
Degree/master’s/doctorate 3 9.7
Employment situation Not active 23 74.2
Active 8 25.8
Relationship with the dependent Mother/father 1 3.2
Wife/husband 6 19.4
Son/daughter 19 61.3
Son/daughter-in-law 1 3.2
Others 4 12.9
Cohabiting with the dependent No 13 41.9
Yes 18 58.1

Legend: Af – absolute frequency; Rf – relative frequency.

With regard to the distribution of the responses of the ICG to the emotions of positive affect (Table 2), the emotions that contributed most to the positivity of affections were feeling determined, active, and proud, which obtained the percentage of responses, respectively, in the option “quite a lot,” 48.4, 54.8, and 16.1%, and in the option “extremely,” all with a percentage of 9.7%. On the other hand, the emotions that contributed least to the positivity of affect were feeling enchanted, pleasantly surprised, and enthusiastic, which obtained the percentage of answers in the option “not at all” or “very slightly,” respectively, 93.5, 90.3, and 74.2%.

Table 2

Distribution of the response options of ICGs to the items of the SWB scale – PANAS: Amarante, Portugal, 2021 (n = 31)

Not at all or Very slightly (1) A little bit (2) Moderately (3) Quite (4) Extremely (5)
Emotions Af Rf Af Rf Af Rf Af Rf Af Rf
Interested 9 29.0 11 35.5 4 12.9 5 16.1 2 6.5
Disturbed 5 16.1 13 41.9 5 16.1 8 25.8 0 0
Excited 14 45.2 13 41.9 3 9.7 1 3.2 0 0
Tormented 13 41.9 7 22.6 6 19.4 4 12.9 1 3.2
Pleasantly surprised 28 90.3 2 6.5 1 3.2 0 0 0 0
Guilty 30 96.8 1 3.2 0 0 0 0 0 0
Scared 7 22.6 9 29.0 8 25.8 6 19.4 1 3.2
Warm 16 51.6 11 35.5 1 3.2 3 9.7 0 0
Disgusted 24 77.4 2 6.2 2 6.5 1 3.2 2 6.5
Excited 23 74.2 5 16.1 2 6.5 1 3.2 0 0
Proud 19 61.3 4 12.9 0 0 5 16.1 3 9.7
Irritated 9 29.0 8 25.8 7 22.6 6 19.4 1 3.2
Enchanted 29 93.5 1 3.2 0 0 1 3.2 0 0
Remorse 29 93.5 1 3.2 0 0 1 3.2 0 0
Inspired 17 54.8 9 29.0 4 12.9 1 3.2 0 0
Nervous 4 12.9 7 22.6 7 22.6 10 32.3 3 9.7
Determined 2 6.5 3 9.7 8 25.8 15 48.4 3 9.7
Trembling 15 48.4 11 35.5 5 16.1 0 0 0 0
Active 0 0 4 12.9 7 22.6 17 54.8 3 9.7
Frightened 8 25.8 7 22.6 4 12.9 10 32.3 2 6.5

Legend: Af – absolute frequency; Rf – relative frequency.

In relation to negative affect, the emotions that contributed most to this were feeling nervous, frightened, and disturbed, which obtained a percentage of answers in the option “quite a bit,” respectively, of 32.3, 32.3 and 25.8%. The emotions that contributed least to the negativity of affect were feeling disturbed, nervous, and scared, with a percentage of answers in the option “not at all” or “very slightly,” respectively, of 16.1, 12.9, and 22.6%.

The mean difference between positive affects and negative affects at M1 and M2, before and after the intervention, was −0.0581 ± 0.71590 and 0.04645 ± 0.53326, respectively; the difference was higher at M2.

In the SWB categorization, positive affect and negative affect obtained the same percentage (48.4%), meaning that the sample is almost equally divided between both types of affects (Table 3).

Table 3

Categorization of the SWB reported by ICGs: Amarante, Portugal, 2021 (n = 31)

Categorization of SWB Af Rf (%)
SWB negative 15 48.4
SWB neutral 1 3.2
SWB positive 15 48.4
Total 31 100

Legend: Af – absolute frequency; Rf – relative frequency.

The mean rank order of the difference between positive and negative affects of the ICGs differed significantly between Moment 2 and Moment 1 (Wilcoxon: p < 0.000), with the mean rank order of the difference of Moment 2 (16.93) being higher than that of Moment 1 (2.50). This means that the training action increased the SWB of ICGs. Of the 31 ICGs who participated in the training action, 29 increased their SWB and 2 ICGs decreased their SWB (Table 4).

Table 4

Results of the Wilcoxon test between the mean rank difference of positive affects and negative affects at Time Point 1 and Time Point 2: Amarante, Portugal, 2021 (n = 31)

Variables Classification n Mean rank Test value p value
Difference between the mean rank of positive affects and negative affects M2 – difference between the mean of positive affects and negative affects M1 Negative 2 2.50 Wilcoxon = −4.770 0.000
Positive 29 16.93
Draw 0

Legend: n – absolute frequency; p – probability.

4 Discussion

In Portugal, in 2019, there were 1,059,012 people who provided informal care and most of them were women (65.4%); the largest age group was between 25 and 64 years old (70.98%) and their literacy level was basic education or first cycle (53.7%), which is consistent with our study [27].

According to Ferreira et al., there is a predetermination of who will be the caregiver, once there is a social expectation that it is the woman who assumes this role since taking care of the family and performing domestic chores are functions considered “naturally” feminine. Thus, the caregiving role assigned to women seems to be the result of historical and social construction, in which girls are taught from childhood to perform caregiving tasks, creating the expectation that they will exercise the role of caregiver, when necessary, throughout their lives. Therefore, one can designate culture as a guiding element for the choice of who will assist the elderly in their aging process [7].

With regard to work status, the results of our study are in line with the results presented in the Autumn Report (2018), in which the majority of ICGs (54%) were inactive, with slightly more than half being in retired status [28].

A study was conducted in the municipality of São Carlos (São Paulo, Brazil), with 44 caregivers, which aimed to assess and compare the sociodemographic characteristics, depressive and anxiety symptoms, and perceived stress of formal and ICGs of older people with Alzheimer’s disease; the majority of caregivers were son/daughter (65.4%), as in the present study. The fact that most of these caregivers were sons/daughters reinforces the idea of the feeling of obligation to care for these family members or even the lack of resources [29].

Both the mean of the difference between positive affects and negative affects and the mean rank of the difference between these affections are higher in M2 after the formative interventions, which means that they had a positive impact on SWB, significantly increasing positive affects. Of the 31 ICGs who composed our population, 29 (93.5%) obtained a positive difference between affections and, in only two ICGs, this difference was negative. The formative interventions on the preventive measures of COVID-19 thus seem to have contributed to improving the SWB of the ICG. As mentioned by Batello et al., who developed a reflexive analysis conducted in Brazil, these actions are necessary and urgent in order to identify and address problems and ensure the quality and continuity of care for dependent people [10].

These results corroborate those obtained by a study conducted in the city of Tomsk (Russia), in a sample of 119 older people participating in social engagement projects, which increased the participants’ SWB [30], highlighting the difference between the population in question and the fact that these projects were more comprehensive than ours.

Also, a systematic review and meta-analysis study showed small to moderate effects on subjective well-being and suggested that individualized multicomponent interventions for caregivers may be one of the ways to promote their well-being [31].

The main limitations of this study may be the fact that there was no control group, and there may have been interference from extraneous variables in the impact of the interventions performed.

This study may have implications for the professional practice of the nursing team, who provide care to these families, playing the role of ICG, to one of the elements of the family system with dependence, raising their awareness about the support that they can provide and the importance of training ICGs, for the prevention of COVID-19 and other pathologies, protecting their most fragile family members, for the improvement of their own SWB and the care provided to the dependent people in their care.

Acknowledgments

This study had the financial support of CIEC (Research Centre on Child Studies), by the Strategic Project UID/CED/00317/2013, through the National Funds through the FCT (Foundation for Science and Technology) and co-financed by European Regional Development Funds (FEDER) through the Competitiveness and Internationalization Operational Program (POCI) with the reference POCI-01-0145-FEDER-007562.

  1. Author contributions: Study conception and design: DAG, NPG, AASC; data collection: DAG; data analysis and interpretation: DAG, NPG, AASC; drafting of the article: DAG, NPG, AASC; critical revision of the article: DAG, NPG, AASC.

  2. Conflict of interest: The authors state no conflict of interest. One of the authors (AASC) is an editor with Open Medicine, but this did not affect the peer review process, and the authors were not aware of who the peer reviewers were.

  3. Data availability statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Received: 2023-01-10
Revised: 2023-05-28
Accepted: 2023-05-29
Published Online: 2023-06-16

© 2023 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
https://doi.org/10.1515/med-2023-0739
Keywords for this article
subjective well-being; informal caregivers; COVID-19; community health nursing
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. Exosomes derived from mesenchymal stem cells overexpressing miR-210 inhibits neuronal inflammation and contribute to neurite outgrowth through modulating microglia polarization
  3. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia
  4. circ-IARS depletion inhibits the progression of non-small-cell lung cancer by circ-IARS/miR-1252-5p/HDGF ceRNA pathway
  5. circRNA ITGA7 restrains growth and enhances radiosensitivity by up-regulating SMAD4 in colorectal carcinoma
  6. WDR79 promotes aerobic glycolysis of pancreatic ductal adenocarcinoma (PDAC) by the suppression of SIRT4
  7. Up-regulation of collagen type V alpha 2 (COL5A2) promotes malignant phenotypes in gastric cancer cell via inducing epithelial–mesenchymal transition (EMT)
  8. Inhibition of TERC inhibits neural apoptosis and inflammation in spinal cord injury through Akt activation and p-38 inhibition via the miR-34a-5p/XBP-1 axis
  9. 3D-printed polyether-ether-ketone/n-TiO2 composite enhances the cytocompatibility and osteogenic differentiation of MC3T3-E1 cells by downregulating miR-154-5p
  10. Propofol-mediated circ_0000735 downregulation restrains tumor growth by decreasing integrin-β1 expression in non-small cell lung cancer
  11. PVT1/miR-16/CCND1 axis regulates gastric cancer progression
  12. Silencing of circ_002136 sensitizes gastric cancer to paclitaxel by targeting the miR-16-5p/HMGA1 axis
  13. Short-term outcomes after simultaneous gastrectomy plus cholecystectomy in gastric cancer: A pooling up analysis
  14. SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways
  15. Molecular mechanism by which the Notch signaling pathway regulates autophagy in a rat model of pulmonary fibrosis in pigeon breeder’s lung
  16. lncRNA TPT1-AS1 promotes cell migration and invasion in esophageal squamous-cell carcinomas by regulating the miR-26a/HMGA1 axis
  17. SIRT1/APE1 promotes the viability of gastric cancer cells by inhibiting p53 to suppress ferroptosis
  18. Glycoprotein non-metastatic melanoma B interacts with epidermal growth factor receptor to regulate neural stem cell survival and differentiation
  19. Treatments for brain metastases from EGFR/ALK-negative/unselected NSCLC: A network meta-analysis
  20. Association of osteoporosis and skeletal muscle loss with serum type I collagen carboxyl-terminal peptide β glypeptide: A cross-sectional study in elder Chinese population
  21. circ_0000376 knockdown suppresses non-small cell lung cancer cell tumor properties by the miR-545-3p/PDPK1 pathway
  22. Delivery in a vertical birth chair supported by freedom of movement during labor: A randomized control trial
  23. UBE2J1 knockdown promotes cell apoptosis in endometrial cancer via regulating PI3K/AKT and MDM2/p53 signaling
  24. Metabolic resuscitation therapy in critically ill patients with sepsis and septic shock: A pilot prospective randomized controlled trial
  25. Lycopene ameliorates locomotor activity and urinary frequency induced by pelvic venous congestion in rats
  26. UHRF1-induced connexin26 methylation is involved in hearing damage triggered by intermittent hypoxia in neonatal rats
  27. LINC00511 promotes melanoma progression by targeting miR-610/NUCB2
  28. Ultra-high-performance liquid chromatography-tandem mass spectrometry analysis of serum metabolomic characteristics in people with different vitamin D levels
  29. Role of Jumonji domain-containing protein D3 and its inhibitor GSK-J4 in Hashimoto’s thyroiditis
  30. circ_0014736 induces GPR4 to regulate the biological behaviors of human placental trophoblast cells through miR-942-5p in preeclampsia
  31. Monitoring of sirolimus in the whole blood samples from pediatric patients with lymphatic anomalies
  32. Effects of osteogenic growth peptide C-terminal pentapeptide and its analogue on bone remodeling in an osteoporosis rat model
  33. A novel autophagy-related long non-coding RNAs signature predicting progression-free interval and I-131 therapy benefits in papillary thyroid carcinoma
  34. WGCNA-based identification of potential targets and pathways in response to treatment in locally advanced breast cancer patients
  35. Radiomics model using preoperative computed tomography angiography images to differentiate new from old emboli of acute lower limb arterial embolism
  36. Dysregulated lncRNAs are involved in the progress of myocardial infarction by constructing regulatory networks
  37. Single-arm trial to evaluate the efficacy and safety of baclofen in treatment of intractable hiccup caused by malignant tumor chemotherapy
  38. Genetic polymorphisms of MRPS30-DT and NINJ2 may influence lung cancer risk
  39. Efficacy of immune checkpoint inhibitors in patients with KRAS-mutant advanced non-small cell lung cancer: A retrospective analysis
  40. Pyroptosis-based risk score predicts prognosis and drug sensitivity in lung adenocarcinoma
  41. Upregulation of lncRNA LANCL1-AS1 inhibits the progression of non-small-cell lung cancer via the miR-3680-3p/GMFG axis
  42. CircRANBP17 modulated KDM1A to regulate neuroblastoma progression by sponging miR-27b-3p
  43. Exosomal miR-93-5p regulated the progression of osteoarthritis by targeting ADAMTS9
  44. Downregulation of RBM17 enhances cisplatin sensitivity and inhibits cell invasion in human hypopharyngeal cancer cells
  45. HDAC5-mediated PRAME regulates the proliferation, migration, invasion, and EMT of laryngeal squamous cell carcinoma via the PI3K/AKT/mTOR signaling pathway
  46. The association between sleep duration, quality, and nonalcoholic fatty liver disease: A cross-sectional study
  47. Myostatin silencing inhibits podocyte apoptosis in membranous nephropathy through Smad3/PKA/NOX4 signaling pathway
  48. A novel long noncoding RNA AC125257.1 facilitates colorectal cancer progression by targeting miR-133a-3p/CASC5 axis
  49. Impact of omicron wave and associated control measures in Shanghai on health management and psychosocial well-being of patients with chronic conditions
  50. Clinicopathological characteristics and prognosis of young patients aged ≤45 years old with non-small cell lung cancer
  51. TMT-based comprehensive proteomic profiling identifies serum prognostic signatures of acute myeloid leukemia
  52. The dose limits of teeth protection for patients with nasopharyngeal carcinoma undergoing radiotherapy based on the early oral health-related quality of life
  53. miR-30b-5p targeting GRIN2A inhibits hippocampal damage in epilepsy
  54. Long non-coding RNA AL137789.1 promoted malignant biological behaviors and immune escape of pancreatic carcinoma cells
  55. IRF6 and FGF1 polymorphisms in non-syndromic cleft lip with or without cleft palate in the Polish population
  56. Comprehensive analysis of the role of SFXN family in breast cancer
  57. Efficacy of bronchoscopic intratumoral injection of endostar and cisplatin in lung squamous cell carcinoma patients underwent conventional chemoradiotherapy
  58. Silencing of long noncoding RNA MIAT inhibits the viability and proliferation of breast cancer cells by promoting miR-378a-5p expression
  59. AG1024, an IGF-1 receptor inhibitor, ameliorates renal injury in rats with diabetic nephropathy via the SOCS/JAK2/STAT pathway
  60. Downregulation of KIAA1199 alleviated the activation, proliferation, and migration of hepatic stellate cells by the inhibition of epithelial–mesenchymal transition
  61. Exendin-4 regulates the MAPK and WNT signaling pathways to alleviate the osteogenic inhibition of periodontal ligament stem cells in a high glucose environment
  62. Inhibition of glycolysis represses the growth and alleviates the endoplasmic reticulum stress of breast cancer cells by regulating TMTC3
  63. The function of lncRNA EMX2OS/miR-653-5p and its regulatory mechanism in lung adenocarcinoma
  64. Tectorigenin alleviates the apoptosis and inflammation in spinal cord injury cell model through inhibiting insulin-like growth factor-binding protein 6
  65. Ultrasound examination supporting CT or MRI in the evaluation of cervical lymphadenopathy in patients with irradiation-treated head and neck cancer
  66. F-box and WD repeat domain containing 7 inhibits the activation of hepatic stellate cells by degrading delta-like ligand 1 to block Notch signaling pathway
  67. Knockdown of circ_0005615 enhances the radiosensitivity of colorectal cancer by regulating the miR-665/NOTCH1 axis
  68. Long noncoding RNA Mhrt alleviates angiotensin II-induced cardiac hypertrophy phenotypes by mediating the miR-765/Wnt family member 7B pathway
  69. Effect of miR-499-5p/SOX6 axis on atrial fibrosis in rats with atrial fibrillation
  70. Cholesterol induces inflammation and reduces glucose utilization
  71. circ_0004904 regulates the trophoblast cell in preeclampsia via miR-19b-3p/ARRDC3 axis
  72. NECAB3 promotes the migration and invasion of liver cancer cells through HIF-1α/RIT1 signaling pathway
  73. The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk
  74. miR-2053 inhibits the growth of ovarian cancer cells by downregulating SOX4
  75. Nucleophosmin 1 associating with engulfment and cell motility protein 1 regulates hepatocellular carcinoma cell chemotaxis and metastasis
  76. α-Hederin regulates macrophage polarization to relieve sepsis-induced lung and liver injuries in mice
  77. Changes of microbiota level in urinary tract infections: A meta-analysis
  78. Identification of key enzalutamide-resistance-related genes in castration-resistant prostate cancer and verification of RAD51 functions
  79. Falls during oxaliplatin-based chemotherapy for gastrointestinal malignancies – (lessons learned from) a prospective study
  80. Outcomes of low-risk birth care during the Covid-19 pandemic: A cohort study from a tertiary care center in Lithuania
  81. Vitamin D protects intestines from liver cirrhosis-induced inflammation and oxidative stress by inhibiting the TLR4/MyD88/NF-κB signaling pathway
  82. Integrated transcriptome analysis identifies APPL1/RPS6KB2/GALK1 as immune-related metastasis factors in breast cancer
  83. Genomic analysis of immunogenic cell death-related subtypes for predicting prognosis and immunotherapy outcomes in glioblastoma multiforme
  84. Circular RNA Circ_0038467 promotes the maturation of miRNA-203 to increase lipopolysaccharide-induced apoptosis of chondrocytes
  85. An economic evaluation of fine-needle cytology as the primary diagnostic tool in the diagnosis of lymphadenopathy
  86. Midazolam impedes lung carcinoma cell proliferation and migration via EGFR/MEK/ERK signaling pathway
  87. Network pharmacology combined with molecular docking and experimental validation to reveal the pharmacological mechanism of naringin against renal fibrosis
  88. PTPN12 down-regulated by miR-146b-3p gene affects the malignant progression of laryngeal squamous cell carcinoma
  89. miR-141-3p accelerates ovarian cancer progression and promotes M2-like macrophage polarization by targeting the Keap1-Nrf2 pathway
  90. lncRNA OIP5-AS1 attenuates the osteoarthritis progression in IL-1β-stimulated chondrocytes
  91. Overexpression of LINC00607 inhibits cell growth and aggressiveness by regulating the miR-1289/EFNA5 axis in non-small-cell lung cancer
  92. Subjective well-being in informal caregivers during the COVID-19 pandemic
  93. Nrf2 protects against myocardial ischemia-reperfusion injury in diabetic rats by inhibiting Drp1-mediated mitochondrial fission
  94. Unfolded protein response inhibits KAT2B/MLKL-mediated necroptosis of hepatocytes by promoting BMI1 level to ubiquitinate KAT2B
  95. Bladder cancer screening: The new selection and prediction model
  96. circNFATC3 facilitated the progression of oral squamous cell carcinoma via the miR-520h/LDHA axis
  97. Prone position effect in intensive care patients with SARS-COV-2 pneumonia
  98. Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children
  99. Dihydroartemisinin ameliorates cerebral I/R injury in rats via regulating VWF and autophagy-mediated SIRT1/FOXO1 pathway
  100. Knockdown of circ_0113656 assuages oxidized low-density lipoprotein-induced vascular smooth muscle cell injury through the miR-188-3p/IGF2 pathway
  101. Low Ang-(1–7) and high des-Arg9 bradykinin serum levels are correlated with cardiovascular risk factors in patients with COVID-19
  102. Effect of maternal age and body mass index on induction of labor with oral misoprostol for premature rupture of membrane at term: A retrospective cross-sectional study
  103. Potential protective effects of Huanglian Jiedu Decoction against COVID-19-associated acute kidney injury: A network-based pharmacological and molecular docking study
  104. Clinical significance of serum MBD3 detection in girls with central precocious puberty
  105. Clinical features of varicella-zoster virus caused neurological diseases detected by metagenomic next-generation sequencing
  106. Collagen treatment of complex anorectal fistula: 3 years follow-up
  107. LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through down-regulating SP-A by sponging to miR-424
  108. Efficacy analysis of empirical bismuth quadruple therapy, high-dose dual therapy, and resistance gene-based triple therapy as a first-line Helicobacter pylori eradication regimen – An open-label, randomized trial
  109. SMOC2 plays a role in heart failure via regulating TGF-β1/Smad3 pathway-mediated autophagy
  110. A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults
  111. circRNA THBS1 silencing inhibits the malignant biological behavior of cervical cancer cells via the regulation of miR-543/HMGB2 axis
  112. hsa_circ_0000285 sponging miR-582-3p promotes neuroblastoma progression by regulating the Wnt/β-catenin signaling pathway
  113. Long non-coding RNA GNAS-AS1 knockdown inhibits proliferation and epithelial–mesenchymal transition of lung adenocarcinoma cells via the microRNA-433-3p/Rab3A axis
  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
  115. Twenty-four-color full spectrum flow cytometry panel for minimal residual disease detection in acute myeloid leukemia
  116. Hsa-miR-223-3p participates in the process of anthracycline-induced cardiomyocyte damage by regulating NFIA gene
  117. Anti-inflammatory effect of ApoE23 on Salmonella typhimurium-induced sepsis in mice
  118. Analysis of somatic mutations and key driving factors of cervical cancer progression
  119. Hsa_circ_0028007 regulates the progression of nasopharyngeal carcinoma through the miR-1179/SQLE axis
  120. Variations in sexual function after laparoendoscopic single-site hysterectomy in women with benign gynecologic diseases
  121. Effects of pharmacological delay with roxadustat on multi-territory perforator flap survival in rats
  122. Analysis of heroin effects on calcium channels in rat cardiomyocytes based on transcriptomics and metabolomics
  123. Risk factors of recurrent bacterial vaginosis among women of reproductive age: A cross-sectional study
  124. Alkbh5 plays indispensable roles in maintaining self-renewal of hematopoietic stem cells
  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
  126. Correlation between microvessel maturity and ISUP grades assessed using contrast-enhanced transrectal ultrasonography in prostate cancer
  127. The protective effect of caffeic acid phenethyl ester in the nephrotoxicity induced by α-cypermethrin
  128. Norepinephrine alleviates cyclosporin A-induced nephrotoxicity by enhancing the expression of SFRP1
  129. Effect of RUNX1/FOXP3 axis on apoptosis of T and B lymphocytes and immunosuppression in sepsis
  130. The function of Foxp1 represses β-adrenergic receptor transcription in the occurrence and development of bladder cancer through STAT3 activity
  131. Risk model and validation of carbapenem-resistant Klebsiella pneumoniae infection in patients with cerebrovascular disease in the ICU
  132. Calycosin protects against chronic prostatitis in rats via inhibition of the p38MAPK/NF-κB pathway
  133. Pan-cancer analysis of the PDE4DIP gene with potential prognostic and immunotherapeutic values in multiple cancers including acute myeloid leukemia
  134. The safety and immunogenicity to inactivated COVID-19 vaccine in patients with hyperlipemia
  135. Circ-UBR4 regulates the proliferation, migration, inflammation, and apoptosis in ox-LDL-induced vascular smooth muscle cells via miR-515-5p/IGF2 axis
  136. Clinical characteristics of current COVID-19 rehabilitation outpatients in China
  137. Luteolin alleviates ulcerative colitis in rats via regulating immune response, oxidative stress, and metabolic profiling
  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
  139. The application of iliac fascia space block combined with esketamine intravenous general anesthesia in PFNA surgery of the elderly: A prospective, single-center, controlled trial
  140. Elevated blood acetoacetate levels reduce major adverse cardiac and cerebrovascular events risk in acute myocardial infarction
  141. The effects of progesterone on the healing of obstetric anal sphincter damage in female rats
  142. Identification of cuproptosis-related genes for predicting the development of prostate cancer
  143. Lumican silencing ameliorates β-glycerophosphate-mediated vascular smooth muscle cell calcification by attenuating the inhibition of APOB on KIF2C activity
  144. Targeting PTBP1 blocks glutamine metabolism to improve the cisplatin sensitivity of hepatocarcinoma cells through modulating the mRNA stability of glutaminase
  145. A single center prospective study: Influences of different hip flexion angles on the measurement of lumbar spine bone mineral density by dual energy X-ray absorptiometry
  146. Clinical analysis of AN69ST membrane continuous venous hemofiltration in the treatment of severe sepsis
  147. Antibiotics therapy combined with probiotics administered intravaginally for the treatment of bacterial vaginosis: A systematic review and meta-analysis
  148. Construction of a ceRNA network to reveal a vascular invasion associated prognostic model in hepatocellular carcinoma
  149. A pan-cancer analysis of STAT3 expression and genetic alterations in human tumors
  150. A prognostic signature based on seven T-cell-related cell clustering genes in bladder urothelial carcinoma
  151. Pepsin concentration in oral lavage fluid of rabbit reflux model constructed by dilating the lower esophageal sphincter
  152. The antihypertensive felodipine shows synergistic activity with immune checkpoint blockade and inhibits tumor growth via NFAT1 in LUSC
  153. Tanshinone IIA attenuates valvular interstitial cells’ calcification induced by oxidized low density lipoprotein via reducing endoplasmic reticulum stress
  154. AS-IV enhances the antitumor effects of propofol in NSCLC cells by inhibiting autophagy
  155. Establishment of two oxaliplatin-resistant gallbladder cancer cell lines and comprehensive analysis of dysregulated genes
  156. Trial protocol: Feasibility of neuromodulation with connectivity-guided intermittent theta-burst stimulation for improving cognition in multiple sclerosis
  157. LncRNA LINC00592 mediates the promoter methylation of WIF1 to promote the development of bladder cancer
  158. Factors associated with gastrointestinal dysmotility in critically ill patients
  159. Mechanisms by which spinal cord stimulation intervenes in atrial fibrillation: The involvement of the endothelin-1 and nerve growth factor/p75NTR pathways
  160. Analysis of two-gene signatures and related drugs in small-cell lung cancer by bioinformatics
  161. Silencing USP19 alleviates cigarette smoke extract-induced mitochondrial dysfunction in BEAS-2B cells by targeting FUNDC1
  162. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022
  163. Ferroptosis involves in Schwann cell death in diabetic peripheral neuropathy
  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
  165. Activation of UBEC2 by transcription factor MYBL2 affects DNA damage and promotes gastric cancer progression and cisplatin resistance
  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
  167. Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients
  168. Upregulated microRNA-429 confers endometrial stromal cell dysfunction by targeting HIF1AN and regulating the HIF1A/VEGF pathway
  169. Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia
  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
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