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Objectives: The purpose of the study is to investigate body awareness and body image perception of patients with type 2 diabetes mellitus (T2DM) and to explore the association between clinical parameters and body awareness. Methods: A total of 92 participants with T2DM (38 women and 54 men) aged 36–76 years were recruited. Biochemical measurements, including fasting blood glucose, postprandial blood glucose and hemoglobin A1c (HbA1c), were obtained from the patients’ blood sample records. The Body Awareness Questionnaire (BAQ), Body Cathexis Scale (BCS) and Awareness Body Chart (ABC) were filled in by all subjects. Results: Most participants had an above-average BAQ (81.5%) and BCS (87%) score. There was a significant correlation between body mass index and ABC pain subscale. HbA1c was significantly associated with the duration of diabetes and sleep-wake cycle, process domains and total BAQ score. The body awareness score for the lower leg and foot regions (ABC parts) was negatively correlated with fasting blood glucose and HbA1c levels, while body awareness in the foot region was negatively correlated with the duration of diabetes. There was no association between BCS and any clinical parameters. Conclusion: This study showed that body awareness is associated with diabetes-related clinical parameters, such as fasting blood glucose and HbA1c levels, and duration of diabetes in patients with T2DM. Following diabetes progression and an increase in blood glucose levels, body awareness tended to decrease, particularly in the lower leg and foot regions. These findings highlighted the importance of evaluating body awareness in patients with T2DM. © 2023 Elsevier Ltd

Zusammenfassung: Hintergrund: Die in diese Studie involvierte Population betrifft Personen mit Anorexia nervosa (AN). AN ist eine Erkrankung mit teilweise lebensbedrohlichem Untergewicht. Selbstwertproblematik, Ängste und soziale Probleme begleiten Betroffene. AN verläuft oft chronisch. Hospitalisiert nehmen die Betroffenen an Gewicht zu, oft persistiert die zugrundeliegende Essproblematik, was zur Rehospitalisation führt. Untersuchungen zur Selbstwirksamkeitserwartung (SWE) Betroffener fehlen weitgehend. Ziel: Das Ziel dieser Arbeit ist die Untersuchung der SWE bei Betroffenen im poststationären Setting mit Bezug zum Alter, der Anzahl Hospitalisationen und des Krankheitsverlaufs. Methode: Im Rahmen dieser Querschnittstudie wurden Betroffene im poststationären, psychosomatischen Setting anhand eines standardisierten Fragebogens „Allgemeine SWE“ befragt. Die Daten wurden deskriptiv und mittels Inferenzstatistik ausgewertet. Ergebnis: Befragt wurden 85 Jugendliche. Bei der Stichprobe lag der SWE-Score bei durchschnittlich = 28.53 bis und mit drei und bei = 24.68 ab vier Hospitalisationen. Lag der stationäre Aufenthalt erst kürzlich zurück, wies der SWE-Score einen tieferen Wert auf (= 26.08) als bei jenen mit länger zurückliegendem Aufenthalt (= 29.00). Schlussfolgerung: Die Resultate weisen darauf hin, dass die SWE den Krankheitsverlauf von Betroffenen beeinflussen können. Personen mit höheren SWE-Werten zeigen einen günstigeren Krankheitsverlauf mit weniger Rehospitalisationen. Die Stärkung der SWE ist deshalb im stationären und ambulanten Setting durch gezielte Interventionen seitens Fachpersonen von großer Bedeutung.

Introduction GOLD 2017 report proposed that the combined COPD assessment should be done according only to symptom burden and exacerbation history in the previous year. Objective This study aims to investigate the change in the COPD groups after the GOLD 2017 revision and also to discuss the evaluation of group C and D as a single group after the GOLD 2019 report. Method The study was designed as a cross-sectional. 251 stable COPD patients admitted to our out-patient clinic; aged ≥40 years, at least one-year diagnosis of COPD and ≥10 pack-year smoking history were consecutively recruited for the study. Results In GOLD 2017, a significant difference was found between the distribution of all groups compared to GOLD 2011 (P = 0,001). 31 patients included in group C were reclassified into group A and 37 patients in group D were reclassified into group B. The FEV1 values of group A and B patients were significantly low and group C and D patients had had exacerbations in more frequently the previous year in GOLD 2017 compared to GOLD 2011. Conclusion After the GOLD 2017 revision, the rate of group C patients decreased even more compared to GOLD 2011 and the group C and D may be considered as a single group in terms of the treatment recommendations with the GOLD 2019 revision. We think that future prospective studies are needed to support this suggestion.

Introductions : Along with the increasing life expectancy, there are many processes of development and growth found in human body. But the development and growth will stop at a certain stage, so many changes in the functioning of the human body will take place. During this period, physiological changes can arise which can lead to anxiety. Anxiety is often associated with anxiety in dealing with a situation that has never been experienced before. This study aims to determine the frequency distribution of physical changes and frequency of anxiety, and to determine the relationship between physical changes and anxiety of premenopause women. Methods : This study was an analytical study designed with a cross sectional design, carried out in March-May 2019. The study samples were 47 premenopause women aged 40-55 years in Jaharun A Village obtained through Purposive Sampling techniques from 90 populations. The data used in this study are primary data obtained from the questionnaires. The data obtained will be analyzed with univariate and bivariate analysis and tested with Chi Square test with a value of ?

Parenting stress is affected by various factors, including maternal attachment; however, the number of studies focusing on Japanese samples is limited. As such, we explored the association between mothers’ attachment styles and parenting stress among Japanese mothers with 18-month-old toddlers. This cross-sectional study was conducted in Sasebo City, Japan between 2018 and 2019. Anonymous self-reported questionnaires were distributed to 1399 mothers who attended an infant health check-up. We categorized maternal attachment style as secure, anxious/ambivalent, or avoidant, and conducted a multiple logistic regression analysis to evaluate the associations between each attachment style and parenting stress. Of the 1399 mothers, 529 responded to the survey (37.8%). About 40% reported experienced parenting stress. Further, approximately two-thirds showed a secure attachment style, 20% had an anxious/ambivalent style, and 15% had an avoidant style. In the multiple logistic regression analysis, the ambivalently attached mothers had a significantly higher level of parenting stress than those with secure attachment (odds ratio = 2.4, 95% confidence interval (1.5, 3.9)), but avoidantly attached mothers did not have a significantly higher level of parenting stress than those with secure attachment (odds ratio = 0.9, 95% confidence interval (0.5, 1.6)). The findings demonstrate that an anxious/ambivalent attachment style is associated with a higher level of parenting stress than a secure style. Thus, it is important for experts to understand the mother’s attachment style when offering childrearing support., 長崎大学学位論文 学位記番号:共博(医歯薬)甲第29号 学位授与年月日:令和5年3月31日, Author: Ayano Kit, Kazuhiko Arima, Yasuyo Abe, Satoshi Mizukami, Yoshihito Tomita, Maiko Hasegawa, Yoko Sou, Takayuki Nishimura, Mayumi Ohnishi and Kiyoshi Aoyagi, Citation: Psychiatry International, 3(2), pp. 122-130; 2022

Background Osteoporosis may result from risk factors such as smoking, alcohol, low body mass index, less physical exercise, and dietary calcium deficiency. The risk of osteoporosis fractures can be reduced with lifestyle changes, which include diet, exercise, and preventing falls. The present study is an effort to measure the burden of risk factors of osteoporosis in adult male soldiers in the Armed Forces. Methods The present study was a cross-sectional study among serving soldiers in South-Western part of India, and 400 participants consented to be included in the study. After obtaining informed consent, the questionnaire was distributed. Venous blood samples were collected to measure serum calcium, phosphorus, vitamin D, and parathyroid hormone (PTH). Results The prevalence of vitamin D3 severe deficiency ( 66.5 pg/mL) was seen in 5.5% of the participants. A statistically significant association was found between consumption of milk and milk products and levels of calcium. With a cutoff value of 20 ng/mL for vitamin D3 deficiency, a statistically significant association was found for consumption of fish, physical activity, and sun exposure. Conclusion A remarkably large percentage of otherwise normal healthy soldiers have deficiency or insufficiency of vitamin D and might be prone to osteoporosis. Despite significant advances in our understanding and management options for male osteoporosis, there still remain important gaps in knowledge which needs to be looked into.

Background Male osteoporosis is under-diagnosed and poorly studied. With the ageing population, osteoporotic fracture in men is an emerging health problem. The aim of this study was to study the prevalence of osteoporosis and its association with serum testosterone and serum vitamin D in elderly men (>60 years old) attending the outpatient department (OPD). Methods An observational cross-sectional study was performed in elderly men (>60 years old) attending OPD of a tertiary care hospital of Western Maharashtra between April 2017 and June 2019. Patients with rheumatological disorders, history of vertebral/femoral fractures, chronic kidney disease, chronic liver disease, thyroid disorders and alcohol dependence were excluded. Data were analysed using the chi-square test and descriptive statistics. Results In total, 408 male patients were included. The mean age was 68.33 years. Osteoporosis was seen in 39.5% of patients (161/408) with a T score of ≤2.5. Osteopenia was noted in 48.3% of patients (197/408). T and Z scores had significant correlation (p = Conclusion Osteoporosis was noted in 39.5% of the elderly men. In addition, decreased testosterone, COPD and BPH were significantly associated with male osteoporosis. It is important to screen elderly men to diagnose osteoporosis early and prevent osteoporotic fractures.

The study aimed to investigate frailty among elderly fitness club users by comparing them with the elderly local population. The subjects were 273 fitness club members aged 65 or above and 224 local residents. The methods used were questionnaire and evaluation of physical and oral function. The Mantel-Haenszel test was applied separately to the groups of younger senior citizens (65-74) and older senior citizens (75+) using sex as a stratifying factor, and binomial logistic regression analysis was applied to the all subjects and separately to the younger and older senior groups. The Mantel-Haenszel test for the senior citizens indicated that tendency to frailty and extent of deterioration in the ability to stand on one leg with the eyes open were significantly lower in fitness club members. The regression analysis showed that the extent of deterioration in the one-leg test was lower among fitness club members in all groups (odds ratio 0.329) and that older senior club members had a lower endency to frailty (odds ratio 0.325). As usership of fitness clubs among the elderly is increasing, these clubs would seem to have a major role in frailty prevention.

Background Emerging epidemiological evidence suggests that compared to engaging in 1 activity mode alone, a combination of moderate-to-vigorous physical activity (MVPA: brisk walking/jogging, cycling) and muscle-strengthening exercise (MSE: push-ups/sit-ups, using weight machines) has more favorable associations with optimal weight status. However, few studies have examined the dose-dependent and joint associations of MVPA and MSE with obesity. Methods Based on cross-sectional analyses of the European Health Interview Survey Wave 2 (2013–2014), we examined prevalence ratios (PRs) of joint and stratified associations between MVPA (4 categories: (i) 0 min/week, (ii) 1–149 min/week, (iii) 150–299 min/week, and (iv) ≥300 min/week) and MSE (3 categories: (i) 0 day/week, (ii) 1 day/week, and (iii) ≥2 days/week) with body mass index-defined obesity (body mass index of ≥30.0 kg/m2) using Poisson regression with robust error variance. PRs were examined unadjusted and adjusted for sociodemographic and lifestyle characteristics (e.g., sex, age, education, income, and smoking status). Results Data were available for 280,456 adults (≥18 years), of which 46,166 (15.5%) were obese. The interaction MVPA × MSE guideline adherence was statistically significant for obesity (p ≤ 0.05). The joint MVPA–MSE analysis showed that compared to the reference group (i.e., no MVPA and no MSE), the PRs followed a dose-dependent pattern, with the lowest observed among those reporting ≥150 MVPA min/week and ≥1 MSE days/week (PR: 0.43; 95% confidence interval: 0.41–0.46). When stratified across each MVPA strata, the PRs were mostly lower among those engaging in MSE 1 day/week, as compared to those doing MSE ≥2 days/week. Conclusion There was evidence for a dose-dependent association between joint MVPA–MSE with a reduced prevalence of obesity. Public health strategies for the prevention and management of obesity should recommend both MVPA and MSE.

Cannabis products available for retail purchase are often marketed based on purported plant species (e.g., "indica" or "sativa"). The cannabis industry frequently claims that indica versus sativa cannabis elicits unique effects and/or is useful for different therapeutic indications. Few studies have evaluated use patterns, beliefs, subjective experiences, and situations in which individuals use indica versus sativa. A convenience sample of cannabis users (n = 179) was surveyed via Amazon Mechanical Turk (mTurk). Participants were asked about their prior use of, subjective experiences with, and opinions on indica versus sativa cannabis and completed hypothetical purchasing tasks for both cannabis subtypes. Participants reported a greater preference to use indica in the evening and sativa in the morning and afternoon. Participants were more likely to perceive feeling "sleepy/tired" or "relaxed" after using indica and "alert," "energized," and "motivated" after using sativa. Respondents were more likely to endorse wanting to use indica if they were going to sleep soon but more likely to use sativa at a party. Hypothetical purchasing patterns (i.e., grams of cannabis purchased as a function of escalating price) did not differ between indica and sativa, suggesting that demand was similar. Taken together, cannabis users retrospectively report feeling different effects from indica and sativa; however, demand generally did not differ between cannabis subtypes, suggesting situational factors could influence whether someone uses indica or sativa. Placebo-controlled, blinded studies are needed to characterize the pharmacodynamics and chemical composition of indica and sativa cannabis and to determine whether user expectancies contribute to differences in perceived indica/sativa effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

PURPOSE The purpose of this study was to examine differences between urban and rural primary care clinics in the use of colorectal cancer (CRC) screening methods and evidence-based interventions to promote CRC screening. METHODS This was a cross-sectional survey of primary care clinics in Nebraska. Surveys in paper form were sent out and followed up with telephone interviews to nonrespondents. Of the 375 facilities, 263 (70.1%) responded to the survey. FINDINGS Over 30% of urban clinics indicated that 80% or more of their patients were meeting the CRC guidelines compared to 18.3% of rural clinics (P = .03). Rural clinics were more likely than urban clinics to prefer the use of colonoscopy alone or in combination with stool tests (P = .02). The most common interventions for CRC screening included one-on-one patient education and use of computer-based pop-ups to remind providers. CONCLUSIONS In conclusion, we found some important differences between rural and urban primary care clinics in the implementation of CRC screening. Given that there is evidence for differences in preference for CRC screening methods (colonoscopy vs stool-based tests) between rural and urban community members, it is important to assess the effectiveness of different types of CRC screening interventions by comparing rural and urban primary care clinic patient populations.

Air pollution is a significant contributor to the global burden of disease with a plethora of associated health effects such as pulmonary and systemic inflammation. C-reactive protein (CRP) is associated with a wide range of diseases and is associated with several exposures. Studies on the effect of air pollution exposure on CRP levels in low to moderate pollution settings have shown inconsistent results. In this cross-sectional study high sensitivity CRP measurements on 18,463 Danish blood donors were linked to modelled air pollution data for NOx, NO2, O3, CO, SO2, NH3, mineral dust, black carbon, organic carbon, sea salt, secondary inorganic aerosols and its components, primary PM2.5, secondary organic aerosols, total PM2.5, and total PM10 at their residential address over the previous month. Associations were analysed using ordered logistic regression with CRP quartile as individuals outcome and air pollution exposure as scaled deciles. Analyses were adjusted for health related and socioeconomic covariates using health questionnaires and Danish register data. Exposure to different air pollution components was generally associated with higher CRP (odds ratio estimates ranging from 1.11 to 1.67), while exposure to a few air pollution components was associated with lower CRP. For example, exposure to NO2 increased the odds of high CRP 1.32-fold (95%CI 1.16-1.49), while exposure to NH3 decreased the odds of high CRP 0.81-fold (95%CI 0.73-0.89). This large study among healthy individuals found air pollution exposure to be associated with increased levels of CRP even in a setting with low to moderate air pollution levels.

Aim: Complementary therapies are being increasingly preferred in patients receiving anticancer therapy to strengthen the effect of chemotherapy and control cancer-related symptoms. In this study, we investigated the prevalence of complementary therapy (CT), the factors associated with its use, physician-patient information sharing about CT use, and the effect of CT on the survival and treatment process in lung cancer patients receiving chemotherapy. Methods: This study was designed as a cross-sectional study including patients who underwent chemotherapy for lung cancer between November 2020 and March 2022 in the department of medical oncology at Tekirdag Namik Kemal University. A structured questionnaire with twenty questions was used. Fluor-18-fluorodeoxyglucose positron emission tomography/CT, and brain magnetic resonance imaging were used to stage the patients. The stages were grouped as early (stages 1B-3A) and advanced (stages 3B-4A). Results: A total of 242 patients included in the study. One hundred and forty-seven (60.7%) patients reported using at least one type of CT since the first diagnosis. “Families/relatives” (n=128; 63.7%) and “other patients” (n=67; 33.3%) were the primary sources from which patients obtained CT information. The most widely used CT methods were recorded as phytotherapy (79.6%) and apitherapy (59.2%). 125 (85%) of the patients said that they used CT to support their existing anticancer treatments. Of the patients using CT, 94 (63.9%) stated that they did not disclose their use of CT to their physicians. The majority of patients stated that their physicians did not inquire about using CT. In the cox regression analysis performed to determine survival benefit, no survival benefit from the use of CT was determined (hazard ratio=0.86, p=0.495). In the subgroup analysis, the use of CT was associated with survival in early-stage patients, but no survival relationship was found in advanced-stage patients (log-rank p=0.027 and p=0.842, respectively). Conclusion: The use of CT in conjunction with medical treatment is common among patients with lung cancer. The influence of the oncologist in guiding the use of CT in cancer patients is weak. Additionally, the use of CT does not provide benefits in terms of survival. © 2023 by The Medical Bulletin of Istanbul Haseki Training and Research Hospital The Medical Bulletin of Haseki published by Galenos Yayinevi.

Abstract. As a follow-up to an earlier study demonstrating healthier cardiometabolic profiles among long-term multiple dietary supplement (LTMDS) users, we examined if cardiometabolic health benefits associated with LTMDS use persisted with aging. The study is based on LTMDS users from North America and 2007–2010 NHANES participants who were used for comparison to the LTMDS users. NHANES subjects were classified as non-dietary supplement (NS) users, single supplement/single purpose supplement (SS) users, multivitamin/mineral supplement (MVMS) users, and multiple dietary supplement (MDS) users. Supplement groups were compared for total, HDL and LDL cholesterol; triglycerides; glucose; insulin; CRP and HbA1c ≥ 6.5%, adjusting for age, sex, income, education, BMI, history of CVD, and medications for hypercholesterolemia and diabetes. Geometric mean (95% confidence interval) LDL cholesterol was significantly lower (P

The objective of this study was to describe the psychological and quality of life outcomes in demobilized Colombian ex-combatants.A cross-sectional study was conducted on 58 ex-combatants from the Colombian government's reintegration program. Posttraumatic stress disorder (PTSD) was measured by the Mini-International Neuropsychiatric Interview. We applied the Beck-II Depression Inventory, Resilience Scale, Everyday Discrimination Scale, and World Health Organization Quality of Life-Short Version (WHOQOL-BREF) for measuring symptoms of depression, resilience, discrimination, and quality of life, respectively.The prevalence of PTSD was 63,8%, principally on ex-combatants with ≤10 years in the reinstatement program. Females with primary/elementary school, extremely low social status, unipersonal family type, family income1 minimal wage, and symptoms of depression showed a higher prevalence ratio (1.30). The mean scores of depression symptoms, resilience, and quality of life were systematically poorer in the group with PTSD. Significant differences were found Resilience scale domains Personal Competence (p = .043) and Acceptance of Self and Life (p = .012), WHOQOL-BREF Psychological (p = .029) and Environment domains (p = .015).Colombian ex-combatants with PTSD attending a reinstatement program presented a higher frequency of depression symptoms, lower quality of life, and lower resilience than those without PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background Most children with atopic dermatitis(AD) suffer from sleep disturbance, but reliable and valid assessment tools are lacking. Objectives To test PROMIS (Patient Reported Outcomes Measurement Information System) sleep measures in pediatric AD and to develop an algorithm to screen, assess and intervene to reduce sleep disturbance. Methods A cross-sectional study was conducted with AD children ages 5-17 years and one parent(n=61), who completed sleep, itch, and AD-specific questionnaires; clinicians assessed disease severity. All children wore actigraphy watches for 1-week-objective sleep assessment. Results PROMIS sleep disturbance parent-proxy-reliability was high (Cronbach's α=0.90) and differentiated among Patient Oriented Eczema Measure (POEM)-determined disease severity groups (mean±SD in mild vs. moderate vs. severe was 55.7±7.5 vs. 59.8±10.8 vs. 67.1±9.5, p Limitations This was a local sample. Conclusions Sleep disturbance in pediatric AD should be screened using the POEM sleep question, with further assessment using the PROMIS sleep disturbance measure or objective sleep monitoring if needed.

Almost half (46%) of people will experience a mental health issue in their lifetime and all nurses need mental health knowledge and skills regardless of their area of specialization. Little is known, however, about student attitudes toward people with mental illness on entry to pre-registration nursing programs. The aims were to investigate Australian pre-registration nursing students’ attitudes toward, and prior experience with, people with mental illness on program commencement. This cross-sectional study used the Community Attitudes Toward Mental Illness (CAMI) scale with pre-registration nursing students, and questions on students’ prior experience with mental illness (self, family, friends). There were n = 311 (271 female/40 male) first year, first semester Bachelor of Nursing students at a national Australian university. Students reported prior experience with mental illness with family (49.5%/n = 154) and friends (61.4%/n = 191). Self-reported (36.3% /n = 113) mental illness, particularly anxiety and depression, significantly exceeded national averages. Most students held accepting attitudes toward people with mental illness, except for perceptions of dangerousness. This study provides new findings on nursing student attitudes and experience with people with mental illness on program entry. The high self-reported prevalence of anxiety and depression at program entry indicates a pressing need for early intervention and mental wellbeing strategies for students from commencement of their tertiary education. Fear-reducing education which challenges perceptions of dangerousness in relation to people with mental illness, and supportive mental health clinical placements during their program, may help improve students’ attitudes and reduce fear and mental health stigma.

BACKGROUND Abnormal foot morphology in children and adolescents is a possible risk factor for lower extremity pain. Foot posture index-6 (FPI-6) is a valid and reliable tool to assess foot morphology. However, the normative data on the age distribution for FPI-6 in Asian children and adolescents are still minimal. Further, the correlation of FPI-6 with lower extremity pain is poorly understood. We aimed to investigate the normative distribution for FPI-6 and the relationship between FPI-6 scores and knee and heel pain in Japanese children. METHODS We included 2569 Japanese children, aged 9-15 years, at a single school from 2016 to 2018. We summarized the age distribution of children and their mean bilateral FPI-6 scores. Additionally, we assessed the tenderness at the apophysis or tendon insertions at the knee and heel. We performed a cross-sectional analysis to investigate the correlations between FPI-6 scores and sex, age, and knee and heel pain for the data obtained each year. RESULTS The mean FPI-6 score was 3.1 ± 2.4, 3.4 ± 2.0, and 3.2 ± 1.9 for the left foot and 3.0 ± 2.4, 3.2 ± 1.9, and 3.1 ± 1.9 for the right foot in 2016, 2017, and 2018, respectively. Boys tended to have higher scores than girls, and the FPI-6 score of the left foot was significantly higher than that of the right foot (p

Patient-clinician goal concordance is associated with improved outcomes in certain chronic diseases but not explored in rheumatoid arthritis (RA). We examined goal concordance, correlates of concordance, and the association of concordance with health outcomes.Adult patients with RA seen at least 1 time in the prior 12 months at 1 of 2 rheumatology clinics participated. Patients and their clinicians independently ranked top 3 goals for RA treatment from 8 options before a routine visit. Patients completed postvisit surveys on health, demographic information, health literacy, and adherence. Goal concordance was defined as the patient's number 1 goal being among the clinician's top 3 goals for that patient. Bivariable and multivariable logistic regression models were used to examine correlates of concordance.Patients were 58% female and 16% Spanish-speaking, and 29% had limited health literacy. Among 204 patient-clinician dyads, 20% were goal-discordant. "Have less pain" was selected by both patient and clinician in 81% of dyads, followed by "have fewer problems doing daily activities" by 63%. Otherwise, clinicians prioritized avoiding side effects, whereas patients ranked improved sleep, fatigue, and mood. Longer disease duration was associated with discordance (median 13.3 years, interquartile range [IQR] 5.2-20 among discordant vs. 7 years, IQR 4-14; P = 0.039); higher depressive symptoms were associated with concordance (8.1% vs. 24%; P = 0.04). Goal concordance was associated with higher medication adherence (adjusted odds ratio 2.76 [95% confidence interval 1.01, 7.56]).One in 5 patient-clinician dyads had discordant treatment goals. Goal concordance was associated with higher medication adherence. Studies to improve goal elicitation and communication of patients with RA's priorities are needed.

Contains fulltext : 287798.pdf (Publisher’s version ) (Open Access) The Family Perceptions of Physician-Family Caregiver Communication scale (FPPFC) was developed to assess quality of physician-family end-of-life communication in nursing homes. However, its validity has been tested only in the USA and the Netherlands. The aim of this paper is to evaluate the FPPFC construct validity and its reliability, as well as the psychometric characteristics of the items comprising the scale. Data were collected in cross-sectional study in Belgium, Finland, Italy, the Netherlands and Poland. The factorial structure was tested in confirmatory factor analysis. Item parameters were obtained using an item response theory model. Participants were 737 relatives of nursing home residents who died up to 3 months prior to the study. In general, the FPPFC scale proved to be a unidimensional and reliable measure of the perceived quality of physician-family communication in nursing home settings in all five countries. Nevertheless, we found unsatisfactory fit to the data with a confirmatory model. An item that referred to advance care planning performed less well in Poland and Italy than in the Northern European countries. In the item analysis, we found that with no loss of reliability and with increased coherency of the item content across countries, the full 7-item version can be shortened to a 4-item version, which may be more appropriate for international studies. Therefore, we recommend use of the brief 4-item FPPFC version by nursing home managers and professionals as an evaluation tool, and by researchers for their studies as these four items confer the same meaning across countries. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10433-022-00742-x.

Person-centred care has the potential to improve the patient experience in the intensive care unit (ICU). However, the relationship between person-centred care perceived by critically ill patients and their ICU experience has yet to be determined.The aim of this study was to investigate the relationship between person-centred care and the ICU experience of critically ill patients.This study was a multicentre, cross-sectional survey involving 19 ICUs of four university hospitals in Busan, Korea. The survey was conducted from June 2019 to July 2020, and 787 patients who had been admitted to the ICU for more than 24 hours participated. We measured person-centred care using the Person-Centered Critical Care Nursing perceived by Patient Questionnaire. Participants' ICU experience was measured by the Korean version of the Intensive Care Experience Questionnaire that consists of four subscales. We analysed the relationship between person-centred care and each area of the ICU experience using multivariate linear regression.Person-centred care was associated with 'awareness of surroundings' (β = 0.29, p lt; .001), 'frightening experiences' (β = -0.31, p lt; .001), and 'satisfaction with care' (β = 0.54, p lt; .001). However, there was no significant association between person-centred care and 'recall of experience'.We observed that person-centred care was positively related to most of the ICU experiences of critically ill patients except for recall of experience. Further studies on developing person-centred nursing interventions are needed.

Objectives: To determine the prevalence of polypoidal choroidal vasculopathy (PCV) in intravitreal (IV) anti-vascular endothelial growth factor (anti-VEGF)-resistant neovascular age-related macular degeneration (nvAMD) cases. Materials and Methods: Eyes that were diagnosed as having active and treatment-naive nvAMD in the Ege University Ophthalmology Department, Retina Unit in 2011-2018, were non-responsive to IV anti-VEGF treatment, and for which indocyanine angiography (ICGA) could be obtained were included in the study. Active nvAMD was defined as the presence of fresh hemorrhage on clinical examination or findings of subretinal, intraretinal, or sub-retinal pigment epithelial fluid on spectral domain optical coherence tomography and accompanying fluorescein dye leakage in fluorescein angiography. Eyes that had activation findings despite at least 6 consecutive intravitreal anti-VEGF injections were defined as non-responders and underwent ICGA to assess for PCV. The diagnosis of PCV was based on the Everest II study criterion. Results: A total of 97 eyes of 88 patients were included in the study. Of 88 patients, 44 (50%) were female, 44 (50%) were male, and the mean age was 75.9±8.3 years (range: 59-93). The mean number of anti-VEGF injections until the time of ICGA was 7.3±2.2 (range: 6-15). PCV was detected in 62 eyes (63.9%) on ICGA. Conclusion: The prevalence of PCV is quite high among eyes with IV anti-VEGF treatment-resistant nvAMD in Turkey (63.9%). ICGA evaluation for PCV should be conducted for all nvAMD cases that are non-responsive to IV anti-VEGF treatment, both to shed light on the reason for resistance and to modify treatment as necessary. © 2022 by Turkish Ophthalmological Association Turkish Journal of Ophthalmology, published by Galenos Publishing House.

Malaysia recently entered third-wave of COVID-19 pandemic starting from October 2020 to end of January 2021. Therefore, objective of our study was to identify the prevalence of depression and its associated factors among adults during third wave of COVID-19 pandemic in Malaysia. A total of 1468 Malaysian adults participated in this cross-sectional web-based survey. A standardized questionnaire was generated using the Google Form, and the link was shared through social media such as Facebook, Twitter, Instagram and WhatsApp. Patient Health Questionnaires (PHQ-9) was used to assess the levels of depression. Among 1468 participants, 320 (22 %) and 358 (24.6 %) indicated to have moderate to severe depression during third-wave of COVID-19 in Malaysia. Multiple predictors were identified that contributed to depression. These included female gender, family’s source income affected by the pandemic, do not perform exercise, victim of abuse and those with family and/or friends infected with COVID-19 virus. COVID-19 pandemic had caused the implementation of lockdown and physical distancing in Malaysia and nations across the globe. The pandemic had brought serious negative impacts on mental health of the adults especially depression especially during third wave of pandemic. The findings of our study suggested that new interventions or strategies are needed to be developed to address the severity of depression among Malaysian adults.

Background: COVID-19 pandemic, which still continues to affect the whole world, has led to an increase in PTSD symptoms in societies, especially individuals who have been diagnosed with the disease and recovered are at significant risk for PTSD have been reported. Although it has been observed that PTSD symptoms of individuals who were infected in the past epidemics such as SARS and Ebola continued for a long time even after the epidemic, it is noteworthy that the studies conducted during the COVID-19 process do not focus enough on people who survived the COVID-19 disease. The purpose of this study is to determine the direct and indirect impact of positivity on PTSD symptoms of individuals who have recovered from COVID-19 and the role of rumination and fear of COVID-19 as potential mediators in this effect. Subjects and methods: In the study, the Impact of Event Scale-Revised, Ruminative Response Scale, Positivity Scale, and Fear of COVID-19 Scale were applied to 551 Turkish participants, who survived the COVID-19 disease. SEM-based mediation analysis was used to test hypothesized relationships. Results: Mediating roles of fear of COVID-19 and rumination between positivity and PTSD were tested. Results indicated that rumination andfear of COVID-19 had a full mediating role in the relationship between positivity and PTSD. Conclusion: These findings pointed out that positivity might be an indirect protective disposition against COVID-19-related PTSD and might reduce risk factors associated with PTSD among COVID-19 survivors. Mental health practices for COVID-19 patients should aim to increase positive thinking, since they have ruminative thoughts about transmission of the virus and hospitalization process and these thoughts may lead to negative mental health conditions. In this sense, positive psychology-focused implementations can be organized for COVID-19 patients and survivors. © Medicinska naklada - Zagreb, Croatia.

Background Healthcare workers (HCWs) involved in administration and patient management during COVID-19 pandemic are at high risk of developing psychological problems related to fear and stress of contacting COVID infection. This is augmented by the stigma faced at home and society, owing to the nature of their job. Aim To assess the mental health issues and stigma amongst health care workers involved in COVID care. Methodology We conducted a hospital based cross sectional study where 150 health care workers involved in the care of COVID-19 patients, directly and indirectly, were selected using systematic random sampling. They were assessed using Depression, Anxiety and Stress Scale (DASS-21) Hindi Version, The Impact of Event Scale - Revised scale and a Modified Stigma scale. Results Significant psychological stress, anxiety, depression and high risk for developing post-traumatic stress disorder was found in more than half of the healthcare workers, albeit more in those having direct contact with COVID patients (p

Bronchiectasis is a chronic pulmonary disease characterized by progressive and irreversible bronchial dilatation. The present study aimed to assess the clinical, demographic, microbiological, and radiological features of patients with bronchiectasis.The study population included 60 subjects with bronchiectasis diagnosed by HRCT, who attended the Department of Respiratory Medicine a tertiary care teaching center. A single examiner examined all the 60 participants. Pulmonary function assessment was done on all the subjects on a spirometer, and early-morning sputum samples were taken for culture and sensitivity. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency, and proportion for categorical variables. Categorical outcomes were compared between study groups using the chi-square test. P value0.05 was considered statistically significant. Co-Guide was used for statistical analysis.The majority of the participants were males (62%). The most common sign observed was crepitations (75%). Pseudomonas aeruginosa (36%) was the primary pathogen isolated from sputum, followed by Klebsiella pneumonia (20%). Drug resistance was highest for ampicillin (56%), and imipenem (100%) was the most sensitive drug.Bronchiectasis is a heterogeneous entity with varied etiologies and multifarious clinic-radiological patterns. The information on etiology and the causative microorganism and antibiotic sensitivity and resistance aids in providing early treatment and thereby improving the lung function of affected individuals.

Background Non-adherence is major factor in failure of any drug regimen. The significance of non-adherence is so much that WHO states that increasing the effectiveness of Adherence Interventions may have far greater impact on health of population than any improvement in specific medical treatments. Incidence of non-adherence to Anti Tubercular Treatment (ATT) usually ranges from 8.4% to 55.8%. This study aims to find out the reasons of Non-adherence to ATT in patients receiving anti-tubercular treatment at DIRECTLY OBSERVED TREATMENT SHORTCOURSE (DOTS) Centre at District Tuberculosis Centre (DTC), Kalibadi, Raipur during COVID-19 pandemic. Methods A cross sectional study was conducted at Department of Pharmacology, Pt. JNM Medical College and DTC Kalibadi Raipur. 55 Patients taking ATT fulfilling inclusion and exclusion criteria were interviewed using structured questionnaire. The data obtained was analysed to know causes of non-adherence. Results Study was carried out between March & April 2020. In our study, 80% subjects were male and 20% were female. The main reasons for Non-adherence were Side-effects of drug in 36% cases, missing medication intentionally in 34% cases, lack of encouragement by family members in 32% cases, patient's unawareness of consequences of skipping medication in 25% cases, unaware of treatment duration in 22%, not feeling any change, forgetting to take medication, and burden of concomitant medication besides ATT, each in 20% cases, 13% cases had difficulty in procuring medication due to lockdown, 5% cases did not go to collect their medicine due to fear of contracting COVID-19 infection. Conclusions Our study shows reasons for Non-adherence are multi-factorial with drug side –effects & intentionally skipping medication being major factors.

Objective Vesical Imaging Reporting and Data System (VIRADS) score was developed to standardize the reporting and staging of bladder tumors on pre-operative multiparametric magnetic resonance imaging (mpMRI). It helps in avoiding unnecessary repeat transurethral resection of bladder tumor (Re-TURBT) in high-risk non-muscle-invasive bladder cancer (NMIBC) patients. This study was done to determine the validity of VIRADS score prospectively for the diagnosis of muscle-invasive bladder cancer. Methods This study was conducted from March 2019 to March 2020 at Sawai Mansingh Medical College and Hospital, Jaipur, Rajasthan, India. Patients admitted with the provisional diagnosis of bladder tumor were included as participants. All these patients underwent a 3 T mpMRI to obtain a VIRADS score before they underwent a TURBT and these data were analysed to evaluate the correlation of pre-operative VIRADS score with muscle invasiveness of the tumor in final biopsy report. Results A cut off of VIRADS ≥4 for prediction of detrusor muscle invasion yielded a sensitivity of 79.4%, specificity of 94.2%, positive predictive value (PPV) of 90%, negative predictive value (NPV) of 87.5%, and diagnostic accuracy of 86.37%. A cut off of VIRADS ≥3 for prediction of detrusor muscle invasion yielded a sensitivity of 91.2%, specificity of 78.8%, PPV of 73.8%, NPV of 93.2%, and accuracy of 83.7%. The receiver operating curve (ROC) showed the area under the curve (AUC) to be 0.922 (95% confidence interval: 0.862–0.983). Conclusions VIRADS score appears to be an excellent and effective preoperative radiological tool for the prediction of detrusor muscle invasion in bladder cancer.

The COVID-19 pandemic has a profound impact on the everyday lives of people around the world. This includes economic issues, social isolation and anxieties directly related to the coronavirus. Some of these phenomena relate to social disintegration, which in turn has been linked to negative outgroup sentiments. However, the tenuous connection between pandemic developments and international migration processes calls into question whether a link between pandemic concomitants and immigration-related attitudes exists empirically. Arguments based on political cues and media effects even suggest that the widespread focus on the COVID-19 pandemic suppresses the issue salience of immigration and negative immigration sentiments. To test these propositions, we employ data from a newly collected cross-sectional study carried out in November and December 2020 in 11 European countries. We distinguish between general migration-related threats and blaming the pandemic on immigration as outcome variables. The results suggest that pandemic-related concerns increase both threat perceptions and perceptions that immigration is driving the pandemic, but more clearly so for the latter. On the macro level, we find that where the pandemic is more severe, respondents are less likely to blame immigrants. This suggests that a country-level suppression of salience of immigration is indeed taking place.

This study aimed to assess the validity and reliability of the Turkish version of the Women’s Perception of Respectful Maternity Care Scale. This methodological, cross-sectional study was conducted between December 2020 and July 2021. The sample of the study consisted of 259 women who had vaginal birth and gave birth to a healthy baby with normal birth weight. Data analysis and evaluation were performed using factor analysis, Cronbach’s alpha, split-half, item-total score correlation, Hotelling T2, Tukey’s test and ceiling and floor effect of the scale. The scale consists of 19 items and three sub-dimensions. The scales explained 76.04 percent of the total variance. In both exploratory and confirmatory factor tests, the overall factor loading was greater than 0.30. In the confirmatory factor analysis, all the goodness-of-fit indexes were greater than 0.90, and the root mean square error of approximation was less than 0.08. The Cronbach’s alpha coefficient of the scale was 0.96, with Cronbach’s alpha values ranging between 0.88 and 0.95 for the subscales. In conclusion, this scale can be used by nurses, midwives and other health professionals as a valid and reliable measurement tool to evaluate women’s perception of respectful maternity care. © 2022 Taylor & Francis Group, LLC.

Background Increasing the coverage of vaccinations recommended by the World Health Organization in the older adult population is an urgent issue, especially in the context of avoiding co-epidemics during the current coronavirus disease 2019 crisis. The aim of this study was to examine factors associated with the quality of perceived patient-physician communication and whether this variable was associated with increased odds of vaccination. Methods We used cross-sectional data from the Japan Gerontological Evaluation Study conducted from October 2016 to January 2017. The participants were 22,253 physically and cognitively independent individuals aged 65 or older living in 39 municipalities in Japan. Multilevel logit models were used to estimate the odds of vaccination. Results Among the participants, 40.0% and 58.8% had received pneumococcal and influenza vaccinations as per the recommended schedule, respectively. People with low educational levels were more likely to have a family physician but rate their experience in asking questions lower than those with higher educational levels. Having a family physician and high rating for physicians' listening attitude were positively associated with increased odds of pneumococcal and influenza vaccinations. High rating for patients' questioning attitude and shared decision-making, compared to an ambiguous attitude toward medical decision-making, were positively associated with increased odds of pneumococcal vaccination. Conclusion The results suggest that promotion of having a family physician, better patient-physician communication, and shared decision-making may encourage older adults to undergo recommended vaccinations.

Lower limb flexibility is known to be decreased in those living in mountainous areas, and musculoskeletal growth is often influenced by lifestyle factors. The purpose of this study was to determine the relationship between the means of transportation to school and lower limb musculoskeletal function and low back pain.During routine medical examinations conducted in two cities in a prefecture in 2016, a questionnaire was administered. The parents of 15,259 students who attended elementary school answered questions evaluating the following parameters: (1) anteflexion limit in the standing posture, (2) crouching failure, (3) one leg standing failure, (4) low back pain during lumbar extension, (5) lower limb alignment abnormalities, and (6) flat foot. Students were divided into a walking commuting group (13,569 students) and a vehicle commuting group (1690 students), and findings were compared between the two groups using chi-square tests.In the walking and vehicle commuting groups, anteflexion limit in the standing posture was present in 23.3% and 26.1% of students, respectively (p = 0.013). Crouching failure was present in 4.6% and 7.3% of students (p 0.001); one leg standing failure in 5.3% and 8.5% of students (p 0.001); low back pain in 5.0% and 7.1% of students (p 0.001); positive leg alignment abnormalities in 7.3% and 8.0% of students (p = 0.260); and flat foot in 7.4% and 8.7% of students (p = 0.067), respectively. Significant differences were observed in all four of the failure measures. No significant differences were observed in the two methods evaluating morphological abnormalities.The decreased walking duration and increased sitting duration associated with vehicle commuting had little effect on lower limb morphology but could induce lower limb dysfunction and low-back pain in children. Thus, supplemental walking should be instated for children who commute by car.

INTRODUCTION Although mortality rates among children after surgery in developing countries are higher than in developed nations, little is known about the causes of post-operative pediatric death. Further insight into post-operative mortality rates and causes of death may help improve postoperative care. The present study investigates in-hospital mortality rates and causes of death at a major pediatric tertiary referral hospital in Iran. METHODS Patients younger than 18 years of age who underwent surgery with anesthesia between January 1, 2015 and Jan 1, 2018 at Dr. Sheikh Children's Hospital in Mashhad, Iran, were included in this retrospective study. Factors connected to the surgery and mortality rate were analyzed, including patient demographics and comorbidities, surgery type and emergency level, length of operation, and the mortality rate at different time intervals after surgery, were analyzed. RESULTS A total of 55,027 surgeries were performed between 2015 and 2018, resulting in 214 deaths. Pediatric mortality within 30 days was 78.6 deaths per 10,000 procedures. The highest mortality rate was observed in children under three years of age (67.2 per 10,000), and females were more likely than males to die after an operation (52.8%). The most common comorbidity associated with postoperative death was cardiac disease(18.9%). There was a significant relationship between age and time interval between surgery and death showed (p

Background & Aims Chronic pancreatitis (CP) is associated with osteopathy (osteoporosis or osteopenia). However, existing literature is mostly limited to retrospective or administrative studies that have not clearly defined the prevalence and risk factors. Our aim was to identify patient- and disease-related associations with osteopathy in a prospective cohort study of CP. Methods We studied 282 subjects with definitive CP enrolled in the PROCEED study who had a baseline dual-energy X-ray absorptiometry (DXA) scan. Osteopenia and osteoporosis were defined using the lowest T-scores. Clinical data were collected using standardized case report forms. Comparisons were performed with a multivariate logistic regression model with forward selection to identify risk factors for osteopathy. Results The majority of subjects had osteopathy on DXA scan (56.0%; 17.0% osteoporosis; 39.0% osteopenia). Subjects with osteopathy had a higher prevalence of traumatic (40.0% vs 26.4%; P = .02) and spontaneous fractures (3.9% vs 0; P = .04). On multivariate analysis, older age (odds ratio [OR], 1.29 per 5 years; 95% confidence interval [CI], 1.15–1.45), female sex (OR, 3.08; 95% CI, 1.75–5.43), white race (OR, 2.68; 95% CI, 1.20–6.01), and underweight body mass index category (OR, 7.40; 95% CI, 1.56–34.99) were associated with higher probability of osteopathy. There were no significant associations between osteopathy and other patient and disease-related features of CP. Conclusion In the largest study of patients with CP who underwent DXA screening, the majority had osteopathy. There are overlapping risk factors with osteopathy in the general population, but the high prevalence in men and younger women supports the need for future investigations into the mechanisms of bone loss in CP. ClinicalTrials.gov number, NCT03099850.

Objective This cross-sectional study examined environmental correlates of sedentary behavior (SB) and physical activity (PA) in preschool children in the urban area of Tianjin, China. Methods Data were collected from the Physical Activity and Health in Tianjin Chinese Children study, involving healthy children 3–6 years old and their families. In all children (n = 980), leisure-time SB (LTSB) and leisure-time PA (LTPA) were reported in min/day by parents. In a subgroup (n = 134), overall sedentary time, light PA, and moderate-to-vigorous PA (MVPA) were objectively measured using ActiGraph accelerometry (≥3 days, ≥10 h/day). Environmental correlates were collected using a questionnaire that included home and neighborhood characteristics (e.g., traffic safety, presence of physical activity facilities) and children's behaviors. Potential correlates were identified using linear regression analysis. Results Multiple linear regression analysis showed that “having grandparents as primary caregivers” (βs and 95% confidence interval (CI) for overall sedentary time: 29.7 (2.1 to 57.2); LTSB (ln): 0.19 (0.11 to 0.28)) and “having a television (for LTSB (ln): 0.13 (0.00 to 0.25)) or computer (for LTSB (ln): 0.13 (0.03 to 0.23)) in the child's bedroom” were both associated with higher SB. Furthermore, “having grandparents as primary caregivers” was associated with less MVPA (β (95%CI): −7.6 (−14.1 to −1.2)), and “active commuting to school by walking” correlated with more MVPA (β (95%CI): 9.8 (2.2 to 17.4)). The path model showed that “more neighborhood PA facilities close to home” was indirectly related to higher LTPA (ln), which was partly mediated by “outdoor play” (path coefficients (95%CI): 0.005 (0.002 to 0.008)) and “going to these facilities more often” (path coefficients (95%CI): 0.013 (0.008 to 0.018)). Traffic safety was not a correlate. Conclusion Family structure and media exposure in the home maybe important factors in shaping preschoolers’ PA patterns. Built environmental correlates could indirectly influence preschoolers’ LTPA through parental help with engaging in active behaviors.

Background: Hypertension is a major global concern and public health problem affecting more than one billion individuals worldwide. It is risk factor for cardiovascular diseases (CVDs). The main objective of this study was to determine the prescription pattern of antihypertensive medications among patients on follow-up at cardiac clinic of Zewditu Memorial Hospital. Method: A cross-sectional retrospective study design was used to collect the data from the patient chart by reviewing the hypertension patient’s medical record. Result: Out of the 356 patient cards reviewed, 204 (57.3%) were for females and with the mean age of 56.2 ± 12.4 years. Among total study participants, 124 (34.8%) had co-morbid conditions. Majority of the patients were on combination therapy 252 (70.8%). Angiotensin converting enzyme inhibitor (ACEI), 215 (60.4%) was the most prescribed drug. Blood pressure was controlled in 107 (30.1%) of patients. About 140 (39.3%) and 134 (37.6%) hypertensive patients were appropriately prescribed according to national guideline 2014 and Joint National Committee (JNC 8) guideline, respectively. The result of the multivariate analysis showed that there was a positive statistically significant association between inappropriate prescription pattern of antihypertensive medications with age ≥ 60 years (P=0.01) and uncontrolled blood pressure (BP) (P=0.001). Conclusion: In conclusion, the general use of antihypertensive medications seemed not to be in accordance with the Ethiopia national guideline.

BACKGROUND: With the increase in the older adult population, it is essential to identify the living and health conditions that can impact the quality of life of these individuals. OBJECTIVES: To identify the domains and factors associated with the quality of life of older adults under the Family Health Strategy program. DESIGN AND SETTING: This was a cross-sectional analytical study was conducted in the municipality of Palmas, Tocantins, Brazil. METHODS: We assessed 449 older adults enrolled in the Family Health Strategy program. Data were collected between April and July, 2018. World Health Organization Quality of Life Assessment (WHOQOL-OLD) was used to assess the quality of life (QoL) and multiple linear regression was used to estimate the factors associated with QoL. RESULTS: The QoL domain with the highest score was death and dying (mean = 70.4), and the lowest score was for sensory functions (mean = 61.0 points). The factors associated with QoL were single marital status (β = -4.55; P = 0.014), level of independence for daily living activities (β = 4.92; P < 0.001), self-assessment of regular health (β = 5.35; P < 0.001), and poor health (β = -8.67; P < 0.001). CONCLUSION: The death and dying domain of QoL presented the highest score. Marital status, impairment in daily activities, and health self-assessment were associated with QoL.

Chronic diseases are a major cause of mortality and morbidity globally, with non-communicable diseases being responsible for most deaths. Older adults are at a higher risk of developing chronic diseases due to various sociodemographic and lifestyle factors such as age, sex, income, education, employment, place of residence, dietary supplementation, tobacco use, and alcohol consumption. Understanding the relationship between these factors and chronic diseases is crucial for identifying vulnerable populations and improving healthcare delivery. Through both an online and an interview-based survey, this cross-sectional study aimed to examine these associations, focusing on adults aged 50 and above, with the goal of identifying potential areas for intervention and prevention. The study found that gender, area of residence, education status, employment status, nutritional supplementation, body mass index (BMI), alcohol usage, and age are associated with the risk of chronic disease, cardiovascular disease, and diabetes. Female gender, higher educational level, employment, normal BMI, and younger age were found to be protective factors, while living in rural areas, alcohol consumption, and older age were identified as risk factors. The study recommends targeted interventions and improved access to healthcare to reduce risk factors and enhance healthcare delivery for better health outcomes.

Healthcare access and a high quality of the provided services to healthcare users are fundamental human rights according to the Alma Ata Declaration of 1978. Although 45 years have passed since then, health inequalities still exist, not only among countries but also within populations of the same country. For example, several small Greek islands have only a small Primary Healthcare Center in order to provide healthcare services to the insular population. In the current study, we investigated the level of self-reported overall, dental and mental health status and the level of satisfaction regarding the access to and the quality of the healthcare services provided by the Primary Healthcare center of Alonissos, along with registering the requirements for transportation to the mainland in order to receive such services. In this questionnaire-based cross-sectional study, 235 inhabitants of the remote Greek island of Alonissos that accounts for nearly 9% of the population participated (115 males and 120 females). The self-reported overall health status was reported to be moderate to very poor at a percentage of 31.49%, and the results were similar for dental and self-reported mental health status. Although nearly 60% of the participants reported very good/good quality of the healthcare provision, only 37.45% reported that the access to healthcare was very good/good, while around 94% had at least one visit to the mainland in order to receive proper healthcare services. Strategies for improving access to healthcare services need to be placed in remote Greek islands like Alonissos.

BACKGROUND Models estimating risk for advanced proximal colorectal neoplasia (APN) may be used to select colorectal cancer (CRC) screening test, either prior to knowing distal colorectal findings or afterward. Current models have only fair discrimination and nearly all require knowing distal findings. OBJECTIVE Derive and test risk prediction models for APN with and without distal findings. SETTING Selected endoscopy centers within central Indiana, USA. PARTICIPANTS Average-risk persons undergoing first-time screening colonoscopy. INTERVENTIONS Demographics, personal and family medical history, lifestyle factors and physical measures were linked to the most advanced finding in proximal and distal colorectal segments. For both models, logistic regression identified factors independently associated with APN on a derivation set. Based on equation coefficients, points were assigned to each factor, and risk for APN was examined for each score. Scores with comparable risks were collapsed into risk categories. Both models and their scoring systems were tested on the validation set. MAIN OUTCOME APN, defined as any adenoma or sessile serrated lesion ≥1 cm, one with villous histology or high-grade dysplasia, or CRC proximal to the descending colon. RESULTS Among 3025 subjects in the derivation set (mean age 57.3 ± 6.5 years; 52% women), APN prevalence was 4.5%; 2859 (94.5%) had complete data on risk factors. Independently associated with APN were age, sex, cigarette smoking, cohabitation status, metabolic syndrome, non-steroidal anti-inflammatory drug use and physical activity. This model (without distal findings) was well-calibrated (P = 0.62) and had good discrimination (c-statistic = 0.73). In low-, intermediate- and high-risk groups that comprised 21, 58 and 21% of the sample, respectively, APN risks were 1.47% (95% CI, 0.67-2.77%), 3.09% (CI, 2.31-4.04%) and 11.6% (CI, 9.10-14.4%), respectively (P

(1) Background: We aimed to explore the associations between menopause, postmenopausal hormone therapy, and metabolic syndrome in a large community-based group of Asian women. (2) Methods: This is a cross-sectional study in which we enrolled women aged 30 to 70 years with sufficient information about menopausal status from the Taiwan Biobank. The definition for metabolic syndrome used in this study aligns with the Bureau of Health Promotion’s (Taiwan) proposed definition. (3) Results: A total of 17,460 women were recruited. The postmenopausal group had a higher metabolic syndrome prevalence (30% vs. 14%) and 1.17 times higher odds ratio (OR) than the premenopausal group (95% confidence interval [CI] = 1.02 to 1.33). Regarding the types of menopause, surgical menopause was associated with metabolic syndrome (OR = 1.40; 95% CI = 1.20 to 1.63); however, natural menopause was not associated with metabolic syndrome. Interestingly, postmenopausal hormone therapy was associated with a lower risk of metabolic syndrome in the women with natural menopause (OR = 0.79; 95% CI = 0.70 to 0.89), but not in those with surgical menopause. (4) Conclusions: Our results suggest that menopause is associated with an increased prevalence of metabolic syndrome, while postmenopausal hormone therapy is associated with a lower prevalence of metabolic syndrome in women with natural menopause.

Background: Vitamin D has been suggested to play a role in the development of depression, but the nature of the relationship between the two is still not fully understood. Although some studies have shown an association between vitamin D deficiency and depression, others have yielded inconsistent or inconclusive results. As a result, further research is needed to better understand the relationship between vitamin D and depression. Objectives: This study aims to assess the association between serum vitamin D and the risk of depressive symptoms in individuals aged 20 years and older in the United States. Methods: We selected 7562 participants from the 2007–2018 US National Health and Nutrition Examination Survey (NHANES). Participants’ serum vitamin D levels were determined from laboratory data, and those with a Patient Health Questionnaire-9 (PHQ-9) score of ≥ 10 were considered to have depressive symptoms. Associations between vitamin D and depressive symptoms were investigated using multiple logistic regression, subgroup analysis, and smoothed curve fitting. Results: In our study, 11.17% of the participants had depression. Multiple regression stratified analysis showed a significant inverse association between serum vitamin D and depression in the 29–39 years age group after full adjustment (OR = 0.54, 95% CI: 0.31–0.95, p = 0.0316). This result was supported by subgroup analysis and smoothed curve fitting. Conclusions: The association between serum vitamin D and depressive status in US adults varied across populations. Among those aged 29–39 years, vitamin D supplementation tended to show a lower rate of depression.

This study investigates food literacy-related abilities and adherence to dietary recommendations in relation to sociodemographic characteristics and health-related features (health literacy, self-rated health and morbidity) in the North-Western region of Romania. This is a secondary analysis of cross-sectional data collected in 2019 from a representative and randomised sample of 1572 individuals. A questionnaire was employed to record participants’ sociodemographic characteristics, food-related and health-related features. Most participants were non-adherent to dietary recommendations for fruit and vegetables (83.5%), fish and seafood (61.3%), and water intake (67.9%). However, most participants reported an adequate ability to understand the connection between nutrition and health (89.1%), to distinguish between healthy and less healthy options (84.4%), and to acquire nutrition information (75.6%). Non-adherence to dietary recommendations and low food literacy abilities were more prevalent in disadvantaged groups (older age, rural settings, retirement or social welfare, low educational attainment, formerly married). Health literacy was negatively associated with not adhering to dietary recommendations and poor self-rated food literacy abilities. The study suggests that low socioeconomic status negatively impacts food literacy and adherence to dietary recommendations among Romanian adults. Identifying target populations to improve food-related abilities and health literacy can aid public health services in improving health outcomes.

Background: Efforts to regulate tobacco products and reduce consumption in the European Union (EU) include the European Tobacco Products Directive (TPD), which went into force in May 2016. Despite the initial discussion to include a ban on sale of slim cigarettes, it was excluded in the final TPD. The main goal of this study was to examine support for a ban on slim cigarettes among smokers in six European Countries. Methods: Data from the 2018 (Wave 2) International Tobacco Control Policy Evaluation Project 6 European Country (ITC 6E) EUREST-PLUS project survey, a cross sectional study of adult smokers (n=5592) from Germany, Greece, Hungary, Poland, Romania, and Spain, was analysed. Descriptive statistics were used to estimate support for a ban on slim cigarettes by sociodemographic characteristics and smoking behaviors. Logistic regression analysis was used to examine factors associated with support for a ban on slim cigarettes and perceptions of harm. Results: Support for a ban on slims varied across countries, with highest support in Romania (33.8%), and lowest in Greece (18.0%). Female smokers (OR=0.77; 95%CI=0.66-0.90, daily smokers (OR=0.59; 95%CI=0.42-0.83), menthol smokers (OR=0.56; 95%CI=0.36-0.87), and smokers who did not have plans to quit within next six months (OR=0.45; 95%CI=0.36-0.57) had significantly lower odds of supporting a ban on slim cigarettes. Overall, 20% of smokers perceived slim cigarettes as less harmful than regular cigarettes. Conclusions: Support for a ban of slim cigarettes was relatively low among smokers, while misperceptions that slim cigarettes are less harmful is high, particularly among countries where slim cigarette use is more prevalent. Findings support a ban on slim cigarettes to reduce misperceptions around slim cigarettes being less harmful.

Self-medication is identified by the consumption of medications without a prescription or guidance from a qualified prescribing professional. This study estimated the prevalence, profile, and associated factors with self-medication during the COVID-19 pandemic in Brazil. A cross-sectional study was conducted through a household survey in the Alegre city, from November to December 2021. Descriptive analysis was performed for the sociodemographic and clinical characteristics of the interviewees. Poisson regression with robust variance was used to identify the association of sociodemographic and clinical variables with self-medication. A total of 654 people were interviewed, of whom 69.4% were self-medicating. The younger age group (PR = 1.13; 95% CI = 1.01–1.26), female gender (PR = 1.19; 95% CI = 1.04–1.37), consumption of alcoholic beverages (PR = 1.13; 95% CI = 1.01–1.25), and problems with adherence to pharmacological treatment (PR = 1.15; 95% CI = 1.04–1.28) were associated with self-medication, while the occurrence of polypharmacy (PR = 0.80; 95% CI = 0.68–0.95) was a protective factor for self-medication. Self-medication was directly related to over-the-counter drugs, with analgesics dipyrone and paracetamol being the most commonly used. Self-medication consumption of prescription drugs, including those under special control, was identified to a lesser extent.

Despite the notable benefits of palliative care (PC) for patients with chronic diseases, its delivery to people with cardiac problems, particularly in the Middle East region (EMR), remains a critical issue. There is a scarcity of research assessing nursing staff’s needs and knowledge in providing PC to cardiac patients in the EMR. This study aimed to assess the level of knowledge and needs of PC among nurses towards the provision of PC in intensive coronary care units (ICCUs) in the Gaza Strip, Palestine. It also identified the barriers to the provision of PC services in ICCUs in the Gaza Strip. A hospital-based descriptive quantitative cross-sectional design was adopted to collect data from 85 nurses working in ICCUs at four main hospitals in the Gaza Strip. Knowledge about PC was collected using a developed questionnaire based on the Palliative Care Quiz Nursing Scale (PCQN) and Palliative Care Knowledge Test (PCKT). PC training needs and barriers were assessed using the PC Needs Assessment instrument. Approximately two-thirds of nurses did not receive any PC educational or training programs, which contributed to their lack of PC knowledge. Most nurses would like to enroll in PC training programs, such as family support and communications skills courses. Nurses reported that there was a high demand for PC guidelines and discharge planning for patients with chronic illnesses. Insufficient healthcare professionals’ knowledge about PC and a staff shortage were the main barriers to integrating PC into the Gaza healthcare system. This study suggests incorporating PC into nursing curricula and in-service training, and it covers both basic and advanced PC principles. Intensive coronary care unit nurses need knowledge and training about PC, guidance, and support to provide appropriate care to patients with cardiovascular issues.