Metabolic functions of insulin.
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More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"5177",leadTitle:null,fullTitle:"Respiratory Management of Newborns",title:"Respiratory Management of Newborns",subtitle:null,reviewType:"peer-reviewed",abstract:"In this book, you'll learn multiple new aspects of respiratory management of the newborn. For example, ventilator management of infants with unusually severe bronchopulmonary dysplasia and infants with omphalocele is discussed, as well as positioning of endotracheal tube in extremely low birth weight infants, noninvasive respiratory support, utilization of a protocol-driven respiratory management, and more. This book includes a chapter on noninvasive respiratory function monitoring during chest compression, analyzing the efficacy and quality of chest compression and exhaled carbon dioxide. It also provides an overview on new trends in the management of fetal and transitioning lungs in infants delivered prematurely. Lastly, the book includes a chapter on neonatal encephalopathy treated with hypothermia along with mechanical ventilation. The interaction of cooling with respiration and the strategies to optimize oxygenation and ventilation in asphyxiated newborns are discussed.",isbn:"978-953-51-2575-4",printIsbn:"978-953-51-2574-7",pdfIsbn:"978-953-51-7292-5",doi:"10.5772/61451",price:119,priceEur:129,priceUsd:155,slug:"respiratory-management-of-newborns",numberOfPages:178,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"0cdbf2acba5c3434c255d74419ae2250",bookSignature:"Hany Aly and Hesham Abdel-Hady",publishedDate:"August 31st 2016",coverURL:"https://cdn.intechopen.com/books/images_new/5177.jpg",numberOfDownloads:21498,numberOfWosCitations:9,numberOfCrossrefCitations:4,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:9,numberOfDimensionsCitationsByBook:2,hasAltmetrics:0,numberOfTotalCitations:22,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 7th 2015",dateEndSecondStepPublish:"October 28th 2015",dateEndThirdStepPublish:"January 24th 2016",dateEndFourthStepPublish:"February 23rd 2016",dateEndFifthStepPublish:"July 13th 2016",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"104221",title:"Dr.",name:"Hany",middleName:null,surname:"Aly",slug:"hany-aly",fullName:"Hany Aly",profilePictureURL:"https://mts.intechopen.com/storage/users/104221/images/4596_n.jpg",biography:"Dr. Hany Aly is a professor in Pediatrics and Obstetrics at the George Washington University and Children’s National Medical Center. He is the director of the Division of Newborn Services at the George Washington University Medical Center in Washington, DC, USA, and the editor-in-chief for Journal of Neonatal-Perinatal Medicine. He is a regional trainer for the Neonatal Resuscitation and a member of the American Academy of Pediatrics, American Pediatric Society, and Society of Pediatric Research.",institutionString:null,position:null,outsideEditionCount:null,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Cleveland Clinic",institutionURL:null,country:{name:"United States of America"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"106402",title:"Prof.",name:"Hesham",middleName:"Elsayed",surname:"Abdel-Hady",slug:"hesham-abdel-hady",fullName:"Hesham Abdel-Hady",profilePictureURL:"https://mts.intechopen.com/storage/users/106402/images/3031_n.jpg",biography:"Dr. Hesham Abdel-hady is a professor in Pediatric/Neonatology and Chief of the Division of Neonatology at Mansoura University Children’s Hospital in Egypt. He is a regional trainer for the Neonatal Resuscitation Program of the American Academy of Pediatrics, a board member of the International Society for Evidence-Based Neonatology (EBNEO), a member of the Society of Pediatric Research, and an editorial board member for multiple international journals.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"1047",title:"Pulmonology",slug:"pulmonology"}],chapters:[{id:"50654",title:"Respiratory Function During Chest Compressions",doi:"10.5772/63510",slug:"respiratory-function-during-chest-compressions",totalDownloads:1953,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Chest compression (CC) is an infrequent event (0.08%) in newborns delivered at near-term and term gestation, and occurs at a higher frequency (10%) in preterm deliveries. In addition, outcome studies of deliveries requiring resuscitation or chest compression have reported high rates of mortality and neurodevelopmental impairment in surviving children. A respiratory function monitor (RFM) can help guide a resuscitator during cardiopulmonary resuscitation (CPR) in a neonate and help assess the quality and efficacy of chest compression. Utilizing a non-invasive respiratory function monitor during chest compression may decrease high mortality rates in addition to having many distinct advantages, which will benefit both the newborn and the resuscitators. There are several different ways that a respiratory function monitor can assist a resuscitator during chest compression; these include confirming and ensuring adequate lung ventilation, analyzing the efficacy and quality of chest compression and exhaled CO2 monitoring.",signatures:"Georg M Schmölzer, Anne Solevåg, Erica McGinn, Megan O’Reilly\nand Po-Yin Cheung",downloadPdfUrl:"/chapter/pdf-download/50654",previewPdfUrl:"/chapter/pdf-preview/50654",authors:[{id:"179622",title:"Dr.",name:"Georg",surname:"Schmolzer",slug:"georg-schmolzer",fullName:"Georg Schmolzer"},{id:"179804",title:"Dr.",name:"Anne",surname:"Solevag",slug:"anne-solevag",fullName:"Anne Solevag"},{id:"179805",title:"Dr.",name:"Po-Yin",surname:"Cheung",slug:"po-yin-cheung",fullName:"Po-Yin Cheung"},{id:"179806",title:"Dr.",name:"Megan",surname:"O'Reilly",slug:"megan-o'reilly",fullName:"Megan O'Reilly"}],corrections:null},{id:"51036",title:"Alternative Therapies for the Management of Respiratory Distress Syndrome",doi:"10.5772/63384",slug:"alternative-therapies-for-the-management-of-respiratory-distress-syndrome",totalDownloads:1997,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Respiratory distress syndrome (RDS) is a disorder caused by a deficiency of surface-active agent called pulmonary surfactant, in the pulmonary alveoli. This deficiency leads the alveoli to collapse, impeding air entry, gas exchange, and oxygenation in newborns. Conventional treatment involves exogenous surfactant administration, ventilation, and hydroelectrolytic management.",signatures:"Alejandro González-Garay and Vicente González-Bustamante",downloadPdfUrl:"/chapter/pdf-download/51036",previewPdfUrl:"/chapter/pdf-preview/51036",authors:[{id:"178849",title:"Dr.",name:"Alejandro",surname:"Gonzalez-Garay",slug:"alejandro-gonzalez-garay",fullName:"Alejandro Gonzalez-Garay"},{id:"184952",title:"Dr.",name:"Vicente",surname:"Gonzalez-Bustamante",slug:"vicente-gonzalez-bustamante",fullName:"Vicente Gonzalez-Bustamante"}],corrections:null},{id:"50842",title:"Respiratory Management of the Newborn with an Omphalocele",doi:"10.5772/63735",slug:"respiratory-management-of-the-newborn-with-an-omphalocele",totalDownloads:2008,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Despite advances in neonatal care, infants with omphalocele have a mortality rate ranging between 5% and 25%. Respiratory insufficiency is a common clinical challenge and an independent predictor of mortality in these infants. The causes of respiratory failure are diverse and are not well understood. This chapter discusses the unique aspects of respiratory management in omphalocele infants. The authors have chosen references in this chapter with appropriate sample size, variable comparisons, regression analyses, and documented median follow-up times. Omphalocele is rare; therefore, the case reports of chapter references have important information.",signatures:"Joanne Baerg, Arul Thirumoorthi and Andrew Hopper",downloadPdfUrl:"/chapter/pdf-download/50842",previewPdfUrl:"/chapter/pdf-preview/50842",authors:[{id:"178844",title:"Dr.",name:"Joanne",surname:"Baerg",slug:"joanne-baerg",fullName:"Joanne Baerg"},{id:"180308",title:"Dr.",name:"Arul",surname:"Thirumoorthi",slug:"arul-thirumoorthi",fullName:"Arul Thirumoorthi"},{id:"180310",title:"Dr.",name:"Andrew",surname:"Hopper",slug:"andrew-hopper",fullName:"Andrew Hopper"}],corrections:null},{id:"50731",title:"Respiratory Care Protocols in Neonatal Intensive Care",doi:"10.5772/63556",slug:"respiratory-care-protocols-in-neonatal-intensive-care",totalDownloads:2198,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Neonatal respiratory care involves physicians with variable backgrounds treating multiple respiratory problems and populations with a number of invasive and non-invasive devices and strategies. Unfortunately, there is a lack of strong evidence to guide the most adequate management for several specific situations. Altogether, this complexity leads to significant practice variability that can affect patient and health care outcomes. Respiratory care protocols, guided by evidence and/or consensus, are an attractive solution to promote standardization of care and reduction of unnecessary practice variations. Indeed, despite the limited evidence supporting the use of respiratory protocols in neonates, a significant number of units have already developed and implemented them into clinical practice. Respiratory care protocols appear to promote evidence-based practices, discourage outdated approaches and ultimately improve patient safety.",signatures:"Wissam Shalish and Guilherme Mendes Sant’ Anna",downloadPdfUrl:"/chapter/pdf-download/50731",previewPdfUrl:"/chapter/pdf-preview/50731",authors:[{id:"179293",title:"Dr.",name:"Guilherme",surname:"Sant'Anna",slug:"guilherme-sant'anna",fullName:"Guilherme Sant'Anna"},{id:"186754",title:"Dr.",name:"Wissam",surname:"Shalish",slug:"wissam-shalish",fullName:"Wissam Shalish"}],corrections:null},{id:"50655",title:"The Impact of Ventilation on the Development of Brain Injury in Asphyxiated Newborns Treated with Hypothermia",doi:"10.5772/63385",slug:"the-impact-of-ventilation-on-the-development-of-brain-injury-in-asphyxiated-newborns-treated-with-hy",totalDownloads:1745,totalCrossrefCites:0,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Birth asphyxia and the resulting neonatal encephalopathy are a significant cause of mortality and long-term morbidity in children. Hypothermia is currently the only neuroprotective treatment to have been clinically tested in large trials to prevent the development of brain injury in some term asphyxiated newborns. Most of the asphyxiated newborns treated with hypothermia are intubated at birth as per resuscitation measures and remain on mechanical ventilation during some part of the hypothermia treatment or during the whole length of the treatment. They also may present with oxygenation problems. Very often, they present with hypocapnia that can be worsened with the use of mechanical ventilation during the first days of life. When taking care of these newborns, a few important points should be remembered about the impact of asphyxia and therapeutic hypothermia on oxygenation and ventilation. In this article, we review some of the physiopathology behind neonatal encephalopathy and the implications of brain cooling from a respiratory point of view. Strategies to optimize oxygenation and ventilation for these newborns, as well as to prevent further brain injury, are also discussed based on a current literature review.",signatures:"Asim Al Balushi, Maria A. Lopez Laporte and Pia Wintermark",downloadPdfUrl:"/chapter/pdf-download/50655",previewPdfUrl:"/chapter/pdf-preview/50655",authors:[{id:"179934",title:"Dr.",name:"Pia",surname:"Wintermark",slug:"pia-wintermark",fullName:"Pia Wintermark"},{id:"185009",title:"Dr.",name:"Asim",surname:"Al Balushi",slug:"asim-al-balushi",fullName:"Asim Al Balushi"},{id:"185010",title:"Ms.",name:"Maria Agustina",surname:"Lopez Laporte",slug:"maria-agustina-lopez-laporte",fullName:"Maria Agustina Lopez Laporte"}],corrections:null},{id:"51148",title:"Mechanical Ventilation of the Infant with Severe Bronchopulmonary Dysplasia",doi:"10.5772/63691",slug:"mechanical-ventilation-of-the-infant-with-severe-bronchopulmonary-dysplasia",totalDownloads:3661,totalCrossrefCites:0,totalDimensionsCites:4,hasAltmetrics:0,abstract:"Bronchopulmonary dysplasia (BPD) is the chronic lung disease of prematurity, and is the most common morbidity associated with preterm birth. Severe BPD is defined currently as a supplemental oxygen requirement at 28 days of age and a need for >30% oxygen and/or positive pressure at 36 weeks of corrected gestational age (CGA) in an infant born at <32 weeks of gestational age. The vast majority of severe BPD is characterized by high lung resistance, such that ventilation approaches must consider the relatively long time constants needed to adequately ventilate all portions of the lung to maximize ventilation-perfusion (V/Q) matching. At the same time, any ventilation strategy must take into account the vulnerable neurodevelopmental stage that characterizes the preterm infant with severe BPD. To maximize neurodevelopmental outcomes the ventilation strategy must avoid chronic use of sedation. In this chapter, we present the physiology underlying a low-rate, high-volume ventilation approach that maximizes V/Q matching, while optimizing neurodevelopment in patients with severe BPD.",signatures:"Edward G. Shepherd, Susan K. Lynch, Daniel T. Malleske and Leif D. Nelin",downloadPdfUrl:"/chapter/pdf-download/51148",previewPdfUrl:"/chapter/pdf-preview/51148",authors:[{id:"179965",title:"Prof.",name:"Leif",surname:"Nelin",slug:"leif-nelin",fullName:"Leif Nelin"},{id:"179967",title:"Dr.",name:"Edward",surname:"Shepherd",slug:"edward-shepherd",fullName:"Edward Shepherd"},{id:"180630",title:"Dr.",name:"Susan",surname:"Lynch",slug:"susan-lynch",fullName:"Susan Lynch"},{id:"180631",title:"Dr.",name:"Daniel",surname:"Malleske",slug:"daniel-malleske",fullName:"Daniel Malleske"}],corrections:null},{id:"51856",title:"Respiratory Distress and Management Strategies in the Newborn",doi:"10.5772/64397",slug:"respiratory-distress-and-management-strategies-in-the-newborn",totalDownloads:4569,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Approximately 10% of neonates require respiratory support immediately after delivery due to transitional problems or respiratory disorders, and up to 1% of neonates are in need of resuscitation. Respiratory distress is the most frequent cause of neonatal intensive care unit (NICU) admission, and the individual management strategies should be the main task in NICUs for these infants. Regardless of the cause, if not recognized and managed in advance, respiratory distress can escalate to respiratory failure and cardiopulmonary arrest. This chapter explores the evaluation and differential diagnosis of respiratory distress in neonates and presents an update on management strategies according to the protocol of Ankara University Children’s Hospital Neonatal Intensive Care Unit.",signatures:"Begüm Atasay, İlke Mungan Akın and Serdar Alan",downloadPdfUrl:"/chapter/pdf-download/51856",previewPdfUrl:"/chapter/pdf-preview/51856",authors:[{id:"180034",title:"Prof.",name:"Begum",surname:"Atasay",slug:"begum-atasay",fullName:"Begum Atasay"}],corrections:null},{id:"51066",title:"Perinatal Lung Development: The Lung at Birth",doi:"10.5772/63819",slug:"perinatal-lung-development-the-lung-at-birth",totalDownloads:1690,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The successful transition from liquid to air breathing at birth is essential in mammalian lung development and the primary biological role of the hypothalamic-pituitary-adrenal axis. At this moment, the lung experiences a major environmental change in oxygen tension as the fluid that filled this organ in utero (pO2 ∼26) is rapidly replaced with ambient air during the first few breaths (pO2 ∼150). This change induces oxidant stress in the lung which is balanced by antioxidant genes that are induced in the late gestational fetal lung to protect against injury. These antioxidant genes impact distinct antioxidant molecules, including glutathione, which can regulate the level of redox stress in lung cells. Cells, such as the alveolar macrophage, are central for host defense and surfactant homeostasis at the newly established air-liquid surface. Yet they are prone to dysfunction with excessive oxidant stress and the newborn lung is susceptible to infection. And yet the rise in alveolar oxygen tension can also serve as a physiologic redox signal that initiates expression of genes that regulate postnatal lung development. Taken together, birth can be viewed as a natural experiment with hyperoxia where the birth process itself serves as an integrator for that level of redox stress that limits lung injury while activating genes required for postnatal lung development.",signatures:"Jyh-Chang Jean, Lou Ann Scism Brown and Martin Joyce-Brady",downloadPdfUrl:"/chapter/pdf-download/51066",previewPdfUrl:"/chapter/pdf-preview/51066",authors:[{id:"77068",title:"Dr.",name:"Martin",surname:"Joyce-Brady",slug:"martin-joyce-brady",fullName:"Martin Joyce-Brady"},{id:"180396",title:"Dr.",name:"Lou Ann Scism",surname:"Brown",slug:"lou-ann-scism-brown",fullName:"Lou Ann Scism Brown"}],corrections:null},{id:"50701",title:"Non‐Pulmonary Management of Newborns with Respiratory Distress",doi:"10.5772/63386",slug:"non-pulmonary-management-of-newborns-with-respiratory-distress",totalDownloads:1678,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Due to the developmental immaturity of the lungs and other organs, the premature newborns are more prone to develop respiratory distress syndrome (RDS) and other problems of prematurity. The prevention of heat and water loses improves survival. Intolerance to excessive fluids and electrolytes in the transitional period may affect urine and sodium excretion together with maladaptation of cardiovascular system, the development of heart failure, and deterioration of RDS due to patent ductus arteriosus (PDA) and further development of bronchopulmonary dysplasia (BPD). Closure of PDA is frequently needed. The “trophic feeding” and intensive nutrition as soon as possible prevent weight loss and further growth restriction. Greater sensitivity to pain, short‐ and long‐term effects of inappropriately treated pain, use of opioids and sedatives are of concern in the short‐ and long‐term outcomes. Cardiovascular stability and adequate perfusion of the brain both affect the neurological outcome. Delayed cord clamping and erythropoietin help maintaining adequate levels of circulating hemoglobin which might affect later cognitive outcomes. In the following sections, detailed descriptions of non‐pulmonary management will be presented. We conducted electronic searches of articles on supportive (non‐pulmonary) management of newborns with RDS. Consensus guidelines on newborns with respiratory distress have been reviewed.",signatures:"Petja Fister and Štefan Grosek",downloadPdfUrl:"/chapter/pdf-download/50701",previewPdfUrl:"/chapter/pdf-preview/50701",authors:[{id:"180648",title:"Associate Prof.",name:"Petja",surname:"Fister",slug:"petja-fister",fullName:"Petja Fister"},{id:"185445",title:"Prof.",name:"Štefan",surname:"Grosek",slug:"stefan-grosek",fullName:"Štefan Grosek"}],corrections:null}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},subseries:null,tags:null},relatedBooks:[{type:"book",id:"956",title:"Cystic Fibrosis",subtitle:"Renewed Hopes Through Research",isOpenForSubmission:!1,hash:"703f0969078948d82535b7b0c08ab613",slug:"cystic-fibrosis-renewed-hopes-through-research",bookSignature:"Dinesh Sriramulu",coverURL:"https://cdn.intechopen.com/books/images_new/956.jpg",editedByType:"Edited by",editors:[{id:"91317",title:"Dr.",name:"Dinesh",surname:"Sriramulu",slug:"dinesh-sriramulu",fullName:"Dinesh Sriramulu"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"969",title:"Lung Diseases",subtitle:"Selected State of the Art Reviews",isOpenForSubmission:!1,hash:"b4344208b8b993d83e0131d23db46343",slug:"lung-diseases-selected-state-of-the-art-reviews",bookSignature:"Elvis Malcolm Irusen",coverURL:"https://cdn.intechopen.com/books/images_new/969.jpg",editedByType:"Edited by",editors:[{id:"87213",title:"Prof.",name:"Elvis",surname:"Irusen",slug:"elvis-irusen",fullName:"Elvis Irusen"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"648",title:"Chronic Obstructive Pulmonary Disease",subtitle:"Current Concepts and Practice",isOpenForSubmission:!1,hash:"d52ddc19c473a70b91e5a64f41760a04",slug:"chronic-obstructive-pulmonary-disease-current-concepts-and-practice",bookSignature:"Kian-Chung Ong",coverURL:"https://cdn.intechopen.com/books/images_new/648.jpg",editedByType:"Edited by",editors:[{id:"103585",title:"Dr.",name:"Kian Chung",surname:"Ong",slug:"kian-chung-ong",fullName:"Kian Chung Ong"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3843",title:"Lung Inflammation",subtitle:null,isOpenForSubmission:!1,hash:"92938e8752fa3444849d88b776cd7892",slug:"lung-inflammation",bookSignature:"Kian Chung Ong",coverURL:"https://cdn.intechopen.com/books/images_new/3843.jpg",editedByType:"Edited by",editors:[{id:"103585",title:"Dr.",name:"Kian Chung",surname:"Ong",slug:"kian-chung-ong",fullName:"Kian Chung Ong"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"5444",title:"Hypoxia and Human Diseases",subtitle:null,isOpenForSubmission:!1,hash:"331b1aa8d399bc404988a8bc5e431582",slug:"hypoxia-and-human-diseases",bookSignature:"Jing Zheng and Chi Zhou",coverURL:"https://cdn.intechopen.com/books/images_new/5444.jpg",editedByType:"Edited by",editors:[{id:"89898",title:"Dr.",name:"Jing",surname:"Zheng",slug:"jing-zheng",fullName:"Jing Zheng"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3309",title:"Respiratory Disease and Infection",subtitle:"A New Insight",isOpenForSubmission:!1,hash:"2e85d47bf0576f1c2ccf642156ccbda2",slug:"respiratory-disease-and-infection-a-new-insight",bookSignature:"Bassam H. 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Nowadays, when society is leading an increasingly sedentary lifestyle with constant access to food without the need for effort, we observe the raising occurrence of diseases with metabolic dysregulation. This financial and social burden has caused the great need for understanding mechanistic details of metabolic response pathways, causes of their impairment, and following consequences. Carbohydrate metabolism is mainly related to glucose. Its level should remain in a narrow range (4–7 mM) by balancing glucose release into the circulation, its absorption from the intestine, the breakdown of stored glycogen in liver, and the uptake of blood glucose by peripheral tissues. These processes are regulated by a few metabolic hormones with insulin being the most important one.
\nInsulin is an anabolic peptide hormone secreted by pancreatic β cells, whose mature form arises in two stages [1]. First, preproinsulin is processed via cutting of the signal fragment and forming proinsulin [2]. This is followed by the excision of the middle fragment (C chain—35 aa), which gives dipeptide made up of two chains (A—21 aa, B—30 aa) connected by two disulfide bonds [3]. Insulin is a multitask protein involved, among others, in the regulation of carbohydrate and lipid metabolism (Table 1). The most important stimulus for insulin production is a postprandial increase of blood glucose level. By increasing insulin production and its impact on effector cells (myocytes, adipocytes, and hepatocytes), glucose transport to the inside of the cells gets increased while reducing blood glucose level. This is achieved by an increased translocation of the insulin-dependent glucose carriers (GLUT), with GLUT-4 being found in skeletal muscle, hepatocytes, and adipocytes [4].
\n\n | Upregulation | \nDownregulation | \n
---|---|---|
Carbohydrate metabolism | \nGlucose uptake via GLUT4 Glycogen synthesis Glycolysis Conversion of pyruvate to acetyl CoA | \nGlycogenolysis Gluconeogenesis | \n
Lipid metabolism | \nFatty acids synthesis Triglycerides synthesis Cholesterol synthesis | \nLipids oxidation Triglycerides breakdown | \n
Protein metabolism | \nTranscription of proteins involved in energy stores generation | \nTranscription of proteins involved in energy stores release | \n
Metabolic functions of insulin.
When glucose concentration exceeds 30 mM in the small intestine, glucose transport to the inside of the pancreatic β cells is initiated in an insulin-independent way
Insulin release. Glucose is transported into β-cells via GLUT2 in an insulin-independent way with concentration gradient. Then, glucose is phosphorylated by glucokinase to glucose-6-phosphate, which allows for its inclusion to metabolic processes and ATP production. Raised ATP level triggers accumulation of K+ ions along with membrane depolarization. The latter activates Ca2+ channels, leading to increased concentration of Ca2+ ions inside the cell and consequent release of insulin from vesicles. For details see text.
Released insulin participates in many metabolic actions, such as glycogen deposition in liver and skeletal muscles, a stimulation of lipogenesis and inhibition of lipolysis, and repression of gluconeogenesis in liver, but mainly in increased glucose uptake through insulin receptor signaling pathway [6]. Signal transmission from the blood to the inside of the cell is a complicated and strongly integrated process. It begins with binding of the hormone to the insulin receptor (IR), eliciting the large protein signal complex formation just below the surface of the cell membrane around IR’s cytoplasmic domains (Figure 2) [7]. IRs are heterotetrameric glycoproteins containing two extracellular (α) and two intracellular (β) subunits. They occur mainly on the cell surface of metabolically active tissues like muscles, liver, and fat. The binding of insulin by extracellular subunits leads to IR dimerization, which allows ATP binding to β-subunits [8]. This causes the activation of the catalytic domains of tyrosine kinases in the cytoplasm [9]. In the first stage, there is an autophosphorylation of the receptor followed by phosphorylation of several substrate proteins, where IRS (insulin receptor substrate) proteins seem to be most significant ones. The phosphorylation occurs on tyrosine residues, and then, phosphorylated IRS proteins can trigger two major signaling pathways. First pathway leads from Ras to mitogen-activated kinases (MAPK), being involved in the expression regulation of genes playing a role in cell growth and differentiation. The second one, phosphatidylinositol 3 kinase (PI3K) pathway, elicits AKT/PKB kinase phosphorylation, and it is responsible for the metabolic action of insulin.
\nInsulin signaling pathway. Insulin attaches to insulin receptors triggering its dimerization and intracellular autophosphorylation of their tyrosine residues, which constitute an attachment for IRS proteins. These molecules also undergo phosphorylation and form a complex with PI3K utilizing SH2 domains. PI3K phosphorylates PIP2, which results in PIP3 formation and activation of PDK1/2. AKT gets phosphorylated and activated by PDK1/2, subsequently eliciting phosphorylation of AS160. The latter is responsible for GLUT4 translocation to cellular membrane and glucose inflow.
As shown in Figure 2, activation of PI3K/AKT pathway starts with binding of IRS proteins via SH2 domains to PI3 kinase regulatory subunits. This results in the activation of PI3K that phosphorylates phosphatidylinositol 4,5-biphosphate (PIP2) to phosphatidylinositol(3,4,5)-triphosphate (PIP3). This, in turn, leads to the activation of PIP3-dependent kinases: PDK-1 and PDK-2 and eventually to the activation of AKT/PKB kinase and atypical PKCs [10]. Subsequently, AKT catalyzes the phosphorylation of AS160 substrate protein that stimulates the translocation of GLUT glucose transporters from the cytoplasmic vesicles onto the cell membrane surface and thereby increases the insulin-dependent transport of glucose into the cell. GLUT4 occurs mainly in the interior of the nonstimulated cell, due to the proper proportion of two actions: slow exocytosis and rapid endocytosis. AS160 increases GLUT4 exocytosis and inhibition of its endocytosis via its downstream target, Rab10, in adipocytes. This results in GLUT4 accumulation in the plasma membrane [11]. Besides the activation of insulin-dependent glucose uptake via GLUT4, AKT has many intracellular targets and mediates numerous metabolic effects. For instance, AKT triggers phosphorylation of glycogen synthase kinase 3 (GSK3), which leads to stimulation of glycogen synthesis in liver and skeletal muscle [12].
\nThe PI3K/AKT pathway is under strict control, and its disturbances are the cause of many diseases, including primarily insulin resistance. Further knowledge of the mechanisms regulating this signaling is one of the most important challenges of modern science. Currently, three specific signaling nodes have been distinguished: (a) IRS proteins, (b) regulatory-PI3K kinase subunits, and (c) kinase isoform Akt/PKB [13]. Disturbances of any of these nodes are mainly responsible for the reduction of the signal transmission efficiency and related diseases.
\nIRS family consists of six proteins (IRS1–6), where two representatives, IRS1 and IRS2, are crucial in insulin signaling transduction. IRS proteins show tissue-specific expression and functionality [14]. They have three characteristic domains: (a) pleckstrin homology domain at N-terminus, (b) a phosphotyrosine-binding domain enabling binding to IR in the center, and (c) several sites of phosphorylation on tyrosine and serine residues at C-terminus. After tyrosine residues become phosphorylated, IRS binds by C-terminus domain to molecules containing an Src-homology-2 domain (SH2) [15]. IRS-1 and IRS-2 are widely expressed in all tissues, playing major roles in the maintenance of energy balance: muscle, liver, fat, and pancreatic islets. However, it seems that IRS1 plays the main role in myocytes and adipose tissue, while IRS2 is a key player in hepatocytes and islet cells [16, 17].
\nGenerally, there are three ways allowing the regulation of IRS (Figure 3). Crucial control occurs mainly by multiple serine and threonine residues, which may be phosphorylated by different kinases. The phosphorylation of serine residues may inhibit insulin signaling by blocking tyrosine phosphorylation, which is necessary for signal transduction. However, the details of this inhibitory mechanism are still not well understood. Indeed, there is a strong correlation among serine phosphorylation, decreased tyrosine phosphorylation, and insulin resistance, which is closely related to abnormalities within PI3K pathway. Most critical enzymes being able to phosphorylate IRS in serine residue are stress-induced kinases like ERK, JNK, and AMPK along with inflammatory kinase IKK and other downstream kinases, such as AKT, atypical PKC isoforms, mTOR, or S6K [18, 19]. Blockage of IRS causes the reduced cell response for stimulation with insulin and formation of insulin resistance, the first step toward diabetes. This inhibitory phosphorylation mostly occurs because of low-grade inflammation state, which is caused by lipid accumulation [20]. Studies on palmitate showed that it significantly decreased the insulin-stimulated Ser phosphorylation of Akt and Tyr phosphorylation of IRS-1 [21]. Some drugs exert similar effect. The prominent example is simvastatin, which is commonly used in the prevention and treatment of cardiovascular diseases. Simvastatin reduces the phosphorylation of insulin-induced IR at Tyr, IRS-1 at Tyr, and AKT at Thr [22, 23]. Therefore, therapy with simvastatin or other statins might be a risk factor for the development of insulin resistance or diabetes. This effect can be decreased by many natural substances like silibinin (principal flavonoid contained in silymarin, a mixture of flavonolignans extracted from
Overview of three major mechanisms affecting IRS-dependent signal transduction. Signaling via IR may be modulated simply by the decreased rate of IRS gene transcription. Second, proteins with PTB domains may compete with IRS for binding to phosphotyrosines of IR. Finally, IRS phosphorylation of serine residue is known to suppress phosphorylation of its tyrosine, which is indispensable for signal transduction.
IRS function can be also regulated by competitively inhibiting the binding of IR to IRS, primarily by proteins containing phosphotyrosine-binding (PTB) domain. One of them, NYGGF4, is highly expressed in obese individuals. Studies on skeletal myotubes showed the reduced insulin-induced phosphorylation of IRS1 at Tyr and Akt phosphorylation at Ser residue without changes in the insulin-stimulated tyrosine phosphorylation of IR [28, 29].
\nAmong other IRS modulatory mechanisms, it is worth mentioning about expression regulation of IRS mediated by hyperinsulinemia and other hormones [30]. Anjali et al. showed that FSH (follicle stimulating hormone) induces expression of IRS2 in granulosa cells [31]. Also, some natural medicines like Tangzhiqing formula, a mix of five herbs, modulate IRS expression level in HEPG2 cells (IR1 and IRS2) and L-6 myotubes (IRS1) [32].
\nPI3 kinases constitute protein family, which exhibits activity of phosphorylation of lipids and proteins. They are divided into three groups according to their structural features and substrate preferences (Table 2). Members of I class are the most crucial in insulin signaling pathway. PI3K-1 are heterodimers made up of regulatory and catalytic subunits. The regulatory subunit is generally referred to as p85. They all have a similar domain structure: SH3 domain, breakpoint cluster region homology (BH), and two SH2 domains with iSH2 (interSH2) domain in between [33]. Signaling is initiated by p85 interacting through the SH2 domain with IRS phosphotyrosine motif. Subsequently, p85 is joined through its iSH2 domain to the adapter binding domain (ABD) of catalytic subunit called p110. Besides ABD, p110 also contains Ras-binding domain (RBD), which is involved in interaction with Ras protein superfamily, C2 and the helical scaffolding domains, along with kinase domain participating in PIP3 formation [34].
\nClass | \nMembers | \nCatalytic subunit | \nRegulatory subunit | \nMain reaction | \nReference | \n
---|---|---|---|---|---|
Ia | \nPI3Kα PI3Kβ PI3Kδ | \np110 (α/β/δ) | \np85α, p55α, p50α, p85β, p55γ | \nPtdIns(4,5)P2 → PtdIns (3,4,5)P3 | \n[33] | \n
Ib | \nPI3Kγ | \np110γ | \np101 p84/87 | \nPtdIns(4,5)P2 → PtdIns (3,4,5)P3 | \n[33] | \n
II | \nPI3K-C2α PI3K-C2β PI3K-C2γ | \nMonomeric | \nPtdIns(4)P → PtdIns (3,4)P2 | \n[76] | \n|
III | \nPI3K-C3 | \nVps34 | \nVps15 | \nPtdIns → PtdIns (3)P3 | \n[77] | \n
Classification of PI3K family members.
p85 protects p110 from degradation by forming a heterodimer. Furthermore, this binding allows p110 translocation to the cell membrane, where catalytic subunit is able to send a signal via phosphorylation of PIP2 to PIP3, a lipid second messenger. Interestingly, p110α is the most prominent one from all PI3K catalytic subunits in insulin-dependent pathway [35]. Cells with its deletion exhibit hyperglycemia and glucose intolerance [36]. While p110β seems to play a secondary role, its presence is necessary for p110α activity and thus maintenance of basal threshold of PIP3 [37, 38]. PIP3 is bound by proteins with PH domain such as AKT and PDK1. This critical event allows further signal transduction to downstream proteins.
\nIn this control node, a few aspects are taken into account. Firstly, signaling via PI3K is critically dependent upon PI3K regulatory subunit with p85 mediating either its restriction or promotion. In cells deprived of upstream stimuli, p85 reduces p110 activity. It is executed through C2 and helical scaffolding domains, which form inhibitory contacts with p85. Furthermore, monomeric p85 binds to phosphorylated sites of IRS, thus blocking p85-p110 heterodimer attached to IRS [39]. p110, another essential regulatory molecule, undergoes spatial regulation in some types of human cancer. Studies on HepG2 cells demonstrated that PAQR3 (progestin and adipoQ receptor family member 3) associates with p110α by attracting it to Golgi apparatus, a place of PAQR3 exclusive localization. This event inhibits the interaction between p85a and p110α [40, 41].
\nThere are two other possible PI3K activation pathways, both being dependent on ligand-membrane receptor binding. The first mechanism is based on binding the adaptor protein GRB2 to RTK (receptor tyrosine kinase). When GRB2 is already attached to GAB protein, it is allowed to bind p85. By contrast, the second way of PI3K activation is not dependent on p85 subunit. In this scenario, GRB2 binds to SOS, which activates RAS, leading to activation of p110α subunit. In addition, the p110β catalytic subunit may be stimulated in a similar, p85-independent way via G protein-coupled receptors [42].
\nAnother critical regulatory mechanism is associated with the control of PIP3 level. There are several well-known inhibitors which dephosphorylate PIP3 with phosphatase and tensin homolog (PTEN) being the most well-known one. Undoubtedly, PTEN is an intriguing protein for research in the context of diseases with PI3K signaling impairment. For instance, in adipose tissue, it can be blocked by H2S or its precursor, l-cysteine. Diet supplementation of l-cysteine increases PIP3 level and mediates the activation of PI3K, resulting in improvement of glucose metabolism [43, 44]. Expression level of PTEN is also regulated epigenetically in adipocytes via several miRNAs such as miR-21, miR-23a-3p, miR-26a, miR-26b, and miR-181a-5p [45, 46, 47, 48, 49]. Another widely known PIP3 inhibitor is SHIP (SH2-containing inositol 5′-phosphatase). SHIP dephosphorylates PIP3 at 5′-inositol position (in contrast to PTEN targeting 3′-inositol position) and inhibits AKT primarily through regulation of its cellular localization [50].
\nLast but not least, PI3K dysregulation can be also underlain by gene mutations of p110α and p85 subunits or PI3K negative regulators. For instance, loss of function or deletion of PTEN is known to occur in numerous types of cancer. Therefore, enormous attempts are put into research focused on searching compounds targeting PI3K. The most common PI3K regulators are Wortmannin (steroid fungal metabolite) and LY294002 (morpholine-containing chemical compound) [51]. Moreover, there are multiple members of a new generation of more stable molecules such as SF-1126, CAL101, GSK615, XL147, and PF-4989216, which evoke the suppression of overactive PI3K signaling particularly in cancer [52].
\nAKT (also named PKB) occurs in mammals in three isoforms (AKT1, AKT2, and AKT3). Although they share a similar domain structure (N-terminal PH domain, a central kinase domain, and C-terminal domain), AKT isoforms exhibit target specificity and play divergent roles. AKT2 is the most essential in glucose uptake [53].
\nThe PH domain enables AKT to be attracted by PIP3 just as PDK1. After binding to PIP3, AKT undergoes conformational changes that allow revealing the phosphorylation site. While they are in nearby, PDK is able to phosphorylate AKT on Thr308. Nevertheless, for full activation of AKT (besides AKT3), second phosphorylation on Ser residue is necessary (AKT1-Ser473 and Ser-474 AKT2). Ser473 is modified by PDK-2/mTORC2 (mammalian target of rapamycin complex 2) [54]. AKT activation is terminated through the action of PP2 (protein phosphatase 2) and PHLPP (PH domain leucine rich repeat phosphatase), which perform dephosphorylation of Thr308 and Ser473, respectively [55].
\nWhile phosphorylation status of both of these sites is fundamental for AKT activity, there is plethora of other posttranslational modifications affecting its performance [56]. For instance, oxidation of Cys124 triggered by PDGF-induced (platelet-derived growth factor) ROS leads to the blockage of AKT2 activity [57]. Besides PI3K-dependent activation, AKT may be switched on by alternative modulators. Namely, two groups of uncommon AKT activators are distinguished: tyrosine kinases (e.g., ACK1, SRC, PTK6) and serine/threonine kinases (e.g., TBK1, IKBKE). ACK1, a non-receptor tyrosine kinase, is capable of regulating AKT recruitment to the plasma membrane due to AKT phosphorylation on Tyr176, making it preferentially binding to phosphatidic acid—a membrane phospholipid. This elicits AKT attachment to plasma membrane even in the presence of some specific PI3K inhibitors. The increase of AKT2 activity occurs in many cancers, which may be underlain by auto-activating mutations of ACK1. Another nonreceptor kinase involved in AKT regulation is Src. Its action takes place on Tyr315 and 326. By contrast, PTK6 responds to epidermal growth factor (EGF), whose overexpression is typical of many cancers, via phosphorylating Tyr215 and 326. Modifications triggered by Src and PTK6 are resistant to some popular PI3K inhibitors. The second group of AKT activators, Ser/Thr kinases, modifies Thr195, Ser378, and Ser473 (TBK1), as well as Ser137, Thr308, and Ser473 (IKBKE). These alternative activation modes may suggest that under some particular conditions, cells can turn on AKT signaling in quick response [58].
\nDue to the fact that AKT, just like PI3K, is one of the most commonly deregulated molecules in human cancers, AKT inhibitors development constitutes an important field of research. Currently tested molecules utilize two major mechanisms. First group acts as competitors for ATP-binding site of AKT (e.g., GSK690693, GDC-0068, GSK2110183, and GSK2141795). They share features of major pharmacophore with minor differences. The second group is composed of allosteric AKT inhibitors (e.g., 2,3-diphenylquinoxaline and analogs, alkylphospholipids). Many of these molecules are in clinical trial phase and have a potential in the treatment of AKT dysregulations [59].
\nThe relationship between environmental factors like diet, drugs, lifestyle in general, and PI3K pathway remains undeniable. Herein, we will discuss major agents responsible for PI3K modulation. In terms of mediated effect, they can be divided into two types: insulin sensitizing factors and insulin-resistance inducing factors. They do not usually affect a specific protein, but through their action, they dysregulate the entire pathway and the overall metabolism.
\nDue to the fact that insulin is one of the key regulators of metabolism, it is not surprising that the most important factor modulating its action is diet. Impairment of PI3K signaling is well known to be connected with obesity. Depending on the tissue, the mechanism of obesity-induced insulin resistance seems to differ, but it is in general connected with lipid overload. In liver and muscles, the most crucial is elevation of FFA level, which is characteristic for the obese. In consequence, toxic lipids, mainly ceramides and diacylglycerol (DAG), do accumulate. The increased amount of ceramides causes PP2A stimulation, which terminates insulin pathway via AKT dephosphorylation. On the other hand, DAG activates PKC isoforms (ε and θ) [60]. The latter ones are able to obstruct signaling either by IRS (muscles) or IR (liver). PKC isoforms activation leads to increased expression of NFκB (nuclear factor kappa-light-chain-enhancer of activated B cells), which takes part in inflammatory cell response. Subsequently, NFκB activates pro-inflammatory cytokines and stress-induced serine-threonine kinases like JNK, which are able to block insulin signaling pathway via improper IRS phosphorylation. Furthermore, the increasing concentration of lipids in the cells leads to the aggregation of toxic metabolites derived from the incomplete oxidation, and, as a result, the elevated synthesis of free radicals. This is also correlated with increased activation of stress-induced kinases. In overall, these events lead to PI3K pathway impairment and the emergence of insulin resistance [60, 61, 62].
\nThe mechanism of obesity-induced insulin resistance formation in adipose tissue is also related to lipid overload but has a different course. It is connected to the constant enlargement of adipocytes, which along with dysregulation of adipogenesis leads to the introduction of hypoxia. Reduced oxygen supply introduces cellular stress response, which includes activation of stress-induced kinases, pro-inflammatory cytokines, and tissue infiltration by pro-inflammatory macrophages. These events result in low-grade inflammation state characteristic of PI3K impairment. Adipose tissue is not only an energy reservoir but also an active endocrine organ, which produces hormones called adipocytokines. They are sensors of nutritional and metabolic homeostasis. Accumulation of visceral fat and inflammation development alters the secretary profile of adipocytokines. Adipocytes start to send pro-inflammatory signals like TNF-α and interleukin1 (IL1). Other typical insulin resistance-inducing cytokines are resistin and IL-6, which activate pro-inflammatory pathways of NFκB and JNK kinase, leading to defective response to insulin [63].
\nWhile prolonged high-calorie diet undeniably leads to insulin resistance, proper dietary style can be a sensitizing factor as well. There are many diet supplements improving insulin signaling. Herein, we will point out only a few members of this enormous group. For instance, glutamine (Gln) supplementation Gln increases the expression of key PI3K signaling molecules (PI3K, PDK1, and GLUT4) and promotes AKT phosphorylation, GLUT4 translocation, and glucose uptake in the presence of insulin during exposure to hyperglycemia [64]. An epidemic of obesity and numerous side effects of drugs that increase insulin sensitivity has caused the great interest among scientists to search for natural sensitizers. They include dieckol (an extract from a brown seaweed), which enhances translocation of GLUT4 in peripheral tissues [65]. Another seaweed improving glucose uptake is
Components of the diet are not the only ones able to improve the signaling via discussed pathway. Studies on rat model demonstrated that long-term caloric restriction may enhance AKT2-dependent mechanism for improving insulin-stimulated glucose uptake. Moreover, a lot of research has been carried out to indicate that physical exertion has a positive effect on insulin [70, 71, 72, 73].
\nPI3K pathway impairment is related to many diseases, among which the most common and worth attention are insulin resistance and numerous types of cancers.
\nInsulin resistance may be defined as a subnormal glucose response to endogenous and/or exogenous insulin. Peripheral tissues are not able to respond to the hormone by increasing glucose uptake from the bloodstream. Initially, pancreatic β-cells are not harmed yet, and in response to high glucose level, they synthesize more and more insulin. However, if this state lasts for a long time, islet cells start to overgrow, and deterioration of their function and/or decline of β-cell mass do occur. As normalization of glucose level does not occur, cells are becoming more and more resistant to insulin simultaneously forming a vicious circle of insulin resistance. The most affected tissues are the most metabolically active ones like liver, muscles, and fat. Although the pathogenesis of insulin resistance is getting better understood, the exact mechanism is still not clear. The causes may be connected to abnormal insulin production, but in most cases, the changes in insulin receptors and their substrates along with defects in post-receptor signaling play the role.
\nPI3K pathway is one of the most frequently deregulated signaling pathways in human cancers. As it plays an essential role in many biological processes like cell survival, proliferation, migration and differentiation, its dysregulation may result in tumorigenesis. The most common changes are mutations (
Insulin is the most crucial agent in glucose metabolism. It stimulates glucose uptake from the bloodstream to peripheral tissues. Furthermore, it is responsible for energy storage through accelerating glycogen synthesis and lipogenesis. In general, it promotes cellular events leading to energy storage and represses processes of energy release (Figure 4). Insulin action takes place mainly through PI3K pathway and results not only in metabolic effects but also in mitotic response. Insulin is also involved in phenomena connected with cell survival. Multitasking nature of this hormone causes that any abnormality in its signal transmission can result in serious consequences, such as diabetes and cancer. These two diseases are the scourge of the modern world. The steadily increasing percentage of people suffering from insulin resistance or full-blown diabetes and the high incidence of cancer have caused scientists to focus on seeking therapeutic goals that may contribute to the prevention or treatment of these disorders. In insulin-resistance, the main target constitutes the improvement of insulin sensitivity. Among common approaches, it is worth to highlight two of them: increasing fatty acids oxidation and elongation of IR activation state by blocking PTP1B activity. Promising therapeutic targets seem to be also pro-inflammatory cytokines and other proteins involved in inflammation response. On the other hand, cancer cells show mainly hyperactivity of PI3K pathway and the increased glucose uptake. Therefore, it seems that blockage of impaired signal transduction may contribute to suppression of the growth of the tumor. For this reason, intensive search for selective inhibitors or silencers of the insulin pathway are underway. Conducting further research may become the basis for the development of new methods of prevention and more effective treatment strategies for these diseases.
\nCritical actions and pathways controlled by insulin.
This paper was supported by a grant no. 503/2-159-01/503-21-002 from the Medical University of Lodz and by The Polish Society of Metabolic Disease.
\nThe authors declare that there is no conflict of interest regarding the publication of this paper.
ABD | adapter binding domain |
ACK-1 | activated CDC42 kinase 1 |
AKT (PKB) | protein kinase B |
AMPK | 5’AMP-activated protein kinase |
AS160 | Akt substrate of 160 kDa |
BH domain | breakpoint cluster region homology domain |
EGF | epidermal growth factor |
ERK | extracellular signal-regulated kinase |
FSH | follicle stimulating hormone |
FYGL | Fudan-Yueyang G. lucidum extract |
GAB | GRB2-associated binding protein |
GLUT1–4 | glucose transporter type 1–4 |
GSK3 | glycogen synthase kinase 3 |
GRB2 | growth factor receptor-bound protein 2 |
HEPG2 | human liver cancer cell line |
IKBKE | inhibitor of nuclear factor kappa-B kinase subunit epsilon |
IKK | IκB kinase |
IR | insulin receptor |
IRS | insulin receptor substrate |
JNK | c-Jun N-terminal kinase |
MAPK | mitogen-activated protein kinase |
mTOR | mammalian target of rapamycin kinase |
mTORC2 | mammalian target of rapamycin complex 2 |
NYGGF4 (PID1) | phosphotyrosine interaction domain-containing protein 1 |
PAQR3 | progestin and adipoQ receptor family member 3 |
PDGF | platelet-derived growth factor |
PDK1 | pyruvate dehydrogenase lipoamide kinase isozyme 1 |
PH domain | pleckstrin homology domain |
PHLPP | PH domain leucine rich repeat phosphatase |
PI3K | phosphatidylinositol-4,5-bisphosphate 3-kinase |
PIP2 | phosphatidylinositol 4,5-bisphosphate |
PIP3 | phosphatidylinositol (3,4,5)-trisphosphate |
PKC | protein kinase C |
PP2 | protein phosphatase 2 |
PTB domain | phosphotyrosine-binding domain |
PTB1 | polypyrimidine tract binding protein-1 |
PTEN | phosphatase and tensin homolog |
PTK6 | tyrosine-protein kinase 6 |
PTP1B | protein-tyrosine phosphatase 1B |
RBD | Ras-binding domain |
ROS | reactive oxygen species |
S6K | ribosomal S6 kinase |
SH2 domain | Src-homology-2 domain |
SHIP | SH2-containing inositol 5′-phosphatase |
SOS | son of sevenless, guanine nucleotide exchange factor |
SRC | proto-oncogene tyrosine-protein kinase Src |
TBK1 | TANK binding kinase 1 |
Evidence indicates that in the face of catastrophes, natural disasters and conflicts, social services and care workers are exposed to higher levels of demands [1]. Indeed, due to vicarious stress, which is developed from working with vulnerable populations, and from their own experience of the catastrophe, social service workers could develop higher stress levels, affecting their well-being and quality of life [2, 3].
In this way, regarding the coronavirus disease established as a pandemic in March 2020 [4], it is possible to project high levels of stress and affectation on the quality of life of social care workers. Indeed, care workers were strained worldwide as the health and social care systems were quickly overwhelmed by the virus’s rapid spread and the limited availability of effective treatments [5]. At the same time, social care workers, like any citizen, had to face the closure of entire cities, the limitations of displacement and the health crisis, generating an impact on their quality of life [6, 7].
Due to the effects of the pandemic on their lives and jobs, it is necessary to know the effect that the COVID-19 disease has had on the quality of life of care social service workers. While studies are available for similar populations such as health workers, the reality of care workers has not been addressed. On the other hand, although there are studies focusing on well-being and stress in the care workforce in times of COVID-19, there are no studies that research the impact of COVID-19 on the quality of life of these workers.
Studying this question is quite relevant, especially concerning the strategies to be developed to face post-traumatic stress, exhaustion, and vicarious stress that naturally follows situations of catastrophe or disasters [8]. In this sense, the information will allow practitioners to design strategies to cope with stress and promote the well-being and quality of life of those who work in the care industry. Likewise, this study collaborates with the generation of knowledge about the effect of the pandemic on the quality of life.
In this way, this study sought to analyze the effect of the COVID-19 pandemic on the quality of life of social care workers in Chile to guide social and care service managers to face the effect that COVID-19 has had on the well-being of social services workers.
Care is a fundamental activity for a society that affects the well-being of all and, in particular, of populations that require greater support. Although caregiving tasks represent a substantial physical and emotional burden for those who perform them, these responsibilities have not been recognized as a social need. They are usually carried out through the donation of time and energy by caregivers [9]. Likewise, people who provide care services have negative working conditions, with low salaries and limited recognition of the social value of such work [10].
Due to the disease generated by the SARS-CoV-2 virus, the precarious conditions associated with care work were even more stressed. The situations of stress, uncertainty, and permanent confinement [11] affected care workers who have faced more demanding confinement and isolation to take care of themselves and those they have to care for [12]. Hence, it is possible to assume that care workers have seen their well-being more affected by the pandemic than other populations for various reasons.
In the first place, the literature confirms that in conditions of regularity, those who care, especially women, have lower levels of well-being compared to different populations analyzed. It has been established that, compared to the general population, caregivers experience lower levels of self-reported health and psychological well-being while reporting a greater number of days with poor physical or mental health [13].
On the other hand, a second factor that allows understanding the decrease in caregivers’ well-being, especially women again, is the situation experienced by formal caregivers who perform domestic work. The evidence shows how there would be a relationship between being a caregiver and playing other social roles with having a lower level of well-being and satisfaction with life, especially when playing the role of head of household [14, 15]. This statement becomes especially relevant when we analyze that domestic task also became tense and increased due to the crisis of care generated due to the pandemic [16].
Thus, it is also possible to estimate higher levels of affectation on quality of life among caregivers based on their living conditions, such as family support, stress, frustration, and economic difficulties, which impact emotional difficulties and high levels of overload [17]. The negative effect of care work would not necessarily be given by care but is configured when other relevant factors appear, such as a high workload and not having the support of another person to perform these functions [18]. All factors have been emphasized during the socio-health crisis [11].
Finally, another way of entering to project the effect of COVID on the well-being of caregivers is by considering the relationship they establish with the people who receive care. This becomes especially relevant in caregivers who exercise their functions toward vulnerable populations, such as people with different types of disease, people with disabilities, and older people. For example, those who care for autistic children experience a deterioration due to the deterioration of daily skills of those who receive care, children’s emotional and behavioral difficulties, the population’s high educational level, and a low-income level of the population median [19]. In the same vein, caregivers who assist people who have suffered strokes present feelings of loss of life that once was, the daily workload, the creation of a new normal, and the interaction with health care providers [20].
In conclusion, evidence suggests that it is possible to project the effect of COVID-19 and the health crisis on carers’ well-being and quality of life. Now, to advance the understanding of the phenomenon, it is relevant to analyze the level of affectation of COVID-19 on the well-being of different populations.
Due to the effect of the COVID-19 pandemic on people’s routines globally and, therefore, on people’s quality of life, different studies were quickly carried out that allowed us to know and measure the impact of the disease on people’s lives. Although no measurements have been reported in people who care, different adult populations have been analyzed to understand a problem in full development.
A measure used globally to observe the effect of the pandemic on people’s well-being and quality of life has been the COV19-QoL scale [21], which measures the effect of the pandemic on people’s quality of life and was developed a few months after COVID-19 was declared a pandemic. Hence, the different results it has had in different populations worldwide are presented.
One of the first studies reported describes the application of the measure in Filipino teachers. It was found a significant difference in the impact of COVID-19 on the quality of life according to the degree program of the people, but not according to age, sex, marital status, employment status, monthly salary, presence of a case of COVID-19 near their residence, personal knowledge of someone who was infected or died of COVID-19, presence of a medical condition, and perceived threat [22].
On the other hand, a second study in the Philippines, but this time applied to nursing students, showed that the COVID-19 pandemic had a moderate impact on the quality of life of nursing students and that the effect varied significantly depending on sex and the close presence of COVID-19 cases. The study also revealed a significant moderate inverse relationship between psychological resilience and the impact of COVID-19 on quality of life [23].
The same scale was implemented in a study applied to populations from different parts of the world. In this case, Khodami and his colleagues [24] analyzed changes in quality of life and psychological changes due to the pandemic in 3002 people worldwide. The results showed that quality of life decreases significantly over time, perceived stress increases significantly, and the regulation of emotions is problematic.
To these cases is added the study of the impact on the quality of life in Saudi Arabia. In this country, Islam and Alharthi [25] examined the effects of the pandemic on the quality of life in 506 households in Saudi Arabia. The results show that the quality of life of households was significantly reduced due to the COVID-19. At the same time, negative quality of life was related to low-income households, large households, male-headed households, urban households, households with unemployed or low-educated heads, and households with the elderly.
A group of researchers in Singapore [26] sought to determine the impact of COVID-19 stress syndrome on quality of life and gratitude in Singapore. A sample of 199 people confirmed that fear of foreigners spreading SARS-CoV2 was the most stressful fear among Singaporeans, while traumatic stress from COVID-19 was the least stressful fear. Similarly, COVID-19 stress syndrome was positively correlated with negative quality of life and negatively correlated with gratitude.
The same scale used in the previous studies was used in mental health patients in Serbia. Considering a sample of 251 patients, the research led by Maric et al. [27] confirmed that the effect of the pandemic on quality of life was above the theoretical mean of a 5-point scale. On the other hand, no association was found between the total VOC19-QoL score, demographic characteristics, and patient diagnoses.
Finally, the study by Bolatov et al. [28] aimed to investigate the influence of psychological well-being and different study formats on the academic motivation of medical students during the pandemic. The study concluded that the effect of COVID-19 quality of life on academic motivation was minimal.
In conclusion, based on these various studies, it is possible to establish that the affectation of quality of life does not necessarily depend on some demographic aspect, but eventually on external effects such as the time of experience of pandemic and traumas and stress previously experienced.
Recognizing that the COVID-19 pandemic is a global phenomenon, it is necessary to recognize that the crisis is shaped in a particular way in different social, political, and economic contexts. Specifically, in the Chilean case, the same month in which the WHO declared COVID-19 as a pandemic, in March 2020, Chile reported its first case [29], and like other countries in South America, the cases began to rise rapidly.
However, in the case of Chile, the health crisis that has had political, social, and economic repercussions has occurred in parallel with a social, economic, and political crisis that became evident months before the appearance of the disease caused by the SARS CoV-2 virus.
On October 18, 2019, Chile witnessed a “social explosion.” This was characterized by massive marches in the country’s main cities that had as their center the historical, social demands associated with an unacceptable level of inequality in a context of neoliberal policies that marked individualism and the lack of social cohesion [30]. This search for social transformations was not without its difficulties. The large mobilizations were accompanied by the use of violence by demonstrators and the police [31], causing looting, fires, and the vandalization of emblematic sites and spaces [32], which in turn had an impact on the mental health of the population [31].
Thus, in October 2019, the country was immersed in the most relevant social and political crisis of the last 40 years, and months later, the Chile faced one of the most significant health crises in its history, which severely exacerbated the above in economic terms.
In this scenario, the demand for assistance for workers in the so-called psychosocial area had to face new scenarios and challenges in a context of precarious work [33]. Thus, these workers, not only in Chile, had consequences and implications for their mental health [34]. On the other hand, the neoliberal policies on social welfare implemented in Chile during the Pinochet dictatorship [35] have exposed the necessary coordination between chiefs and frontline workers, stressing the work with budget cuts, demands for results, and other matters in terms of efficiency [36]. In addition, the institutional support to have sufficient resources—internet for the home, adequate mobile phones, computers—for a quality social intervention were not present [33].
Demands in Chile for greater social care were characterized by increased poverty, overcrowding, and precarious settlements, leading to an increase in infections [33]. Individuals and families experienced fragility and uncertainty, and professionals in care industries inhabit the same contradictions: social distancing policies include mandatory quarantines, periods of isolation and fear of getting sick, suspension of productive activity or radical changes, loss of income, and fear of the future [37].
A quantitative observational study was developed for exploratory purposes to analyze the effect of COVID-19 on caregiver quality of life. Thus, a before-after research design was carried out. First, demographic and occupational characteristics were asked, and between 2 and 4 weeks later, the impact of COVID-19 on quality of life was collected.
The sample of this research corresponds to workers dependent on organizations that provide care services in Chile and pursue social purposes such as overcoming poverty, the inclusion of people with disabilities, and caring for vulnerable and excluded people. The detail of the sample and its participation rate is described in Table 1.
Organization | Number of workers contacted | Number of workers who finished the study | % |
---|---|---|---|
1 (NGO aimed at overcoming poverty in Chile) | 119 | 57 | 47.9% |
2 (NGO that provides free care to children and young people with Down syndrome) | 41 | 20 | 48.78% |
3 (NGO that seeks to expand opportunities for a better life for Chile’s poorest and most excluded) | 150 | 73 | 48.67% |
The study samples.
The sample considered 310 people who were accessed through the organization in which they worked, communicating in detail the study’s objective, its stages, the treatment of the information, its anonymity, and its confidentiality. The number of people who answered the two surveys was 150, equivalent to 48.39% of the sample.
The demographic and identity characteristics were collected in the first questionnaire sent to the sample. Information on gender, age, nationality, experience, school level, socioeconomic level, occupation, place of work, and modality of work during the last 6 months was requested.
To observe the effect of the pandemic on quality of life, the scale “Impact on Quality of Life” (COV19-QoL) developed by Repišti et al. [21] was used, which aims to capture the effect of COVID-19 on people’s quality of life and has been applied in different populations.
For application in a Spanish-speaking population, the questionnaire, composed of six statements, was translated into Spanish and then tested by three expert judges. The questionnaire in English and Spanish is in Table 2.
Due to the spread of the coronavirus | Debido al CORONAVIRUS, usted: |
---|---|
I think my quality of life is lower than before | Creo que mi calidad de vida es peor/baja que antes |
I think my mental health has deteriorated | Creo que mi salud mental se ha deteriorado |
I think my physical health may deteriorate | Creo que mi salud física se ha deteriorado |
I feel more tense than before | Me siento más tensa(o) que antes |
I feel more depressed than before | Me siento más deprimida(o) que antes |
I feel that my personal safety is at risk | Siento que mi seguridad personal está en riesgo |
English version and Spanish translation of the COV19-QoL scale.
The scale was applied through an online form. Thus, using a Likert scale, the statements were presented to the individuals, and they were asked to identify the level according to each sentence between 1 (strongly disagree) and 5 (strongly agree). The total score is the mean of the item scores, and the higher scores indicate a more severe impact of COVID-19 on QoL.
Reliability tests were applied through Cronbach’s alpha statistic, evidencing good reliability equivalent to 0.88.
Regarding the validity of the construct, a study was carried out considering a study of different populations of social organizations, among which was that of this sample, and a factor analysis test was applied considering the six items and 217 responses. The results are shown in Table 3 and allow to establish an adequate adjustment of the scale model.
Estimator | Result |
---|---|
RMSEA (Root Mean Square Error Of Approximation) | 0.083 |
CFI | 0.975 |
TLI | 0.959 |
SRMR | 0.09 |
COV19-QoL scale confirmatory factor analysis estimators.
The study contemplated the application of two online questionnaires. The first one collected demographic information, while the second one observed the impact of COVID-19 on quality of life 2 to 4 weeks later. Both were emailed to the participants. Compensation draws were committed to those who completed the study to ensure adherence to the study. Access to the sample was coordinated with the human resources office of each organization, ensuring that it did not intervene in the performance of its tasks.
The participants were informed about the study purpose, the content of the questionnaires, confidentiality, and their anonymous and voluntary participation. The form application began in June and ended in October 2021. Once the survey was closed, the database was created in the statistical software (SPSS), where the information was processed.
To meet the study’s objective, a descriptive statistical analysis was carried out to measure and characterize the level of affectation of COVID-19 on the sample. The responsible researchers carried out the analysis of the information. Additionally, the impact of COVID-19 on quality of life was explored about demographic variables identified by the specialized literature and that were self-reported by the participants, such as occupation, age, socioeconomic level, and race.
The first analysis sought to describe the sample based on demographic characteristics based on frequencies and summary statistics such as mean, median, and standard deviation.
Thus, Table 4 describes the sample as a feminized population, while women represent 72%. Regarding ethnicity, most people identify as mestizos. Only 30% define themselves as white people. The percentage of black people or mulattos is less than 1%. This is different about other studies focused on social services, where the distribution of people according to their race presents greater dispersion than the case presented [38].
Variables | n | % | Average (years) | Median (years) | Standard deviation (years) |
---|---|---|---|---|---|
Organización | |||||
1 | 57 | 38.0 | |||
2 | 20 | 13.3 | |||
3 | 73 | 48.7 | |||
Gender Women Men | 108 42 | 72 28 | |||
Ethnicity White Mestiza Indigenous Mulata Afro-American Other | 45 86 9 1 0 9 | 30 57.3 6 0.7 0 6 | |||
School Level Primary High School Technical Ed. Undergraduate Postgraduate | 0 8 16 68 58 | 0 5.3 10.7 45.3 38.7 | |||
Socioeconomic Level Low Middle High ND | 21 55 72 2 | 14 36.7 48 1.3 | |||
Age | 40.23 | 38 | 9.799 | ||
Tenure | 7.77 | 6 | 5.95 | ||
COV19-QoL | 2.94 | 3 | 0.95 |
Characteristics of the study sample.
Other relevant information regarding the sample is its high level of education, while 94.7% have higher education courses. Moreover, 38.5% have postgraduate studies that far exceed the national reality. 1
On the other hand, it is relevant to note that the people in the sample have a mean of 40.23 years old and 7.7 years of tenure, thus constituting a young population with average seniority higher than other studies in the same area. Finally, it is important to highlight the composition of the socioeconomic level of the sample since a large part of the people who participated in the study belongs to the middle and upper sections. Although this composition is different from that observed in the national population, it makes sense that people with a high level of schooling have a high average socioeconomic situation.
Finally, it should be noted that the sample presents a mean index of affectation of quality of life above the arithmetic mean of the scale. In addition, 50% of the sample has an index higher than 3, which can mean a high affectation.
After a description of the sample, bivariate analyses were performed to observe the relationship between demographic aspects that could be configured as antecedents of people’s quality of life.
Thus, we analyzed the average affectation of quality of life by COVID-19 according to organization, gender, ethnicity, work modality, school level, and socioeconomic level, identifying a relationship between affectation of quality of life according to the organization of those who responded, their age, level of schooling and socioeconomic level.
Based on these first results and regarding the objective of the study, we made contingency tables to evaluate the factors that show a relationship with the COV19-QoL index.
In the first place, we observed the age, as it presents a negative relationship with COV19-QoL, which in the framework of the sector and sample analyzed could be related to the care work that people could have, particularly women, younger, for this we categorize people in age ranges and gender. This analysis is presented in Table 5.
Age | |||||
---|---|---|---|---|---|
Gender | 18–24 years | 25–35 years | 36–45 years | 46–55 years | 55 < years |
Women | — | 3.20 | 2.82 | 2.70 | 2.55 |
Men | 2.67 | 3.44 | 2.94 | 2.58 | 2.58 |
COV19-QoL mean and age.
In fact, the group between 25 and 35 years old presents the highest levels of affectation, both in men and women, exceeding the average of the sample. Because one of the organizations has a higher percentage of men, we observe the same relationship according to the organization, and the trend is maintained, that is, considering the gender and organization of people, people between 25 and 35 years old are the most affected.
On the other hand, we were particularly struck by the relationship observed between the organization and COVID-19 affectation, which is detailed in Table 6, despite the differences in mission, they are similar in relation to the type of services they offer and the work they do. Because of the above, we reviewed the timing of the data collection, because the study was conducted at a time when the pandemic was active, therefore, the specific COVID-19 situation could affect the average affectation. In fact, the organization that had an average affectation of 3.34, the highest, participated in the study when the infection positivity rate was 12%, while the organization that had the lowest affectation value participated in the study when the positivity rate was also the lowest (1%).
Variables | n | Mean COV19-QoL | Standard deviation |
---|---|---|---|
Organización 1 2 3 | 57 20 73 | 3.34 3.04 2.6 | 0.12 0.21 0.1 |
Gender Women Men | 108 42 | 2.89 3.05 | 0.09 0.15 |
Ethnicity White Mestiza Indigenous Mulata Afro-American Other | 45 86 9 1 0 9 | 2.72 3.12 3.03 - - 2.05 | 0.11 0.10 0.36 - - 0.27 |
School Level Primary High School Technical Ed. Undergraduate Postgraduate | 0 8 16 68 58 | - 2.95 2.32 3 3.04 | - 0.31 0.12 0.12 0.12 |
Socioeconomic Level Low Middle High ND | 21 55 72 2 | - 2.5 3.01 3.03 | - 0.15 0.13 0.11 |
COV19-QoL and demographics variables.
Finally, we analyze the results associated with the socioeconomic level and the negative relationship to COV19-Qol. Given the low representation of the endpoint levels in the sample, we categorized the variable into three: low, medium, and high. According to this classification, it became clearer that the most affected were middle-class people, regardless of organization and gender, as presented in Table 7.
Socioeconomic level | ||||
---|---|---|---|---|
Organization | Gender | Low | Middle | High |
1 | Women | 2.63 | 3.23 | 3.38 |
Men | 4.00 | 3.38 | ||
2 | Women | 2.58 | 3.12 | 2.97 |
Men | 3.17 | 4.17 | 2.25 | |
3 | Women | 2.32 | 2.78 | 2.66 |
Men | 2.63 | 2.70 | 2.06 |
Cov19-QoL mean by organization, gender, and socioeconomic level.
However, considering this information and the results of the bivariate analyses, a bivariate correlation test was applied, obtaining the Pearson coefficient. The results are described in Table 8.
1 | 2 | 3 | 4 | |
---|---|---|---|---|
COV19- QoL | 1 | .174* | .340** | −.266** |
Socioeconomic Leve | 1 | 304** | -,175* | |
% COVID-19 Test Positive | 1 | −0.102 | ||
Age | 1 |
Correlations Cov19-QoL mean by organization, gender, and socioeconomic level.
According to the results of the correlations, it is possible to confirm a positive relationship between socioeconomic status and the affectation of quality of life. Therefore, people from the lower ranges of socioeconomic levels have lower average scores that show a lower affectation of COVID on quality of life. There is also a negative relationship between age and affectation, which means that older people have a lower level of affectation on quality of life. Finally, the direct relationship between test positivity and deterioration of quality of life was confirmed.
The quality of life of people who worked in care social services in Chile during the COVID-19 pandemic was affected by the pandemic. Our study confirmed that the sample obtained a COV19-QoL score higher than the arithmetic means, and almost half of them obtained high scores (>3). More specifically, our study confirmed that it was young people from middle socioeconomic levels were most affected by the pandemic in Chile.
With respect to age, the findings present that there is a greater impact of COVID on social service workers at a younger age. This makes sense given that younger people generally have less professional experience in dealing with complex situations in their work environment. In addition, it is expected that younger people have lower levels of training in the area, so they have fewer professional tools to cope with these situations, an issue that has been considered by the literature previously [39, 40]. It is also important to consider that young workers are more likely to be employed in occupations more affected by the pandemic, with a higher risk of losing their jobs or reducing their working hours [41]. The negative relationship between age and COV19-QoL could also be explained due to other care roles held by people between 25 and 35 years old, the age range most affected in the study. In this sense, age could be related to care functions within their home, assuming that workers in care industries, men and women, must face the difficulties of care in the organizations where they work and their homes.
Moreover, a positive and significant relationship is reported between the socioeconomic level of social service workers and a COVID affectation on quality of life. It could be considered that this socioeconomic level is related to professional profile and positions of high responsibility in care centers. Therefore, modifications in work routines, protocols, and other activities have gone through these workers, who have been called to lead the transformations in the workspaces [42], which could mean a higher level of stress and exhaustion.
In this way, it is expected that COVID represents an especially complex challenge for women, considering situations such as quarantine, and telematic classes, to point out some examples have generated that the boundaries between the workspace and the domestic space become blurred. This could be reflected in women between 25 and 35 years old cases, where a higher level of impact of the pandemic is observed. The results allow understanding the connection between two of the groups most exposed to experiencing complex situations at work; women with a high workload for care work outside the workplace and young people with a less academic or professional specialization.
The results of our study are consistent with previous results in other parts of the world since the effect of demographic factors on the impact of quality of life (gender, age, socioeconomic status, ethnicity, among others) is unclear. It seems that other demanding and stressful experiences are antecedents of the greater impact of the pandemic on the quality of life. In the case of the population analyzed, it seems that the demands of other roles or identities would affect how people live the pandemic.
Thus, these results are added to the fact that social services were affected by the absence of face-to-face, the incorporation of digital technologies, and the adaptation, on the fly, of work processes, in an environment of great uncertainty. Telematic work developed a favorable area to withdraw the labor rights achieved in salaried work, in terms of privacy, control of leisure and rest, conciliation of work and family life, and rights with a gender focus, among others [43]. Given the above, it is necessary to intervene in the working conditions in these organizations, recognizing the double experience of stress in their workplaces.
COVID-19 has transformed the lives of people around the world, and care social service workers are no exception. The pandemic changed their practices and routines at work, having to face a double challenge, that of the pandemic and that of caring for others during the pandemic.
Through our study, we were able to know that the levels of affectation in this population are high and that those who are most affected are the youngest people, who could be developing other care and parenting tasks in their own homes. Also, as noted in other studies, women are affected.
In addition to providing key information, our study allows us to have a tool in Spanish to evaluate the impact of COVID-19 on people’s lives and thus monitor the welfare status of people in a Spanish-speaking context.
While this research highlights the deterioration of the quality of life to which health care workers are exposed, its results should be observed with caution. First, the COVID-19 pandemic continues to be a developing phenomenon that continues to be researched and about which new things are constantly known.
Likewise, the study sample is limited to the unique context of social services in Chile, and they are not generalizable because of the context and because some attributes of caregivers in this type of service may have cultural roots [44]. In fact, the results may not be generalizable to other countries, as cultural norms are one of the key factors that can shape individual behavior [45]. Therefore, studies that test a similar model in an intercultural setting should be encouraged.
However, the scenario described is an urgent call to social work managers and leaders to promote the well-being and performance of care workers and to address post-traumatic stress and vicarious stress while populations served by the care workforce present significant mental health issues.
Therefore, it is proposed that those in leadership positions implement practices that address the problem described. In this way, the first step for managers should be to recognize the problem, while many times, the symptoms of stress are overlooked by teams, naturalizing the impact on quality of life. Once the different actors have recognized the problem, the provision of permanent personal and collective protective equipment must be guaranteed, and effective use must be ensured. In the same way, health in all its dimensions of caregivers should be monitored, breaks in their working day should be encouraged, and periodic instances of self-care and progress in individual or collective supervision should be provided.
By following some of these guidelines, we believe that social service will be a little stronger than what has happened in the last 2 years.
The authors declare no conflict of interest.
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\n\nWe have adopted the Protocol to increase the number of readers of our publications. All our Works are more widely accessible, with resulting benefits for scholars, researchers, students, libraries, universities and other academic institutions. Through this method of exposing metadata, IntechOpen enables citation indexes, scientific search engines, scholarly databases, and scientific literature collections to gather metadata from our repository and make our publications available to a broader academic audience.
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His studies in robotics lead him not only to a PhD degree but also inspired him to co-found and build the International Journal of Advanced Robotic Systems - world's first Open Access journal in the field of robotics.",institutionString:null,institution:{name:"TU Wien",country:{name:"Austria"}}},{id:"441",title:"Ph.D.",name:"Jaekyu",middleName:null,surname:"Park",slug:"jaekyu-park",fullName:"Jaekyu Park",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/441/images/1881_n.jpg",biography:null,institutionString:null,institution:{name:"LG Corporation (South Korea)",country:{name:"Korea, South"}}},{id:"465",title:"Dr",name:"Christian",middleName:null,surname:"Martens",slug:"christian-martens",fullName:"Christian Martens",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"479",title:"Dr.",name:"Valentina",middleName:null,surname:"Colla",slug:"valentina-colla",fullName:"Valentina Colla",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/479/images/358_n.jpg",biography:null,institutionString:null,institution:{name:"Sant'Anna School of Advanced Studies",country:{name:"Italy"}}},{id:"494",title:"PhD",name:"Loris",middleName:null,surname:"Nanni",slug:"loris-nanni",fullName:"Loris Nanni",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/494/images/system/494.jpg",biography:"Loris Nanni received his Master Degree cum laude on June-2002 from the University of Bologna, and the April 26th 2006 he received his Ph.D. in Computer Engineering at DEIS, University of Bologna. On September, 29th 2006 he has won a post PhD fellowship from the university of Bologna (from October 2006 to October 2008), at the competitive examination he was ranked first in the industrial engineering area. He extensively served as referee for several international journals. He is author/coauthor of more than 100 research papers. He has been involved in some projects supported by MURST and European Community. His research interests include pattern recognition, bioinformatics, and biometric systems (fingerprint classification and recognition, signature verification, face recognition).",institutionString:null,institution:null},{id:"496",title:"Dr.",name:"Carlos",middleName:null,surname:"Leon",slug:"carlos-leon",fullName:"Carlos Leon",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Seville",country:{name:"Spain"}}},{id:"512",title:"Dr.",name:"Dayang",middleName:null,surname:"Jawawi",slug:"dayang-jawawi",fullName:"Dayang Jawawi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Technology Malaysia",country:{name:"Malaysia"}}},{id:"528",title:"Dr.",name:"Kresimir",middleName:null,surname:"Delac",slug:"kresimir-delac",fullName:"Kresimir Delac",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/528/images/system/528.jpg",biography:"K. Delac received his B.Sc.E.E. degree in 2003 and is currentlypursuing a Ph.D. degree at the University of Zagreb, Faculty of Electrical Engineering andComputing. His current research interests are digital image analysis, pattern recognition andbiometrics.",institutionString:null,institution:{name:"University of Zagreb",country:{name:"Croatia"}}},{id:"557",title:"Dr.",name:"Andon",middleName:"Venelinov",surname:"Topalov",slug:"andon-topalov",fullName:"Andon Topalov",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/557/images/1927_n.jpg",biography:"Dr. Andon V. Topalov received the MSc degree in Control Engineering from the Faculty of Information Systems, Technologies, and Automation at Moscow State University of Civil Engineering (MGGU) in 1979. He then received his PhD degree in Control Engineering from the Department of Automation and Remote Control at Moscow State Mining University (MGSU), Moscow, in 1984. From 1985 to 1986, he was a Research Fellow in the Research Institute for Electronic Equipment, ZZU AD, Plovdiv, Bulgaria. In 1986, he joined the Department of Control Systems, Technical University of Sofia at the Plovdiv campus, where he is presently a Full Professor. He has held long-term visiting Professor/Scholar positions at various institutions in South Korea, Turkey, Mexico, Greece, Belgium, UK, and Germany. And he has coauthored one book and authored or coauthored more than 80 research papers in conference proceedings and journals. His current research interests are in the fields of intelligent control and robotics.",institutionString:null,institution:{name:"Technical University of Sofia",country:{name:"Bulgaria"}}},{id:"585",title:"Prof.",name:"Munir",middleName:null,surname:"Merdan",slug:"munir-merdan",fullName:"Munir Merdan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/585/images/system/585.jpg",biography:"Munir Merdan received the M.Sc. degree in mechanical engineering from the Technical University of Sarajevo, Bosnia and Herzegovina, in 2001, and the Ph.D. degree in electrical engineering from the Vienna University of Technology, Vienna, Austria, in 2009.Since 2005, he has been at the Automation and Control Institute, Vienna University of Technology, where he is currently a Senior Researcher. His research interests include the application of agent technology for achieving agile control in the manufacturing environment.",institutionString:null,institution:null},{id:"605",title:"Prof",name:"Dil",middleName:null,surname:"Hussain",slug:"dil-hussain",fullName:"Dil Hussain",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/605/images/system/605.jpg",biography:"Dr. Dil Muhammad Akbar Hussain is a professor of Electronics Engineering & Computer Science at the Department of Energy Technology, Aalborg University Denmark. Professor Akbar has a Master degree in Digital Electronics from Govt. College University, Lahore Pakistan and a P-hD degree in Control Engineering from the School of Engineering and Applied Sciences, University of Sussex United Kingdom. Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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Very young children are regular users of smartphones and tablet, so their early digital engagement poses new challenges to parent-child relationships and parental role. First, the chapter introduces the “digital parenting” construct, moving through the literature from “traditional” parenting styles to more recent studies on “parental mediation,” that is, the different behaviors parents adopt to regulate children’s engagement with the Internet and digital media. Second, the chapter reviews empirical researches on different parental mediation practices (active or restrictive behaviors) and how they are adjusted according to the child’s characteristics (age, digital competences, etc.) or parent’s media competence and beliefs. Finally, from a bidirectional perspective of parent-child relationships, the chapter discusses the role of youths’ social involvement, communication, self-disclosure, and digital skills on parent’s beliefs and practices. 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A particular parenting style influences all phases of development and life style of adolescent. Helicopter parents overly protect their children from the difficulties by setting some set of instructions without consideration of the uniqueness of their children. Recent literature has got huge attention on this parenting style and debating the pros and cons on the development of child. Higher life satisfaction and better psychological wellbeing have been found in the children of highly intrusive parents. When there are positive effects of helicopter parenting, there are negative outcome and impacts that have also been studied. The difficulties in emotional regulation, academic productivity, and social skills among children raised by helicopter parenting have been reported in the literature. Low self-efficacy, lack of trust on peers, and alienation from peers have also been associated with helicopter parenting. The chapter highlights the associated aspects of childhood and adolescence, raised by helicopter parenting. As parents have their own concern about raising their children in certain manner, it is important to understand the underlying mechanism of parenting style. Therefore, this chapter also describes the theoretical framework. The associated mental health issues and supportive psychological intervention to be also discussed.",book:{id:"9043",slug:"parenting-studies-by-an-ecocultural-and-transactional-perspective",title:"Parenting",fullTitle:"Parenting - Studies by an Ecocultural and Transactional Perspective"},signatures:"Deepika Srivastav and M.N. 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He also obtained an MSc in Molecular and Genetic Medicine, and a Ph.D. in Clinical Immunology and Human Genetics from the University of Sheffield, UK. He also completed a short-term fellowship in Pediatric Clinical Immunology and Bone Marrow Transplantation at Newcastle General Hospital, England. Dr. Rezaei is a Full Professor of Immunology and Vice Dean of International Affairs and Research, at the School of Medicine, Tehran University of Medical Sciences, and the co-founder and head of the Research Center for Immunodeficiencies. He is also the founding president of the Universal Scientific Education and Research Network (USERN). Dr. Rezaei has directed more than 100 research projects and has designed and participated in several international collaborative projects. He is an editor, editorial assistant, or editorial board member of more than forty international journals. He has edited more than 50 international books, presented more than 500 lectures/posters in congresses/meetings, and published more than 1,100 scientific papers in international journals.",institutionString:"Tehran University of Medical Sciences",institution:{name:"Tehran University of Medical Sciences",country:{name:"Iran"}}},{id:"180733",title:"Dr.",name:"Jean",middleName:null,surname:"Engohang-Ndong",slug:"jean-engohang-ndong",fullName:"Jean Engohang-Ndong",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180733/images/system/180733.png",biography:"Dr. Jean Engohang-Ndong was born and raised in Gabon. After obtaining his Associate Degree of Science at the University of Science and Technology of Masuku, Gabon, he continued his education in France where he obtained his BS, MS, and Ph.D. in Medical Microbiology. He worked as a post-doctoral fellow at the Public Health Research Institute (PHRI), Newark, NJ for four years before accepting a three-year faculty position at Brigham Young University-Hawaii. Dr. Engohang-Ndong is a tenured faculty member with the academic rank of Full Professor at Kent State University, Ohio, where he teaches a wide range of biological science courses and pursues his research in medical and environmental microbiology. Recently, he expanded his research interest to epidemiology and biostatistics of chronic diseases in Gabon.",institutionString:"Kent State University",institution:{name:"Kent State University",country:{name:"United States of America"}}},{id:"188773",title:"Prof.",name:"Emmanuel",middleName:null,surname:"Drouet",slug:"emmanuel-drouet",fullName:"Emmanuel Drouet",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/188773/images/system/188773.png",biography:"Emmanuel Drouet, PharmD, is a Professor of Virology at the Faculty of Pharmacy, the University Grenoble-Alpes, France. As a head scientist at the Institute of Structural Biology in Grenoble, Dr. Drouet’s research investigates persisting viruses in humans (RNA and DNA viruses) and the balance with our host immune system. He focuses on these viruses’ effects on humans (both their impact on pathology and their symbiotic relationships in humans). He has an excellent track record in the herpesvirus field, and his group is engaged in clinical research in the field of Epstein-Barr virus diseases. He is the editor of the online Encyclopedia of Environment and he coordinates the Universal Health Coverage education program for the BioHealth Computing Schools of the European Institute of Science.",institutionString:null,institution:{name:"Grenoble Alpes University",country:{name:"France"}}},{id:"131400",title:"Prof.",name:"Alfonso J.",middleName:null,surname:"Rodriguez-Morales",slug:"alfonso-j.-rodriguez-morales",fullName:"Alfonso J. Rodriguez-Morales",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/131400/images/system/131400.png",biography:"Dr. Rodriguez-Morales is an expert in tropical and emerging diseases, particularly zoonotic and vector-borne diseases (especially arboviral diseases). He is the president of the Travel Medicine Committee of the Pan-American Infectious Diseases Association (API), as well as the president of the Colombian Association of Infectious Diseases (ACIN). He is a member of the Committee on Tropical Medicine, Zoonoses, and Travel Medicine of ACIN. He is a vice-president of the Latin American Society for Travel Medicine (SLAMVI) and a Member of the Council of the International Society for Infectious Diseases (ISID). Since 2014, he has been recognized as a Senior Researcher, at the Ministry of Science of Colombia. He is a professor at the Faculty of Medicine of the Fundacion Universitaria Autonoma de las Americas, in Pereira, Risaralda, Colombia. He is an External Professor, Master in Research on Tropical Medicine and International Health, Universitat de Barcelona, Spain. He is also a professor at the Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru. In 2021 he has been awarded the “Raul Isturiz Award” Medal of the API. Also, in 2021, he was awarded with the “Jose Felix Patiño” Asclepius Staff Medal of the Colombian Medical College, due to his scientific contributions to COVID-19 during the pandemic. He is currently the Editor in Chief of the journal Travel Medicine and Infectious Diseases. His Scopus H index is 47 (Google Scholar H index, 68).",institutionString:"Institución Universitaria Visión de las Américas, Colombia",institution:null},{id:"332819",title:"Dr.",name:"Chukwudi Michael",middleName:"Michael",surname:"Egbuche",slug:"chukwudi-michael-egbuche",fullName:"Chukwudi Michael Egbuche",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/332819/images/14624_n.jpg",biography:"I an Dr. Chukwudi Michael Egbuche. I am a Senior Lecturer in the Department of Parasitology and Entomology, Nnamdi Azikiwe University, Awka.",institutionString:null,institution:{name:"Nnamdi Azikiwe University",country:{name:"Nigeria"}}},{id:"284232",title:"Mr.",name:"Nikunj",middleName:"U",surname:"Tandel",slug:"nikunj-tandel",fullName:"Nikunj Tandel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284232/images/8275_n.jpg",biography:'Mr. Nikunj Tandel has completed his Master\'s degree in Biotechnology from VIT University, India in the year of 2012. He is having 8 years of research experience especially in the field of malaria epidemiology, immunology, and nanoparticle-based drug delivery system against the infectious diseases, autoimmune disorders and cancer. He has worked for the NIH funded-International Center of Excellence in Malaria Research project "Center for the study of complex malaria in India (CSCMi)" in collaboration with New York University. The preliminary objectives of the study are to understand and develop the evidence-based tools and interventions for the control and prevention of malaria in different sites of the INDIA. Alongside, with the help of next-generation genomics study, the team has studied the antimalarial drug resistance in India. Further, he has extended his research in the development of Humanized mice for the study of liver-stage malaria and identification of molecular marker(s) for the Artemisinin resistance. At present, his research focuses on understanding the role of B cells in the activation of CD8+ T cells in malaria. Received the CSIR-SRF (Senior Research Fellow) award-2018, FIMSA (Federation of Immunological Societies of Asia-Oceania) Travel Bursary award to attend the IUIS-IIS-FIMSA Immunology course-2019',institutionString:"Nirma University",institution:{name:"Nirma University",country:{name:"India"}}},{id:"334383",title:"Ph.D.",name:"Simone",middleName:"Ulrich",surname:"Ulrich Picoli",slug:"simone-ulrich-picoli",fullName:"Simone Ulrich Picoli",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334383/images/15919_n.jpg",biography:"Graduated in Pharmacy from Universidade Luterana do Brasil (1999), Master in Agricultural and Environmental Microbiology from Federal University of Rio Grande do Sul (2002), Specialization in Clinical Microbiology from Universidade de São Paulo, USP (2007) and PhD in Sciences in Gastroenterology and Hepatology (2012). She is currently an Adjunct Professor at Feevale University in Medicine and Biomedicine courses and a permanent professor of the Academic Master\\'s Degree in Virology. She has experience in the field of Microbiology, with an emphasis on Bacteriology, working mainly on the following topics: bacteriophages, bacterial resistance, clinical microbiology and food microbiology.",institutionString:null,institution:{name:"Universidade Feevale",country:{name:"Brazil"}}},{id:"229220",title:"Dr.",name:"Amjad",middleName:"Islam",surname:"Aqib",slug:"amjad-aqib",fullName:"Amjad Aqib",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229220/images/system/229220.png",biography:"Dr. Amjad Islam Aqib obtained a DVM and MSc (Hons) from University of Agriculture Faisalabad (UAF), Pakistan, and a PhD from the University of Veterinary and Animal Sciences Lahore, Pakistan. Dr. Aqib joined the Department of Clinical Medicine and Surgery at UAF for one year as an assistant professor where he developed a research laboratory designated for pathogenic bacteria. Since 2018, he has been Assistant Professor/Officer in-charge, Department of Medicine, Manager Research Operations and Development-ORIC, and President One Health Club at Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. He has nearly 100 publications to his credit. His research interests include epidemiological patterns and molecular analysis of antimicrobial resistance and modulation and vaccine development against animal pathogens of public health concern.",institutionString:"Cholistan University of Veterinary and Animal Sciences",institution:null},{id:"62900",title:"Prof.",name:"Fethi",middleName:null,surname:"Derbel",slug:"fethi-derbel",fullName:"Fethi Derbel",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/62900/images/system/62900.jpeg",biography:"Professor Fethi Derbel was born in 1960 in Tunisia. He received his medical degree from the Sousse Faculty of Medicine at Sousse, University of Sousse, Tunisia. He completed his surgical residency in General Surgery at the University Hospital Farhat Hached of Sousse and was a member of the Unit of Liver Transplantation in the University of Rennes, France. He then worked in the Department of Surgery at the Sahloul University Hospital in Sousse. Professor Derbel is presently working at the Clinique les Oliviers, Sousse, Tunisia. His hospital activities are mostly concerned with laparoscopic, colorectal, pancreatic, hepatobiliary, and gastric surgery. He is also very interested in hernia surgery and performs ventral hernia repairs and inguinal hernia repairs. He has been a member of the GREPA and Tunisian Hernia Society (THS). During his residency, he managed patients suffering from diabetic foot, and he was very interested in this pathology. For this reason, he decided to coordinate a book project dealing with the diabetic foot. Professor Derbel has published many articles in journals and collaborates intensively with IntechOpen Access Publisher as an editor.",institutionString:"Clinique les Oliviers",institution:null},{id:"300144",title:"Dr.",name:"Meriem",middleName:null,surname:"Braiki",slug:"meriem-braiki",fullName:"Meriem Braiki",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/300144/images/system/300144.jpg",biography:"Dr. Meriem Braiki is a specialist in pediatric surgeon from Tunisia. She was born in 1985. She received her medical degree from the University of Medicine at Sousse, Tunisia. She achieved her surgical residency training periods in Pediatric Surgery departments at University Hospitals in Monastir, Tunis and France.\r\nShe is currently working at the Pediatric surgery department, Sidi Bouzid Hospital, Tunisia. Her hospital activities are mostly concerned with laparoscopic, parietal, urological and digestive surgery. She has published several articles in diffrent journals.",institutionString:"Sidi Bouzid Regional Hospital",institution:null},{id:"229481",title:"Dr.",name:"Erika M.",middleName:"Martins",surname:"de Carvalho",slug:"erika-m.-de-carvalho",fullName:"Erika M. de Carvalho",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/229481/images/6397_n.jpg",biography:null,institutionString:null,institution:{name:"Oswaldo Cruz Foundation",country:{name:"Brazil"}}},{id:"186537",title:"Prof.",name:"Tonay",middleName:null,surname:"Inceboz",slug:"tonay-inceboz",fullName:"Tonay Inceboz",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/186537/images/system/186537.jfif",biography:"I was graduated from Ege University of Medical Faculty (Turkey) in 1988 and completed his Med. PhD degree in Medical Parasitology at the same university. I became an Associate Professor in 2008 and Professor in 2014. I am currently working as a Professor at the Department of Medical Parasitology at Dokuz Eylul University, Izmir, Turkey.\n\nI have given many lectures, presentations in different academic meetings. I have more than 60 articles in peer-reviewed journals, 18 book chapters, 1 book editorship.\n\nMy research interests are Echinococcus granulosus, Echinococcus multilocularis (diagnosis, life cycle, in vitro and in vivo cultivation), and Trichomonas vaginalis (diagnosis, PCR, and in vitro cultivation).",institutionString:"Dokuz Eylül University",institution:{name:"Dokuz Eylül University",country:{name:"Turkey"}}},{id:"71812",title:"Prof.",name:"Hanem Fathy",middleName:"Fathy",surname:"Khater",slug:"hanem-fathy-khater",fullName:"Hanem Fathy Khater",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/71812/images/1167_n.jpg",biography:"Prof. Khater is a Professor of Parasitology at Benha University, Egypt. She studied for her doctoral degree, at the Department of Entomology, College of Agriculture, Food and Natural Resources, University of Missouri, Columbia, USA. She has completed her Ph.D. degrees in Parasitology in Egypt, from where she got the award for “the best scientific Ph.D. dissertation”. She worked at the School of Biological Sciences, Bristol, England, the UK in controlling insects of medical and veterinary importance as a grant from Newton Mosharafa, the British Council. Her research is focused on searching of pesticides against mosquitoes, house flies, lice, green bottle fly, camel nasal botfly, soft and hard ticks, mites, and the diamondback moth as well as control of several parasites using safe and natural materials to avoid drug resistances and environmental contamination.",institutionString:null,institution:{name:"Banha University",country:{name:"Egypt"}}},{id:"99780",title:"Prof.",name:"Omolade",middleName:"Olayinka",surname:"Okwa",slug:"omolade-okwa",fullName:"Omolade Okwa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/99780/images/system/99780.jpg",biography:"Omolade Olayinka Okwa is presently a Professor of Parasitology at Lagos State University, Nigeria. She has a PhD in Parasitology (1997), an MSc in Cellular Parasitology (1992), and a BSc (Hons) Zoology (1990) all from the University of Ibadan, Nigeria. She teaches parasitology at the undergraduate and postgraduate levels. She was a recipient of a Commonwealth fellowship supported by British Council tenable at the Centre for Entomology and Parasitology (CAEP), Keele University, United Kingdom between 2004 and 2005. She was awarded an Honorary Visiting Research Fellow at the same university from 2005 to 2007. \nShe has been an external examiner to the Department of Veterinary Microbiology and Parasitology, University of Ibadan, MSc programme between 2010 and 2012. She is a member of the Nigerian Society of Experimental Biology (NISEB), Parasitology and Public Health Society of Nigeria (PPSN), Science Association of Nigeria (SAN), Zoological Society of Nigeria (ZSN), and is Vice Chairperson of the Organisation of Women in Science (OWSG), LASU chapter. She served as Head of Department of Zoology and Environmental Biology, Lagos State University from 2007 to 2010 and 2014 to 2016. 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