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Background: The use of e‐exams in higher education is increasing. However, the role of student diversity in the acceptance of e‐exams is an under‐researched topic. In the current study, we considered student diversity in terms of three sociodemographic characteristics (age, gender, and second language) and three dispositional student characteristics (computer anxiety, test anxiety, and technology openness). Objectives: The main objective of this study was to investigate the relationship between student diversity and acceptance of e‐exams. Methods: Our research combined cross‐sectional analyses (N = 1639) with data from a natural experiment on the introduction of e‐exams versus the established paper‐pencil exams (N = 626) and used both self‐report and institutional data. Sociodemographic and dispositional characteristics were indirectly related to pre‐exam acceptance via expectancy variables from the Technology Acceptance Model framework. Results and Conclusions: Comparisons of post‐exam acceptance showed that practical experience with the e‐exam led to a significant increase in e‐exam acceptance, and that students with low openness toward technology particularly benefited from this effect. Students' exam performance (i.e., grades) was unrelated to the exam format or their pre‐exam acceptance of the e‐exam format, and this was true across students' sociodemographic and dispositional characteristics. Takeaway: Student diversity plays a role in e‐exam acceptance, but its influence is mitigated by first‐hand experience with e‐exams. The practical implications for higher education institutions aiming to implement e‐exams are discussed. Lay Description: What is already known about this topic: The use of e‐exams in higher education is increasingThe role of student diversity for e‐exam acceptance is unclearTechnology acceptance is predicted by expectancies towards new system What this paper adds: We investigated students' sociodemographic and dispositional diversityDiversity predicted e‐exam acceptance via the expectanciesIn a natural experiment, first‐hand experience increased e‐exam acceptanceNo difference between performance in e‐exams and paper‐pencil‐exams found Implications of the study findings for practitioners: Higher education institutions implementing e‐exams should consider diversitySupport for older students and students with low technology openness neededNo student groups systematically disadvantaged by e‐exam implementationPractice rooms can increase experience with new system before exam [ABSTRACT FROM AUTHOR]

Background: Mindfulness practices enhance executive function skills and academic achievement, spurring interest in integrating mindfulness interventions into education. Embedding mindfulness practice into a digital math game may provide a low‐cost, scalable way to induce mindfulness and boost game‐based learning, yet this approach remains unexplored. Objectives: We investigated the learning benefits of integrating mindfulness exercises in a digital math learning game and examined how students' trait mindfulness might moderate the outcomes. Methods: Two classroom studies were conducted with 404 5th and 6th grade students from six public schools in the U.S. (nStudy 1 = 227, nStudy 2 = 177). The two randomized controlled experiments assigned students to one of the three conditions: passive control (playing the digital learning game Decimal Point), story‐enriched active control, or mindfulness‐enriched condition. Trait mindfulness, learning gains, and in‐game problem‐solving (including problem‐solving duration, error count and correctness after reminder) were assessed. Study 2 included a manipulation check to better understand the effects of the mindfulness intervention. Results: Findings showed no significant differences in learning gains, problem‐solving duration or error count among the conditions. Students' trait mindfulness did not moderate these outcomes. Mindfulness reminders in the mindfulness‐enriched game led to more correct answers after errors than jokes in the story‐enriched game. Study 2 revealed that we failed to induce higher state mindfulness through the mindfulness inductions. Conclusions: Mindfulness prompts could be especially beneficial for students experiencing frustration during gameplay, warranting more exploration for digital game‐based instruction. We highlight barriers and future directions for fostering mindfulness through computer‐based instruction in classrooms. Lay Description: What is currently known about this topic?: Researchers focus on digital games as productive learning environments for math, with potential for higher learning gains compared with traditional methods. However, results are mixed, and not all games lead to improved math outcomes.Executive function (EF) skills are crucial for math learning, and mindfulness‐based interventions show promise in enhancing EF skills in school‐aged students.Embedding mindfulness practice into a digital math game may provide a low‐cost, scalable way to induce mindfulness and, in turn, boost EF skills and game‐based learning, yet this approach remains unexplored What does this paper add?: This paper presents the results of two randomized control trials investigating the feasibility and benefits of incorporating mindfulness exercises into a digital math game designed for middle school students. Benefits are compared to those of a story‐enriched and regular version of the same digital math learning game.The paper also explores variations in the effects of the mindfulness‐enriched game based on students' initial trait mindfulness levels.We observe that listening to mindfulness inductions at the beginning of game sessions do not induce mindfulness, and therefore does not benefit math learning.We find that mindfulness prompts received after recurrent errors can be beneficial for students' problem solving. Implications of study findings for practitioners: Our study provides important information on how digital learning game designers should attempt to induce mindfulness in a digital game to promote learning.Digital learning game designers should consider incorporating mindfulness exercises into their games strategically. Presenting mindfulness inductions in audio format at the beginning of game sessions may not induce mindfulness or benefit math learning. Instead, designers should focus on integrating mindfulness prompts at moments when students encounter frustration within the learning game.Beyond embedding audio mindfulness exercises in the game, learning designers should also consider alternative technological and game features to induce mindfulness within a learning game. [ABSTRACT FROM AUTHOR]

Background Studies: Captioning and repetition are widely used multimedia instructional devices for non‐native students. Generally, studies in this area have tended to focus on second language literacy skills rather than on learning new content knowledge. Additionally, posttests were administered immediately after the treatments, while the delayed influences of captioning and repetition have never been investigated. Objectives: This paper addressed these research gaps in two separate studies. More specifically, this study attempted to examine the influences of captioning and repetition on non‐native students' immediate and relayed retention. Methods: In Study One, three captioning conditions; word‐by‐word captions, closed captions, and no‐captions; were compared to examine their efficacies in immediate and delayed content knowledge retention on 82 Chinese university students. To address the limitations in Study One as the multimedia lesson was short and played only once, Study Two incorporated captioning and two repetition types in its design. One hundred and eleven Chinese university students watch a video lesson in one of four captioning and repetition conditions. Results: The statistical analyses of Study One indicated that there were no significant differences in both immediate and delayed retention test scores across the three captioning condition. Similarly, in Study Two, there were no significant differences in retention tests scores across the four captioning and repetition conditions. Findings: Neither the availability of captions nor the repetition types had any impact on the Chinese students' immediate or delayed content knowledge retention, which lent support to existing studies. Based on the research results, the limitations and future study possibilities are discussed. Lay Description: What Is Already Known About This TopicEmpirical studies on captioning have focused on immediate learning right after the treatment, so have studies on repetition.Empirical studies on multimedia lessons for non‐native students have focused on English language learning. What This Paper AddsThree types of captioning were compared to examine their efficacies in both immediate and delayed content retention of Chinese students.Two types of repetition were compared to examine their efficacies in both immediate and delayed content retention of Chinese students. Implications for Practice and/or Policy:Neither the availability of captions nor the repetition types had any impact on the Chinese students' immediate or delayed content knowledge retention.The availability of textual keywords adjacent to their corresponding graphics might have compromised the efficacy of captioning. [ABSTRACT FROM AUTHOR]

Background: Speech–language pathologists often multitask in order to be efficient with their commonly large caseloads. In stuttering assessment, multitasking often involves collecting multiple measures simultaneously. Aims: The present study sought to determine reliability when collecting multiple measures simultaneously versus individually. Methods & Procedures: Over two time periods, 50 graduate students viewed videos of four persons who stutter (PWS) and counted the number of stuttered syllables and total number of syllables uttered, and rated speech naturalness. Students were randomly assigned to one of two groups: the simultaneous group, in which all measures were gathered during one viewing; and the individual group, in which one measure was gathered per viewing. Relative and absolute intra‐ and inter‐rater reliability values were calculated for each measure. Outcomes & Results: The following results were notable: better intra‐rater relative reliability for the number of stuttered syllables for the individual group (intraclass correlation coefficient (ICC) = 0.839) compared with the simultaneous group (ICC = 0.350), smaller intra‐rater standard error of measurement (SEM) (i.e., better absolute reliability) for the number of stuttered syllables for the individual group (7.40) versus the simultaneous group (15.67), and better inter‐rater absolute reliability for the total number of syllables for the individual group (88.29) compared with the simultaneous group (125.05). Absolute reliability was unacceptable for all measures across both groups. Conclusions & Implications: These findings show that judges are likely to be more reliable when identifying stuttered syllables in isolation than when simultaneously collecting them with total syllables spoken and naturalness data. Results are discussed in terms of narrowing the reliability gap between data collection methods for stuttered syllables, improving overall reliability of stuttering measurements, and a procedural change when implementing widely used stuttering assessment protocols. WHAT THIS PAPER ADDS: What is already known on the subject: The reliability of stuttering judgments has been found to be unacceptable across a number of studies, including those examining the reliability of the most popular stuttering assessment tool, the Stuttering Severity Instrument (4th edition). The SSI‐4, and other assessment applications, involve collecting multiple measures simultaneously. It has been suggested, but not examined, that collecting measures simultaneously, which occurs in the most popular stuttering assessment protocols, may result in substantially inferior reliability when compared to collecting measures individually. What this paper adds to existing knowledge: The present study has multiple novel findings. First, relative and absolute intra‐rater reliability were substantially better when stuttered syllables data were collected individually compared to when the same data were collected simultaneously with total number of syllables and speech naturalness data. Second, inter‐rater absolute reliability for total number of syllables was also substantially better when collected individually. Third, intra‐rater and inter‐rater reliability were similar when speech naturalness ratings were given individually compared to when they were given while simultaneously counting stuttered and fluent syllables. What are the potential or actual clinical implications of this work?: Clinicians can be more reliable when identifying stuttered syllables individually compared to when they judge stuttering along with other clinical measures of stuttering. In addition, when clinicians and researchers use current popular protocols for assessing stuttering that recommend simultaneous data collection, including the SSI‐4, they should instead consider collecting stuttering event counts individually. This procedural change will lead to more reliable data and stronger clinical decision making. [ABSTRACT FROM AUTHOR]

Background: Individuals with developmental language disorder or Williams syndrome are reported to use more gestures than individuals with typical development. However, these two groups differ considerably in visuospatial and language skills, two skills that are hypothesized to shape gesture rate. Aims: We first examined whether children with both developmental language disorder and children Williams syndrome do indeed use more gestures. Our second aim was to disentangle the role of vocabulary and visuospatial skills in the use of supplementary gestures (i.e., containing unique information). To account for participant heterogeneity, analyses included both group comparisons and vocabulary and visuospatial skills at an individual level. As a third aim, the role of visuospatial skills was further examined in relation to gestures containing spatial content. Methods & Procedures: In a cross‐sectional group design, three participant groups watched and then retold a cartoon: children with typical development (n = 25), children with developmental language disorder (n = 25) and children/young people with Williams syndrome (n = 14). Their narrations were transcribed and hand gestures were coded based on gesture–speech integration (redundant, adds information to particular lexical items, gives information that is entirely absent from speech) and spatial content. Participants' expressive vocabulary and visuospatial skills were measured. Outcomes & Results: Between‐group comparisons showed that individuals with developmental language disorder or Williams syndrome did indeed use more gestures. Poisson loglinear modelling demonstrated that a relative higher use of supplementary gestures was determined by lower expressive vocabulary skills. Neither the group distinction nor visuospatial skills shaped the supplementary gesture rate nor spatial gesture rate. Conclusions & Implications: Regardless of neurodevelopmental condition or typical development, a higher use of supplementary gestures was influenced by expressive vocabulary skills. Children with lower vocabulary skills spontaneously capitalized on the multimodality of communication to express constituents that were not present in their verbal speech. This finding is a promising starting point for future gesture intervention studies examining whether implicit modelling of gesture use can encourage gestures even more in these children and if this allows them to achieve higher linguistic complexity. On a methodological note, the observed intra‐group skill variability demonstrates that group comparisons need to be complemented with correlational measures accounting for skills at an individual level. What this paper adds: What is already known on the subject: Children with developmental language disorder and children with Williams syndrome are more inclined to use gestures than typically developing children. Research conducted in adults with typical development points towards the role of lexical and visuospatial skills in gesture use, but it is unclear how these skills shape gesture use in children with atypical development. What this paper adds to existing knowledge: This study compares the rate of gestures that convey meaning that is not expressed in speech between the three aforementioned populations. Novel is the inclusion of the group distinction, individual lexical skills, and visuospatial skills in one encompassing statistical model. What are the potential or actual clinical implications of this work?: The inclination to use gestures that replace speech is related to lexical skills. Visuospatial skills do not seem to play a role and should not be considered as a factor when thinking about gesture intervention. Understanding how gestures relate to specific skills is a first step to understanding how gesture interventions can bolster language production. [ABSTRACT FROM AUTHOR]

Background: Limited research on the effectiveness of additional online and face‐to‐face practise opportunities for promoting active learning among Chinese EFL learners in higher education. Current understanding of self‐regulated and collaborative learning theories in educational contexts. Objectives: To establish the efficacy of interactive online and face‐to‐face practise opportunities for enhancing active learning among Chinese EFL learners. Methods: Employed mixed methods research to assess the impact of different types of practise opportunities on 116 EFL learners. Utilised methodological triangulation of QUAN + QUAL data and one‐way ANOVA for interpretation. Results and conclusions: The study demonstrated the effectiveness of integrating online and face‐to‐face practise opportunities to enhance active learning. Empirical evidence supports the pedagogical and theoretical benefits of these opportunities for promoting active learning among EFL learners. Lay Summary: What is currently known about this topic: Limited scholarly exploration of supplementary practise opportunities for active learning among Chinese EFL learnersExisting understanding of self‐regulated and collaborative learning theories in educational contexts What does this paper add: Establishes the effectiveness of interactive online and face‐to‐face practise opportunities for promoting active learningProvides empirical evidence supporting the integration of these opportunities to enhance active learning Implications for practise/or policy: Advocates for the combined use of online and face‐to‐face practise opportunities to enrich engagement, problem‐solving, feedback, and motivation among EFL learnersSuggests the development of instructional frameworks based on self‐regulated and collaborative learning theories for enhanced CALL courses [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to investigate the incidence of sleep disturbance and its relationship with anxiety and depression symptoms, social support and hope in breast cancer patients in China during chemotherapy. Design: A single‐centre cross‐sectional study. Methods: A total of 329 breast cancer patients were selected via convenience sampling method before they began chemotherapy (n = 115), before the 5th week of chemotherapy (n = 117) or 1 month after chemotherapy ended (n = 97) and administered paper‐and‐pencil questionnaires to evaluate sleep quality, depression and anxiety symptoms, social support and hope. Risk factors significantly associated with sleep disturbance during bivariate were incorporated in the multivariate analysis. Bivariate analyses showed that age, menopausal status, depression and anxiety symptoms, emotional/informational support, tangible support, affectionate support, positive social interaction and total support were predictors of sleep disturbance. Results: Sleep disturbance was prevalent in breast cancer patients before (27.0%), during (32.5%) and after (39.2%) chemotherapy, with 37.4%, 41.9% and 52.6% of participants, respectively, reporting sleeping below the recommended 7 h. Only 8.6%–15.5% of patients reported taking sedative‐hypnotic drugs during the chemotherapy. Multivariate analyses found that participants reporting clinically significant anxiety (HADS > 8) were 3.5 times more likely to report sleep disturbance (PSQI > 8) than participants without clinically significant anxiety, and each increment in emotional/informational support was associated with a 9.04% reduced risk of sleep disturbance. Moreover, age was an independent predictor of sleep disturbance during multivariate modelling. [ABSTRACT FROM AUTHOR]

Background: The coronavirus pandemic has affected education worldwide. Estonian schools moved to distance learning on March 16. Objectives: This paper outlines the stages of unexpected and temporary changes affecting different stakeholders based on activity and content of the messages in the Facebook group 'Homeschooling with technology'. Also the applicability of the concerns‐based adoption model was explored to explain these changes. Methods: The investigated timespan includes the week before the emergency situation and the weeks of the school term and school holidays during the emergency situation, with 52 days in total, divided into seven periods. The 872 messages were coded by two researchers and changes were examined. Results and Conclusions: Four stages were identified, from low exposure and involvement with the change to focusing on collaboration and skipping the consequence stage. Furthermore, the new changes in the educational system might focus people again on personal concerns. Implications: The results help capture the changes in teaching and learning situation caused by the coronavirus pandemic in order to learn from these changes and be prepared for such situations in the future. Lay Description: What is already known about this topicIn the emergency situation, even well‐experienced teachers were not sure what and how to teach.There are several models and there are different models on handling the changes in education.Concerns‐based adoption model (CBAM) looks at how change affects people.Emotions have changed from negative to neutral in social media during school closures What this paper addsPrevious studies have been based mostly on surveys, but this paper adds an in‐depth analysis of messages from social media.Four stages describing how changes affect people have identified.New changes brought back personal concerns and no impact concerns raised.CBAM model is applicable in explaining unexpected temporary changes Implications for practice and/or policyIn teacher training, curricula courses about distance learning methodologies and tools should be added.National guidelines about the management of distance learning situations should be prepared. [ABSTRACT FROM AUTHOR]

Background: Digital texts are progressively becoming the medium of learning for students, but research has indicated that students tend to process information more superficially while reading on screen. It is therefore relevant to examine what strategies can support digital text comprehension. Objectives: This study aimed to investigate the effects of highlighting—both learner generated and experimenter provided—when reading digitally. Methods: University students (N = 170) were randomly assigned to the condition of learner‐generated highlighting, experimenter‐provided highlighting, or control. Reading outcomes were measured as literal and inferential text comprehension, transfer of knowledge, and metacognitive calibration of comprehension performance at immediate and delayed post‐tests. Individual differences in prior knowledge, cognitive reflection, and reading self‐efficacy were taken into account. The quality of the information highlighted by students in the condition of active highlighting was also measured. Results: From linear mixed‐effects models, the main effect of condition did not emerge for any of the outcomes. However, an interactive effect of condition and cognitive reflection emerged for literal text comprehension that favoured readers in the condition of experimenter‐provided highlighting with higher ability to resist automatic thinking. Inferential text comprehension, transfer of knowledge, and calibration of performance were only predicted by cognitive reflection or reading self‐efficacy. Finally, the quality of information highlighted significantly contributed to students' literal text comprehension and transfer of knowledge in the learner‐generated highlighting condition. Takeaways: Active highlighting is not effective per se during digital reading. The "amplification" effect of already highlighted text and higher cognitive reflection suggests that readers who are more able to resist automatic thinking may also invest more effort in the task, taking more advantage of the provided support. Even if active highlighting may not be effective per se compared to other reading conditions, what students highlight contributes to literal text comprehension and their learning from text. Lay Description: What is already known about this topic: Reading on a screen to learn new content for academic assignments is a typical learning activity for todays' students.For digital reading students tend to adopt a more superficial approach compared to traditional reading.Reading strategies can help readers to comprehend complex digital texts.Highlighting is a technically simple strategy to use for digital reading, which can at least support the selection of relevant information for text comprehension. What this paper adds: When considering digital reading neither learner‐generated highlighting nor experimenter‐provided highlighting is effective by itself.Experimenter‐provided highlighting is more effective for literal text comprehension than learner‐generated highlighting when combined with readers' ability to cognitively reflect and resist more automatic responses.The individual differences of cognitive reflection and reading self‐efficacy predicted inferential text comprehension and transfer of knowledge.Reading self‐efficacy also predicted readers' metacognitive calibration of comprehension performance (accuracy of self‐judgements of comprehension performance). The implications of study findings for practitioners: The effective use of highlighting for text comprehension probably requires some explicit instruction and practice in learning devices.The potential benefits of either learner‐generated highlighting or experimenter‐provided highlighting should be considered in relation to cognitive and motivational individual differences.It is important to create or refine readers' awareness that the quality of the information they highlight matters as it is associated with their text literal text comprehension and transfer of knowledge. [ABSTRACT FROM AUTHOR]

Background: Studies suggest swallow intervention programmes that incorporate visual biofeedback and motor programming principles can improve swallowing and quality of life for people with idiopathic Parkinson's disease (IPD) and dysphagia. Few studies have examined outcomes using instrumentation. Aims: Using fibreoptic endoscopic examination of swallowing (FEES), this study examines the effectiveness of a neurorehabilitation intervention involving biofeedback via surface electromyography (sEMG) to improve swallowing in people with IPD, and to explore the feasibility of the intervention approach. Methods & Procedures: We recruited 12 participants with IPD and dysphagia. A total of 10 completed the study. Intervention was delivered for 1 h per day, 5 days per week, for 4 weeks (20 h). Swallowing tasks using sEMG biofeedback incorporated principles of motor learning and neuroplasticity. Instrumental and non‐instrumental assessment, including quality‐of‐life measures carried out at four different time points (two pre‐treatment and two post‐treatment). The final assessment was at 3 months post‐intervention. Outcome & Results: Statistically significant improvement (p < 0.05) in oral intake methods (95% confidence interval (CI) = 4.70–5.50) and in pharyngeal residue from saliva (95% CI = 2.14–3.15) and solids (95% CI = 2.4–3.5) post‐intervention were confirmed using FEES with improvements at 3 months. The intervention protocol was well tolerated. Participants reported positive change in saliva control and duration of mealtimes as well as unanticipated improvements in voice and cognitive attention. Conclusions & Implications: An intensive neurorehabilitation with biofeedback shows positive effects in improving swallow function in IPD. This protocol is feasible with amendments to inform a larger clinical trial. What this paper adds: What is already known on the subject: Biofeedback has positive effects on increasing swallowing function and quality of life in people with IPD and dysphagia. sEMG is the most common method used to deliver swallowing biofeedback in this population. The quality of the evidence on the intervention, based on findings from a recent systematic review, is low. Included studies in this review were heterogeneous in terms of type and frequency of biofeedback, study design and outcome measures. The majority of outcome measures were subjective and higher quality studies to examine the efficacy of biofeedback using sEMG are needed. What this study adds: Recognizing the limitations of earlier studies, this within‐subject feasibility study examined the efficacy and effectiveness of an intensive biofeedback intervention using sEMG in a sample of people with dysphagia and IPD. Valid and reliable outcome measures were used and repeated after a 3‐month period. The feasibility of the methodological approach was also tested and a qualitative component was included in the study. Positive findings were evident. Qualitative information added new perspectives and provided direction for new outcomes to be included in future studies. This study helps to inform further research trials as well as clinical practice. Clinical implications of this study: This intensive intervention using principles of neuroplasticity and motor programming with sEMG biofeedback led not only to positive swallowing outcomes but also to unexpected benefits such as improved voice production and general attention skills. No adverse events were reported. Improvement in function was retained at 3 months post‐intervention. Despite the small sample size, participants described the benefits of the treatment, and enjoyed sEMG biofeedback tasks, especially using an sEMG game mode. This suggests that intensive biofeedback not only improved swallowing but also was acceptable to these participants. This intensive protocol has merit and is worth considering further in clinical practice. [ABSTRACT FROM AUTHOR]

Aim: To test the psychometric properties of the Finnish version of the Dempster Practice Behaviour Scale and explore nurses' professional autonomy along with which characteristics are related to it. Design: An instrument validation and a descriptive cross‐sectional study. Methods: The web‐based survey was conducted in September 2021 at two university hospitals in Finland. Exploratory factor analysis (EFA) was used to explore the factor structure of the modified instrument, while Cronbach's α coefficients were calculated to determine the reliability of the scale. Descriptive univariate and multivariate analyses were conducted to examine Registered Nurses' professional autonomy. The study followed STROBE guidelines. Results: During the validation process, the 30 items of the Dempster Practice Behaviour Scale were reduced to 25 items. The S‐CVI/Ave for the translated scale was 0.94. When one additional item was omitted from the EFA, the results supported five factors, which explained 45.9% of the total variance. The mean overall autonomy score was 3.63 out of 5, with readiness and empowerment the subscales with the highest and lowest, respectively, mean values. The linear regression models showed that age, nursing experience, unit type, education, shift, and perceptions of the importance of professional autonomy were related to the subscales describing professional autonomy. Conclusion: The psychometric testing provided evidence that the translated instrument was reliable. Nurses assessed that they are skilled professionals who are accountable for their actions. However, they experienced rather low levels of professional autonomy in empowerment and valuation. Health care organizations should consider this through authentic leadership and, thus, possibly strengthen professional autonomy. [ABSTRACT FROM AUTHOR]

Prenatal iron supplementation improves children's health and cognitive performance, but few studies explore behavioural development. This study assessed the effects of adjusting prenatal iron supplementation to maternal iron stores during early pregnancy on children's behavioural problems. Randomized controlled trial conducted in Tarragona (Spain) involving 230 nonanaemic pregnant women and their children after a 4‐year follow‐up. Based on haemoglobin (Hb) levels before gestational week (GW) 12, women receive different iron doses: those with Hb = 110–130 g/L were randomized to receive 80 or 40 mg/day and those with Hb > 130 g/L were randomized to receive 20 or 40 mg/day. Maternal iron stores at GW12 were classified using serum ferritin (SF) as low (SF < 15 µg/L), normal (SF = 15–65 µg/L), and normal‐high (SF > 65 µg/L). Children's behaviour was assessed by parents using the Child Behaviour Checklist for ages 1.5–5 years and the Behaviour Rating Inventory of Executive Function‐Preschool Version, and by teachers using the Teacher's Report Form for ages 1.5–5 years. Multivariable regression models were performed. Taking 80 mg/day of iron improved child behaviour when women had low iron stores but worsened it when mothers had normal–high iron stores, except for depressive and attention/hyperactivity problems. Taking 20 mg/day of iron improved behaviour only in those children whose mothers had SF > 65 µg/L in early pregnancy. Additionally, executive functioning improved at high doses of prenatal iron when maternal baseline SF < 15 µg/L. Adjusting prenatal iron supplementation to both maternal baseline Hb levels and iron stores reduces behavioural problems in 4‐year‐old children. Key messages: Prenatal iron supplementation succeeds in improving maternal haematological outcomes and cognitive performance of children, but few studies have focused on behavioural development.Prenatal iron supplementation adjusted to maternal iron stores reduces behavioural problems in 4‐year‐old children.Maternal iron stores early in pregnancy should be measured in addition to haemoglobin concentration.These findings contribute greatly to the advancement of public health by giving physicians the tools to prescribe the most appropriate dose of iron supplementation to contribute to better child development. [ABSTRACT FROM AUTHOR]

Limited studies have been conducted on Chinese women's willingness to donate milk following perinatal loss. In this study, we explore the relationship among childbirth trauma, willingness to donate milk, and resilience in women following perinatal loss, and the mediating effect of resilience between childbirth trauma and willingness to donate milk. A cross‐sectional study was carried out throughout 4 months. We used convenience sampling methods and recruited 241 women following a perinatal loss from eight tertiary hospitals in Sichuan Province, China. Participants completed four questionnaires during a face‐to‐face individual interview: the general information questionnaire, the Willingness to Donate Milk Scale (WMDS), the City Birth Trauma Scale, and the Brief Resilience Scale. SPSS 20.0 was used to analyze the collected data. In our study, childbirth trauma was negatively correlated with the total and each dimension score of WMDS (p < 0.001). Resilience was positively correlated with the total and each dimension score of WMDS (p < 0.001). Resilience partially mediated the relationship between childbirth‐related symptoms and willingness to donate milk (β = −0.38, 95% confidence interval [CI]: −0.50 to −0.26), which accounted for 69.03% of the total effect. Resilience partially mediated the relationship between general symptoms and willingness to donate milk (β = −0.31, 95% CI: −0.40 to −0.21), which accounted for 66.89% of the total effect. Resilience partially mediated the relationship between childbirth trauma and willingness to donate milk in women following perinatal loss. Our findings suggest that resilience can play a significant role in mediating the relationship between childbirth trauma and willingness to donate milk in women following perinatal loss. These results could help healthcare professionals design interventions for physical and mental recovery after perinatal loss. Key messages: Women's age, occupation, marital age, and degree of postpartum pain affected their willingness to donate milk after perinatal loss.Resilience has a positive association with the willingness to donate milk and a negative association with childbirth trauma in women following perinatal loss.Childbirth trauma could negatively predict their willingness to donate milk after perinatal loss.Resilience partially mediated the relationship between childbirth trauma and willingness to donate milk in women following perinatal loss. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to identify a new barrier to the use of the Mini‐Nutrition Assessment Short‐Form (MNA‐SF), which is a malnutrition assessment tool for the risk assessment of sarcopenia in a nourished population. Methods: The MNA‐SF was completed, and individuals with a score of > 11 were considered nourished in this cross‐sectional feasibility study of a registry. Sarcopenia was assessed in 766 healthy, nourished adults (33.4% men, 64.9 ± 7.1 years) based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Results: The MNA‐SF scores for non‐sarcopenia, pre‐, confirmed, and severe sarcopenia were 13.59 ± 0.69, 13.73 ± 0.60, 12.64 ± 0.74, and 12.5 ± 0.71, respectively. The higher MNA‐SF score association with pre‐sarcopenia [odds ratio (OR): 1.41, 95% confidence interval (CI): 1.06–1.86, P = 0.02], confirmed sarcopenia (OR = 0.25, 95% CI: 0.13–0.49, P < 0.001), and severe sarcopenia (OR = 0.20, 95% CI: 0.09–0.46, P < 0.001) was as significant as in the MNA‐SF categories. Individuals with a score = 13 (compared with 14), had a higher risk of confirmed sarcopenia (OR = 10.07, 95% CI: 1.92–52.71, P = 006) and severe sarcopenia (OR = 12.09, 95% CI: 1.24–117.50, P = 0.032). Individuals with a score of 12 had a higher risk of confirmed sarcopenia (OR = 30.94, 95% CI: 4.25–103.02, P < 0.001) and severe sarcopenia (OR = 35.90, 95% CI: 4.25–303.07, P = 0.001) compared with subjects with a score of 14. The models also showed that MNA‐SF < 13 could predict sarcopenia. Conclusion: There was a significant association between MNA‐SF and confirmed and severe sarcopenia in nourished people. Sarcopenia assessment in people with MNA‐SF < 13 can be beneficial. Developing a tool to identify the risk of malnutrition and sarcopenia at the same time based on MNA‐SF can be considered. [ABSTRACT FROM AUTHOR]

Introduction: This study was performed to evaluate the effects of varying brushing times on the dental plaque‐removal efficacy of a power toothbrush to determine the optimal length of time required to brush the teeth. Methods: A typodont with 32 teeth was divided into four quadrants and further divided into four zones each (two teeth per zone). Using a robotic arm, toothbrushing was performed over eight different brushing times (0, 60, 120, 180, 240, 300, 360, and 420 s) to remove the artificial plaque applied on the labial surface of the teeth in occlusion. Photographs were taken every 60 s from each zone of the typodont. The images obtained were processed using ImageJ software to measure the percentage of remaining plaque. Data were analysed with factorial ANOVA, least squares regression analysis, and post hoc Tukey tests. Results: Plaque removal significantly increased with brushing time across the brushing intervals studied (p < 0.05). Efficient plaque removal was achieved after 240 s of brushing. There was no significant difference in plaque accumulations between the maxillary and mandibular arch (p = 0.19) and the right and left areas after each time interval (p = 0.49). Conclusion: Brushing duration is negatively correlated with the remaining plaque for a given toothbrush. Two minutes of brushing is not sufficient for significant plaque removal. Considering the limitations of this in vitro study, clinical studies are needed in order to change brushing recommendations to 240 s. [ABSTRACT FROM AUTHOR]

The southeastern region of Kenya is prone to aflatoxin outbreaks, yet maternal and infant aflatoxin intake levels remain unclear. We determined dietary aflatoxin exposure of 170 lactating mothers breastfeeding children aged 6 months and below in a descriptive cross‐sectional study involving aflatoxin analysis of maize‐based cooked food samples (n = 48). Their socioeconomic characteristics, food consumption patterns and postharvest handling of maize were determined. Aflatoxins were determined using high‐performance liquid chromatography and enzyme‐linked immunosorbent assay. Statistical analysis was conducted using Statistical Package Software for Social Sciences (SPSS version 27) and Palisade's @Risk software. About 46% of the mothers were from low‐income households, and 48.2% had not attained the basic level of education. A generally low dietary diversity was reported among 54.1% of lactating mothers. Food consumption pattern was skewed towards starchy staples. Approximately 50% never treated their maize, and at least 20% stored their maize in containers that promote aflatoxin contamination. Aflatoxin was detected in 85.4% of food samples. The mean of total aflatoxin was 97.8 μg/kg (standard deviation [SD], 57.7), while aflatoxin B1 was 9.0 μg/kg (SD, 7.7). The mean dietary intake of total aflatoxin and aflatoxin B1 was 7.6 μg/kg/b.w.t/day (SD, 7.5) and 0.6 (SD, 0.6), respectively. Dietary aflatoxin exposure of lactating mothers was high (margin of exposure < 10,000). Sociodemographic characteristics, food consumption patterns and postharvest handling of maize variably influenced dietary aflatoxin exposure of the mothers. The high prevalence and presence of aflatoxin in foods of lactating mothers are a public health concern and calls for the need to devise easy‐to‐use household food safety and monitoring measures in the study area. Key messages: A high prevalence of aflatoxin (84.4%) and high dietary aflatoxin exposure were reported among lactating mothers in the study.The mean concentration of 90% of maize‐based cooked food samples exceeded the 2 and 10 µg/kg set limits for aflatoxin B1 and total aflatoxin, respectively.Household size, education, socioeconomic status and limited food consumption patterns were potential determinants of dietary aflatoxin exposure in lactating mothers. Within dietary diversity, the type of food constituting a diverse diet played an important role.Postharvest handling of maize could be one of the factors contributing to dietary aflatoxin exposure in the study area.The reported results call for the need to devise easy‐to‐use household food safety and monitoring measures in the study area. [ABSTRACT FROM AUTHOR]

BACKGROUND: Associations between school participation in an academic medical center‐supported school‐based wellness initiative and programmatic components implemented with change in average student body mass index (BMI) over time were examined. METHODS: This was an observational study of 103 K‐12 South Carolina schools over school years 2014‐2018, classified as participating (n = 87 schools, 27,855 students) or non‐participating (n = 16 schools; 3608 students). Associations between students' BMI z‐score (BMIz) and school participation were evaluated by linear multilevel mixed‐effects modeling using data from FitnessGram and the School Wellness Checklist© (SWC), respectively. RESULTS: One‐third of the students had a BMI percentile ≥85. Average student BMIz decreased in participating schools (p =.026) and increased in non‐participating schools (p =.004) over time. For schools that participated two or more years, there was an inverse relationship between SWC score and student BMIz (p =.002) that did not differ by school type, rural/urban location, Title 1 status, or student sex. Physical activity and stress management interventions for students, as well as employee wellness and establishing a wellness committee at the school level were significantly associated with decreased average student BMIz (all p <.05). CONCLUSION: Implementation of similar comprehensive school‐based wellness programs focused on improving physical activity, stress management, and employee engagement may help prevent and reduce pediatric obesity in diverse communities. [ABSTRACT FROM AUTHOR]

Vegan dietary patterns are increasingly being adopted by endurance athletes, yet research examining the influence of this dietary pattern on exercise‐related physiology is limited. This pilot study, therefore, aimed to explore nutrient status, diet quality and cardiovascular and inflammatory responses in aerobically trained adult males following vegan and omnivorous dietary patterns during aerobic exercise. An incremental ramp running test was used to assess peak oxygen consumption (VO2peak) in males aged 18–55 years, engaging in >4 h training/week. Exercise testing was performed during walking and steady‐state running conditions (60% and 90% of VO2peak). Participants were grouped by dietary pattern type and were equivalent for age, training volume and VO2peak. When compared to the omnivorous group (n = 8, age 35.6 years, VO2peak 55.7 mL/kg/min), the vegan group (n = 12, age 33.4 years, VO2peak 56.4 m/kg/min) consumed more energy from carbohydrates (p = 0.007), and less energy from protein (p = 0.001) while exhibiting a higher overall diet quality score (p = 0.008). No differences in inflammatory biomarkers were observed before or after running. Total red blood cell count, haemoglobin and haematocrit levels were lower in the vegan dietary group. In summary, aerobically trained males, following a long‐term vegan diet, can tolerate a short bout of running broadly comparatively to their omnivore counterparts. More arduous endurance exercise conditions should be explored to further uncover potential outcomes of consuming a vegan dietary pattern and exercise‐related physiology. [ABSTRACT FROM AUTHOR]

Since the beginning of the SARS-CoV-2 pandemic, the community use of facemasks has been widely recommended. However, their use during exercise has raised safety concerns. Thus, we compared the physiological differences between exercising wearing a surgical (SM) or a double-layer-cotton (DLC) facemask and not wearing a mask (NM). Sixteen volunteers underwent 4 bouts of cycling-based exercise, which consisted of two different intensities: light-to-moderate and moderate-to-high. Facemasks were used as follows: bout-1 and 4: NM; bout-2: SM or DLC and bout-3: DLC or SM. Ventilatory, metabolic, pulmonary gas exchange (PGE) and perceptual variables were collected. At both exercise intensities compared to NM, both facemasks induced similar ventilatory adaptations, increasing inspiratory time and tidal volume and decreasing breathing frequency. Effect sizes (ES) were larger for DLC than for SM. At moderate-to-high, both facemasks reduced the minute ventilation, whereas at light-to-moderate, it was only seen with DLC. End tidal and mixed CO2 pressures, as well as the difference between them, increased with both facemasks. Again, ES was larger for DLC than SM. No relevant oxygen saturation drop was observed with both facemaks and exercise intensities. A small ES increament in VO2 and VCO2 were seen with both facemasks. Effort perception increased at moderate-to-high for both exercise intensities, buth larger EF were with DLC than SM. DLC increased facial temperature during both exercise intensities. In conclusion, ventilatory adjustments imposed during facemask exercise influenced PGE and metabolic and perceptual changes. Larger ES were mostly seen for DLC than SM. Abbreviations: Bf: Breathing frequency.; CPET: Cardiopulmonary exercise test.; CI: Confidence interval.; DLC: Double-layer cotton.; ETCO2: End tidal CO2 pressure.; ES: Effect size.; ΔET-PECO2: Difference between ETCO2 and PECO2.; FMMT: Facemask microclimate temperature.; HR: Heart rate.; IQR: Interquartile range.; NM: No mask.; PECO2: Mixed-expired CO2 pressure.; RER: Respiratory exchange ratio.; RPE: Rate of perceived effort.; SD: Standard deviation.; SM: Surgical Mask.; SpO2: Oxygen saturation.; STP: Subjective thermal perception.; Ti/TTOT: Duty cycle.; VE: Minute ventilation.; VCO2: Carbon dioxide output.; VO2: Oxygen uptake.; VT: Tidal volume.; VT: Ventilatory threshold. Highlights Facemasks affect the breathing pattern by changing the frequency and amplitude of pulmonary ventilation. The augmented ventilatory work increases VO2, VCO2, and RPE and promotes nonconcerning drops in SpO2 and CO2 retention. Increased inspiratory and expiratory pressure can account for the reduction in pulmonary physiological dead space. [ABSTRACT FROM AUTHOR]

Aim: This study aims to examine the relationship between professional identity and job satisfaction and their impact on intention to stay among clinical nurses in China during the prolonged COVID‐19 pandemic. Methods: A cross‐sectional survey was conducted from April 30 to May 25, 2021, in China. Data were collected using professional identity, job satisfaction, and intention to stay questionnaires from 1425 clinical nurses. A single mediation analysis was utilized to test the interrelationship among the variables, and the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist as a reporting guide. Results: Nurses indicated a medium level of professional identity, job satisfaction, and intention to stay, with mean scores of 3.85, 3.25, and 3.47, respectively. The professional identity displayed positive indirect effect on nurses' intention to stay through job satisfaction (indirect effect = 0.498, 95% CI [0.439, 0.558]). Conclusion: Cultivating professional identity among nurses can increase their job satisfaction and ultimately enhance the intention to stay in the nursing profession. However, this study also suggests paying more attention to job satisfaction to keep nursing retention. These may be helpful to retain the nursing workforce. [ABSTRACT FROM AUTHOR]

Several challenges have been identified for patients with concurrent disorders to access adequate services and for nurses to care for them. These challenges contribute to a pressing need for continuing educational interventions, particularly within the mental health nursing workforce. To address this issue, an innovative interprofessional videoconferencing programme based on the ECHO® model (Extension for Community Healthcare Outcomes) was implemented in Quebec, Canada to support and build capacity among healthcare professionals for CD management. The aim of this prospective cohort study was to examine nurses' self‐efficacy, knowledge, and attitude scores over a 12‐month period. All nurses who registered in the programme between 2018 and 2020 were invited to participate in the study (N = 65). The data were collected online using a self‐administered survey at baseline, after 6 months, and then 12 months following entry‐to‐programme. Twenty‐eight nurses participated in the study (96.4% women), with a mean age of 39.1 (SD = 6.2). Compared to other professions (n = 146/174), the group of nurses also showed significant improvements in their knowledge and attitude scores, with respective effect sizes of 0.72 and −0.44 at 6 months, and 0.94 and −0.59 at 12 months. However, significant changes in self‐efficacy were only found at the 12‐month follow‐up (P = 0.0213), among the nurses who attended more than 25% of the 20‐session curriculum. ECHO is a promising intervention to improve the accessibility of evidence‐based practice and to support nurses in suitably managing concurrent disorders. Further research is needed to establish the effectiveness of this educational intervention on clinical nursing practice and patient outcomes. [ABSTRACT FROM AUTHOR]

Pointing to novel links between mental representation and social communication, we examine the association between vividness of imagery and use of metaphors. In a study on individual differences and three experiments, we demonstrate that vivid imagery is linked to greater use of metaphors and that this relationship is bi‐directional. We also show that this relationship is stronger in the context of negative valence. We demonstrate that vivid imagery results in greater generation of metaphors (in particular, for negative concepts). In examining the reverse direction of influence, we show that in the negative (rather than positive) context, use of metaphors results in greater perceptions of vividness. We suggest that vividness can be signified and produced by using metaphors that play an important role in meaning making and communication. [ABSTRACT FROM AUTHOR]

Summary: Background: Neighbourhood socio‐economic environment (SEE) is associated with obesity in older children and adults, but little is known about this relationship in younger children. Breastfeeding is an important preventative of adiposity in childhood, but its relationship with neighbourhood SEE is unknown. Aims: We assessed differences in adiposity and obesity in children before age two by neighbourhood SEE, controlling for family socio‐demographics and breastfeeding duration. Materials and Methods: Family socio‐demographics, child body mass index z scores (BMIz), and breastfeeding duration were collected at periodic study visits from participants in PREVAIL (n = 245), a birth cohort in Cincinnati, OH. Addresses were assigned a Deprivation Index score, a validated measure of SEE, and dichotomized into highest SEE (least deprived quartile of scores) and not highest SEE (remaining quartiles). Longitudinal and Poisson models assessed differences in BMIz by SEE over the second year of life and obesity risk at age two, respectively (highest SEE, reference), while attenuation of obesity risk by breastfeeding duration was tested in mediation models. Results: Residing outside of the highest SEE neighbourhoods was associated with an increased BMIz of 0.04 (95%CI 0.02, 0.06) per month of life and increased obesity risk at age two (aRR: 3.7, 95%CI 1.2, 16.2), controlling for family socio‐demographics. Breastfeeding duration attenuated >9% of the obesity risk attributable to SEE (mediated RR: 3.4, 95%CI 1.1, 14.8). Discussion: In the PREVAIL Cohort, residing outside of the highest SEE neighbourhoods predicted a significant increase in BMIz and obesity risk in children before age two, a relationship that was partially mediated by breastfeeding duration. Conclusion: Breastfeeding support may play an important role in reducing obesity rates in children in lower SEE neighbourhoods. [ABSTRACT FROM AUTHOR]

Introduction: Growing evidence suggests that impairment in rest‐activity rhythms may be a risk factor for cognitive decline and impairment in the aging population. However, previous studies included only a limited set of rest‐activity metrics and produced mixed findings. We studied a comprehensive set of parametric and nonparametric characteristics of rest‐activity rhythms in relation to mild cognitive impairment (MCI) and probable dementia in a cohort of older women. Methods: The prospective analysis included 763 women enrolled in two ancillary studies of the Women's Health Initiative (WHI): the WHI Memory Study‐Epidemiology of Cognitive Health Outcomes and Objective Physical Activity and Cardiovascular Health studies. The association between accelerometry‐based rest‐activity parameters and centrally adjudicated MCI and probable dementia were determined using Cox regression models adjusted for sociodemographic characteristics, lifestyle factors, and comorbidities. Results: Overall, the results support a prospective association between weakened rest‐activity rhythms (e.g., reduced amplitude and overall rhythmicity) and adverse cognitive outcomes. Specifically, reduced overall rhythmicity (pseudo F statistic), lower amplitude and activity level (amplitude/relative amplitude, mesor, and activity level during active periods of the day [M10]), and later activity timing (acrophase and midpoint of M10) were associated with a higher risk for MCI and probable dementia. Women with lower amplitude and mesor also exhibited faster cognitive decline over follow‐up. Conclusion: Weakened rest‐activity rhythms may be predictive markers for cognitive decline, MCI, and dementia among older women. [ABSTRACT FROM AUTHOR]

Past research has found that regulatory closure, that is, successful goal striving regulated either under a promotion or prevention focus, has important consequences in terms of motivational activation and mobilisation of cognitive resources in subsequent tasks, but it mostly investigated motivation in the same or similar tasks to the one for which closure was achieved. Drawing from an energisation‐deactivation hypothesis, we investigated the effect of closure on performance and persistence in unrelated subsequent cognitive tasks. Across four studies, we found that promotion closure had an energising effect leading to: quicker decision times in lexical tasks (Studies 1–2), increased persistence and greater originality (Study 3), and greater visuospatial memory performance (Study 4). In contrast, prevention closure had a deactivating effect leading to reduced performance and persistence. No systematic differences arose in situations of non‐closure. We discuss results and implications with respect to both regulatory closure and regulatory fit theoretical approaches. [ABSTRACT FROM AUTHOR]

Background: There is a gap in the literature regarding data on sexting among youth under the age of 16 whereas the problems related to this practice could affect them more because of their ongoing development. This study aims to determine the prevalence rate and characteristics of sending one's own sexually related image among middle‐school teens. Methods: Data were obtained from a web‐based in‐school survey conducted between October 2019 and February 2020. The sample comprised 3006 (mean age 13.7; 50.2% males) 10th‐grade pupils in the canton of Vaud (Switzerland). Participants were asked "Have you ever sent a sexually related/sexy image of yourself?". Analysis of variance/chi‐square tests and multinomial regression analyses were used to compare the groups. Results: Overall, 93.0% reported never, 3.7% once and 3.3% several times. No gender differences were found. Sending was associated with older age, low academic performance, cyberbullying victimization and reception of unsolicited sexually related images. Conclusions: Education and health professionals should be aware that it is necessary to discuss the theme, perhaps with a more global approach including pressure, consent, exchange of nonsexual images, and so on from an early age. The context and reasons for sending remain to be explored, particularly to determine if the pressure is greater at this age. [ABSTRACT FROM AUTHOR]

Objectives: Healthcare workers (HCWs) are considered an important target group for the COVID‐19 vaccines. The current study assesses the knowledge and attitudes of Israeli HCWs regarding COVID‐19 immunization, and how various occupational and demographic factors may underlie COVID‐related knowledge and attitudes differences. Methods: Following a pre‐test to validate measures, a cross‐sectional online anonymous survey was distributed to HCWs using a snowball sampling method. Results: The survey was completed by 714 participants (mean age 39.9; range 18–74; 447 female), 52% doctors, 32% nurses, and the remainder by paramedical staff. Of the respondents, 553 (77.4%) answered the question are you in favor of getting the COVID‐19 vaccine, 105 (14.7%) were not sure, and 56 (7.8%) were not in favor. Doctors had higher odds of agreement as compared to both nurses (p <.025) and paramedical staff (p <.001). Multivariate logistic regression analysis revealed that increased age (OR: 1.075; 95% CI: 1.04–1.11, p <.001), profession (physician vs. nurse; OR: 2.73; 95% CI: 1.32–5.65; p <.007), and getting the current influenza vaccine (OR: 4.96; 95% CI: 2.47–9.95) were significant predictors of agreement. Conclusions: A high level of HCWs knowledge and in favor attitudes were observed. Yet negative attitudes were also noted, particularly among nurses, paramedical staff, and young employees. [ABSTRACT FROM AUTHOR]

Background: Studies have reported difficulties in job acquisition and retention as well as unstable employment status among individuals with intellectual disabilities. Method: Chi‐square, one‐way ANOVA, and binary logistic regression analysis were employed to investigate the factors that affect the labour market transition of 374 individuals with intellectual disabilities. Results: There were significant differences in sex between the sustained unemployment group and the sustained employment groups; in educational level, between sustained employment and other groups; and in basic living security assistance received, between sustained unemployment and other groups. All psychological factors in the sustained employment group were higher than in the sustained unemployment group. Communication ability significantly affected sustained employment. Conclusions: Greater family support was associated with a lower turnover probability, and a higher educational level and greater family support increased the probability of retention. Developing family support systems may decrease the possibility of turnover and increase retention. [ABSTRACT FROM AUTHOR]

BACKGROUND: We present results of the development and feasibility testing of CATCH Healthy Smiles, a school‐based oral health program, among children in grades K‐2 in Houston, Texas. METHODS: Study design was cross‐sectional (N = 2 schools; N = 125 parent‐child dyads; 31 kindergarteners, 42 first graders, and 52 second graders). CATCH Healthy Smiles program was implemented by trained school teachers in the 2016‐2017 school year. Trained dentists conducted dental assessments to measure dental caries increment score (d3mfs). Parent‐reported 24‐hour dietary recalls and surveys assessed child and parent behavioral, environmental, and psychosocial factors. Logistic regression analysis assessed factors associated with caries experience adjusting for covariates. RESULTS: Of the 113 children with complete dental assessments, 54% children in grade K, 62% in first grade, and 73% in second grade had caries experience. Children with caries experience had a higher body weight (AdjOR = 1.13, 95% confidence interval [CI]: 1.02‐1.29), were less likely to be girls (AdjOR = 0.22, 95% CI: 0.05‐0.82), had greater odds of difficulty drinking hot or cold beverages because of dental problems (AdjOR = 13.13, 95% CI: 1.09‐275.14), greater frequency of consuming sugar‐sweetened beverages (AdjOR = 11.53, 95% CI: 2.10‐87.19), greater odds of receiving government assistance (AdjOR = 14.62, 95% CI: 2.74‐119.81), and lower odds of seeing a dental provider (AdjOR = 0.11, 95% CI: 0.02‐0.45). Process evaluation showed that 100% of the CATCH Healthy Smiles lessons and activities were taught in the two schools with a high degree of program fidelity and acceptability across the schools, children, and parents. CONCLUSIONS: These data will be used to conduct a subsequent fully powered cluster randomized controlled trial. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives: Emergency short‐stay unit (SSU) alleviates emergency department (ED) overcrowding, but may affect in‐hospital indicators. Cardiology patients comprise a substantial part of patients admitted at SSU. This study evaluated whether SSU opening differentially modified in‐hospital indicators at a whole general hospital and at its cardiology division (CARD). Methods: We retrospectively analysed indicators based on 859 686 ED visits, and 171 547 hospital admissions, including 12 110 CARD admissions, from 2007 to 2018 at a general tertiary hospital, and compared global ED indicators and in‐hospital indicators at the hospital and CARD before (2007‐2011) and after (2011‐2018) SSU opening. Results: After SSU opening, monthly ED bed occupancy rate decreased (mean ± SD 200 ± 18% vs 187 ± 22%; P <.001) and in‐hospital admissions from ED increased at the hospital (median [interquartile range] 460 [81] vs 524 [41], P <.001) and CARD (50 [12] vs 54 [12], P =.004). In parallel, monthly in‐hospital elective admissions decreased at CARD (34 [18] vs 28 [17], P =.019), but not at the hospital (712 [73] vs 700 [104], P =.54). Average length of stay (LOS) increased at both hospital (8.5 ± 0.3 vs 8.7 ± 0.4 days, P <.001) and CARD (9.2 ± 1.5 vs 10.3 ± 2.3 days, P =.002) after SSU opening, but percent admissions at SSU showed a direct relationship with LOS solely at CARD. Furthermore, cardiology patients admitted at SSU had greater LOS, prevalence of coronary heart disease and age than those admitted at the conventional cardiology ward. Conclusions: SSU opening improved ED crowding, but was associated with changes in in‐hospital indicators, particularly at CARD, and in the characteristics of hospitalized cardiology patients. These findings suggest that in‐hospital cardiology services may need re‐evaluation following SSU opening at a general hospital. [ABSTRACT FROM AUTHOR]

Child undernutrition in Cambodia is a persistent public health problem requiring low‐cost and scalable solutions. Rising cellphone use in low‐resource settings represents an opportunity to replace in‐person counselling visits with phone calls; however, questions remain on relative effectiveness. Our objective was to evaluate the impact of two options for delivering a World Vision infant and young child feeding (IYCF) counselling programme: (1) traditional Positive Deviance/Hearth (PDH) programme with in‐person visits or (2) PDH with Interactive Voice Calling (PDH‐IVC) which integrates phone calls to replace 62.5% of face‐to‐face interaction between caregivers and volunteers, compared to the standard of care (SOC). We conducted a longitudinal cluster‐randomised controlled trial in 361 children 6–23 months. We used an adjusted difference‐in‐difference approach using baseline, midline (3 months) and endline (12 months) surveys to evaluate the impact on child growth among the three groups. At baseline, nearly a third of children were underweight, and over half were food insecure. At midline the PDH group and the PDH‐IVC groups had improved weight‐for‐age z‐scores (0.13 DID, p = 0.011; 0.13 DID, p = 0.02, respectively) and weight‐for‐height z‐score (0.16 DID, p = 0.038; 0.24 DID, p = 0.002), relative to SOC. There were no differences in child height‐for‐age z‐scores. At endline, the impact was sustained only in the PDH‐IVC group for weight‐for‐age z‐score (0.14 DID, p = 0.049), and the prevalence of underweight declined by 12.8 percentage points (p = 0.036), relative to SOC. Integration of phone‐based IYCF counselling is a potentially promising solution to reduce the burden of in‐person visits; however, the modest improvements suggest the need to combine it with other strategies to improve child nutrition. [ABSTRACT FROM AUTHOR]

Maternal depression has been associated with adverse child growth and development; less is known about its relation to children's diet. In a cross‐sectional study embedded at endline of a longitudinal community development intervention, mothers of 629 children (age 23–66 months) in rural Nepal responded to household and children's diet questionnaires and were screened for depression. Child anthropometry and development (Ages and Stages Questionnaire) were assessed. Regression models examined children's diet, growth and development, adjusting for household, child and maternal characteristics. The prevalence of maternal depression was 21%. Maternal depression was associated with 11% lower likelihood that the child consumed one additional food group [Poisson regression, adjusted relative risk (aRR) 0.89, 95% confidence intervals (95% CI 0.81, 0.99), p = 0.024] and 13% lower likelihood that the child consumed one additional animal source food (ASF) [aRR 0.87, (95% CI 0.76, 1.01), p = 0.061] compared with children of nondepressed mothers. However, maternal depression was not associated with either child anthropometry or development: these outcomes were strongly associated with better home child‐rearing quality. Stunting also related to child age and intervention group; child development related to mother's education and household wealth. This study suggests a correlation between maternal depression and child dietary diversity. This association could be due to unmeasured confounders, and therefore, further research is warranted. Understanding the relationship of depression to child outcomes—and the role of other potentially compensatory household factors—could help address some of the earliest, modifiable influences in a child's life and contribute to innovative approaches to improve child well‐being. [ABSTRACT FROM AUTHOR]

The aim of this prospective cohort study was to assess the maximum intensity of postoperative pain at rest in 620 adults after an elective surgery as well as to determine demographic and clinical predictors of pain. The Hospital Anxiety and Depression Scale was used to evaluate the preoperative mental condition of the patient. Preoperative and postoperative pain were assessed at rest based on the Numeric Rating Scale (range: 0–10). The total median maximum intensity of pain was 3 (interquartile range: 1–5). The linear regression model for the maximum intensity of postoperative pain was statistically significant and very well fitted – the coefficient of determination was 62%. Preoperative anxiety, pain, cancer, a medical history of thyroid (vs abdominal) surgery, and an operation resulting in major (vs moderate) tissue injury have a positive impact on the maximum intensity of postoperative pain. Eye surgery and lower limb operations gave lower scores than abdominal surgery. The early identification of these predictors in patients at risk for postoperative pain will help in preparing an individual pain management plan. [ABSTRACT FROM AUTHOR]

Background: Attention‐deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. Neuroanatomic heterogeneity limits our understanding of ADHD's etiology. This study aimed to parse heterogeneity of ADHD and to determine whether patient subgroups could be discerned based on subcortical brain volumes. Methods: Using the large ENIGMA‐ADHD Working Group dataset, four subsamples of 993 boys with and without ADHD and to subsamples of 653 adult men, 400 girls, and 447 women were included in analyses. We applied exploratory factor analysis (EFA) to seven subcortical volumes in order to constrain the complexity of the input variables and ensure more stable clustering results. Factor scores derived from the EFA were used to build networks. A community detection (CD) algorithm clustered participants into subgroups based on the networks. Results: Exploratory factor analysis revealed three factors (basal ganglia, limbic system, and thalamus) in boys and men with and without ADHD. Factor structures for girls and women differed from those in males. Given sample size considerations, we concentrated subsequent analyses on males. Male participants could be separated into four communities, of which one was absent in healthy men. Significant case–control differences of subcortical volumes were observed within communities in boys, often with stronger effect sizes compared to the entire sample. As in the entire sample, none were observed in men. Affected men in two of the communities presented comorbidities more frequently than those in other communities. There were no significant differences in ADHD symptom severity, IQ, and medication use between communities in either boys or men. Conclusions: Our results indicate that neuroanatomic heterogeneity in subcortical volumes exists, irrespective of ADHD diagnosis. Effect sizes of case–control differences appear more pronounced at least in some of the subgroups. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to compare the plaque control effectiveness of rubber cup polishing with that of air polishing during oral prophylaxis procedures and to investigate the effect of the order of air‐polishing application on the efficiency of oral prophylaxis. Methods: The study included adult patients (≥20 years of age) who had visited the dental clinic for oral prophylaxis. A total of 173 subjects were divided into three groups (scaling followed by rubber cup polishing, SR; scaling followed by air polishing, SA; and air polishing followed by scaling, AS) based on sex, age, oral health status, oral hygiene status, and indications and contraindications according to the oral prophylaxis method. The analysis of variance (ANOVA) was used to determine the difference in oral prophylaxis time, residual deposits rate, subjects and dental hygienist satisfaction. Results: The total scaling time was shorter in the AS group (15.4 ± 6.9 minutes) than in the SA (18.7 ± 5.5 minutes) and SR groups (19.9 ± 6.2 minutes) (p < 0.05). The rate of residual deposits was significantly higher in the SR group than in the AS or SA groups (p < 0.05). The satisfaction level of dental hygienists was higher in the AS group (8.8 ± 1.0 points) and the SA group (8.4 ± 1.0 points) than in the SR group (6.2 ± 1.3 points). Conclusion: During oral prophylaxis, dental plaque removal using air polishing requires a relatively longer time when compared to rubber cup polishing, but it can better eliminate dental plaque. In addition, we found that dental plaque removal using air polishing prior to scaling reduced the total scaling time. [ABSTRACT FROM AUTHOR]