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This paper explores the impact of phonological overlap amongst items on short term memory recall performance by manipulating the type, number and syllabic position of shared phonemes between words in a serial recall task. Roodenrys et al [Roodenrys, S., Miller., L. M., & Josifoski, N. (2022b). Phonemic interference in short-term memory contributes to forgetting but it is not due to overwriting. Journal of Memory and Language, 122, 104301. https://doi.org/10.1016/j.jml.2021.104301] demonstrated that when the phonemes of a target word also occur in words earlier in the list, recall of the target word is impaired. Two experiments are reported that further examine the nature of this interference effect. Experiment 1 varied the type and number of phonemes shared with the single syllable target word by other list words and found a single shared vowel impaired target word recall performance as much as two shared consonants. Experiment 2 altered the syllabic position of the overlapping phonemes and found shared syllabic position was necessary to impair recall of the target word. It is argued these results show that not all phonological overlap is equally detrimental and specific psycholinguistic conditions are necessary to produce interference that impairs recall performance. [ABSTRACT FROM AUTHOR]

Substance use and depressive psychiatric symptoms have been associated with migration and mobility. The Mexico-Guatemala border is a key transit point for internal, regional, and international migration flows. However, there is limited knowledge of the role of substance use, migration, and mobility on mental health among migrants at this border. Our paper explores the association of migration and mobility patterns with possible major depressive symptoms among migrants at this key geographic region. We recruited 392 substance-using migrants using modified time-location sampling. Crude and adjusted logistic regression models were developed. We found that 12% of the sample had possible major depressive symptoms. After adjusting for relevant covariates, including gender, income, and perceived homelessness, we found that recent rural-urban and short-term migrants had higher odds of possible major depressive symptoms, whereas international migrants had lower odds. Findings of this paper suggest that although migrants experience hardship and uncertainty, they may respond with complex and nuanced forms of coping and planning. [ABSTRACT FROM AUTHOR]

The aim of the present study was to estimate risk factors for type 2 diabetes in women. A case–control study included 99 newly diagnosed cases of type 2 diabetes and 198 controls. Descriptive statistics were used, and conditional univariate logistic regression analysis was used to determine differences between cases and controls. According to multivariate analysis-independent risk factors for T2DM were as follows: oral contraceptives (OR = 2.57; 95% CI = 0.99–6.62), and their longer duration of use (OR = 3.55; 95% CI = 1.79–6.99); greater quantity of coffee consumed (OR = 1.89; 95% CI = 1.06–3.39), occupation (odds ratio – OR = 3.17; 95% confidence interval – CI = 1.57–6.41); never been pregnant (OR = 5.88; 95% CI = 2.23–15.49); family history of diabetes (OR = 18.52; 95% CI = 7.25–47.62); overweight and obesity (OR = 2.13, 95% CI = 1.39–4.53); stress (OR = 4.42; 95% CI = 2.19–8.26), and the greater number of stressful life event (OR = 1.65; 95% CI = 1.22–2.23). The present study emphasizes the role of oral contraceptive use, a greater quantity of coffee consumed, occupation, never been pregnant, overweight and obesity, major stressful life events, and family history of diabetes in the development of type 2 diabetes. What is already known about this topic (1) It is well known that lifestyle factors and genetics are involved in the development of type 2 diabetes mellitus (T2DM) and its complications. (2) Gender differences in T2DM are explained by differences in sex chromosomes, sex hormones, possible hormonal disbalance, lifestyle habits in nutrition, and physical activity. (3) The global prevalence of diabetes will increase to 366 million by 2030, even if the prevalence of obesity remains constant. (4) The vast majority of patients with diabetes have T2DM. (5) Knowledge of modifiable and non-modifiable risk factors for T2DM is important for the prevention of this disease. (6) Many factors have been investigated for their relation to T2DM, but data on the association between some of them and the risk for diabetes are not consistent. What this paper adds (1) Independent predictive factors for T2DM in women are oral contraceptive use and quantity of coffee consumption. (2) Other independent predictive factors for T2DM include occupation, never been pregnant, overweight and obesity, major stressful life events, and family history of T2DM. (3) A greater number of children was significantly negatively related to T2DM. (4) In this study, oral contraceptive use and especially their use for 5 years and more were significantly positively associated with T2DM after adjustment for potential confounding factors. (5) This study highlights, in particular, the need to target overweight and obese women who use oral contraceptives, have never been pregnant, and consume a greater quantity of coffee, with major stressful life events and a family history of diabetes. These groups are more vulnerable to T2DM; thus, prevention should focus on these groups. [ABSTRACT FROM AUTHOR]

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Determination of smoking habits of medical students in Belgrade and the factors influencing cigarette use. A cross-sectional study was conducted among undergraduate medical students from all study years at the Faculty of Medicine, University of Belgrade, during the 2015–2016 academic session. A questionnaire, composed of four parts, was administered to all participants: 1. socio-demographic characteristics; 2. habits and lifestyle; 3. Fagerstrom Test for Nicotine Dependence; 4. the Rosenberg self-esteem scale. Logistic regression analysis was conducted to identify the factors significantly associated with cigarette smoking. A total of 2551 subjects, which constituted 81.8% of all undergraduate medical students, participated in the survey. The prevalence of current regular smokers among medical students was 21.7%. The results obtained using the Fagerstrom tolerance scale showed that 41.8% of the students had high nicotine dependence. According to the results of a multivariate analysis, the following were the independent determinants of being a smoker: being male, grade point average of <8/10, daily coffee consumption, self-reported excessive leisure time, self-reported pressure from parents, alcohol consumption, and smokers among parents. Understanding the factors influencing tobacco use is the first step in implementing prevention strategies and can be helpful in the cessation of smoking. What is already known about this topic Previous studies showed a strong association between smoking and alcohol consumption among undergraduate medical students. There is an association between tobacco use and academic performance. Higher-income families and the parents without higher education are significantly associated with students' smoking, but these associations were not independent. What this paper adds Independent predictive factors for smoking among undergraduate medical students are being male, having smokers among parents, daily coffee consumption, self-reported excessive leisure time, self-reported pressure from parents and consumption of alcohol. Family income does not influence smoking status of students directly, but students participated in this study from the higher-income families were more likely to have smokers among parents, which were found to be an independent predictive factor. Early psychologists' cessation smoking interventions can have implications for motivating students to quit smoking. [ABSTRACT FROM AUTHOR]

Consistency of word production contributes to carers' ability to understand children's speech. Reports of the proportion of words produced consistently by typically developing preschool children, however, vary widely from 17% to 87%. This paper examines the quantitative (consistency count) and qualitative (e.g. phonemic analysis) characteristics of word consistency in 96 children aged 36–60 months. Children named 15 pictures twice, in separate trials, in the same assessment session. The mean consistency of the production for the whole group was 82%. Older children were more consistent than younger children. Girls were more consistent than boys. Words produced correctly in one trial and in error in another may indicate resolving error patterns. Words produced in error in two different ways provided useful evidence about the nature of inconsistent word production in typically developing children. The clinical and theoretical implications are discussed. [ABSTRACT FROM AUTHOR]

Across most developmental periods, males tend to drink at a higher frequency and at a higher intensity than females. In identifying the mechanism responsible for these differences, biological factors have been a prevalent focus; however, gender expression is also highlighted. The purpose of this paper is to decipher how differences in binge drinking are attributed to sex differences and gendered traits. Using data from Wave III of the National Longitudinal Study of Adolescent to Adult Health (ADD Health) (n = 8,882), we conducted a multiple group moderation analysis to examine how differences in biological sex and gender roles in emerging adulthood predicted binge drinking. We found that binge drinking in emerging adulthood was most strongly predicted by high levels of masculinity and low levels of femininity in emerging adulthood. As masculinity decreased, alcohol use decreased. Femininity significantly moderated masculinity's association with binge drinking, primarily when masculinity was high, and this did not vary across sex after controlling for gender roles. Our findings expand sex and gender research surrounding alcohol use. For both males and females, the higher the masculinity the more frequent alcohol use, an effect of which was buffered by higher levels of femininity. Clinicians should take into consideration gender role ascription of their clients when determining the risk profile during assessment. [ABSTRACT FROM AUTHOR]

To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic. A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors. Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464) The willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement. As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists. As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary. [ABSTRACT FROM AUTHOR]

In many statistical analysis, a finite population may contain a large proportion of zero-and-one values that make the population distribution severely skew. Confidence intervals based on a normal approximation (NA) for such data may have low coverage probabilities. In this paper, we apply the methods of jackknife empirical likelihood (JEL) and adjusted jackknife empirical likelihood (AJEL) to discuss the confidence intervals for the mean of zero-and-one inflated population. Asymptotic distributions of the likelihood-type statistics are studied. Simulations are conducted to compare coverage probabilities with other methods under different distributions. Real data is given to illustrate the procedure of proposed methods. [ABSTRACT FROM AUTHOR]

This paper aims to analyze the levels and trajectories of physical rehabilitation needs across five resource-poor world regions, against global and key country-specific benchmarks. This comparative, secondary cross-region analysis uses data from the Global Burden of Diseases study 2017 [1990–2017], specifically varied metrics of the Years Lived with Disability (YLD) measure from the health conditions likely benefiting from physical rehabilitation. All the resource-poor world regions had significant increases (p < 0.01) in the absolute, relative, and percentage of physical rehabilitation needs [1990–2017]. Nonetheless, The Asia-Pacific region stood out with the greatest YLD Rates (i.e., per population size) in 2017, the greatest growth in YLD Rates since 1990 (38%), and an exponential growth in the rehabilitation-sensitive YLD Rates. The Asia-Pacific region also had the greatest portion of their YLDs coming from rehabilitation-sensitive conditions (72% in 2017), closely followed by the Latin America & Caribbean (67%). Nonetheless, in South Asia and Sub-Saharan Africa, we observed the greatest percent increases in the portion of physical rehabilitation needs among all YLDs, out of lower initial values. An overall growth but differential patterns were observed in the evolution of physical rehabilitation needs across the resource-poor world regions. Asia-Pacific and Latin America & Caribbean regions had over than two-thirds of their non-fatal health loss arising from conditions sensitive to physical rehabilitation, and important growths in rehabilitation need indicators have been observed also for South Asia and Sub-Saharan Africa. The scale-up and strengthening of rehabilitation services and resources should be informed by needs-based data. The needs-based data from this study can inform trans-national developments and the planning of rehabilitation resources, inclusively at the world-region level. [ABSTRACT FROM AUTHOR]

This paper used a structural perspective to examine unmet healthcare needs in women at risk for eating disorders in Canada utilizing the Canadian Community Health Survey. The results revealed that body dissatisfied women had reported significantly higher unmet needs compared to body satisfied women (χ 2(1) =29.31, p <.05). Body dissatisfied women were also more likely to identify structural reasons for unmet needs. Considering the high costs associated with eating disorders, barriers creating inequitable health services need to be addressed in clinical practice, organizational structures, policy, and in research to improve treatment pathways. [ABSTRACT FROM AUTHOR]

To systematically review literature on nutritional intake, nutritional status and nutritional interventions, and to study their association with short- and long-term clinical outcomes in people with a major dysvascular lower limb amputation. PubMed, Ovid, CINAHL, and The Cochrane Library were searched. Studies were included if nutritional intake, nutritional status, or nutritional interventions in people with a major dysvascular lower limb amputation were analyzed. Of the 3038 unique papers identified, 30 studies were included. Methodological quality was moderate (1 study) or weak (29 studies). Limited information was available on nutritional intake (2 studies) and nutritional interventions (1 study). Nutritional intake and nutritional status were assessed by diverse methods. The percentage of people with a poor nutritional status ranged from 1% to 100%. In some studies, measures of poor nutritional status were associated with adverse short- and long-term clinical outcomes. The percentage of people with a poor nutritional status is inconclusive in the major dysvascular lower limb amputation population, because of the heterogeneity of the assessment methods used. Some included studies reported a negative association between poor nutritional status and clinical outcomes. However, these results should be interpreted with caution, because of the limited quality of the studies available. Studies high in methodological quality and high in hierarchy of evidence are needed. The proportion of people with a poor nutritional status in the major dysvascular lower limb amputation population is inconclusive. Poor nutritional status seems to affect clinical outcomes negatively. More uniformity in assessment of malnutrition in the major dysvascular lower limb amputation population is needed. [ABSTRACT FROM AUTHOR]

Fertility rates in Nigeria are declining at such a modest rate, that if more proactive measures are not employed to reduce fertility, the nation may double its population before long. We empirically examined fertility behaviour as derivatives of specific subgroup social norms, and the variations in the factors responsible for different fertility behaviours, using the 2018 Nigeria Demographic and Health Survey. Descriptive bivariate, and multinomial logistic regression analyses were used to predict the contribution of demographic and sociocultural factors contributing to the fertility level, and findings were reported as odds ratios. Results revealed that age, religion and level of education are the most significant predictors of fertility level, with remarkable differences in birth rate across subgroups, whereas North-West Nigeria had the highest fertility level. Furthermore, marriage had a significantly negative effect on high fertility among North-Western women, whereas higher education significantly increased high fertility among North-Eastern women. In conclusion, subgroup social norms fertility behaviour is responsible for the persistent fertility differential outcome in Nigeria. Thus, the paper strongly advocates the need to intensify community-led, norm-based solution and not a universal approach in addressing fertility control in Nigeria. [ABSTRACT FROM AUTHOR]

In this paper, we explore the performance of past-tense inflection of non-verbs (NVI) in children with developmental language disorder (DLD) and in typically developing controls, to investigate its accuracy as a clinical marker for Swedish-speaking children with DLD. Further, we investigate the relationship between NVI, nonword-repetition, and family history. The sample consists of 36 children with DLD (mean age 9;5 years) and 60 controls (mean age 9;2 years). The DLD group performed significantly lower than the controls on the NVI task, with a large effect size of the difference (d = 1.52). Analysis of the clinical accuracy of NVI resulted in 80.6% sensitivity and 76.6% specificity. NVI was significantly and moderately associated with nonword-repetition in the controls, but not in the DLD group. A positive family history, 80.6% in the DLD group and 6.9% in the controls, was associated with lower performance on NVI. When controlling for group (DLD and controls), a non-significant association between family history and performance on the NVI task was found. NVI is a potential clinical marker of DLD in Swedish school-aged children, but the current NVI task does not reach the level of being acceptable. Further development of the NVI task is warranted to improve its accuracy. [ABSTRACT FROM AUTHOR]

Women in low-and-middle income countries (LMICs) are disproportionately exposed to secondhand smoke (SHS), particularly in the home environment. Girls married before the age of 18 are more likely to remain at home and may be at higher risk of SHS exposure. This paper investigates whether women who were married as child brides had a higher risk of SHS exposure than their peers who were married as adults in India, where both burden of smoking and child marriage are critical public health concerns. Data were obtained from the 2015–2016 wave of the nationally representative India National Family Health Survey and included 306,788 married women ages 18 to 35 years. We estimated bivariate and multivariate logistic regressions to obtain odds ratios in favor of SHS exposure. The prevalence of SHS exposure for those who were married as adults was 50.3% while that was 55.2% for those who were married before age 18. After controlling for sociodemographic characteristics, the adjusted odds of SHS exposure for those who were married as child were 1.06 (95% CI: 1.03, 1.09) times that of those who were married as adults. Findings of this study inform policies for coordinated efforts to eliminate child marriage and strengthen tobacco control. [ABSTRACT FROM AUTHOR]

The objective of this paper was to estimate the inter-rater reliability of expert assessments of occupational exposures. An inter-rater reliability sub-study was conducted within a population-based case-control study of postmenopausal breast cancer. Detailed information on lifetime occupational histories was obtained from participants and two industrial hygienists assigned exposures to 185 jobs using a checklist of 293 agents. Experts rated exposure for each job–agent combination according to exposure status (unexposed/exposed), confidence that the exposure occurred (possible/probable/definite), intensity (low/medium/high), and frequency (% time per week). The statistical unit of observation was each job–agent assessment (185 jobs × 293 agents = 54,205 assessments per expert). Crude agreement, Gwet AC1/2 statistics, and Cohen's Kappa were used to estimate inter-rater agreement for confidence and intensity; for frequency, the intra-class correlation coefficient (ICC) was used. The majority of job–agent combinations were evaluated by the two experts to be not exposed (crude agreement >98% of decisions). The degree of agreement between the experts for the confidence of exposure status was Gwet AC1/2 = 0.99 (95% CI: 0.99–0.99), and for intensity, a Gwet AC2 = 0.99 (95% CI: 0.99–0.99). For frequency, an ICC of 0.31 (95% CI: 0.26–0.35) was found. A sub-analysis restricted to job–agent combinations for which the two experts agreed on exposure status revealed a moderate agreement for confidence of exposure (Gwet AC2 = 0.66) and high agreement for intensity (Gwet AC2 = 0.96). For frequency, the ICC was 0.52 (95% CI: 0.47–0.57). A high level of inter-rater agreement was found for identifying exposures and for coding intensity, but agreement was lower for the coding of frequency of exposure. [ABSTRACT FROM AUTHOR]

We investigated the correlations and agreement between cognitive assessments made using a computerised (CogState™, six domains) and a standard pen-and-paper battery (five domains) in PWH and lifestyle-similar HIV-negative individuals. Demographically adjusted domain and global T-scores were obtained and used to define cognitive impairment according to the multivariate normative comparison (MNC) criteria. Correlations between T-scores and the agreement between the classifications of cognitive impairment obtained from the two batteries were assessed using the Spearman's rank correlation and Cohen's κ, respectively. The correlation between global T-scores from the two batteries was 0.52 (95% CI 0.44–0.60) in PWH and 0.45 (0.29–0.59) in controls (p = 0.38 for their difference). Correlations were generally stronger between domains within the same battery than between those from different batteries. The agreement between the two batteries in classifying individuals as cognitively impaired or not impaired was fair in PWH (κ = 0.24) and poor in HIV-negative individuals (κ = −0.02). The moderate correlation between overall cognitive function and the modest agreement between binary classifications of cognitive impairment obtained from two different batteries indicate the two batteries may assess slightly different components of cognition. [ABSTRACT FROM AUTHOR]

Alcohol Use Disorder is a complex and broad condition with multiple pathways to resolution. Only a small proportion of people with AUD seek formal treatment or support, whilst lower severity AUD is particularly under-addressed. In part, this reflects common misconceptions about AUD as an always severe condition requiring lifelong abstinence. The present study sought to investigate the impact of an online programme focused on supporting participants (n = 928) looking to change their drinking behaviors on outcomes of self-reported happiness with drinking and other well-being outcomes. Results showed that post-intervention, all participants reported significantly increased happiness with their drinking, greater drink-refusal self-efficacy, and improvements in how drinking impacted multiple well-being domains such as sleep and emotions. Importantly, it was found that all participants were happier with their drinking regardless of whether their goal was to abstain from drinking or to reduce their drinking. These results add to evidence highlighting the need to broaden the accessibility and range of options available to support a wider range of people with AUD, particularly via increasing understanding and acceptance of non-abstinent routes to AUD resolution. [ABSTRACT FROM AUTHOR]

It has been proposed that an implicit learning deficit explains the difficulties with grammar commonly observed in children with Developmental Language Disorder (DLD). The present study further investigates this link in two ways. Firstly, we investigate whether kindergartners with DLD have more difficulties with preposition understanding and production as compared to their typically developing peers because they have not (yet) learned to weigh implicit structural information (word order) over more explicit semantic information (noun animacy; Study 1). Secondly, we investigate whether kindergartners with DLD learn to comprehend and produce locative prepositions from an implicit learning context (Study 2). In Study 1 we observed that Dutch kindergartners with DLD (n = 32) made more errors in preposition comprehension (picture-matching task) and preposition production (semi-spontaneous production task) as compared to their typically developing peers (n = 30). We have no evidence that these differences can be explained by a difference in cue weighing or implicit learning ability (serial reaction time task). In Study 2 we observed that the storytelling context led to an increase in preposition production in children with DLD, but we found no evidence that it also led to a better understanding and more semantically accurate productions of the prepositions. We conclude that Dutch kindergartners with DLD have difficulties with locative prepositions but cannot conclude that differences in cue-weighing or implicit learning play a role herein. [ABSTRACT FROM AUTHOR]

Objective: To explore in a primary care setting the associations between patients' daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. Design and setting: The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. Patients: Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. Main outcome measures: Association between self-reported BP and 10 self-report lifestyle-related variables. Results: Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. Conclusion: In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension. KEY POINTS: Associations between daily home blood pressure (BP) and self-reports of lifestyle and symptoms have not been previously well explored. Self-reported higher wellbeing, lower restlessness, less stress, and higher medication adherence were significantly associated with lower same-day BP levels. Physical activity was significantly associated with same-day BP for men, but not for women. Using a hypertension management system may be a valuable tool for communication between the patient and physician. [ABSTRACT FROM AUTHOR]

Introduction: Finite resources limit the amount of time EMS agencies can dedicate to continuing education in pediatric emergencies. EMS instructors need effective, efficient, and affordable educational strategies for these high-risk, low frequency events. Objective: To compare the effectiveness of four training methods in management of pediatric emergencies for paramedics. Methods: A validated, performance-based, simulated clinical assessment module was used to provide a baseline measurement of paramedics' resuscitation skills during three simulated pediatric emergencies. Educational modules were developed that targeted deficiencies identified by the baseline assessment, including advanced pediatric life support skills, airway management, use of the Broselow-Luten Tape®, pediatric drug dose calculations and drug delivery, seizure management, and trauma assessment. Paramedics from five EMS agencies in Michigan were randomized to four education intervention groups. The control group used an existing, online, continuing education course. Three experimental groups were exposed to the same content during five, one-hour sessions conducted over 2.5 years. Instruction was delivered using high-fidelity, simulated case-based training, low-fidelity simulation training, or lecture with procedural skills lab, based on group assignment. After the training, all groups were tested within 4–6 months using methods identical to baseline testing. Results: One hundred forty-seven subjects completed the study. There were no differences in baseline skill levels among the four groups. Only the low fidelity simulation training group demonstrated improvement of combined scenario scores (p = 0.0008). Scores for targeted skills improved in one scenario in the high-fidelity group, two in the low-fidelity group, one in the lecture/lab group, and none in the control group. Conclusions: Although improvements in those skills included in the training were found in three groups, two hours of training in pediatric emergencies per year was insufficient to produce a substantial improvement overall. Expensive, high-fidelity simulators were not necessary for teaching pediatric resuscitation skills to paramedics; instructive scenarios using low-fidelity manikins and debriefings appear to be adequate. The content delivered by an online refresher course did not provide any improvement in performance as measured by simulated, case-based assessments. [ABSTRACT FROM AUTHOR]

Drawing is a major component of cognitive screening for dementia. It can be performed without language restriction. Drawing pictures under instructions and copying images are different screening approaches. The objective of this study was to compare the diagnostic performance between drawing under instructions and image copying for MCI and dementia screening. A literature search was carried out in the OVID databases with keywords related to drawing for cognitive screening. Study quality and risk of bias were assessed by QUADAS-2. The level of diagnostic accuracy across different drawing tests was pooled by bivariate analysis in a random effects model. The area under the hierarchical summary receiver-operating characteristic curve (AUC) was constructed to summarize the diagnostic performance. Ninety-two studies with sample size of 22,085 were included. The pooled results for drawing under instructions showed a sensitivity of 79% (95% CI: 76 − 83%) and a specificity of 80% (95% CI: 77 − 83%) with AUC of 0.87 (95% CI: 0.83 − 0.89). The pooled results for image copying showed a sensitivity of 71% (95% CI: 62 − 79%) and a specificity of 83% (95% CI: 72 − 90%) with AUC of 0.83 (95% CI: 0.80 − 0.86). Clock-drawing test was the screening test used in the majority of studies. Drawing under instructions showed a similar diagnostic performance when compared with image copying for cognitive screening and the administration of image copying is relatively simpler. Self-screening for dementia is feasible to be done at home in the near future. [ABSTRACT FROM AUTHOR]

This work characterizes scientific and health information from posts addressing cosmetic products on Instagram for one-year. Portuguese profiles that cover cosmetic products were selected based on popularity and expertise. Posts concerning cosmetic products were recorded, and those containing scientific and health information were selected. A new method was used, which allows rating each post as "correct," "confuse," or "incorrect". Ten popular profiles and three expert profiles were selected. Forty-five posts containing scientific and health information about cosmetic products were analyzed. Popular profiles were approximately ten times more likely to convey confusing information about cosmetic products than expert profiles. [ABSTRACT FROM AUTHOR]

Globally, adolescent pregnancy is one of the key issues in women's reproductive health. Adolescent mothers face a higher risk of obstetrical concerns, and motherhood in adolescence is strongly influenced by lower education level and lower socioeconomic status. The present study was carried out across all Indian states and Union Territories using the National Family Health Survey, rounds 1 to 5 (1992–1993 to 2019–2021) in which various socioeconomic and cultural factors associated with adolescent pregnancies was examined in detail. The article uses univariate, bivariate with chi-square test, and multivariate logistic regression models to understand the extent of which socioeconomic factors and sexual behavior of the couple are related to early motherhood experiences. It was found that age at marriage, respondent education, employment, age gap between partners, and religion are some of the important variables that affect the likelihood of adolescent pregnancy among females in Indian states. Comprehensive institutional efforts like free contraceptives and counseling services should be provided to address the increasing risk of pregnancy among adolescents. [ABSTRACT FROM AUTHOR]

Handling large datasets and calculating complex statistics on huge datasets require important computing resources. Using subsampling methods to calculate statistics of interest on small samples is often used in practice to reduce computational complexity, for instance using the divide and conquer strategy. In this article, we recall some results on subsampling distributions and derive a precise rate of convergence for these quantities and the corresponding quantiles. We also develop some standardisation techniques based on subsampling unstandardised statistics in the framework of large datasets. It is argued that using several subsampling distributions with different subsampling sizes brings a lot of information on the behaviour of statistical learning procedures: subsampling allows to estimate the rate of convergence of different algorithms, to estimate the variability of complex statistics, to estimate confidence intervals for out-of-sample errors and interpolate their values at larger scales. These results are illustrated on simulations, but also on two important datasets, frequently analysed in the statistical learning community, EMNIST (recognition of digits) and VeReMi (analysis of Network Vehicular Reference Misbehavior). [ABSTRACT FROM AUTHOR]

To assess the cultural competence (CC) of GP trainees and GP trainers. Design and setting: A cross-sectional survey study was conducted at the GP Training Institute of Amsterdam UMC. We included 92 GP trainees and 186 GP trainers. We measured the three domains of cultural competency: 1) knowledge, 2) culturally competent attitudes and 3) culturally competent skills. Regression models were used to identify factors associated with levels of CC. Participants rated their self-perceived CC at the beginning and end of the survey, and the correlation between self-perceived and measured CC was assessed. Approximately 94% of the GP trainees and 81% of the GP trainers scored low on knowledge; 45% and 42%, respectively, scored low on culturally competent attitudes. The level of culturally competent skills was moderate (54.3%) or low (48.4%) for most GP trainees and GP trainers. The year of residency and the GP training institute were significantly associated with one or more (sub-)domains of CC in GP trainees. Having >10% migrant patients and experience as a GP trainer were positively associated with one or more (sub-) domains of cultural competence in GP trainers. The correlation between measured and self-perceived CC was positive overall but very weak (Spearman correlation coefficient ranging from −0.1–0.3). The level of cultural competence was low in both groups, especially in the knowledge scores. Cultural competence increased with experience and exposure to an ethnically diverse patient population. Our study highlights the need for cultural competence training in the GP training curricula. General practitioner (GP) trainees find cross-cultural consultations stressful due to a self-perceived lack of cultural competence (CC). The level of CC in general practice is as yet unknown. On average, the level of CC was low for the majority of GP trainees and GP trainers, especially for the scores on knowledge. CC increased with experience and exposure to an ethnically diverse patient population. GP trainees and trainers perceived a lack of covered education on various topics related to the care of migrants. Our study highlights the need for cultural competence training in the GP training curricula. [ABSTRACT FROM AUTHOR]

This study aimed to analyse outcomes with hearing aid (HA) use and to determine whether common audiological tests, including pure-tone audiometry or word recognition test, correlate with HA wearers' subjective benefit. A retrospective chart review. A total of 129 patients who adopted new HAs between January 2011 and December 2018 were enrolled. Outcome measures including pure tone thresholds, word recognition score (WRS), and self-reported questionnaires were obtained 1, 4, and 12 months post fit. The mean aided threshold and WRS at each post-fit visit significantly improved from the unaided condition. Self-reported outcomes confirmed by the Hearing Handicap Inventory for the Elderly (HHIE) scores significantly improved compared to the unaided condition at 1- and 4-month follow-up. Results of the regression analysis indicated that the aided WRS score is a significant factor at all post-fit visits that explains less than 10% of the variance in HHIE scores. Aided WRS is the factor most associated with subjectively reported HA outcomes, both in the short- and long term. Therefore, aided WRS should be considered as a useful tool for evaluating HA benefits, even after the prolonged use of HAs. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the association between certain social determinants of health (i.e. educational level, income, and social support) and attitudes towards hearing loss and hearing aids among older adults with hearing loss fitted in a Latin American country. Older adults were asked about their attitudes towards hearing loss and hearing aids, years of formal education, income, social support, perception of having a hearing disability, and social pressure when using the hearing aid. To do so, we adapted the Attitudes towards Loss of Hearing Questionnaire (S-ALHQ) into Spanish. All the questionnaires were conducted as structured interview. Two hundred fifty-two older hearing aids users were recruited from a public hospital in Chile. The S-ALHQ showed adequate validity, along with good reliability. The multivariate models showed that educational level and social support were the social determinants of health negatively associated with the attitudes. Aided hearing disability and social pressure to use hearing aids were the co-variables associated with S-ALHQ scores. The study showed a significant relationship between specific social determinants of health and attitudes towards hearing loss and hearing aids. These attitudes should be considered when implementing rehabilitation programs for older adults with hearing loss. [ABSTRACT FROM AUTHOR]

This study aimed to describe the tinnitus severity in patients with chronic otitis media (COM) and describe the sociodemographic and clinical variables associated with tinnitus severity. Cross-sectional study. Two otology-referral centers in Bogotá (Colombia) were included. Sociodemographic, clinical associated factors and quality of life questionnaires were applied. Otoscopic evaluation and audiometric data were collected. About 231 adults with COM. Up to 51.5% of the patients reported severe tinnitus discomfort, 21.7% moderate discomfort, and 26.8% minor discomfort. Factor associated with increased tinnitus severity in patients with COM were older age (aOR: 1.02; 95% CI: 1.01–1.05), higher education (aOR: 2.24; 95% CI: 1.03–4.87), ear discharge during childhood (aOR: 1.88; 95% CI: 1.02–3.45), cholesteatoma in one ear (aOR: 2.26; 95% CI: 1.05–4.88), and pure-tone air average over 15 dB (aOR: 2.08; 95% CI: 1.28–3.36). Differences of 10-points in symptoms severity and 15-points in the total score of the "Chronic Suppurative Otitis Media Questionnaire-12" were found between the tinnitus severity groups. Our results highlight the need for further research on the associated factors of tinnitus severity on COM patients. COM patients with higher tinnitus severity presented worse audiometric results and worse quality of life outcomes. [ABSTRACT FROM AUTHOR]

We assessed fidelity of delivery and participant engagement in the implementation of a community paramedic coach-led Care Transitions Intervention (CTI) program adapted for use following emergency department (ED) visits. The adapted CTI for ED-to-home transitions was implemented at three university-affiliated hospitals in two cities from 2016 to 2019. Participants were aged ≥60 years old and discharged from the ED within 24 hours of arrival. In the current analysis, participants had to have received the CTI. Community paramedic coaches collected data on program delivery and participant characteristics at each transition contact via inventories and assessments. Participants provided commentary on the acceptability of the adapted CTI. Using a multimethod approach, the CTI implementation was assessed quantitatively for site- and coach-level differences. Qualitatively, barriers to implementation and participant satisfaction with the CTI were thematically analyzed. Of the 863 patient participants, 726 (84.1%) completed their home visits. Cancellations were usually patient-generated (94.9%). Most planned follow-up visits were successfully completed (94.6%). Content on the planning for red flags and post-discharge goal setting was discussed with high rates of fidelity overall (95% and greater), while content on outpatient follow-up was lower overall (75%). Differences in service delivery between the two sites existed for the in-person visit and the first phone follow-up, but the differences narrowed as the study progressed. Participants showed a 24.6% increase in patient activation (i.e., behavioral adoption) over the 30-day study period (p < 0.001). Overall, participants reported that the program was beneficial for managing their health, the quality of coaching was high, and that the program should continue. Not all participants felt that they needed the program. Community paramedic coaches reported barriers to CTI delivery due to patient medical problems and difficulties with phone visit coordination. Coaches also noted refusal to communicate or engage with the intervention as an implementation barrier. Community paramedic coaches delivered the adapted CTI with high fidelity across geographically distant sites and successfully facilitated participant engagement, highlighting community paramedics as an effective resource for implementing such patient-centered interventions. [ABSTRACT FROM AUTHOR]

Although most US emergency medical services (EMS) systems collect time-to-treatment data in their electronic prehospital patient care reports (PCRs), analysis of these data seldom appears in publications. We believe EMS agencies should routinely analyze the initial time-to-treatment data for various potentially life-threatening conditions. This not only assures that protocol-required treatments have been provided but can discover avoidable delays and drive protocol/treatment priority change. Our study purpose was to analyze the interval from 9-1-1 call receipt until the first administration of naloxone to adult opioid overdose victims to demonstrate the quality assurance importance of analyzing time-to-treatment data. Retrospective analysis of intervals from 9-1-1 call receipt to initial naloxone treatment in adult opioid overdose victims. We excluded victims <18 years of age and cases where a bystander, police, or a health care worker gave naloxone before EMS arrival. We compared data collected before and during the COVID-19 pandemic to determine its effect on the analysis. The mean patient age of 582 opioid overdose victims was 40.7 years [95% CI 39.6, 41.8] with 405 males (69.6%). EMS units' scene arrival was 6.7 minutes from the 9-1-1 call receipt. It took 1.8 minutes to reach the victim, and 8.6 additional minutes to administer the first naloxone regardless of administration route (70.4% intravenous, 26.1% intranasal, 2.7% intraosseous, 0.7% intramuscular). EMS personnel administered the first naloxone 17.1 minutes after the 9-1-1 call receipt, with 50.3% of the delay occurring after patient contact. There was no statistically significant difference in the times-to-treatment before vs. during the pandemic. The prepandemic interval from 9-1-1 call receipt until initial EMS administration of naloxone was substantial and did not change significantly during COVID-19. Our findings exemplify why EMS agencies should analyze initial time-to-treatment data, especially for life-threatening conditions, beyond assuring that protocol-required treatments have been provided. Based on our analysis, fire department crews now carry intranasal naloxone, and intranasal naloxone is given to "impaired" opioid overdose victims the first-arriving fire department or EMS personnel. We continue to collect data on intervals-to-treatment prospectively and monitor our critical process/treatment intervals using the plan-do-study-act model to improve our process/carry out change, and publish our results in a future publication. [ABSTRACT FROM AUTHOR]

Unhealthy behaviors including smoking, drinking, and drug use often begin during adolescence and are closely related to morbidity and mortality. This study examines the prevalence and factors associated with substance use among adolescent boys in Bihar, India. Data from the Understanding the Lives of Adolescents and Young Adults (UDAYA), conducted in 2015–16 in two Indian states, was used for analysis (n = 2004 adolescent boys aged 14–19 years). A multivariate logistic regression model was applied to estimate the effect of various correlates on substance use. Prevalence of tobacco consumption (19%) is high, followed by consumption of alcohol (8%) and drug use (1.2%) among adolescent boys in Bihar. One-fifth have ever used at least one substance. Age, education, current schooling status, wealth quintile, household head's educational attainment, and mother's education level are found to be important factors influencing substance use. It is essential to adopt more pointed programs which can effectively reduce substance use among adolescents in this and similar states. Programs related to prevention of substances should be expanded effectively through health education programs, media messages at the grassroots level, especially in the socio-economically backward states in India. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive ability (CA) and instrumental activities of daily living (IADL) performance are essential for productive aging. Therefore, it is important to understand if other common issues such as subjective memory complaints (SMCs) and depressive symptoms are related to CA and IADLs, and explore the nature of those relationships. This study aims to explore 1) the associations between SMCs, depressive symptoms, CA, and IADL performance and 2) the role of depressive symptoms in these associations. Method: The study sample included 1,621 community-dwelling oldest-old from the Health and Retirement Study. Results: SMCs were significantly and positively associated with cognitive decline and limitations in IADL performance. Additionally, depressive symptoms mediated the associations between SMCs and cognitive decline and between SMCs and limitations in IADL performance. Conclusion: Depressive symptoms associated with SMCs negatively affect CA and IADL performance. Therefore, healthcare providers should consider and assess SMCs and depressive symptoms in the oldest-old. [ABSTRACT FROM AUTHOR]

Research has demonstrated the Head Control Scale to have almost perfect inter-rater reliability when utilized by experienced clinicians. This study examines if further clinical experience or additional training is required to use the scale for assessment of head control in a reliable and effective manner. First and second year physical and occupational therapy students were shown five videotaped subjects of varying ages and abilities in four positions (supine, prone, supported sitting, and pull to sit). Students then utilized each subscale of the HCS to rate every subject on the rating scale in each of the positions. When utilizing the kappa coefficient statistic, the inter-rater reliability among student participants was "almost perfect" on each of the subscales. Thus, the Head Control Scale was found to be reliable with no significant difference in interrater reliability when used by clinicians or students suggesting that additional training or expertise is not required to reliably use this scale in clinical practice. [ABSTRACT FROM AUTHOR]

Two factors that decrease the replicability of studies in the scientific literature are publication bias and studies with underpowered desgins. One way to ensure that studies have adequate statistical power to detect the effect size of interest is by conducting a-priori power analyses. Yet, a previous editorial published in the Journal of Sports Sciences reported a median sample size of 19 and the scarce usage of a-priori power analyses. We meta-analysed 89 studies from the same journal to assess the presence and extent of publication bias, as well as the average statistical power, by conducting a z-curve analysis. In a larger sample of 174 studies, we also examined a) the usage, reporting practices and reproducibility of a-priori power analyses; and b) the prevalence of reporting practices of t-statistic or F-ratio, degrees of freedom, exact p-values, effect sizes and confidence intervals. Our results indicate that there was some indication of publication bias and the average observed power was low (53% for significant and non-significant findings and 61% for only significant findings). Finally, the usage and reporting practices of a-priori power analyses as well as statistical results including test statistics, effect sizes and confidence intervals were suboptimal. [ABSTRACT FROM AUTHOR]

There is mounting evidence for implementing family-centred care (FCC) in adult audiology services, however FCC is not typically observed in adult clinical practice. This study implemented an intervention to increase family member attendance and involvement within adult audiology appointments. The study involved a mixed method design over three key phases: Standard Care, Intervention I (increasing family member attendance), and Intervention II (increasing family member involvement). Staff from four private audiology clinics within one organisation participated in the intervention. Data was collected from different clients in each phase (n = 27 Standard Care, n = 30 Intervention I, and n = 23 Intervention II). Family member attendance increased from 26% of appointments in Standard Care to 40% at Intervention I, and 48% at Intervention II. Family member involvement also showed improvement on some measures (video analysis) although talk time did not significantly increase. Significant improvements in client satisfaction with services were found (Net Promoter Score and Measure of Processes of Care). The implementation of FCC in audiology clinics needs to be an ongoing, whole-of-clinic approach, including staff in all roles. Increasing family member attendance at adult audiology appointments can lead to benefits to client satisfaction with services. [ABSTRACT FROM AUTHOR]

The objective of this work is to explore whether the relationship between pain after delivery and postpartum depression is increased or decreased by the use of religion as a coping strategy (moderation). A longitudinal cohort study was conducted. The sample was evaluated on three occasions: third trimester of pregnancy (religious coping), after birth (pain severity) and four months after delivery (postpartum depression). Participants were 122 women (mean age = 31.29; SD = 4.9: range = [22, 42 years]) with low obstetric risk. Both pain severity and religious coping contributed to postpartum depression (r =.20, p =.029 and r =.28, p =.04, respectively). Religious coping exacerbated the relationship between pain after delivery and postpartum depression (B = −0.11, t = −2.48, p =.014, [−0.20, −0.02]). Depression was highest in participants using religious coping irrespective of pain severity levels. These findings support the importance of person-environment interaction studies and provide new evidence on the deleterious role of religious coping in the well-being of women after childbirth. [ABSTRACT FROM AUTHOR]

Healthcare professionals caring for children with autism spectrum disorder are more likely to be emotionally and psychologically distressed because of the children's challenging behaviors. This study aimed to investigate whether social support mediates the association between coping strategies and perceived emotional and psychological distress among professionals working with children with autism spectrum disorder. Additionally, this study explored the moderating effect of autism severity on this mediation. The study's design is cross-sectional, correlational, and predictive. An online, self-administered questionnaire was used to recruit a convenience sample of 180 healthcare professionals working with children with autism spectrum disorder. The results revealed a significant mediation effect of family social support on the relationship between problem-focused coping and psychological distress for those dealing with moderate or severe autism. Likewise, there was also a significant mediation effect of family social support on the relationship between avoidant coping and psychological distress for those dealing with moderate autism. Familial social support can serve as a protective factor for healthcare professionals caring for children with autism against accumulated psychological distress. The direct effect of avoidant coping strategies on emotional distress changes depending on autism severity. The study's findings are informative to mental health nurses to create more effective coping strategies as problem-solving interventions or develop new coping strategies based on familial social support for those working with children with autism. [ABSTRACT FROM AUTHOR]

The increasing prevalence of children with obesity has contributed to a higher risk of developing cardiometabolic comorbidities. Adversity and chronic stress are negatively linked to cardiometabolic outcomes, and resilience is positively associated with improved outcomes. However, whether resilience is protective against metabolic disturbances preceding disease presentation is less understood. This study explored correlations between stress, anthropometrics, and metabolic parameters with resilience (total, individual, family, peers, school, community), and determined which resilience domains predict metabolically unhealthy obesity. Adolescents with obesity (n = 39; 12–18y) completed anthropometrics, an oral glucose tolerance test, the Adolescent Resilience Questionnaire, and Perceived Stress Scale. Lower stress (r = −0.70, p < 0.001), BMI (r = −0.42, p = 0.01), fat mass (ρ = −0.41, p = 0.01), and fat-free mass (ρ = −0.41, p = 0.01) were associated with greater resilience. Greater school resilience was associated with lower risk for having metabolically unhealthy obesity (odds ratio = 0.87, 95% Confidence Intervals, 0.78–0.98, p = 0.02). Our findings suggest that resilience is associated with lower adiposity, and that lower school resilience is an independent predictor of having metabolically unhealthy obesity. Further work exploring correlations between school resilience, perceived stress, and metabolic outcomes, would optimize programs for obesity-related chronic conditions. [ABSTRACT FROM AUTHOR]

Scientific journals may counter the misuse, misreporting, and misinterpretation of statistics by providing guidance to authors. We described the nature and prevalence of statistical guidance at 15 journals (top-ranked by Impact Factor) in each of 22 scientific disciplines across five high-level domains (N = 330 journals). The frequency of statistical guidance varied across domains (Health & Life Sciences: 122/165 journals, 74%; Multidisciplinary: 9/15 journals, 60%; Social Sciences: 8/30 journals, 27%; Physical Sciences: 21/90 journals, 23%; Formal Sciences: 0/30 journals, 0%). In one discipline (Clinical Medicine), statistical guidance was provided by all examined journals and in two disciplines (Mathematics and Computer Science) no examined journals provided statistical guidance. Of the 160 journals providing statistical guidance, 93 had a dedicated statistics section in their author instructions. The most frequently mentioned topics were confidence intervals (90 journals) and p-values (88 journals). For six "hotly debated" topics (statistical significance, p-values, Bayesian statistics, effect sizes, confidence intervals, and sample size planning/justification) journals typically offered implicit or explicit endorsement and rarely provided opposition. The heterogeneity of statistical guidance provided by top-ranked journals within and between disciplines highlights a need for further research and debate about the role journals can play in improving statistical practice. [ABSTRACT FROM AUTHOR]

To explore footwear characteristics and foot problems in community dwelling people with stroke as most research to date focused on the general elderly population. Thirty people with mild to moderate stroke (nine men, mean age 68, mean time since onset 67 months) attended a single session to assess footwear and foot problems using established podiatry foot (wear) and ankle assessments. Most participants wore slippers indoors (n = 17, 57%) and walking shoes outdoors (n = 11, 37%). Over half wore unsupportive ill-fitting shoes indoors and 47% of outdoor shoes fitted badly. All participants had foot problems (mean 6.5 (3.1), 95% CI: 5.4–7.7), including impaired single limb heel raise (93%), reduced range of movement (77%), sensation (47%), and muscle strength (43%). Many had foot-pain, hallux valgus (both 50%), or swollen feet (40%). Foot problems were associated with reduced balance confidence, activity, and community participation (all p < 0.05). A greater proportion of fallers (13/16) than non-fallers (4/14) reported foot problems (p = 0.029). Many community-dwelling people with stroke wore poorly fitting shoes; all had foot problems. Foot problems were linked to reduced mobility. Finding more effective pathways to support people with stroke to select supportive, well-fitting indoor and outdoor footwear is indicated. People with stroke often wear unsupportive ill-fitting shoes and experience foot problems. Assessment of foot problems and footwear advice should be considered during stroke rehabilitation particularly when interventions target fall prevention or improvements in balance and mobility. Information on appropriate footwear and signposting that new shoe purchases should include measuring feet to ensure a good fit is recommended. [ABSTRACT FROM AUTHOR]

This study sought to examine differences in measures of intense periods of physical performance during competitive match-play, between one-match (1 match weeks) and two-match microcycles (2 match week). 1, 3 and 5 min "peak" and mean averages for total distance (TD), high-speed running (HSR) and metabolic power (MP) were analysed for each 15 min period of match-play. Linear mixed models were employed to examine the differences in dependent variables for each method of measurement between the 1 and 2 game microcycles. No differences were reported for "peak" values for all epoch lengths, however, results revealed significantly reduced "average" values, during periods of fixture congestion, for 1, 3 and 5 min epochs for average TD, and 3 min epochs for average HSR towards the end of the match (75–90 min split). There was, however, a trend for the opposite response to occur in the 60–75-min period. The current data suggests that players potentially display altered pacing strategies during periods of fixture congestion, with these observed responses being dependent on sampling method and epoch length. [ABSTRACT FROM AUTHOR]

Optimal dosing of opioid agonist therapy (OAT) is essential for treatment success. However, initiation and maintenance of OAT in hospital settings can be challenging given differing levels of opioid tolerance, withdrawal, and intoxication among patients. The objective of this study was to characterize the prevalence and factors associated with in-hospital patient perceived suboptimal OAT dosing among people who use illicit drugs (PWUD) in Vancouver, Canada. Data were derived from three prospective cohorts of PWUD in Vancouver, Canada. Bivariable and multivariable logistic regression models were used to examine factors associated with patient perceived suboptimal in-hospital OAT dose. 273 study participants were prescribed OAT while in hospital: 83 (30.4%) participants perceived their OAT dose to be suboptimal. In a multivariable model, factors positively associated with a perceived suboptimal OAT dose included: homelessness (adjusted odds ratio [AOR] = 2.85; 95% CI: 1.53–5.28), daily stimulant use (AOR = 2.03; 95% CI: 1.14–3.63) and illicit drug use while in hospital (AOR = 2.33; 95% CI: 1.31–4.16). Almost one third of participants perceived receiving a suboptimal OAT dose while in hospital. These observed correlations indicate that a patient's perception of suboptimal OAT dosing in hospital may be more prevalent for patients who are homeless, report polysubstance use with stimulants and opioids and who obtain illicit drugs while hospitalized. While cautious prescribing of OAT in patients experiencing hospitalization is important, these findings demonstrate a high prevalence of and apparent risk factors for perceived suboptimal OAT dosing. [ABSTRACT FROM AUTHOR]

Emergency medical services (EMS) play a key role in access to prehospital emergency care. While EMS has defined levels of certification, the roles in the care paradigm fulfilled by these clinicians vary. The aim of this study is to describe the national differences between EMS clinicians with primary non-patient care vs. patient care roles. We performed a cross sectional evaluation of nationally certified EMS clinicians in the United States who recertified in 2020. As part of the recertification process, applicants voluntarily complete profile questions regarding demographic, job, and service characteristics. We compared the characteristics between individuals self-reporting primary patient care roles vs. non-patient care roles. Using logistic regression, we determined independent predictors for having a non-patient care role. In 2020, 126,038 people completed recertification. Of the 96,661 completing the profile, 80,591 (83.4%) indicated that they provided patient care, and 16,070 (16.6%) did not provide patient care as a primary role. Non-patient care personnel were more likely to be older (median 43 years old vs 34 years old), and to have a higher level of education (bachelor's degree or more: OR 2.25, 95%CI [2.13–2.38]) compared with patient care practitioners. Non-patient care personnel were less likely to be female (0.67 [0.64–0.70]) and minorities (OR 0.80 [0.76–0.84]). Non-patient care personnel reported longer work experience (16 years or more: OR 6.30 [5.98–6.64]), were less likely to hold part time positions (OR 0.62 [0.59–0.65]), and were less often attached to more than one agency (OR 0.83 [0.79–0.86]). Non-patient care personnel were less likely to work in rural settings (OR 0.81 [0.78–0.85]). EMS clinicians in non-patient care roles account for 17% of the study population. The odds of performing as a non-patient care practitioner are associated with characteristics related to demographics and workforce experience. Future work will be necessary to identify mechanisms to encourage diversity within the patient care and non-patient care workforces. [ABSTRACT FROM AUTHOR]

People receiving hematopoietic stem cell transplantation (HSCT) endure long phases of therapy and immobility, which diminish their physical activity (PA) level leading to physical deconditioning. One of the reasons is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. Therefore, our study investigates reported physical activity counseling behavior of health care professionals (HCPs) and the patient perspective on this topic. Physicians (N = 52), nurses (N = 52) physical therapists (N = 26), and patients receiving HSCT (N = 62) participated in a nationwide cross-sectional online-survey. Patients' preferred source of information concerning PA was determined. We examined HCPs self-assessed PA counseling behavior and patients' PA recall by assessing the use of the 5As (Ask, Advice, Agree, Assist, Arrange). Analysis of survey responses was descriptive. Univariate multinomial logistic regression examined whether sociodemographic factors and patient characteristics influence the response behavior. Physicians and PA specialists were patients' preferred source of information regarding PA. A large discrepancy between HCPs' perception and the degree to which HSCT patients recall advice became apparent; profound counseling steps like making referrals were less often recalled in our patient sample. Inactive patients reported to receive less basic PA counseling by physicians. Future research should identify the requirements to increase patients' recall concerning PA counseling in the setting of HSCT. Important messages about PA need to be made more salient to those who are less active and less engaged. [ABSTRACT FROM AUTHOR]

Although South Korea has been relatively successful in addressing the COVID-19 pandemic, there were controversies surrounding the negative social consequences (SC) associated with the infection, such as breach of privacy in contact tracing and stigmatization of patients. We examined how individuals' thinking about the SC of COVID-19 infection influenced preventive intention through this specific case, the early phase of the pandemic in South Korea (March, 2020) when concerns regarding SC were very high but vaccines were not available. We theoretically investigated the path from information exposure about COVID-19, worry and risk perception about SC of COVID-19, attitudes/norms/self-efficacy, and preventive intention. An online survey of 805 South Koreans revealed that information exposure about COVID-19 was positively associated with worry and risk perception about the SC, which indirectly predicted preventive intention through attitudes/norms/self-efficacy. As COVID-19 is a new disease, people learned about it from various sources, and contemplated (worry and risk perception) its negative social outcomes. To avoid such negative SC, they might have changed their beliefs toward preventive behavior, which influenced preventive intention. Given that both worry (affective–cognitive state) and risk perception (cognitive evaluation) are related to thinking activities, the findings suggest that individuals' thinking about negative SC of COVID-19 infection might have partly contributed to the success of the early South Korean quarantine model. However, the results also raise critical questions as to how we can protect individuals' lives during a public health crisis. [ABSTRACT FROM AUTHOR]

We aimed to examine the impact of maternal hypothyroidism on placental pathology and perinatal outcomes in singleton live births resulting from IVF, using medical records of IVF births between 2009 and 2017 at a tertiary hospital. The primary outcomes included anatomical, inflammation, vascular malperfusion, and villous maturation placental features. Secondary outcomes included foetal, maternal, perinatal, and delivery complications. There were 1,057 live births, of which 103 (9.7%) and 954 (90.3%) were in the study and control groups, respectively. Patients in the study group were more likely to have diabetes mellitus, polycystic ovarian syndrome, gestational diabetes mellitus, and non-reassuring foetal heart rate (NRFHR) tracing during delivery. After adjustment for potential confounding factors, hypothyroidism was significantly associated with the bilobed placenta (aOR 4.1; 95% CI 1.2–14.3), retroplacental haematoma (aOR 2.4; 95% CI 1.2–4.9), decidual arteriopathy (aOR 2.0; 95% CI 1.2–4.1) and subchorionic thrombi (aOR 2.4; 95% CI 1.3–5.0). Additionally, there was a statistically significant relationship with NRFHR tracing. The incidence of acute chorioamnionitis and severe foetal inflammatory response was higher in the study group. In conclusion, the placental histopathology patterns of singleton IVF live births show that maternal hypothyroidism has a significant impact on adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

The non-take-up of rights among social service-users is a well-known phenomenon, with grave implications. In response to it, social workers holding various roles are tasked with assisting service-users in obtaining their rights, in accordance with national policies and professional ethics. Despite its importance, research examining factors possibly connected to social workers' engagement in social rights advocacy for/with service-users is very limited, and was mostly conducted several years ago. The purpose of the present study was to explore the role of three types of such factors – organizational milieus (supervisors' support and the adequacy of the working environment); individual capacities (knowledge and skills held by social workers); and the relational aspect (the working alliance between social workers and their service-users). 247 Israeli social workers participated in the study, all employed in public social services. Data were collected using a quantitative approach via an online questionnaire. The results of the study underscore some potent correlates and predictors of social workers' engagement in advocating for social rights, in themselves and especially in the interaction between factors. This is discussed with relation to previous research, policy trends, and contemporary theoretical approaches to social rights advocacy. [ABSTRACT FROM AUTHOR]

Despite the importance of balance in Acrobatic Gymnastic Pyramid performance, there is limited biomechanical analysis of balance during this activity. The aims of this study were to analyse the effect of pyramid difficulty on the centre of pressure (COP) excursion and its inter-trial variability, and determine which parameters had strongest relationship with performance. Forty-seven acrobatic gymnasts performed five trials of back and front pyramids and a third more difficult, handstand pyramid on a force platform. Pyramids were held for 7 seconds and surface area, range, mediolateral amplitude and anteroposterior amplitude of the CoP were examined to analyse balance. The pyramid scores were obtained from qualified judges to assess the performance. Results showed higher CoP excursions and inter-trial variability during the execution of the high difficulty pyramid. Higher judges' scores were associated with lower CoP excursions in all the pyramids regardless of the difficulty. Similarly, correlation between inter-trial variability and pyramid performance was observed, although these coefficients were lower than those reported for the relationship between CoP excursion and performance. These results suggested that CoP monitoring could help coaches and gymnasts to assess the pyramid instability more accurately. [ABSTRACT FROM AUTHOR]

To understand the role of affected upper extremity (UE) self-efficacy for explaining daily-hand-use in individuals post-stroke. Specifically, to describe UE self-efficacy and to assess the associations between UE self-efficacy to UE motor and functional capacity and daily hand-use. This cross-sectional study included individuals post-stroke receiving rehabilitation with high UE functional capacity [Action Research Arm Test (ARAT) > 50]. The Rating of Everyday Arm-Use in the Community and Home (REACH) assessed perceived UE daily use and the Confidence in Arm and Hand Movement scale (CAHM) assessed UE self-efficacy. Functional capacity was assessed by the ARAT and the Fugl-Meyer-motor-assessment assessed motor impairment. Correlations between measures were assessed. Twenty-two individuals, aged 19–80, with high UE functional capacity [median (IQR) ARAT-56.5 (54–57)] and varying UE self-efficacy [median (IQR) CAHM-76.7 (58–84.4)], were included. UE self-efficacy was significantly correlated with the ARAT (rs = 0.53, p < 0.01) and REACH (rs = 0.51, p < 0.01) but ARAT was not significantly correlated with REACH. UE self-efficacy is correlated with perceived daily hand-use in individuals with high functional capacity. Further research and a deeper understanding of the clinical implications of UE self-efficacy are warranted. UE self-efficacy should perhaps be assessed during rehabilitation. Individuals with stroke with high affected upper extremity functional capacity do not necessarily use this hand for daily living. Upper extremity self-efficacy is correlated with perceived daily hand-use in individuals with high functional capacity; participants with higher upper extremity self-efficacy also reported more daily hand-use. Upper extremity self-efficacy seems to be upper extremity task or situation-specific. Upper extremity self-efficacy should be assessed during rehabilitation and the clinical implications of (low) upper extremity self-efficacy should be further researched. [ABSTRACT FROM AUTHOR]