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Background: Lack of adherence to prescribed medication is common among patients with depression in China, posing serious challenges to the health care system. Online health communities have been found to be effective in enhancing patient compliance. However, empirical evidence supporting this effect in the context of depression treatment is absent, and the influence of online health community content on patients' attitudes toward medication adherence is also underexplored., Objective: This study aims to explore whether online depression communities (ODCs) can help ameliorate the problem of poor medication taking among patients with depression. Drawing on the stimulus-organism-response and feelings-as-information theories, we established a research model to examine the influence of useful institution-generated content (IGC) and positive user-generated content (UGC) on attitudes toward medication adherence when combined with the mediating role of perceived social support, perceived value of antidepressants, and the moderating role of hopelessness., Methods: A cross-sectional questionnaire survey method was used in this research. Participants were recruited from various Chinese ODCs, generating data for a main study and 2 robustness checks. Hierarchical multiple regression analyses and bootstrapping analyses were adopted as the primary methods to test the hypotheses., Results: We received 1515 valid responses in total, contributing to 5 different datasets: model IGC (n=353, 23.3%), model UGC (n=358, 23.63%), model IGC+UGC (n=270, 17.82%), model IGC-B (n=266, 17.56%), and model UGC-B (n=268, 17.69%). Models IGC and UGC were used for the main study. Model IGC+UGC was used for robustness check A. Models IGC-B and UGC-B were used for robustness check B. Useful IGC and positive UGC were proven to have positive impact on the attitudes of patients with depression toward medication adherence through the mediations of perceived social support and perceived value of antidepressants. The findings corroborated the role of hopelessness in weakening or even negating the positive effects of ODC content on the attitudes of patients with depression toward medication adherence., Conclusions: This study provides the first empirical evidence demonstrating the relationship between ODC content and attitudes toward medication adherence, through which we offer a novel solution to the problem of poor medication adherence among patients with depression in China. Our findings also provide suggestions about how to optimize this new approach-health care practitioners should generate online content that precisely matches the informational needs of patients with depression, and ODC service providers should endeavor to regulate the community atmosphere. Nonetheless, we warn that ODC interventions cannot be used as the only approach to addressing the problem of poor medication taking among patients with severe depressive symptoms., (©Runnan Chen, Xiaorong Fu, Mochi Liu, Ke Liao, Lifei Bai. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 19.11.2024.)

Background: Poststroke cognitive impairment (PSCI) is a common and debilitating complication that affects stroke survivors, impacting memory, attention, and executive function. Despite its prevalence, the factors contributing to PSCI remain unclear, with limited insights into how demographic and clinical variables influence cognitive outcomes., Objective: This study investigates the incidence of cognitive impairment in patients with stroke and examines key demographic and clinical factors, such as age, gender, and education level, which contribute to cognitive decline. The aim is to provide a deeper understanding of PSCI to inform early intervention strategies for improving patient outcomes., Methods: A cross-sectional study was conducted on 305 patients with ischemic stroke admitted to Zhongda Hospital, Southeast University, from January 2019 to September 2022. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) within 72 hours of hospital admission. Demographic information, including age, gender, and education level, were collected. Statistical analyses were performed using chi-square tests, independent t tests, and multivariate regression to assess the relationship between cognitive function and key variables. Pearson correlation analysis explored associations among age, education, and MMSE scores., Results: Among the 305 patients with stroke, 16.7% (n=51) were diagnosed with cognitive impairment based on MMSE scores. The prevalence of cognitive impairment was slightly higher in males (17.6%, n=159) than females (15.8%, n=146), but this difference was not statistically significant. A strong negative correlation was found between MMSE scores and age (r=-0.32; P<.01), indicating that older patients had lower cognitive function. Education level showed a positive correlation with MMSE scores (r=0.41; P<.01), with patients with higher educational attainment demonstrating better cognitive outcomes. Cognitive function showed a marked decline in patients older than 60 years, particularly in domains such as memory, attention, and language skills., Conclusions: This study confirms that age and education are significant factors in determining cognitive outcomes after stroke. The results align with existing literature showing that cognitive function declines with age, while higher educational attainment serves as a protective factor. The findings suggest that individuals with greater cognitive reserve, often linked to higher education, are better equipped to cope with the impact of brain injury. However, the study's reliance on MMSE may have limited its ability to detect domain-specific impairments. Future studies should consider using more sensitive cognitive tools, such as the Montreal Cognitive Assessment (MoCA), to provide a more comprehensive evaluation of PSCI. Cognitive impairment is prevalent among stroke survivors, with age and education level being key factors influencing outcomes. These findings underscore the importance of early detection and targeted interventions to mitigate cognitive decline. Further research with larger samples and more sensitive cognitive assessments is needed to fully understand PSCI and improve rehabilitation strategies for patients with stroke., (©Wu Zhou, HaiXia Feng, Hua Tao, Hui Sun, TianTian Zhang, QingXia Wang, Li Zhang. Originally published in JMIR Formative Research (https://formative.jmir.org), 19.11.2024.)

This study investigated the knowledge, attitude, and practice (KAP) concerning stone formation and recurrence among patients with urolithiasis treated at Ningbo Medical Centre Lihuili Hospital between August 19, 2023, and April 19, 2024. A total of 394 patients were included, among which 70.30% were males. The median scores for knowledge, attitude, and practice were 7 (6-8.25), 29 (26.75-31), and 21.5 (18-25), respectively, indicating good knowledge and attitude but suboptimal practice. Positive correlations were found between knowledge and attitude (r = 0.274, P < 0.001) and between attitude and practice (r = 0.126, P < 0.05). Logistic regression revealed that knowledge, education, and whether the patient experienced a new or recurrent stone were independent predictors of attitude. Attitude, education, body mass index (BMI), and daily water intake were independent predictors of practice. Structural equation modeling (SEM) showed that knowledge, family history, and education directly influenced attitude, while education also significantly impacted practice. Our findings highlight the need for targeted diet, hydration, and lifestyle education to enhance preventive practices among patients with urolithiasis., Competing Interests: Declarations Ethics approval and consent to participate The study was carried out after the protocol was approved by the Ningbo Medical Center LiHuiLi Hospital (2023 − 216). We confirm that all methods were performed in accordance with the relevant guidelines. All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments, and informed consent was obtained from all participants. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: With increasing focus on patient-reported outcome measures (PROMs) in chronic rheumatic diseases, we aimed to evaluate the self-reported physical and psychosocial health in children with juvenile idiopathic arthritis (JIA) compared to matched population-based controls. Furthermore, we aimed to study the association of patient- and physician-reported outcome measures in JIA with patient-reported physical disability., Methods: We used data from a Norwegian JIA cohort study (NorJIA), including clinical characteristics and outcome measures in participants with JIA and sex- and age-matched population-based controls. Self-reported physical and psychosocial health were assessed using the generic Child Health Questionnaire (CHQ). Comparisons between children with JIA and controls were performed by test of proportions for categorical variables and t-test for continuous variables. To evaluate the association of patient- and physician-reported outcome measures with patient-reported physical disability, assessed with the Child Health Assessment Questionnaire (CHAQ) in children with JIA, we used logistic regression to estimate adjusted odds ratio (OR) with 95% confidence interval (CI)., Results: In total, 221 participants with JIA (59.3% females, median age 12.7 years) and 207 controls with available data were included. In the JIA group, 24.3% scored below the norm for physical health (CHQ PhS < 40) and 8.7% scored below the norm for psychosocial health (CHQ PsS < 40). The corresponding numbers for the control group were 0.5% and 1.9%, respectively. In the JIA group, 57.9% reported physical disability (CHAQ > 0). Several patient-reported outcome measures, such as poor physical health (CHQ PhS < 40), disease-related pain, and the patient's global assessment of disease impact on wellbeing, were strongly associated with self-reported physical disability (CHAQ > 0), adjusted OR 19.0 (95% CI 5.6, 64.1), 14.1 (95% CI 6.8, 29.2), and 14.0 (95% CI 6.2, 31.6), respectively. Associations were also found for active disease according to Wallace (adjusted OR 36.3, 95% CI 10.3, 128.1), and physician-reported global assessment of disease activity (adjusted OR 6.2, 95% CI 3.1, 12.6)., Conclusions: The strong association between patient- and physician-reported outcome measures and patient-reported physical disability strengthens the importance of including the patient's voice in a comprehensive evaluation of patient outcome in JIA., Trial Registration: ClinicalTrials.gov (No: NCT03904459)., Competing Interests: Declarations Ethics approval and consent to participate The NorJIA study is approved by The Ethics Committee, Helse Vest (REC no 2012/542). The study is registered on ClinicalTrials.gov with Identifier: NCT03904459 https://ClinicalTrials.gov/show/NCT03904459. The NorJIA research group has granted access to the data material for this study. Personal data is collected, managed, and stored according to the General Data Protection Regulation (GDPR). Parents of participants < 16 years have given their written informed consent. Younger children have been informed of the study by their parents and the researchers. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Aging often leads to changes in hormone levels, particularly testosterone, which is thought to significantly affect bone health in older males., Objective: This study aimed to explore the link between testosterone levels and bone mineral density in men aged 60 and above., Methods: Data from the National Health and Nutrition Examination Survey 2013-2014 were used. Weighted multivariable linear regression models were employed to study the association between testosterone and bone mineral density. Furthermore, a weighted generalized additive model and smooth curve fitting were used to address potential nonlinear patterns in the data., Results: The analysis included 621 elderly men. After accounting for various factors, the study uncovered a Inverted U-shaped correlation between testosterone levels and femoral neck density. Notably, a turning point was identified at the testosterone level of 406.4 ng/dL. Further examination, using different models, showed that testosterone levels in the third quartile (group Q3) were positively linked to bone density. However, contrasting trends were observed in the first (group Q1) and fourth quartiles (group Q4), where testosterone levels displayed a negative relationship with bone density., Conclusion: The results indicate a complex interplay between testosterone levels and bone mineral density in elderly men. The U-shaped trend suggests that both low and high testosterone levels could negatively impact bone health. These findings highlight the importance of maintaining testosterone levels within an optimal range to preserve bone health in aging men., Competing Interests: Declarations Ethics approval and consent to participate The survey protocol received ethical clearance from the Ethics Review Board of the National Center for Health Statistics. Prior to their participation in the study, every individual participant provided their written informed consent, ensuring adherence to ethical principles. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Endometriosis is a chronic inflammatory disease and an estrogen-dependent disease, so dietary factors that can modulate estrogen activity may be clinically important. Dietary fiber, widely distributed in vegetables and fruits, is closely associated with a plant-based diet. Therefore, this study aims to analyze and explore the relationship between dietary fiber intake and the risk of endometriosis providing insights for future clinical significance and treatment approaches. This cross-sectional study obtained data from the National Health and Nutrition Examination Survey (NHANES) 1999-2006 for women aged 20-54 years. A total of 2840 subjects were finally included for analysis, 2599 (91.51%) in the non-endometriosis group and 241 (8.49%) in the endometriosis group. The study used dietary fibre intake as exposure variable and endometriosis risk as outcome variable. Through the use of multiple regression modelling, subgroup analyses, smoothed curve fitting, and threshold effect tests, we uncovered a significant link between exposure and outcome. In Model 2 (Multiple regression equation model after adjusting all confounding variables), after adjusting for confounders, dietary fiber intake was negatively associated with the likelihood of developing endometriosis(OR = 0.588, 95% CI = 0.360-0.959, p = 0.041). In subgroup analyses stratified by age, race, BMI, educational level, hypertension, diabetes,and hyperlipidemia, significant interactions were visualised from smoothed fitted curves. In the cross-sectional study, a connection was observed between a higher intake of dietary fiber and a decreased risk of endometriosis., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethics approval The National Center for Health Statistics’ Ethics Committee has granted approval for this study, in accordance with the Declaration of Helsinki. The retrospective analysis used in this study ensured that no potential harm was caused to the participants. The study was conducted without revealing any personal information or compromising the privacy of the participants. Before attending, all participants were asked to sign a form stating their informed consent. Electronic downloads enable quick and convenient access to all necessary materials, which can be found at https://wwwn.cdc.gov/nchs/nhanes/default.aspx, (© 2024. The Author(s).)

Cardiometabolic index (CMI) is a novel anthropometric metric that integrates lipid and adiposity characteristics. The correlation between periodontitis development and CMI is ambiguous. The objective of this study was to establish the association between CMI and periodontitis by analyzing data from the NHANES (National Health and Nutrition Examination Survey) database. A cross-sectional study was conducted on a cohort of 6188 people selected from the NHANES database, covering the period from 2009 to 2014. The study employed multivariate logistic regression to examine the independent correlation between CMI and periodontitis. Subgroup data were analyzed and interaction tests were conducted to assess the impact of variables on the correlation between CMI and periodontitis. The CMI index was significantly and positively associated with the presence of periodontitis (β = 0.03, 95%CI(0.01, 0.05), p = 0.0092). In addition, a U-shaped relationship was found between CMI index and periodontitis severity in an older American population (65 < = age < = 80, with a folding point of 1.44, p = 0.008). This study demonstrates a significant correlation between CMI and periodontitis, positioning CMI as a crucial indicator for assessing periodontal health. Future efforts should prioritize oral hygiene interventions for patients with elevated CMI levels to facilitate early intervention and enhance overall health outcomes., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Aim: This study aimed to describe self-assessed clinical gerontological nursing competence and its associated factors among licensed practical nurses., Design: A descriptive cross-sectional design was adopted for the study., Methods: Data were collected in Autumn 2023 from 394 licensed practical nurses working in healthcare services for older people in one well-being services county in Finland. The nurses, recruited through convenience sampling, were surveyed using a 40-item self-assessment clinical gerontological nursing competence instrument (on a Likert scale from 1 = poor to 5 = excellent). Descriptive statistical methods were used to analyse the results., Results: Participants mainly assessed their clinical gerontological competence as good. Competence in using assistive devices to support functional ability was assessed as very good, while competence in postoperative wound care was assessed as the weakest. Participants working in 24-h services assessed their competence as the weakest among the three clinical gerontological nursing areas. Participants under 40 years of age with 5-10 years of work experience self-assessed statistically significantly stronger competence in disease-specific nursing than those over 40 with less work experience., Conclusion: The self-assessed competence of licensed practical nurses varies across different service and care units. Competence in wound care requires more focus and education in the future. Attention should also be paid to competence development in different educational areas, for example, through continuous education and competence development models. The results could facilitate licensed practical nurses' competence development and management in clinical gerontological nursing. The study's insights can also guide allocating resources and education to ensure high-quality care in different service areas., (© 2024 The Author(s). Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Objectives. Extremes of maternal age at childbirth may influence child nutritional outcomes, but this is under-researched in Roma populations. Methods. The study was a secondary data analysis of Multiple Indicator Cluster Surveys for Serbian Roma settlements and included 2564 children aged 0 to 59 months. Results. About 19% of children were stunted, 9% underweight, 16% were unwanted and born with a low birth weight. Logistic and linear regressions show that maternal age at childbirth had no association with either nutritional or growth outcomes of Roma children ( P  > .05). Instead, child characteristics: being born as a boy, low birth weight, unwanted, younger age, and maternal characteristics: short birth spacing, higher parity and low socioeconomic status were associated with children's malnutrition. Conclusion. Maternal age at childbirth per se does not increase the chances of poor child health outcomes, as the risks seem to be related more to individual child and maternal characteristics and maternal behavioral patterns., Competing Interests: The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Despite the paucity of scientific evidence, complementary and alternative medicine (CAM) is widely used for the prevention and treatment of chronic illness, holistic care, and counteracting the adverse effects of conventional therapies. This study aims to determine the prevalence of CAM use and its associated factors among patients undergoing hemodialysis (HD) in Taiwan., Methods: This quantitative study was conducted from August 2022 to July 2024 in the HD unit at Kaohsiung Chang Gung Memorial Hospital in Taiwan. Face-to-face questionnaire-based interviews were held with 154 of 163 eligible patients (response rate, 94.5%) at the bedside during HD. The completed questionnaires were entered into a secure computer database. Data was performed by descriptive analysis, Chi-square, and Fisher tests., Results: More than half of the patients were CAM users (n = 86; 56%), and women was associated with significantly more usage of CAM. Fifty-six CAM users took Chinese herbal medicine (CHM), 52.3% (n = 45) used dietary supplements, and 19.8% (n = 17) used acupuncture. The benefit in the effectiveness of CAM was the main reason for use, the need of CAM to improve the well-being and HD-related complication was high. 32.7% of patients had used CAM based on recommendation from their family and friends. More than one-third (33.7%) of patients did not disclose their use of CAM to their doctors, most of them think it is unnecessary., Conclusions: The use of CAM by patients with maintenance HD was relatively frequent. Of these, most used CHM, of which are shown to the trend into routine HD care is inevitable by high coverage and utilization in Taiwanese national health insurance system. These findings indicate that it is important for health care providers working in dialysis to assess CAM use., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee at Kaohsiung Chang Gung Memorial Hospital (registration number 202200422B0) as well as each research facility. This study was performed in accordance with the tenets set forth in the Declaration of Helsinki. All enrolled patients provided informed written consent prior to participation. Consent for publication Not Applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: This study aims to explore the relationship between basal metabolic rate (BMR) and cognitive impairment and assess the potential of BMR as a protective factor against cognitive decline., Methods: This investigation initially conducted a cross-sectional study of American adults from 2011 to 2014 using data from the National Health and Nutrition Examination Survey. It examined the correlation between participants' BMR and cognitive functions, exploring the association with cognitive impairment. Subsequently, publicly available genome-wide association study data was used to examine potential causal links between genetically determined BMR and specific cognitive disorders using Mendelian randomization., Results: Cross-sectional findings revealed a significant positive correlation between higher BMR and cognitive scores. In Mendelian randomization analysis, BMR demonstrated an inverse causal relationship with Alzheimer's disease and Parkinson's dementia, suggesting BMR as a potential protective factor against these diseases. No causal links were found with vascular dementia, Lewy body dementia, and frontotemporal dementia., Conclusion: This study supports the role of BMR as a potential protective factor against Alzheimer's disease and Parkinson's dementia, suggesting that BMR may play an important role in preventing cognitive decline. However, due to the limitations of cross-sectional studies, further prospective studies and broader demographic samples are necessary to verify these results and explore underlying biological mechanisms. Key messages What is already known on this topic: Existing knowledge suggests a close relationship between BMR and health and cognitive functions, but detailed studies on its connection with specific cognitive impairments are still needed. What this study adds: This study found a significant positive correlation between higher BMR and cognitive improvement, potentially aiding in the prevention of Alzheimer's and Parkinson's dementia. How this study might affect research, practice, or policy: This finding guides public health strategies and personalized medicine, emphasizing the necessity for further research to validate BMR's protective effects., (© The Author(s) 2024. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Healthcare workers (HCWs) can face situations that conflict with their moral beliefs, leading to moral injury, an adverse psychological consequence that was more frequent during the COVID-19 pandemic. Self-compassion is a potential coping mechanism for moral injury by encouraging acceptance of human limitations and suffering., Objectives: This study aimed to examine the associations between self-compassion components and moral injury prevalence among HCWs in Quebec, Canada, during the COVID-19 pandemic., Research Design: A cross-sectional study design was employed. Participants : and research context: The sample of this study consisted of HCWs and leaders from the Quebec province. Participants completed validated self-administered questionnaires assessing both positive and negative self-compassion components (self-kindness vs self-judgment; common humanity vs isolation; and mindfulness vs overidentification) and moral injury dimensions (self-oriented and other-oriented). Prevalence ratios (PRs) and 95% confidence intervals (CIs) for the associations between self-compassion components and moral injury dimensions were modeled using Poison robust regressions. The models were adjusted for various covariates, including sex, age, gender, and socio-demographic and lifestyle factors., Ethical Considerations: Ethical approval for this study was obtained from the ethics committee of the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale in Quebec, Canada. All participants provided written informed consent prior to participating in the study. Additionally, permission was sought and obtained from the original authors of the tools used in this study, including the self-compassion and moral injury scales., Results: The study involved 572 HCWs (60.5% nurses) and leaders. Around half of the participants (50.70%) exhibited moderate levels of self-compassion, while the prevalence of low levels of self-compassion ranged from 21.68% to 48.08% for the positive subscales and from 23.78% to 44.41% for the negative subscales. Regarding moral injury, 10.14% of participants reported moderate to high self-oriented moral injury, 29.19% reported moderate to high other-oriented moral injury, and 13.81% demonstrated moderate to high total moral injury. Higher self-compassion levels were associated with lower moral injury prevalence. HCWs with high self-compassion had a 93% lower likelihood of experiencing moral injury (PR: 0.07, 95% CI: 0.03-0.19). Self-kindness demonstrated the strongest association with reduced moral injury (PR: 0.24, 95% CI: 0.11-0.52), followed by mindfulness (PR: 0.37, 95% CI: 0.18-0.75). However, common humanity did not show a statistically significant association with moral injury prevalence., Conclusion: These findings suggest a potential association between self-compassion and reduced prevalence of moral injury among HCWs, highlighting promising interventions to manage moral injury during crises. Such initiatives could promote the mental wellbeing of HCWs and preventing the negative consequences of moral injury, including anxiety, depression, and burnout., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The health implications of e-cigarette use compared to traditional cigarette smoking continue to attract significant public health interest. This study examines self-rated health (SRH) outcomes among exclusive e-cigarette users versus exclusive traditional cigarette smokers, using data from the Health Survey for England 2019. From an initial sample of 10,299 participants, the study focused on 8204 adults, excluding those aged 0-15. Further refinement to exclusive nicotine product users led to 274 e-cigarette users and 1017 cigarette smokers, after excluding dual users, never users, ex-users, non-responders, and users of other tobacco products such as pipes and cigars. SRH was derived from participants' responses to a question asking how they rated their general health, with five possible options: "very good", "good", "fair", "bad", and "very bad". For the purposes of this study, these responses were collapsed into two categories: "Good Health" (combining "very good" and "good") and "Poor Health" (combining "fair", "bad", and "very bad"). Consequently, 834 participants were classified as reporting good health, while 457 reported poor health. Binary logistic regression, adjusted for factors such as age, sex, ethnicity, residence, education, body mass index, alcohol use, age started smoking, physical or mental health conditions, and frequency of GP visits, revealed that exclusive e-cigarette users were significantly more likely to report good health compared to exclusive cigarette smokers, with an odds ratio (OR) of 1.59 (95% CI: 1.10 - 2.32, p = 0.014). As a sensitivity analysis, a generalized ordered logistic regression model was performed using the original five SRH categories. The adjusted model confirmed consistent results, with exclusive e-cigarette users showing higher odds of reporting better health across the full range of SRH outcomes (OR = 1.40, 95% CI: 1.08-1.82, p = 0.011). These findings suggest that exclusive e-cigarette users perceive their health more positively than traditional cigarette smokers, contributing useful insights to the discussions around harm reduction strategies., Competing Interests: Declarations Conflict of interest Yusuff Adebayo Adebisi previously received funding through the Tobacco Harm Reduction Scholarship and the Kevin Molloy Fellowship, both awarded by Knowledge-Action-Change (KAC) UK, an independent public health organization dedicated to advancing the science of tobacco harm reduction. KAC receives funding from Global Action to End Smoking (GA), an independent U.S. nonprofit 501(c)(3) grantmaking organization that supports Health & Science Research, Cessation Education, and Agricultural Transformation initiatives. The scholarship and fellowship did not influence the study’s design, preparation, writing, or interpretation of findings. The contents, selection, and presentation of facts, as well as any opinions expressed, are the sole responsibility of the authors and do not reflect the positions of KAC or GA. The research presented in this paper was conducted independently of any external funding sources. Abdullah Bafail declares no competing interests. Ethical approval Approval for this analysis was granted by the UK Statistics Authority Data Ethics Team, falling under the National Statistician’s Data Ethics Advisory Committee while East Midlands-Nottingham 2 Research Ethics Committee; 15/EM/0254 approved the research ethics. All survey respondents provided verbal informed consent to participate in the Health Survey for England. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Human and animal rights and Informed consent This study is based on the analysis of secondary data obtained from the Health Survey for England (HSE) 2019, which consists of anonymized, publicly accessible data. The data were collected by the original researchers in compliance with ethical standards, and informed consent was obtained from all participants by the original data collectors. As this study involved secondary data analysis, no additional ethical approval or informed consent was required by the authors for this research, as it qualifies for exemption from human subject research., (© 2024. The Author(s).)

Numerous studies have suggested that the hemoglobin-to-red blood cell distribution width ratio (HRR) is associated with the onset, progression, and prognosis of various diseases. However, to the best of our knowledge, no research has conducted statistical analyses to determine the association between HRR and stroke. This cross-sectional study was conducted among adults with complete data on hemoglobin-red cell distribution width ratio (HRR) and stroke from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). HRR was calculated by dividing hemoglobin (HGB) in grams per deciliter (g/dL) by the red blood cell distribution width (RDW). Weighted multivariable logistic regression and generalized additive models were employed to investigate the independent and nonlinear relationships between HRR and stroke. Threshold effects were assessed using two-piece linear regression models. Additionally, subgroup analyses and interaction tests were performed. A total of 36,215 participants were included, with 2.92% classified as stroke patients. The prevalence of stroke decreased across increasing tertiles of HRR (Q1: 5.07%; Q2: 2.63%; Q3: 1.69%; P < 0.0001). A negative association between HRR and stroke was observed in both unadjusted and adjusted models. In Model III, each one-unit increase in HRR was associated with a 58% reduction in the likelihood of stroke (Model III: OR = 0.42, 95% CI: 0.29-0.63). Subgroup analyses and interaction tests revealed that the association between HRR and stroke was BMI-dependent (P < 0.05), with the negative association only observed in participants with BMI < = 25 and BMI 25-30, but not in those with BMI > 30. Using a two-piece linear regression model, a threshold effect was identified at a BMI of 30 (K = 1.16). To the left of this breakpoint, there was a negative association between HRR and stroke (OR = 0.55, 95% CI: 0.27-0.97), whereas no such association was detected to the right of the breakpoint (OR = 6.49, 95% CI: 0.75-56.11). HRR is negatively associated with the likelihood of stroke, with a lower risk of stroke in individuals with higher HRR levels., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethics approval The studies involving humans were approved by the National Center for Health Statistics Research Ethics Review Board. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study., (© 2024. The Author(s).)

Background: Multiple studies have confirmed the mutual enhancement of percutaneous permeation of benzophenone-3 (BP-3) and N,N-diethyl-m-toluamide (DEET), which are effective ingredients in sunscreen products and insect repellents, respectively. However, the association between percutaneous absorption of BP-3 and DEET in a large general adult population remains to be elucidated., Methods: This cross-sectional study included US adults who had available data on urinary BP-3 and two DEET metabolites, 3-(diethylcarbamoyl) benzoic acid (DCBA) and 3-(ethylcarbamoyl) benzoic acid (ECBA), from the National Health and Nutrition Examination Survey (NHANES) conducted in 2015-2016. We conducted three weighted multivariable linear regression models to investigate the potential correlation between percutaneous absorption of BP-3 and DEET, along with trend tests, smooth curve fitting, and subgroup analysis to assess the robustness of the findings., Results: Weighted multivariable linear logistic regression revealed a positive correlation between log 10 BP-3 and log 10 DCBA (β = 0.1678, 95 % CI: 0.0970 to 0.2386) as well as log 10 ECBA (β = 0.1416, 95 % CI: 0.0707 to 0.2125), after adjusting for all covariates. After converting log 10 BP-3 from a continuous variable to a categorical variable (quartiles), the trend tests showed that the results were stable (all P for trend < 0.05). Smoothed curve fitting demonstrated a linear positive correlation between log 10 BP-3 and both log 10 DCBA and log 10 ECBA. In subgroup analyses, the positive correlation between BP-3 and DEET metabolites was more pronounced in participants who were male, middle-aged, non-Hispanic white, had a moderate PIR level and reported always or most of the time using sunscreen., Conclusions: Our findings revealed a statistically significant linear and positive correlation between the percutaneous absorption of BP-3 and DEET in the general adult population., Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Artificial intelligence (AI) chatbots such as ChatGPT are expected to impact vision health care significantly. Their potential to optimize the consultation process and diagnostic capabilities across range of ophthalmic subspecialties have yet to be fully explored., Objective: This study aims to investigate the performance of AI chatbots in recommending ophthalmic outpatient registration and diagnosing eye diseases within clinical case profiles., Methods: This cross-sectional study used clinical cases from Chinese Standardized Resident Training-Ophthalmology (2nd Edition). For each case, 2 profiles were created: patient with history (Hx) and patient with history and examination (Hx+Ex). These profiles served as independent queries for GPT-3.5 and GPT-4.0 (accessed from March 5 to 18, 2024). Similarly, 3 ophthalmic residents were posed the same profiles in a questionnaire format. The accuracy of recommending ophthalmic subspecialty registration was primarily evaluated using Hx profiles. The accuracy of the top-ranked diagnosis and the accuracy of the diagnosis within the top 3 suggestions (do-not-miss diagnosis) were assessed using Hx+Ex profiles. The gold standard for judgment was the published, official diagnosis. Characteristics of incorrect diagnoses by ChatGPT were also analyzed., Results: A total of 208 clinical profiles from 12 ophthalmic subspecialties were analyzed (104 Hx and 104 Hx+Ex profiles). For Hx profiles, GPT-3.5, GPT-4.0, and residents showed comparable accuracy in registration suggestions (66/104, 63.5%; 81/104, 77.9%; and 72/104, 69.2%, respectively; P=.07), with ocular trauma, retinal diseases, and strabismus and amblyopia achieving the top 3 accuracies. For Hx+Ex profiles, both GPT-4.0 and residents demonstrated higher diagnostic accuracy than GPT-3.5 (62/104, 59.6% and 63/104, 60.6% vs 41/104, 39.4%; P=.003 and P=.001, respectively). Accuracy for do-not-miss diagnoses also improved (79/104, 76% and 68/104, 65.4% vs 51/104, 49%; P<.001 and P=.02, respectively). The highest diagnostic accuracies were observed in glaucoma; lens diseases; and eyelid, lacrimal, and orbital diseases. GPT-4.0 recorded fewer incorrect top-3 diagnoses (25/42, 60% vs 53/63, 84%; P=.005) and more partially correct diagnoses (21/42, 50% vs 7/63 11%; P<.001) than GPT-3.5, while GPT-3.5 had more completely incorrect (27/63, 43% vs 7/42, 17%; P=.005) and less precise diagnoses (22/63, 35% vs 5/42, 12%; P=.009)., Conclusions: GPT-3.5 and GPT-4.0 showed intermediate performance in recommending ophthalmic subspecialties for registration. While GPT-3.5 underperformed, GPT-4.0 approached and numerically surpassed residents in differential diagnosis. AI chatbots show promise in facilitating ophthalmic patient registration. However, their integration into diagnostic decision-making requires more validation., (©Shuai Ming, Xi Yao, Xiaohong Guo, Qingge Guo, Kunpeng Xie, Dandan Chen, Bo Lei. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 14.11.2024.)

Background: Apathy is a prevalent and debilitating neuropsychiatric symptom among persons living with Alzheimer's disease and related dementias, particularly those residing in long-term care facilities (LTCF). Despite its profound effects on the quality of life for both residents and their caregivers, apathy remains underrecognized and poorly understood in the context of dementia care., Objective: To investigate the prevalence and biopsychosocial characteristics of apathy among newly admitted residents with dementia in Canadian LTCF using an Apathy Index derived from the interRAI Minimum Data Set (MDS) 2.0., Methods: This cross-sectional study analyzed data from newly admitted residents with dementia from various LTCF (N = 97,789) across seven Canadian provinces between 2015 and 2019. Logistic regression analysis was performed to determine the relationship between apathy and multiple variables including sociodemographic and clinical variables. The biopsychosocial model of health was used to guide analysis., Results: The prevalence rate of apathy among the Canadian long-term care residents with Alzheimer's disease and related dementias was 13.1%. Apathy was associated with various variables including male sex, pain, use of psychotropics, high Activity of Daily Living Self-Performance Hierarchy Scale scores, depression, aggression, severe cognitive impairment, and insomnia. Preferences for certain activities such as card games, art and craft, reading, music and exercise were inversely related to apathy while gardening was not., Conclusions: By shedding light on this complex phenomenon within a Canadian context, we recommend that targeted interventions and improved care strategies to enhance the well-being of persons living with dementia should be prioritized in LTCF.

Aim: To investigate the discrepancies between clinical practices and aspiration prevention standards among advanced practice nurses (APNs) in geriatrics and provide a basis for risk evaluation and prevention strategies for older adults., Methods: Using convenience sampling from November 20 to December 30, 2023, we surveyed 227 APNs in geriatrics from Guangdong Province, China. Data were collected using demographic forms and questionnaires focused on aspiration prevention strategies for older adults. Univariate and multivariate linear stepwise regression analyses were conducted to identify factors that influenced the effectiveness of aspiration prevention by APNs., Results: The mean score of APNs in geriatrics for older adult aspiration prevention was 94.9 ± 17.4. The multivariate regression analysis identified hospital level, evidence-based practice, and job satisfaction as significant factors., Conclusion: This study highlights the essential contribution of APNs to geriatric care and emphasizes the need for sustained professional development and adherence to evidence-based protocols to optimize aspiration prevention strategies., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: In clinical practice, psoriasis is a prevalent chronic inflammatory cutaneous disease featured with the development of red plaque with silvery scales, which considerably affects cutaneous health and quality of life of those afflicted., Objective: This research aimed to examine the association between the body roundness index (BRI) and psoriasis, using data sourced from the National Health and Nutrition Examination Survey (NHANES)., Methods: Our study used a cross-sectional design, including 8,479 adults, of whom 234 were diagnosed with psoriasis. Multivariable logistic regression was used to analyze the relationship between BRI and psoriasis, with stepwise adjustments for covariables., Results: Results from multivariable logistic regression analyses indicated a significant positive relationship between BRI and the risk of developing psoriasis; specifically, after comprehensive adjustment for covariables, per 1 unit increase in BRI was linked to an 11% rise in psoriasis risk (OR = 1.11, 95% CI = 1.05-1.17). Furthermore, psoriasis patients exhibited higher average BRI compared to non-psoriasis patients and a greater prevalence of comorbidities such as hypertension and smoking., Conclusion: These findings suggest that higher BRI is positively correlated with the risk of psoriasis in the adult population in the US. BRI could potentially act as a practical anthropometric index for more accurately predicting the risk of developing psoriasis., Competing Interests: Declarations Ethical approval The research methodology for NHANES has received approval from the NCHS Institutional Review Board (IRB), with all participants providing informed consent prior to their involvement in the study. As all NHANES data is publicly accessible, no additional IRB approval is required for human research. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: Life's Essentials 8 (LE8) is a new indicator developed by the American Heart Association to assess cardiovascular health, including diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose and blood pressure. And more and more studies have shown that this index can evaluate other diseases, such as chronic kidney disease, abdominal aortic calcification and so on. However, there is no relevant study to evaluate the association between LE8 and psoriasis. The purpose of this study was to investigate the relationship between LE8 and the prevalence of psoriasis in American adults., Patients and Methods: The data are from the National Health and Nutrition Examination Survey (NHANES) of the United States from 2003 to 2006, 2009 to 2014. Psoriasis was the dependent variable. LE8 is an independent variable and is divided into three levels: high, medium and low. Multivariate logistic regression model was used to explore the relationship between LE8 and psoriasis., Results: A total of 13430 people were included in this study, including 391 patients with psoriasis and 13039 patients without psoriasis. The prevalence of psoriasis was 2.91%. In the fully adjusted logistic regression model, LE8 score was negatively correlated with psoriasis (OR=0.99; 95% CI, 0.98-0.99, P=0.0003). And this result still exists when LE8 is divided into high, medium and low groups. Compared with the low LE8 group, the high LE8 group had a 61% lower risk of psoriasis (OR=0.39; 95% CI, 0.26-0.57, p <0.0001)., Conclusion: This cross-sectional study suggested that LE8 score was negatively correlated with psoriasis risk., Competing Interests: Weiqing Zhang and Zengze Yuan contributed equally to this work and share first authorship. All authors declare no conflicts of interest in this work., (© 2024 Zhang et al.)

Purpose: To investigate economic inequality in age-related macular degeneration (AMD) and decompose it into its determinants using Oaxaca-Blinder decomposition (OBD)., Methods: The Tehran Geriatric Eye Study was a cross-sectional study conducted on individuals aged 60 years and older, utilizing stratified random cluster sampling. Each participant received a comprehensive optometric, and slit-lamp examination. Diagnosis and classification of AMD were conducted utilizing fundus camera images., Results: The data of the 3268 participants were analyzed. According to OBD, a significant difference was found in AMD between the rich and poor groups (8.36%) disfavoring the poor ( p < 0.001). The explained and unexplained portions comprised 93.37% and 6.63% of the difference ( p < 0.001 and p = 0.405, respectively). Among study variables, age (coefficient = 4.70; p < 0.001), economic status (coefficient = 3.58; p = 0.004), and myopia (coefficient = 0.73; p = 0.001) were significant determinants of inequality in the explained portion., Conclusion: A significant disparity in the prevalence of AMD was observed between individuals of different socioeconomic statuses, primarily attributed to the explained factors. Factors such as age, economic status, and myopia were found to have the most substantial impact in exacerbating the inequality that disadvantaged the poor group (contributing percentages: 52.17%, 39.73%, and 8.10%, respectively). The findings of this research can be valuable for health policymakers in prioritizing and addressing the determinants of inequality within the population.

Background: Elevated homocysteine (Hcy) levels have been linked to cardiovascular disease (CVD), but their association with cardiometabolic multimorbidity (CMM) remains uncertain., Methods: Data from the baseline survey of the China Northwest Cohort-Ningxia Project (CNC-NX) were used to recruit 22,566 participants. Demographic characteristics, lifestyle factors, and laboratory exam results were collected. Logistic regression was used to evaluate the association between Hcy levels and CMM risk. Restricted cubic splines (RCS) explored potential non-linear relationships, and subgroup analyses assessed the consistency of the association across distinct groups. Sensitivity analysis accounted for cluster variability., Results: The final analysis included 18,126 participants. Higher Hcy levels were significantly associated with an increased risk of CMM (adjusted OR = 1.005, P = 0.003), with a linear relationship confirmed by RCS analysis (P for non-linearity = 0.142). There was a stronger association between Hcy-CMM in high-risk people, including elderly, males, and those with high BMI (P < 0.05). No significant association was observed between Hcy levels and more severe types of CMM., Conclusions: Elevated Hcy levels are correlated with an increased risk of CMM, warranting further investigation into the underlying mechanisms and potential interventions. Given the individual differences in the Hcy-CMM relationship, targeted comprehensive interventions for high-risk groups are necessary to reduce the risk of CMM., Competing Interests: Declarations Ethics approval and consent to participate This study was approved by the Institutional Ethics Committee (IEC) of Ningxia Medical University (Ethics ID: 2018-012, 2020 − 689). Written informed consent was obtained from all participants. All investigations were conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: As global aging accelerates, depression among the elderly becomes more common. Research had revealed that patients with late-life depression (LLD) face a higher risk of suicide compared to their counterparts in other age groups, with the pathways to suicide being multifaceted. Thus, investigating the various factors linked to the elevated risk of suicide in patients with LLD is critical., Objective: To investigate the factors associated with a high level of suicide risk among patients with LLD., Methods: A total of 108 patients with LLD were recruited for this study. From October 2022 to November 2023, a cross-sectional study was conducted on patients with LLD from the Affiliated Brain Hospital of Guangzhou Medical University. Suicide risk was evaluated using the Chinese version of the Nurses' Global Assessment of Suicide Risk Scale (NGASR). Potential influencing factors were included and analyzed through multivariate linear regression to identify the factors associated with a high level of suicide risk among patients with LLD., Results: The mean NGASR score among patients with LLD was 7.30 ± 4.34 (range: 0 ~ 19). Multiple linear regression analyses revealed that depression-anxiety of the Brief Psychiatric Rating Scale (BPRS) (β = 0.31, 95% CI = 0.13, 0.45, p<0.001), activation of the BPRS (β=-0.29, 95% CI=-1.22, -0.35, p<0.001), normal cognitive function of the Mini-Mental State Examination (MMSE) (β = 0.21, 95% CI = 0.50, 3.48, p<0.05), involuntary admission (β = 0.20, 95% CI = 0.44, 3.43, p<0.05), and objective support of the Social Support Rating Scale (SSRS) (β = 0.21, 95% CI = 0.08, 0.66, p<0.05) were statistically associated with a high level of suicide risk in patients with LLD., Conclusion: This study found that LLD patients with severe depression-anxiety, low activation, normal cognitive function, involuntary admission, and strong objective support exhibited a high level of suicide risk. These patients should receive intensified monitoring and comprehensive measures should be implemented to prevent the occurrence of suicidal behaviors during hospitalization., Competing Interests: Declarations Ethics approval and consent to participate This study obtained ethical approval from the IRB of the Affiliated Brain Hospital of Guangzhou Medical University (approval number: 2024-003). The entire study was carried out in accordance with the Declaration of Helsinki. The participants’ data were used solely for this research study and kept confidential. Informed consent was obtained from all participants before enrollment in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Copyright Statement An unauthorized version of the Chinese MMSE was used by the study team without permission, however this has now been rectified with PAR. The MMSE is a copyrighted instrument and may not be used or reproduced in whole or in part, in any form or language, or by any means without written permission of PAR (www.parinc.com)., (© 2024. The Author(s).)

Objective: Information regarding the relationship between epilepsy and vitamin K1 remains unclear. We aimed to assess the association between dietary vitamin K1 intake and epilepsy., Methods: Data was obtained from the National Health and Nutrition Examination Survey (NHANES) conducted from 2013 to 2018. The study enrolled participants aged ≥ 18 years that provided complete information on their dietary vitamin K1 intake and epilepsy status. Weighted multivariable regression and subgroup analyses were performed to detect the association between dietary vitamin K1 intake and epilepsy., Results: In total, 10 137 participants (mean age, 48 years) were enrolled. Among them, 84 (0.83%) participants were identified as having epilepsy, whereas 10 053 (99.17%) were included in the non-epilepsy group, with an average dietary vitamin K1 intake of 67.2 ± 6.9 and 105.5 ± 1.5 µg/d, respectively. Each unit (10 µg/d) increase in vitamin K1 intake was associated with a 7% decrease in the odds of epilepsy (odds ratio = 0.93, 95% confidence interval: 0.88-0.98, p = 0.011). Multivariate logistic regression analysis revealed that participants in the higher quartile had lower odds of epilepsy than those in the first quartile of vitamin K1 intake. Subgroup analysis showed a stable and consistent inverse association between dietary vitamin K1 intake and epilepsy., Conclusion: Higher dietary vitamin K1 intake was associated with lower incidence of epilepsy. Our study did not establish a cause-and-effect relationship. Further large-scale prospective studies and randomized trials are warranted to confirm our findings., Competing Interests: Declarations Ethics approval and consent to participate The National Center for Health Statistics and Research Ethics Review Committee approved the use of human participants for the NHANES study. In addition, written informed consent was provided by each participant. Due to the retrospective nature of this study (publicly available NHANES data), the requirement for an institutional review board approval was waived. Consent for publication NA. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: As intrinsic capacity (IC) declines, older adults are at a significantly increased risk of frailty, care dependency, and death. Currently, the research on IC among older adults in China was still insufficient. We aimed to identify the status quo and influencing factors among community-dwelling older adults in China and explore the relationship between IC, external environment, and social network., Methods: A convenience sampling method was used to collect 312 older people from May 2023 to February 2024 in five communities in Chengdu, Sichuan Province. Data were collected using the general information questionnaire, Integrated Care of the Elderly (ICOPE) screening tool, World Health Organization Quality of live scale (WHOQOL-100), and Social Network Scale (LSNS-6)., Results: The IC score among Chinese community-dwelling older adults was 3.39 ± 1.60, and the prevalence of IC decline was 86.9%. Marital status, age, number of chronic diseases, social network, and external environment were influencing factors of IC, which explained 35.7% of the total variance. External environment and social network were positively correlated with IC., Conclusions: Chinese community-dwelling older adults had low IC scores and a high prevalence of IC decline. The government should focus on IC for older adults, especially those who are older, not married or widowed, and suffering from multiple chronic diseases. In addition, the richer the external resources available to older adults, the more social support they received, and the better the IC. These findings could provide a theoretical basis for managing and improving IC in older adults., Competing Interests: Declarations Ethics approval and consent to participate Written informed consent was obtained from all participants. The study was approved by Medical Ethics Committee of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (2022KL-033). All the participants were given detailed information about the goals, purposeand reasons for the research. All methods were carried out in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Metabolic dysfunction is associated with respiratory diseases, and the triglyceride-glucose (TyG) index is an important indicator of metabolic dysfunction., Objectives: The purpose of this study was to explore the possible relationship between TyG and asthma exacerbation, while also investigating potential subgroup differences in this relationship., Methods: Data from the 2009-2018 National Health and Nutrition Examination Survey (NHANES) were included. Multifactorial logistic regression, subgroup analysis, smoothed curve fitting, and threshold effect analysis models were used to explore the relationship between TyG and asthma exacerbations., Results: A total of 964 participants were included in the analysis (34.13 % male, 65.87 % female, 45.4 % Non-Hispanic White, 25.3 % Non-Hispanic Black), with a mean age of 50.57 ± 17.32 years. We found a nonlinear positive relationship between TyG and asthma exacerbation, which was maintained in all three models. In the fully adjusted model, the risk of asthma exacerbation increased by 25 % with each unit increase in the patient's TyG level (OR:1.25, 95 %CI: 1.21-1.30). Subgroup analysis showed significant associations between TyG and asthma exacerbations among females, as well as in individuals aged 20-59, body mass index (BMI) <25 or BMI≥30. Furthermore, a U-shaped relationship between TyG and asthma exacerbation was identified in males using smoothed curve fitting, with an inflection point at the TyG level of 9.15., Conclusions: We found a nonlinear positive association between TyG and asthma exacerbation. Our study highlights the potential clinical value of TyG in managing asthma exacerbations, particularly emphasizing the need for gender-specific risk management strategies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Importance: The homepage of medical records holds significant importance for national performance assessments, DIP settlement lists, and DRG payments. Coders, as auditors of the codes, wield a crucial influence on the quality of the medical records' homepage., Objective: To analyze the general situation of the allocation of medical record full-time coders in China., Data Source: CNKI, Wanfang, VIP, PubMed and other databases were searched from database inception to November 31, 2023., Main Outcomes and Measures: The primary outcome was the allocation of medical records to full-time coders, with the workload of the coders being the primary focus. Secondary outcomes encompassed the professional background of the coders, including their academic qualifications, professional titles, possession of medical coding certificates, and years of experience in coding., Results: Eleven studies, comprising data from 1783 hospitals and 4448 coders, were analyzed. Among the coders, 61% had a medical-related professional background, 62% held a bachelor's degree or higher, 54% possessed an intermediate title or higher, 61% had coding certificates, and 51% had less than 5 years of work experience. The summary findings regarding the number of coders and coded medical records in secondary and tertiary hospitals indicated an average discharge rate of 22,704.0 per hospital in China. The number of coded cases averaged around 11,300. Specifically, coders in tertiary hospitals coded approximately 12,049 medical records on average, while those in secondary hospitals coded around 7,399 medical records., Conclusion and Relevance: Our study highlights the shortage of medical record coding personnel in the majority of hospitals, coupled with a significant coding workload, low educational qualifications among staff, short working hours, and an imbalanced title structure. Given these findings, hospitals and relevant management authorities should prioritize the recruitment of highly educated professionals, streamline the assessment process for professional titles, alleviate the coding workload, and enhance coding quality., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: The weight-adjusted-waist index (WWI) is a novel obesity measurement indicator, and this study aims to determine the relationship between WWI and Familial hypercholesterolemia (FH)., Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) from 2017 to March 2020, cross-sectional data from 3698 participants were analyzed. The study examined the correlation between WWI and FH using multivariate logistic regression and smooth curve fitting, and conducted subgroup analysis and interaction tests., Results: The study sample consisted of 3698 subjects for whom the overall probable prevalence of FH was 5.43% and increased with WWI tertile (quantile 1: 4.00%; quantile 2: 4.94%; quantile 3: 7.34%); individuals with the highest WWI tertile were significantly more likely to have FH than those with the lowest tertile (OR = 4.60,95% CI: 2.00-10.60). Subgroup analysis and interaction tests showed significant significance between WWI and personal history of early Atherosclerotic cardiovascular disease (ASCVD), family history of early ASCVD and probable prevalence of FH (p < 0.05)., Conclusion: This study demonstrates a nonlinear positive correlation between WWI and FH. This may provide new ideas for the prevention and treatment of FH in the future., Competing Interests: Declarations Ethics approval and consent to participate The portions of this study involving human participants, human materials, or human data were conducted in accordance with the Declaration of Helsinki and were approved by the National Center for Health Statistics (NCHS) Ethics Review Board. The patients/participants provided their written informed consent to participate in this study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: The triglyceride glucose-body mass index (TyG-BMI) is a well-established surrogate marker for insulin resistance. While an association between insulin resistance and depression has been identified, that between TyG-BMI and depression remains unclear. Therefore, we used data from the National Health and Nutrition Examination Survey (NHANES) database to investigate this., Study Design: This cross-sectional study included 9673 adults (aged ≥20 years) from the NHANES in the United States from 2011 to 2020., Methods: Depressive symptoms were assessed using a nine-item version of the Patient Health Questionnaire. The covariates included age, sex, race/ethnicity, marital status, educational level, poverty-income ratio, smoking status, alcohol intake, diabetes status, cardiovascular disease, hypertension, physical activity, high-density lipoprotein, low-density lipoprotein, and total cholesterol. Multivariate logistic regression models, subgroup analyses, and threshold saturation effect analyses were conducted., Results: After adjusting for age, sex, race/ethnicity, marital status, education level, poverty-income ratio, smoking status, drinking status, diabetes status, cardiovascular disease, hypertension, physical activity, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol, the threshold saturation effect showed a TyG-BMI inflection point of 174.4. Below the inflection point, a 10-unit increase in TyG-BMI was associated with a 12 % lower prevalence of depression. Above the inflection point, each 10-unit increase in TyG-BMI was associated with a 4 % increase in prevalence of depression., Conclusions: TyG-BMI had a U-shaped relationship with prevalence of depression. There was a significant link between higher TyG-BMI levels and increased prevalence of depression. When the TyG-BMI value was below 174.4, any further increase in TyG-BMI was associated with a significantly lower prevalence of depression., (Copyright © 2024. Published by Elsevier Ltd.)

Depression frequently comorbidities with cancer, adversely affecting survivors' quality of life. Liver dysfunction is also prevalent among cancer survivors. However, the association between these two conditions remains unclear. This study aimed to explore the relationship between depression and liver function biomarkers in US cancer survivors. A cross-sectional study was conducted utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2005-2020. Cancer survivors were screened and depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and 18 liver function biomarkers were included. Survey-weighted generalized linear models with multiple covariables adjusted were employed to examine the associations between depression and liver function biomarkers. A total of 4118 cancer survivors were included, representing a weighted population of 21 501 237. After adjusted with age, gender, race, marital status, education level, family income-to-poverty ratio, and number of cancer types, 8 biomarkers demonstrated positive correlations with depression in cancer survivors, included alanine aminotransferase (ALT, OR = 1.007, 95% CI: 1.000 to 1.013), alkaline phosphatase (ALP, 1.006 [1.002, 1.010]), gamma glutamyl transferase (GGT, 1.004 [1.001, 1.007]), lactate dehydrogenase (LDH, 1.004 [1.000, 1.009]), total protein (TP, 1.040 [1.009, 1.072]), globulin (GLB, 1.060 [1.030, 1.091]), total cholesterol (TC) to high-density lipoprotein cholesterol (HDL-C) ratio (1.162 [1.050, 1.286]), and low-density lipoprotein cholesterol (LDL-C) to HDL-C ratio (1.243 [1.012, 1.526]); while 4 other biomarkers exhibited negative correlations, included HDL-C (0.988 [0.980, 0.997]), total bilirubin (TBi, 0.501 [0.284, 0.883]), aspartate aminotransferase (AST) to ALT ratio (0.588 [0.351, 0.986]), albumin (ALB) to GLB ratio (0.384 [0.229, 0.642]). Following sensitivity analysis, 5 biomarkers included LDH, HDL-C, TBi, AST/ALT and LDL-C/HDL-C lost their statistical significance for the association. This study identified certain associations between 7 liver function biomarkers and depression in US cancer survivors. Further research, particularly prospective longitudinal studies, is warranted to elucidate the causal relationships and explore the potential of improving liver function for the management of depression in cancer patients., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethics approval and consent to participate All the NHANES protocols were approved by the Ethics Review Board of U.S. National Center for Health Statistics, and written informed consents were obtained from all participants of NAHNES surveys., (© 2024. The Author(s).)

Purpose: The aim of this cross-sectional study was to investigate the association between blood lead levels and serum creatinine., Methods: In the present study, sample data were derived from the National Health and Nutrition Examination Survey (NHANES) 2015-2018 of participants with complete data of blood lead levels and serum creatinine. Multivariate linear regression models were used to examine the association between blood lead levels and serum creatinine. The nonlinear connection was described using fitted smoothing curves and threshold effect analysis. Furthermore, subgroup analyses and interaction tests were performed., Results: A total of 9026 participants were enrolled in this study, and the mean serum creatinine for all subjects was 0.86 ± 0.34 mg/dL. When blood lead levels were divided into quartiles, it was found that participants' serum creatinine levels gradually increased with increasing blood lead levels (Q1: 0.77 ± 0.19 mg/dL, Q2: 0.84 ± 0.23 mg/ dL, Q3: 0.89 ± 0.34 mg/dL, Q4: 0.94 ± 0.50 mg/dL). Compared to the lowest serum quartile, the highest quartile of blood lead levels had a positive correlation with serum creatinine in the fully adjusted model (β = 0.05 95% CI 0.01-0.08). Smooth curve fittings and threshold effect analysis showed an inverted J-shaped nonlinear relationship between blood lead levels and serum creatinine, with an inflection point of 3.10 (μg/dL). Subgroup analyses and interaction tests revealed that diabetes mellitus impacted the relationship between serum creatinine and blood lead levels., Conclusion: This study suggests a positive correlation between blood lead levels and serum creatinine., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Because of its possible significance in metabolic diseases, the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) has garnered attention as a novel and trustworthy lipid biomarker. Psoriasis may be linked to metabolic problems and obesity, according earlier research. Uncertainty surrounds the relationship between NHHR and the onset of psoriasis, though. The primary aim of this investigation was to examine the relationship between NHHR and psoriasis., Patients and Methods: This cross-sectional analysis used data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2009 and 2014. The association between psoriasis and NHHR was examined using multivariate logistic regression, and smoothed curve fitting was done to explore the non-linear relationship. Furthermore, Subgroup and sensitivity studies were performed in order to confirm the robustness of the findings., Results: Psoriasis and NHHR were shown to be positively correlated in 15,951 adult individuals who were at least 20 years old. Psoriasis risk rose by 7% for each unit increase in NHHR [1.07 (1.01, 1.14)]. Individuals in the highest NHHR tertile were 39% more likely compared to those in the bottom tertile to have psoriasis [1.39 (1.09, 1.78)]. Across subgroups, this favorable connection remained consistent., Conclusion: Elevated NHHR levels are positively correlated with an upsurge chance of psoriasis in the adult population in the United States. The significance of NHHR as an indication for early psoriasis risk assessment is shown by this study., Competing Interests: The authors state that there were no financial or commercial connections that would have given rise to a conflict of interest in relation to the study., (© 2024 Jiang and Jia.)

Background: Severe acute respiratory infection (SARI) is a major cause for hospital admission and associated with high mortality among children worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses and respiratory syncytial virus (RSV) are the most frequently identified pathogens in children with SARI. The duration of care can be affected by the type of infection and patient characteristics. Therefore, the objective of this study was to identify factors affecting the length of hospitalization in children infected with SARS-CoV-2, influenza A and RSV., Methods: We collected data on 713 children with SARI from the medical databases of a university hospital in Hungary. To examine whether there is a difference in the length of hospitalization in children with the SARI Kruskal-Wallis test was performed. To determine the factors that may have an impact on the duration of care a multiple logistic regression analysis was executed., Results: Our results showed that among RSV infected patients the proportions of children requiring intensive care (8.94%), mechanical ventilation (8.94%) and oxygen therapy (13.01%) and suffering from pneumonia (29.27%) were larger than among cases with SARS-CoV-2 and influenza A infection. Considering the age distribution and the duration of care in children with SARI, cases with RSV were significantly younger (p < 0.001) and stayed longer in the hospital (median: 5 days, IQR: 4-7 days, p < 0.001) than those with SARS-CoV-2 and influenza A virus. Multiple logistic regression analysis showed that RSV infection (adjusted odds ratio (aOR): 3.25, 95% confidence interval (CI): 1.43-7.38; p = 0.005), pneumonia (aOR: 3.65, 95% CI: 2.14-6.24; p < 0.001), mechanical ventilation or oxygen therapy (aOR: 3.23, 95% CI: 1.29-8.11; p = 0.012) and underlying illnesses (aOR: 2.39, 95% CI: 1.35-4.23; p = 0.003) significantly increased the odds of hospitalization for more than 4 days., Conclusions: Our research showed that of the viruses causing SARI, RSV had the greatest clinical relevance, contributing to hospital stays of more than 4 days in a large share of paediatric patients below 1 year of age. Our results supply new information on children with SARI, and provide evidence for health policy makers to allocate additional resources to hospitals during SARI epidemics., (© 2024. The Author(s).)

This study aimed to evaluate the level of oral health knowledge among teachers in a city of the Brazilian Amazon region (Belem, Pará) and explore the association between teachers' knowledge and their proposed actions in the event of dental trauma accidents within the school environment. The descriptive cross-sectional study involved 170 elementary teachers from public schools in the Metropolitan Region of Belem, Para State, Brazil. A self-administered questionnaire with multiple-choice questions was utilized to assess teachers' oral health knowledge across various domains. The questionnaire comprised seven targeted sections: the first section focused on demographic and professional aspects of the educators, while the remaining six sections addressed the oral health knowledge related to oral health education, dental caries, dental trauma (specifically dental avulsion), periodontal disease, visits to the dentist, and the educator's role in promoting oral health. Data analysis involved descriptive statistics and χ 2 tests using Statistical Package for Social Science (SPSS; 20.0 version). Most of the sample were female (92.2%) and around 41-60 years (36.0%). Most teachers had over 5 years of teaching experience (87.0%) and held an undergraduate degree (63.0%). A significant association was found between teaching experience and the choice of storage method for avulsed teeth following dental trauma ( p =0.005). However, the teachers examined in this study exhibited inadequate knowledge concerning the appropriate treatment for cavities and the recommended age for a child's first dental appointment. These findings underscore the crucial role teachers play in promoting oral health among students, particularly in regions characterized by social inequality and limited access to basic sanitation and healthcare services., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Samuel de Carvalho Chaves Junior et al.)

Introduction: The aim of this cross-sectional study was to explore the degree whereby dentists differentiate between repair versus replacement for failed restorations. A random selection of adult patients from North Norway was chosen from the larger Tromsø 7 study., Methods: A randomized sample of 3,653 persons (11.5% of the total number of individuals invited to the Tromsø 7 study, 51.5% women, aged 40-93 years) were included. Based on FDI's clinical criteria for the evaluation of restorations - 2010, 17 calibrated dentists evaluated patients by clinical and radiographical pictures in a specially designed software developed for this purpose. The dental practitioners' opinions gave rise to the reported treatment decisions. Descriptive statistics and multivariable multilevel mixed-effect logistic regression models (STATA 17/SE) were performed., Results: The participants' DMFT values ranged from 0 (0.9%) to 24 (8.8%) (median DMFT 21.3, mean 20.0). A total of 90.062 teeth (24.7 teeth per patient) were assessed. Re-treatment suggestions were made for 3,006 restorations, i.e., an average of 3.3% re-treatments. Of these, 25.3% (n = 814) were suggested for repair and 74.7% (n = 2,192) for replacement. Dental treatment was suggested for 1,597 patients and varying from 1 to 14 suggestions per patient. Secondary caries (37.6%) and restoration fracture (15.2%) were found to be most frequently used indications for re-treatment, surface properties the least. No significant difference was found between assessing dentists based on sex or age. Clustering by dentist level was checked using intra-class correlation coefficients, demonstrating that 16% of the variance in suggestions for restoration re-treatment was explained at the dentist level. Thus, a wide range of treatment suggestions was noted among the dentists., Conclusion: Need for restoration revision seems low in North Norway. There is a tendency towards larger and more indirect restorations, and the diagnosis of secondary caries is still a matter of uncertainty., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Our study aimed to investigate the association between RFM and kidney stones, focusing specifically on the mediating role of high-density lipoprotein cholesterol (HDL-C). We performed a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) covering the years 2007 to 2018. Our analytical approach included multivariate logistic regression modeling, subgroup analysis, generalized additive modeling (GAM), smoothed curve fitting, and receiver operating characteristic (ROC) curve, as well as mediation analysis to assess the association between RFM and kidney stones. Finally, we categorized RFM into normal and elevated groups to conduct a sensitivity analysis. This study involved 29,712 participants, with a kidney stone prevalence of 9.88%. We discovered a positive association between RFM and kidney stones (OR = 1.41 per SD increment, 95% CI: 1.24, 1.60). Subgroup analysis revealed a consistent positive association across all subgroups, with a notably higher likelihood of developing kidney stones in young adulthood (P for interaction < 0.05). The smooth curve fitting shows that RFM is nonlinearly and positively correlated with the prevalence of kidney stones. Additionally, HDL-C was found to be negatively associated with kidney stones. Importantly, HDL-C demonstrated a significant mediating effect, with a mediation ratio of 13.52%. ROC analysis indicated that RFM (AUC = 0.616) provided better diagnostic accuracy than traditional measures such as BMI (AUC = 0.565) and WC (AUC = 0.599). Furthermore, the sensitivity analysis further supports the robustness of our findings. RFM is nonlinearly and positively correlated with the prevalence of kidney stones, with HDL cholesterol playing a significant mediating role in this relationship. However, further studies are needed to confirm these associations and explore potential mechanisms., (© 2024. The Author(s).)

Background: Gout stands as a prevailing manifestation of inflammatory arthritis. While it is linked to several well-established risk factors, the associations between lipid profiles and the risk of gout remain unclear., Methods: This research involved National Health and Nutrition Examination Survey data (2007-2018). The cardiometabolic index, which incorporates the Triglycerides (TG)/High-density lipoprotein cholesterol (HDL) ratio and waist to height ratio (WHtR), was used to assess lipid profiles and metabolic health. Multivariate logistic regression analysis, propensity score matching, and mediation analyses were utilized to evaluate the associations of lipid profiles and the cardiometabolic index with the risk of developing gout., Results: Among 11,032 participants, each 1-unit increase in TG levels was associated with a 65% increase in the odds of developing gout before matching [1.65 (1.15-2.38), P = 0.007] and a 155% increase in the odds of developing gout after matching [2.55 (1.59-4.09), P = 0.007]. Each 1-unit increase in the cardiometabolic index was linked to an 81% increase in the odds of developing gout before matching [1.81 (1.22-2.70), P = 0.004] and a 215% increase in the odds of developing gout after matching [3.15 (1.84-5.40), P < 0.001]. The participants with HDL levels in the third quartile presented a 35% reduction in gout risk relative to those with HDL levels in the first quartile before matching [0.65 (0.46-0.92), P = 0.014] and a 51% reduction in gout risk after matching [0.49 (0.32-0.75), P < 0.001]. Mediation analyses revealed that BMI, WHtR, and homeostatic model assessment for insulin resistance (HOMA-IR) mediated the relationships between TG levels and the risk of developing gout at 18.75%, 24.28%, and 5.35%, respectively. For the association between HDL levels and the risk of developing gout, the mediating effects of BMI, WHtR, leukocytes, γ-glutamyltransferase (in those with HDL < 56 mmol/L), and HOMA-IR were 57.98%, 69.03%, 8.77%, 5.18%, and 11.14%, respectively., Conclusion: This study reveals the relationship between lipid profiles and the risk of developing gout. Regularly checking TG and HDL levels and actively managing obesity, insulin resistance, oxidative stress and inflammation are important for lowering the risk of developing gout., (© 2024. The Author(s).)

Background: The cardiometabolic index (CMI) is a new predictor of obesity-related diseases, but its link to periodontitis is under-researched. This study aims to examine the potential association between the CMI and periodontitis., Methods: We conducted a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database (2009-2014) to examine the potential association between CMI and periodontitis. The study utilized a weighted multivariate logistic model to assess the association between TG, HDL-C, TG/HDL-C, obesity indices (BMI, WC, WHtR, CMI), and periodontitis, employing the area under the receiver operating characteristic curves (ROC) to estimate areas under the curve (AUC). Furthermore, generalized smooth curve fitting was conducted to examine the relationship between CMI and periodontitis. Finally, the study incorporated subgroup analysis and interaction tests to examine consistency across different populations., Results: TG/HDL-C, WHtR, and CMI were positively associated with periodontitis in the fully adjusted classification model. It was observed that for each unit increase in CMI, there was a corresponding 17.8% increase in the prevalence of periodontitis [1.178 (1.049, 1.322) 0.00562] and 18.7% increase in the prevalence of moderate/severe [1.187 (1.057, 1.334) 0.00376] in the fully adjusted model. When CMI was used as a categorical variable, the adjusted OR for periodontitis prevalence increased significantly with increasing CMI after adjusting for all potential covariates (T3 vs. T1: OR, 1.28 [1.06, 1.55], p < 0.05). The ROC analysis indicated that a larger area under the curve was found in the CMI [0.554 (0.538-0.570)] than in the WC [0.544 (0.528-0.560)] and WHtR [0.544 (0.528-0.561)]. Nonetheless, the discrepancy observed did not reach statistical significance (all p > 0.05). Further generalized smooth curve fitting and threshold effect models indicated a positive linear correlation between CMI and periodontitis. Moreover, there is no interactive association between TG/HDL-C, WHtR, CMI, and periodontitis., Conclusions: This cross-sectional study revealed a positive relationship between CMI and periodontitis. Further prospective studies are warranted to validate our findings., (© 2024. The Author(s).)

Introduction: Gestational diabetes mellitus (GDM) is associated with an increased risk of developing type 2 diabetes mellitus (T2DM). The inflammatory potential of diet is crucial in GDM development. This study compares dietary inflammatory indices (DII) in females with and without a history of GDM and constructs a predictive model for prediabetes risk., Methods: Cross-sectional data from NHANES cycles (2011-2014) were analyzed using the DII. Independent t tests, chi-square test, and Mann-Whitney U test examined DII scores in relation to GDM history. Multivariate logistic regression assessed DII's association with prediabetes in females with GDM history. Restricted cubic spline (RCS) and LASSO regression modeled non-linear relationships and predicted prediabetes risk., Results: 971 female participants were included. Those with GDM history had lower DII scores (1.62 (0.58, 2.93) vs. 2.05 (0.91, 2.93)). Higher DII scores in females with GDM were linked to prediabetes, remaining significant after adjusting for confounders. RCS analysis found no non-linear correlation (non-linear p = 0.617). The prediabetes model for GDM history had strong predictive performance (AUC = 88.6%, 95% CI: 79.9-97.4%)., Conclusion: Females with GDM history show lower DII levels, potentially reflecting improved diet and health awareness. Higher DII scores correlate with increased prediabetes risk in this group, emphasizing diet's role in diabetes risk. Further studies are needed to confirm these findings., (© 2024. The Author(s).)

Background: The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) index is a relatively new composite lipid index, the relationship between NHHR and depression is unclear from the current study. The primary aim of our study was to examine the association between the prevalence of depression and NHHR in a US population., Methods: The National Health and Nutrition Examination Survey (NHANES) provided the data for our investigation from 2005 to 2018. and primarily included participants who contained complete data on NHHR and depression in U.S. adults (age ≥20 years). Associations between NHHR and depression were assessed using multifactorial logistic regression analysis, subgroup analysis, and smoothed curve fitting., Results: In our study, 29,561 subjects in total showed a mean NHHR index of 3.12± 1.58,A noteworthy positive correlation was observed between NHHR and depression in multifactorial logistic regression analysis. Subgroup analyses and tests of interaction showed that gender, age, ethnicity, PIR, smoking, alcohol consumption, coronary heart disease, diabetes mellitus, hypertension, and stroke did not influence the NHHR and the association between depression (P for interaction > 0.05), whereas two stratification factors, BMI and sleep disturbance, may be potential factors in the association between NHHR and depression (P for interaction < 0.05)., Conclusion: According to our present study, if the level of NHHR rises in American adults, their likelihood of developing depression also increases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Yan, Wang, Liu, Fu and Zhou.)

Purpose: To evaluate the association between Composite Dietary Antioxidant Index (CDAI) and the risk of endometriosis in American women., Methods: The study adopted a cross-sectional design, incorporating 3862 women aged over 20 years, selected from the National Health and Nutrition Examination Survey (NHANES) dataset from 2001 to 2006. Six dietary antioxidants were taken into account in calculating CDAI. Endometriosis was determined based on self-report. To evaluate the association between CDAI and the risk of endometriosis, we employed models with multivariable logistic variables. For subgroup assessment in relation to CDAI, a stratified multivariate logistic regression model was utilized., Results: Among all participants, 273 participants (7.1%) were found to exhibit endometriosis. The preliminary analysis showed a reverse association between CDAI and the likelihood of endometriosis (odds ratio [OR] = 0.95; 95% confidence interval [CI]: 0.92~0.98). Upon full adjustment within the multivariable logistic regression, the ORs (95% CI) for endometriosis prevalence per unit increase in CDAI were estimated to be 0.96 (0.93~1). When the CDAI levels were divided into quartiles, it was found that the ORs for endometriosis with CDAI levels in Q2 (-2.131-0.023), Q3 (0.023-2.650), and Q4 (2.650-42.854) were 0.74 (0.52, 1.05), 0.76 (0.53, 1.1), and 0.53 (0.36, 0.79), respectively, compared to those with CDAI levels in Q1 (-7.151--2.131). We evaluated the association between CDAI and endometriosis using subgroups stratified by age, race/ethnicity, education level, body mass index (BMI), oral contraceptive, and menopausal status, revealing a substantial negative relationship., Conclusion: In this cross-sectional study, increasing CDAI was proportionally associated with a reduced risk of endometriosis among American women, suggesting a diet high in antioxidants may play an important role in reducing the risk of endometriosis. The findings of NHANES data spanning 2001 to 2006 suggest that promoting antioxidant-rich diets could be an important prevention strategy for endometriosis., Competing Interests: The researchers state to have no conflicts of interest., (© 2024 Xu et al.)

The aim of this study was to assess the sleep status of middle-aged and elderly adults in Bengbu City, Anhui Province, China, to identify the major dietary patterns, and to analyze the association of different sleep duration and dietary patterns with metabolic syndrome (MetS) and its related influencing factors, as well as to explore the predictive value of sleep duration and dietary patterns. A cross-sectional analysis was performed utilizing data collected from the Community-based Cardiovascular and Health Promotion Study 2019 (COCHPS 2019) conducted in Bengbu. The definition of MetS adhered to the criteria of Guidelines for the Prevention and Treatment of Dyslipidemia in Chinese Adults (2016 Revision). Dietary information was obtained using the Food Frequency Questionnaire (FFQ) to assess dietary intake over the past year. Principal component analysis (PCA) was performed to identify dominant dietary patterns. A logistic regression model was developed to analyze the associations among sleep duration, dietary patterns, and MetS, and a decision tree (DT) model was developed to compare factors affecting MetS and screen people at high risk for MetS. The prevalence of MetS was 13.4% among the 9132 middle-aged and elderly residents over 45 years of age included in COCHPS 2019. Participants were divided into short (< 6 h/d), normal (6-8 h/d), and long (> 8 h/d) groups based on their daily sleep duration. Three dietary patterns were identified by PCA, the fruit-milk pattern, the tubers-meat pattern, and the vegetable-cereal pattern. After adjusting for covariables, logistic regression analysis showed that long sleep duration was significantly negatively associated with MetS. The fruit-milk and vegetable-cereal patterns were negatively associated with MetS, whereas the tubers-meat pattern was positively correlated with MetS. The results of the DT model analysis showed that the vegetable-cereal pattern is the most important factor impacting MetS, followed by marital status, the tubers-meat pattern, the fruit-milk pattern, exercise, sleep duration, and gender. The DT model also screened out five types of MetS high-risk groups. The results of our study indicate that normal sleep duration and consumption of either a fruit-milk or vegetable-cereal diet may lower the likelihood of developing MetS in middle-aged and elderly adults., (© 2024. The Author(s).)

Background: The field of dietary therapies for migraine has grown in popularity. Less research has been conducted to establish the relationship between migraine and the composite dietary antioxidant index (CDAI), a crucial indicator for evaluating the overall combined effects of multiple dietary antioxidants. Therefore, this study addressed this gap based on the National Health and Nutrition Examination Survey (NHANES) database., Methods: Multivariate logistic regression equations were used to investigate the relationship between CDAI and migraine, and smoothed-fitted curves were plotted. After a nonlinear relationship was discovered, the recursive algorithm and a two-stage linear regression model were employed to calculate the turning point. Additional stratified analyses were performed to explore differences between populations., Results: This study included a total of 9,190 participants aged 20 years old or older. A U-shaped association was observed between the CDAI and migraine, with an inflection point of 0.2. They were negatively correlated before the inflection point with OR of 0.93 (95% CI = 0.88-0.97) and positively correlated after the inflection point with OR of 1.04 (95% CI = 1.01-1.07). This U-shaped relationship persisted among people aged <60 and ≥60 years, women, and people with BMI <30 and ≥30., Conclusions: We identified a U-shaped association between CDAI and migraine in the U.S. adult population. Further case-control studies and experimental research are needed to explore the underlying mechanisms of action.

Background: The oxidative balance score (OBS) serves as an indicator of systemic oxidative stress status, where a higher OBS indicates significant exposure to antioxidants through dietary and lifestyle choices. Studies exploring the relationship between OBS and suicidal ideation are limited. Therefore, this study aimed to examine the association between OBS and suicidal ideation., Methods: This cross-sectional study selected 28,598 individuals aged ≥20 years from the 2005-2018 National Health and Nutrition Examination Survey dataset. The OBS was determined using 16 dietary components and 4 lifestyle components. Item 9 of the Patient Health Questionnaire-9 was used to evaluate suicidal ideation. The association between suicidal ideation and OBS, dietary OBS, and lifestyle OBS was examined using weighted logistic regression and restricted cubic spline. The subgroup analyses and interaction tests were further conducted to assess the robustness of these associations across different populations., Results: The prevalence of suicidal ideation was 3.35 %. OBS, dietary OBS, and lifestyle OBS were substantially and inversely linked with suicidal ideation in Models 1, 2, and 3 (p < 0.05). The odds ratio for the highest quartile (Q4) of these variables and suicidal ideation in Model 3 was 0.44 [95 % confidence interval (CI): 0.30-0.65], 0.54 (95 % CI: 0.37-0.78), and 0.50 (95 % CI, 0.34-0.74), respectively, compared with the lowest quartile (Q1). The subgroup analyses revealed consistent connections between the three oxidative stress indices and suicidal ideation. The lifestyle OBS was negatively correlated with suicidal ideation, especially in women (p for interaction < 0.05)., Conclusions: The dietary and lifestyle OBSs may influence suicidal ideation by modulating oxidative balance. An antioxidant diet and lifestyle are crucial in mitigating suicidal ideation. These findings suggest a potential sex-specific suicide ideation risk, which significantly correlates with suicidal ideation in women but not in men., Competing Interests: Declaration of competing interest The authors report no conflicts of interest in this work., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Psychiatric nurses often encounter patients with mental health disorders and consequently experience prolonged periods of high stress, increased workload, and frequent incidents of workplace violence. These aspects can lead to a higher incidence of poor sleep quality. This study examined the interplay between workplace violence and emotional labour (surface and deep acting) to suggest measures for enhancing sleep quality among psychiatric nurses., Methods: A total of 300 completed and valid online questionnaires were collected. The Pittsburgh Sleep Quality Index was used to measure sleep quality, Workplace Violence Scale (WVS) to measure the occurrence of workplace violence, and Emotional Labour Scale to measure surface and deep acting. The data were analysed using Hayes' PROCESS macro with SPSS. Independent samples t-tests and one-way ANOVA were used to compare differences in sleep quality and emotional labour (surface and deep acting) between psychiatric nurses with different demographics., Results: The prevalence of poor sleep quality (PSQI > 5) was 55% among the nurses. Surface acting in emotional labour partially mediated the relationship between workplace violence and sleep quality(a1*b1=0.035,95%CI: 0.002, 0.079), whereas deep acting had a suppressive effect(a2*b2=-0.033,95%CI: -0.071, -0.003). Occupational identity had a positive moderating effect on the relationship between workplace violence and surface acting(Effect=0.091,95%CI: 0.004, 0.179)., Conclusions: The relationship between workplace violence and poor sleep quality was partially mediated by surface acting and suppressed by deep acting. Moreover, nurses with higher occupational identity engaged in more surface acting after workplace violence. Workplace violence, surface acting, and deep acting emerged as significant factors influencing sleep quality among psychiatric nurses. Deep acting can reduce the impact of workplace violence on sleep quality. The results provide a new and expanded view of the interplay between workplace violence and emotional labour concerning sleep quality. Interprofessional collaboration with clinicians, administrators, educators, and spiritual leaders can contribute to the development of related education and training., Trial Registration: Chinese Clinical Trial Registry ChiCTR2200062347. https://www.chictr.org.cn/showproj.html?proj=173264., (© 2024. The Author(s).)

Objective: This study aimed to thoroughly explore the relationship between individual oral behavior and the differing numbers of temporomandibular disorder (TMD) symptom in the general population., Methods: A total of 565 participants were recruited and completed a questionnaire containing demographic characteristics, eight specific oral behaviors, and five major TMD symptoms (5Ts) checklist. Multivariate linear regression analysis was performed to assess the relationship between individual oral behavior and the number of TMD symptoms, after controlling for confounders., Results: The prevalence of TMD symptoms was up to 38.2% in the general population, with 64.6% of the participants engaging in one or more oral behaviors. Female participants showed a stronger positive association with most oral behaviors than males. Moreover, wake oral behaviors exhibited a higher correlation coefficient value with TMD symptom number than sleep oral behaviors. Among the eight oral behaviors, bruxism in sleep exhibited no significant correlation with the of TMD symptom number ( P >0.05). Seven other specific oral behaviors were significantly correlated with the number of TMD symptoms by multivariate linear regression analysis ( P <0.01). The associations between the seven oral behaviors and TMD symptom number remained significant in sleep posture pressuring jaw (β: 0.165, 95% CI: 0.080-0.250), bruxism in awake (β: 0.341, 95% CI: 0.132-0.550), teeth clenching (β: 0.422, 95% CI: 0.264-0.580), pressing, holding, or touching teeth together (β: 0.282, 95% CI: 0.169-0.395), holding or tightening muscles without clenching (β: 0.447, 95% CI0.304-0.589), holding jaw forward or to the side (β: 0.694, 95% CI0.526-0.861), and holding jaw in rigid or tense position (β: 0.571, 95% CI0.418, 0.724) after adjustment for demographic factors ( P <0.01)., Conclusion: There was a positive association between seven specific oral behaviors and TMD symptom number. Individuals with higher frequency of specific oral behaviors are more likely to suffer from more TMD symptoms. Sleep bruxism exhibited no association with TMD symptoms and symptom number., Competing Interests: The authors declare that they have no conflicts of interest., (© 2024 Tian et al.)

Background/objectives: This cross-sectional study aimed to investigate the relationship between swallowing function and low serum albumin levels in older Japanese people (aged ≥ 75 years)., Methods: A total of 3258 participants (1325 males, 1933 females; mean age, 80.8 years) who had a dental checkup in Gifu City, Japan, between April 2020 and March 2021 were recruited. Swallowing function was assessed using the repetitive saliva swallow test, with poor swallowing function defined as swallowing fewer than three times in 30 s. A serum albumin level < 3.6 G/dL was considered low., Results: In total, 78 participants (2%) had a low serum albumin level. Furthermore, after adjusting for age, gender, circulatory disease, support/care-need certification, number of present teeth, and tongue and lip function, a low serum albumin level was positively associated with older (odds ratio [OR]: 1.115; 95% confidence interval [CI]: 1.064-1.169), male (OR: 2.208; 95% CI: 1.360-3.584), circulatory disease (OR: 1.829; 95% CI: 1.079-3.099), support/care-need certification (OR: 2.087; 95% CI: 1.208-3.606), and poor swallowing function (OR: 2.379; CI: 1.377-4.112)., Conclusions: These results indicate that poor swallowing function was associated with a low serum albumin level in older Japanese people aged ≥ 75 years.

Bovine herpesvirus 1 (BoHV-1) is the infectious agent that causes infectious bovine rhinotracheitis (IBR), a disease affecting the reproductive and respiratory systems of cattle. Significant economic losses result from infectious bovine rhinotracheitis because of metritis, abortions, placenta retention, recurrent breeding, animal deaths, and losses from trade restrictions. Reports of the diseases have been made in southern, southwestern and in major cities that kept improved breed of dairy cows in Ethiopia with prevalence ranging from 28.5-67 %. However, there is insufficient information available regarding the frequency and spread of IBR in the northwest part of the nation. In northwest Ethiopia, a cross-sectional study was carried out to estimate seroprevalence of BoHV-1 and identify associated risk factors. Dairy farms and farm owners were chosen using a multistage cluster sampling technique, while dairy cattle were chosen using a simple random sample technique. Four hundred and thirty-one dairy cattle from 177 herds in the Debark and Lay-Armachiho districts in the North and Central Gondar zones, respectively, both in Northwestern Ethiopia, were selected to provide serum samples. Owners of dairy animals provided information via questionnaires. Using a competitive enzyme-linked immunosorbent assay (c-ELISA), anti-BoHV-1 antibodies were detected in serum samples. To identify risk factors, univariable and multivariable mixed effect logistic regression models were used. We calculated animal level and herd level seroprevalence of 72 % (95 % CI: 64.9-78.4 %) and 85.7 % (95 % CI: 79.8-90 %), respectively. Parity was associated with seroprevalence of BoHV-1; cows with higher parity had increased seroprevalence of BoHV-1. Bull mating [OR=3.13, (95 % CI: 1.74-5.64)] compared to AI and Debark district [OR=2.73 (95 % CI: 1.63-4.57)] compared to Lay-Armachiho district, were associated with seroprevalence of BoHV-1. The study had shown that BoHV-1 is circulating out of the major cities and also on dairy farms keeping local breeds of dairy cows in Gondar zones, North-West Ethiopia. This suggests need of attention in prevention and control of BoHV-1., Competing Interests: Declaration of Competing Interest Regarding the research, writing, and/or publication of this paper, the authors declared that they had no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The aging global population is increasing the attention to cognitive decline in older individuals., Objective: This study sought to examine the potential link between the neutrophil percentage-to-albumin ratio (NPAR) and cognitive function., Methods: We analyzed data from the National Health and Nutrition Examination Survey 2011-2014 using multivariate logistic regression and smooth curve fitting, to investigate the correlation between NPAR and cognitive performance. Restricted cubic spline analysis assessed the linear relationship with high-risk cognitive dysfunction, while piecewise linear regression identified thresholds. Subgroup analyses confirmed the consistency and reliability of our findings., Results: Our study included data from 2759 individuals aged >60 years. NPAR showed a significant correlation with Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word learning score, CERAD delayed recall score, total z-score and a high risk of cognitive dysfunction. Furthermore, there were statistically significant trends in the changes in CERAD word learning, digit symbol substitution test, and CERAD delayed recall scores as the NPAR quartile increased, these trends were inverted U-shaped. When the NPAR exceeded 14.57, there was a positive association with the likelihood of a high risk of cognitive impairment. The link between NPAR and cognitive performance was notably stronger in individuals with moderate body mass index and those aged 73-80 years., Conclusions: A strong link was observed between the NPAR and cognitive function. NPAR may serve as a tool to identify individuals at increased risk of cognitive decline., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Osteoporosis (OP) is a complex skeletal disorder characterized by reduced bone mass, microarchitectural deterioration of bone tissue, and increased susceptibility to fractures. Bone mineral density (BMD), as the best indicator of bone mineral content per unit area of bone, is one of the key diagnostic factors for OP. Platelets (PLT), serving as important immune cells and components of the coagulation system, have been demonstrated to be associated with bone formation, resorption, and remodeling processes. However, no research has established the relationship between BMD and platelet count (PC) in the American population thus far. This study aims to investigate the correlation between BMD and PC among the American population, and to appraise the effects of additional risk factors on this association., Methods: This investigation examined the relationship between BMD and PC by analyzing data from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018. A weighted multivariate logistic regression analysis was employed to assess this correlation. Additionally, subgroup and smooth curve analyses were conducted to delve deeper into the BMD-PC relationship and to identify other potential determinants of PC., Results: This study reveals a significant negative correlation between BMD and PC in the American adult population (β=-15.05, 95% CI: -22.07 to -8.03, p < 0.0001). Subgroup analysis highlights notable differences in this correlation between genders and various racial groups. Smooth curve fitting and generalized additive models were applied to further explore the relationship between BMD and PC, considering the influence of multiple factors., Conclusion: The present study investigated the correlation between BMD and PC in adults, with a particular focus on the potential risk factors for thrombocytopenia. This negative correlation was found to be markedly pronounced in males, an association not observed in females. Additionally, a potential inverse relationship between BMD and hemoglobin (HGB) levels was identified. Consequently, for individuals with elevated bone mass or osteoporosis (OP), we advocate for routine complete blood count monitoring to identify hematological irregularities. Considering the significant variations by sex, age, and race, special vigilance is advised for changes in PC among non-Hispanic white males under the age of 55., (© 2024. The Author(s).)